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Intact meatal skin, canal wall down approach for difficult cochlear implantation

Published online by Cambridge University Press:  08 March 2017

M J Carfrae  and
D Foyt
M J Carfrae
Affiliation:
Otolaryngology Division, Surgery Department, Albany Medical Center, Albany, New York, USA
D Foyt*
Affiliation:
Northeast Ear Institute, Albany, New York, USA
*
Address for correspondence: Dr David Foyt, Northeast Ear Institute, 6 Executive Park Dr, Albany, New York 12203, USA. Fax: +1 (518) 482 6142 E-mail: [email protected]
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Abstract

Introduction:

The intact posterior meatal skin, canal wall down technique for difficult cochlear implantation provides expanded access to the middle ear for cochleostomy in cases of obscured middle-ear landmarks, limited facial recess access and limited mastoid cavity dimensions. Careful preservation of the posterior canal wall skin in this procedure obviates the need for obliteration of the middle-ear mucosa and closure of the external auditory canal.

Objectives:

To present a canal wall down technique for cochlear implantation, which preserves the intact posterior external auditory canal wall skin. This approach is employed when a standard facial recess cochleostomy is not possible.

Methods:

Three cases of intact posterior meatal skin, canal wall down cochlear implantation are presented together with long-term follow-up results. In all three cases, implantation via a facial recess approach was not possible. One patient suffered from severe cochlear otosclerosis with obliteration of the round window niche. The second patient had severe middle-ear fibrosis with encasement of all middle-ear structures and obliteration of routine landmarks. The third patient had an anterior sigmoid sinus obscuring access to the facial recess. Cochlear implantation via the canal wall down, intact posterior canal wall skin technique was successfully performed in each of these patients.

Results:

All three patients were successfully implanted, with full electrode insertion achieved. All patients subsequently became active implant users. One patient did suffer from a minor wound complication post-operatively, unrelated to the approach. Patient follow up ranged from four to six years.

Keywords

Otologic Surgical ProceduresCochlear ImplantsExternal Auditory Canal
Type
Short Communications
Information
The Journal of Laryngology & Otology , Volume 123 , Issue 8 , August 2009 , pp. 903 - 906
Copyright
Copyright © JLO (1984) Limited 2008

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