The rational for a mid-scala electrode array

Today increasing numbers of cochlear implant candidates have residual hearing that can be aided and hence is worth trying to preserve. This means that surgical technique and electrode array design must be adapted to minimize trauma. Wide opening of the round window is often preferred to reduce drill related trauma and to avoid pressure spikes during electrode array insertion. A recent meta-analysis suggested that there is no significant correlation between hearing preservation and either insertion depth or scala position. However, a slow insertion speed of at least 30seconds was associated with better hearing preservation. An electrode design is proposed that targets the middle of the scala tympani. This minimizes frictional forces from either lateral or medial wall during insertion and imposes less static pressure on cochlear structures following insertion. The flexibility to insert via the round window requires a 0.7-mm maximum dimension at the proximal end of the array. Micro-anatomical analysis by micro-CT indicated that a 420-degree insertion depth was optimal between cochlear coverage and available space within the scala tympani. Physical measurements showed that mean insertion forces remained below 10mN during insertion. A series of 20 human temporal bone insertions found a mean insertion depth of 400 degrees with no scala dislocations. Six clinical series, in total 94 cases, found postoperative hearing in 81% of cases with a mean loss of 12dB compared to preoperative levels. Speech understanding out to one year post-fitting trended better for a mid-scala design group than for a straight electrode array group; although the differences were not statistically significant. A mid-scala array design appears able to be inserted with minimal trauma, to return a predictable insertion depth across various sizes of cochleae and to support reasonable levels of speech understanding without relying on residual hearing.