Endoscopic Cochlear Implant: A Series of Cases

Abstract

Objectives: Cochlear implant is traditionally performed using a mastoidectomy, posterior tympanotomy and cochleostomy using a surgical microscope. Because of the anatomical and physiological understanding of the mastoid cells and their role in maintaining ventilation and pressure equalization in the middle ear, and the possible risk of facial nerve injury, some techniques without mastoidectomy and without posterior tympanotomy have been introduced as an alternative approach, showing excellent results. The aim of the study was to describe totally endoscopic technique without mastoidectomy in 6 patients with bilateral profound hearing loss who underwent cochlear implantation from January 2012 to February 2013, showing its viability and the advantages and disadvantages. Methods: All cases were selected based on computed tomography, magnetic resonance, audiological tests and psychological evaluation. Surgical steps, intra- and postoperative complications were analyzed. Each procedure duration was recorded. Surgical procedure was described step by step focusing on the anatomy of the round window (RW) niche. Results: The mean duration of the procedure was 62 minutes. No facial nerve injury was observed. All cases showed a normal RW conformation and endoscopic cochleostomy was conducted. No difficult insertion of the IC electrode was observed. The longest follow-up is 2 years. No postoperative complications were observed in this series. Conclusions: Totally endoscopic cochlear implantation is safe and allows a direct approach to the RW and cochlea. A larger series is paramount to evaluate its total benefits and may represent a breakthrough in the ongoing process of developing scientific knowledge.