Background

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					      Endoscopic cochlear
 implantation a new procedure,
        primary results


                  Mazen M Alhajri MD
        MB,LRCP&S, FRCSI, FRCSED, MSC, PHD
 ENT consultant, The prince medical specialist center
  Eid charity organization (medical camps manager)

             Alhajri@iolfree.ie




                Background
The classical surgical procedure for cochlear
implantation include mastoidectomy and
posterior tympanotomy
In 2000 Kronenberg introduced the
suprameatal approach (SMA) as an
alternative approach that avoids
mastoidectomy and posterior tympanotomy.
SMA involves a tunnel drilled in the direction
of the body of the incus through which the
active electrode is passed to the middle ear
cavity
  Mastoidectomy and posterior tympanotomy
  in the classic procedure can result in many
  complications that are rare but
  devastating if they happen
  Viena Group reported a 6 year experience in
  a suprametal modified approch
  Hausler in Switzerland also reported a
  similar approch.
  All were done using the microscope as the
  tool




                What’s new
Today and for the first time I would like to
present my work doing a suprameatal approch
using the endoscope
Endoscopic surgery in the ear is widely accepted
The use of endoscope in cochlear implantation
was not done until 2 years ago November 2004
when the first case of this series was done
(since 2001 it was planned, designed and
practiced on cadavers n=24 & temporal bones
and since 2 years it was applied. It was
reported publicly 3 months ago)
               Objective
To report and compare the results of
endoscopic cochlear implantation with
classical cochlear implantation surgery
To report for the first time the use of
endoscope in cochlear implant surgery




               Methods
23 patients were implanted using the
endoscope transcanal approach using
posterior meatal groove and a 3 to 4 cm
length post auricular incision to insert and
secure the implant.
Tympanomeatal flap elevated and groove is
drilled
The implant is secured and the active
electrode is then inserted in the cochlea
and the remnant part is pushed in the
groove and covered with pieces of cartilage
and soft tissue including fat and fascia
   Mastoidectomy was avoided in all
   Patients were followed for a range
   of 2 months to 2 years




               Results
0% facial palsy, 0% meningeal damage or
csf leak, 0% flap infection
The operative time two and half an hour
Cochlea was always easily visualized and
round window was seen clearly in all
cases.
One case of late perforated ear drum one
year post operative post otitis media
Chorda tympani nerve was preserved in all
cases.
Cochlea was always easily visualized and
round window was seen clearly in all
cases.
mean time between surgery and
programming of the implant was 2.2
weeks




             Conclusion
Endoscopic cochlear implantation using
transcanal poster-superior groove is a safe
procedure
There is a learning curve that can be
overcome by intensive training on cadavers
and temporal bones
One should not be attempted if the surgeon is
not used to endoscopic ear surgery
Operative videos

				
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