Round Window Insertion in Veria Technique of Cochlear Implantation: An Essential Modification

Cochlear implants have been done using various surgical approaches. The classical posterior tympanotomy approach has been practiced by majority of surgeons worldwide. An alternative approach is the transcanal Veria approach. This is non mastoidectomy approach where the electrode is threaded via a transcanal tunnel into the cochleostomy site. Majority of "Veria" surgeons are inserting the cochlear electrodes via a cochleostomy. This article focuses on round window insertion of cochlear electrode which has been proven to be a "softer "technique of electrode insertions and finds its role in preservation of residual hearing. Out of 115 cochlear implants done at AIIMS Patna between May 2014-May 2018, using the Veria approach, 52 patients have now been done using the round window insertion. Veria approach is a non-mastoidectomy technique where a special perforator is used to drill a trans canal tunnel which lodges the cochlear electrodes. All kind of implants were used and round window insertion was possible with different kind of electrodes. Out of 52 implants, 24 were MEDEL Sonata with straight electrode and flex soft electrode, 21 were Advanced Bionics Precurved 1 J electrode, 2 were (CI 24 REST) Cochlear devices standard straight array and 5 were Neurelec standard straight array devices. Insertion was uneventful in all the cases and intra op telemetry results were satisfactory post insertion. Round window insertion has now become routine for cochlear implants especially in cases where we have to preserve residual hearing. Veria approach earlier was considered to be only a "cochleostomy" approach but our successful insertion via the round window using the Veria technique is a landmark modification and alleviates any such limitation which was associated with this technique before.