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European Archives of Oto-Rhino-Laryngology

, Volume 273, Issue 9, pp 2355–2361 | Cite as

Impact of the surgical experience on cochleostomy location: a comparative temporal bone study between endaural and posterior tympanotomy approaches for cochlear implantation

  • Clair VandersteenEmail author
  • Thomas Demarcy
  • Coralie Roger
  • Eric Fontas
  • Charles Raffaelli
  • Nicholas Ayache
  • Hervé Delingette
  • Nicolas Guevara
Otology
  • 228 Downloads

Abstract

The goal of this study was to evaluate, in the hands of an inexperienced surgeon, the cochleostomy location of an endaural approach (MINV) compared to the conventional posterior tympanotomy (MPT) approach. Since 2010, we use in the ENT department of Nice a new surgical endaural approach to perform cochlear implantation. In the hands of an inexperienced surgeon, the position of the cochleostomy has not yet been studied in detail for this technique. This is a prospective study of 24 human heads. Straight electrode arrays were implanted by an inexperienced surgeon: on one side using MPT and on the other side using MINV. The cochleostomies were all antero-inferior, but they were performed through an endaural approach with the MINV or a posterior tympanotomy approach with the MPT. The positioning of the cochleostomies into the scala tympani was evaluated by microdissection. Cochleostomies performed through the endaural approach were well placed into the scala tympani more frequently than those performed through the posterior tympanotomy approach (87.5 and 16.7 %, respectively, p ≤ 0.001). This study highlights the biggest challenge for an inexperienced surgeon to achieve a reliable cochleostomy through a posterior tympanotomy, which requires years of experience. In case of an uncomfortable view through a posterior tympanotomy, an inexperienced surgeon might be able to successfully perform a cochleostomy through an endaural (combined approach) or an extended round window approach in order to avoid opening the scala vestibuli.

Keywords

Cochlear implantation Cochleostomy Minimally invasive surgery Endaural approach Learning skills Surgery resident 

Notes

Compliance with ethical standards

Conflict of interest

The authors have no conflict of interest or financial ties to disclose.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Clair Vandersteen
    • 1
    Email author
  • Thomas Demarcy
    • 2
  • Coralie Roger
    • 3
  • Eric Fontas
    • 3
  • Charles Raffaelli
    • 4
  • Nicholas Ayache
    • 2
  • Hervé Delingette
    • 2
  • Nicolas Guevara
    • 1
  1. 1.Department of Ear Nose Throat Surgery, Institut Universitaire de la Face et du CouCentre Hospitalo-UniversitaireNiceFrance
  2. 2.Asclepios Research TeamINRIAValbonneFrance
  3. 3.Department of Biostatistics, Cimiez’s HospitalCentre Hospitalo-UniversitaireNiceFrance
  4. 4.Department of Radiology, Pasteur’s HospitalCentre Hospitalo-UniversitaireNiceFrance

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