Cochlear implant surgery: Analysis of changes in surgical strategies for better outcomes

Abstract

Objectives: Like any surgical procedure, the cochlear implant surgery is constantly in evolution. This paper highlights the various modifications in the surgical strategies that have been incorporated into the surgical procedure with regard to the changes in incision, the route of insertion of electrodes, the depth of electrode insertion, and ultimate outcome in the patients. The modifications in the surgical strategy have been based on scientific evidence. Methods: A retrospective analysis of 220 cochlear implant procedures done with the posterior tympanotomy approach has been performed. The cases performed with the alternate technique, and cochlear anomalies have been excluded. The various surgical strategies which wer evaluated included the incision, the periosteal flap, the drill hole technique, the route and depth of insertion and the surgical outcome. Results: The incorporation of mini incision drastically reduced the incidence of postoperative infection and exposure of implants (P < 0.05). The authors classified the round window membrane at posterior tympanotomy and graded them accordingly. The depth of insertion of electrodes was also evaluated prospectively. The use of modified tie down technique reduced the operative time. The vascularized temporoparietal fascia flap helped in saving 5/9 implants with exposure. Conclusions: The cochlear implant surgery is constantly evolving. This paper highlights the critical appraisal of different steps in surgical strategies that have been incorporated into the surgical procedure. This reflects the surgical audit of our cases. These surgical strategies have resulted in reducing the incidence of complications in our series and improving outcomes.