Non-mastoidectomy Cochlear Implant Approaches: A Literature Review

Abstract

Introduction Posterior tympanotomy approach for cochlear implant (CI) surgery, has been the most commonly used worldwide with current 0.7% rate of facial nerve injury. Non-mastoidectomy CI approaches include the suprameatal approach (SMA) and its modifications, the transcanal approach and its modifications and the pericanal approach for electrode insertion. Objectives The objective of this study was to review the literature regarding non-mastoidectomy CI approaches. Data Synthesis A search was performed in the LILACS, MEDLINE, SciELO, PubMed databases and Cochrane Library in February 2015, and the key words used in the search were CI, SMA, transcanal approach, pericanal approach, or electrode extrusion. About 30 studies that met the criteria described in “Study Selection” were read in full. The studies showed 1014 patients that underwent CI by SMA or its modifications, 266 CI patients treated by transcanal approach or its modifications, and 15 patients implanted by the pericanal approach. Reported complication with SMA was 99 (9.8%) minor and 13 (1.3%) major. With transcanal, there were 24 complications; 19 (7.1%) minor and 5 (1.9%) major. No post-operative complication was reported in pericanal approach. Studies showed no reported facial nerve paresis or paralysis in all non-mastoidectomy approaches. Conclusion Complications rates with non-mastoidectomy approaches are similar to those found in the mastoidectomy approach. Thus, non-mastoidectomy approaches may be an alternative in cases where the conventional mastoidectomy approach is difficult to perform. It would be helpful for CI surgeons to become familiarized with these approaches.

Hearing Outcomes and Complications of Cochlear Implantation in Elderly Patients over 75 Years of Age

“…CI surgery using an approach without mastoidectomy has been reported [ 24 , 25 ]. We also have experience taking this approach in some cases.…”

Cochlear Implant Surgery: Endomeatal Approach versus Posterior Tympanotomy

“…A recent review of the literature suggests that anatomical variability is an important factor in cochlear implant surgery and is usually present [ 9 ]. The anatomy of the ear is very complex and an in-depth knowledge of this is required before carrying out surgery.…”

“…One of the nonmastoidectomy approaches in CI surgery is the endomeatal approach (EMA). This allows an optimal and atraumatic insertion plane for the positioning of the array through the external auditory canal (EAC) and the round window (RW) [ 9 , 10 ].…”

“…The incidence of this condition is around 1%. Anomalies in the facial nerve course are present in 16% of patients with CI, and one third of these have either common cavity malformations or hypoplastic cochleas with aberrant facial nerve courses [ 9 ].…”

Clinical Translation of an Insertion Tool for Minimally Invasive Cochlear Implant Surgery

“…There have been a variety of efforts to minimize the invasiveness of this procedure and obviate the need for mastoidectomy. Some of these approaches include the pericanal technique, the transcanal technique, and the suprameatal approach [3][4][5][6][7][8]. These methods have successfully avoided mastoidectomy; however, the angle of approach for insertion of the electrode array (EA) into the cochlea is suboptimal [9].…”