Transcanal Endoscopic Cochlear Implant Surgery

By June 7, 2019

Tong, Michael C.F.1; Chang, Wai Tsz1
1 Department of Otorhinolaryngology Head and Neck Surgery, and Institute of Human Communicative Research, The Chinese University of Hong Kong, Hong Kong SAR, China.

To describe new techniques of transcanal endoscopic cochlear implantation on the basis of endoscopic ear surgery with the novelty of ‘scarless’ total transcanal approaches and their clinical outcomes in difficult cases to whom the access may offer an advantage.

Between July 2016 and February 2018, consecutive cases of difficult cochlear implantation surgeries with prior consent for the modified surgical approaches were included in the analysis.

Transcanal endoscopic cochlear implant surgery using suprameatal antrostomy (1 case) or blind-sac closure without post-auricular incision and mastoidectomy (4 cases).

Main Outcome Measures:
Successful implantation, operative time, functioning electrodes and non-extrusion after a follow up of 12 to 31 months (mean 19 months).

Five adult patients of age 43 to 86 years, with pathologies including advanced otosclerosis, chronic mucosal disease, intralabyrinthine schwannoma and osteoradionecrosis of the temporal bone were included in the review.  All implants were inserted through the transcanal endoscopic access and the operative time including removal of pathologies were 156 to 320 min (mean: 216 min).  No conversion to mastoidectomy or facial recess approach was needed.  There was no implant extrusion at the last follow-up of this series.

Transcanal cochlear implant surgery in difficult patients offers advantages in terms of better visualization of the operative site and access to pathologies in the mesotympanum/ inner ear, and precise/ custom approaches to placement of implant.  Further, 4 of the 5 patients had a ‘scareless’ surgical procedure in that the receiver-stimulator was placed under the conventional position through the transcanal access.