New window for cochlear implant insertion.

Nine patients with profound bilateral hearing loss received a cochlear implant via the middle fossa. Subjects presented with a bilateral radical mastoidectomy cavity, fibroadhesive otitis media, otosclerosis, autoimmune inner ear disease, previous cranial trauma and genetic prelingual deafness. A classic middle fossa approach was adopted. A small cochleostomy was performed on the most superficial part of the basal turn. A Nucleus CI24M cochlear implant system (Cochlear Corporation) was inserted in four patients, a Lauraflex implant (Philips Hearing Implants) in three patients and a Combi 40 + (Med-el) with double electrode array in two. The receiver-stimulator was positioned in a bone well drilled in the temporal squama and the electrode carrier was inserted in the fenestrated cochlea. Speech perception tests, performed over a period of time ranging from 1 to 6 months after cochlear implant activation, yielded better results than those obtained in postlingually deaf patients operated on via the traditional transmastoid route. Cochlear implant insertion via the middle fossa approach is a technique which is suitable for auditory rehabilitation of subjects with a bilateral radical mastoidectomy cavity, chronic middle ear disease, patients suffering from middle ear malformations, and patients with partial obliteration of the cochlea in the basal turn. However, the main advantage of middle fossa cochleostomy consists in the possibility of stimulating areas of the cochlea, i.e. middle and apical turns, where a greater survival rate of spiral ganglion cells is known to occur. This new approach led to major improvements in speech perception in all patients compared with patients operated on with the transmastoid approach and thus, given the present state of the art, it is the only approach which allows stimulation of the entire cochlea and enables the best auditory outcomes to be achieved in patients with a cochlear implant.