Abstract
The combined approach technique (CAT) is a variation of the classical the mastoidectomy-posterior tympanotomy technique (MPTA) that combines a transcanal approach to cochleostomy with a reduced posterior tympanotomy for insertion of electrodes. AimTo compare and evaluate long-term safety and effectiveness outcomes obtained with the CAT and with MPTA approach in patients submitted to cochlear implant (CI) surgery. Design: series study. MethodsPatients who underwent CI using CAT or MPTA at a Brazilian center were followed in a cohort study. Main outcomes were complications, audiometric performance and radiological evaluation of electrode position. ResultsFourty-four patients were implanted using CAT and 31 MPTA. There were no cases of facial nerve paralysis, mastoiditis, cholesteatoma or cerebrospinal fluid leaks after 3.4±1.0 years. Radiological evaluation of electrode position revealed that the median number of electrodes outside the cochlea was 0 in CAT and 3 in MPTA groups (p < 0.001). There were no differences between both surgical approaches in terms of mean pure-tone thresholds with CI at all frequencies. ConclusionLong-term follow-up data showed that the transcanal route to cochleostomy, combined with a reduced posterior tympanotomy, is a safe alternative approach in cochlear implant surgery, with no related major complications and fewer cases of electrode migration when compared with the MPTA. These findings encourage the use of the transcanal route to cochleostomy as an alternative approach option.
Highlights
The classic mastoidectomy-posterior tympanotomy approach (MPTA) for cochlear implantation (CI) was initially proposed by William House in 19611,2, and few changes have been made to the technique since
Long-term follow-up data showed that the transcanal route to cochleostomy, combined with a reduced posterior tympanotomy, is a safe alternative approach in cochlear implant surgery, with no related major complications and fewer cases of electrode migration when compared with the MPTA
This study reports long-term complications and effectiveness outcomes of CI surgery using the transcanal route (CAT) and compares these outcomes with those observed in a contemporary cohort of patients who underwent CI using the traditional approach
Summary
The classic mastoidectomy-posterior tympanotomy approach (MPTA) for cochlear implantation (CI) was initially proposed by William House in 19611,2, and few changes have been made to the technique since . The approach consists of a mastoidectomy followed by posterior tympanotomy. Cochleostomy is performed through the facial recess[1,2], and the facial nerve and chorda tympani are used as landmarks to demarcate the facial recess as a route of penetration into the middle ear. The method is well established, drilling through a narrow recess may lead to injury of the facial nerve or chorda tympani[3]. The transcanal route to cochleostomy has been elected as a convenient approach by some authors[6,7,10,11], since it provides a direct exposure of middle ear landmarks and the cochleostomy site
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