Modifications on the Alternative Method for Cochlea Implantation

House 1 introduced the classic surgical technique for cochlear implantation. This surgical technique consists of a mastoidectomy and a posterior tympanotomy and this approach is still worldwide the most frequently used technique for cochlear implantation. This classic surgical technique uses a complete mastoidectomy with an attempt to leave a bony overhang posterior and superiorly to capture the proximal electrode lead 2,3. After the complete mastoidectomy a posterior tympanotomy is performed with special attention to the facial nerve and the chorda tympani. Through the large posterior tympanotomy (intraoperative facial nerve monitoring is mandatory) a cochleostomy can be performed for electrode insertion. The classic technique has proven to be sufficient in the vast majority of cochlear implantations. Still complications concerning the facial nerve can occur due to the fact of drilling within a millimetre of the facial nerve making the posterior tympanotomy 4,5 To avoid negative side effects as a temporary or permanent injury to the facial nerve Kronenberg et al 6,Kiratzidis 7 and later Hausler 8 designed a different approach in which no mastoidectomy was needed to create the pathway towards the cochleostomy. These new cochlear implantation techniques without a mastoidectomy and a posterior tympanotomy seem to be safe and effective procedures. After experienced the classic approach of cochlear implantation our cochlear implant team moved over to the new innovative alternative surgical approach introduced by Joan Kronenburg in 2001. Our first positive experiences with the suprameatal approach and our modifications have been published in 2004 9. Our method consists of a number of following steps as shown in the table 1.