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


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.


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


Compliance with ethical standards

Conflict of interest

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


  1. 1.
    Eshraghi AA (2006) Prevention of cochlear implant electrode damage. Curr Opin Otolaryngol Head Neck Surg 14:323–328CrossRefPubMedGoogle Scholar
  2. 2.
    Eshraghi AA, Frachet B, Van De Water TR, Eter E (2009) Hearing loss in adults. Rev Prat 59:645–652PubMedGoogle Scholar
  3. 3.
    Lazard DS, Lee HJ, Gaebler M et al (2010) Phonological processing in post-lingual deafness and cochlear implant outcome. Neuroimage 49:3443–3451CrossRefPubMedGoogle Scholar
  4. 4.
    Wanna AGB, Noble JH, Carlson ML et al (2014) Impact of electrode design and surgical approach on scalar location and cochlear implant outcomes. Laryngoscope 124(Suppl 6):S1–S7CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Shipp DB, Nedzelski JM (1995) Prognostic indicators of speech recognition performance in adult cochlear implant users: a prospective analysis. Ann Otol Rhinol Laryngol Suppl 166:194–196PubMedGoogle Scholar
  6. 6.
    Rubinstein JT, Parkinson WS, Tyler RS, Gantz BJ (1999) Residual speech recognition and cochlear implant performance: effects of implantation criteria. Am J Otol 20:445–452PubMedGoogle Scholar
  7. 7.
    Friedland DR, Venick HS, Niparko JK (2003) Choice of ear for cochlear implantation: the effect of history and residual hearing on predicted postoperative performance. Otol Neurotol 24:582–589CrossRefPubMedGoogle Scholar
  8. 8.
    Blamey P, Arndt P, Bergeron F et al (1996) Factors affecting auditory performance of postlinguistically deaf adults using cochlear implants. Audiol Neurootol 1:293–306CrossRefPubMedGoogle Scholar
  9. 9.
    Hodges AV, Dolan Ash M, Balkany TJ et al (1999) Speech perception results in children with cochlear implants: contributing factors. Otolaryngol Head Neck Surg 121:31–34CrossRefPubMedGoogle Scholar
  10. 10.
    Gantz BJ, Woodworth GG, Knutson JF et al (1993) Multivariate predictors of audiological success with multichannel cochlear implants. Ann Otol Rhinol Laryngol 102:909–916CrossRefPubMedGoogle Scholar
  11. 11.
    House WF (1976) Cochlear implants. Ann Otol Rhinol Laryngol 85(suppl 2):1–93PubMedGoogle Scholar
  12. 12.
    Guevara N, Bailleux S, Santini J et al (2010) Cochlear implantation surgery without posterior tympanotomy: can we still improve it? Acta Otolaryngol 130:37–41. doi: 10.3109/00016480902998299 CrossRefPubMedGoogle Scholar
  13. 13.
    Lavinsky L, Lavinsky-Wolff M, Lavinsky J (2010) Transcanal cochleostomy in cochlear implantation: experience with 50 cases. Cochlear Implants Int 11:228–232. doi: 10.1002/146701010X486453 CrossRefPubMedGoogle Scholar
  14. 14.
    Al Sanosi A (2012) Trans-aditus approach: an alternative technique for cochlear implantation. Indian J Otolaryngol Head Neck Surg 64:142–144. doi: 10.1007/s12070-011-0403-7 CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Häusler R (2002) Cochlear implantation without mastoidectomy: the pericanal electrode insertion technique. Acta Otolaryngol 122:715–719CrossRefPubMedGoogle Scholar
  16. 16.
    Slavutsky V, Nicenboim L (2009) Preliminary results in cochlear implant surgery without antromastoidectomy and with atraumatic electrode insertion: the endomeatal approach. Eur Arch Otorhinolaryngol 266:481–488. doi: 10.1007/s00405-008-0768-8 CrossRefPubMedGoogle Scholar
  17. 17.
    Kronenberg J, Migirov L, Dagan T (2001) Suprameatal approach: new surgical approach for cochlear implantation. J Laryngol Otol 115:283–285CrossRefPubMedGoogle Scholar
  18. 18.
    Kiratzidis T (2000) “Veria operation”: cochlear implantation without a mastoidectomy and a posterior tympanotomy. A new surgical technique. Adv Otorhinolaryngol 57:127–130PubMedGoogle Scholar
  19. 19.
    Marchioni D, Grammatica A, Alicandri-Ciufelli M et al (2014) Endoscopic cochlear implant procedure. Eur Arch Otorhinolaryngol 271:959–966. doi: 10.1007/s00405-013-2490-4 CrossRefPubMedGoogle Scholar
  20. 20.
    Wysocki J (1999) Dimensions of the human vestibular and tympanic scalae. Hear Res 135:39–46CrossRefPubMedGoogle Scholar
  21. 21.
    Avci E, Nauwelaers T, Lenarz T et al (2014) Variations in microanatomy of the human cochlea. J Comp Neurol 00:1–17. doi: 10.1002/cne.23594 Google Scholar
  22. 22.
    Aschendorff A, Kubalek R, Turowski B et al (2007) Quality control after insertion of the nucleus contour and contour advance electrode in adults. Otol Neurotol 26:34–37CrossRefGoogle Scholar
  23. 23.
    Aschendorff A, Kromeier J, Klenzner T, Laszig R (2007) Quality control after insertion of the nucleus contour and contour advance electrode in adults. Ear Hear 28:75S–79S. doi: 10.1097/AUD.0b013e318031542e CrossRefPubMedGoogle Scholar
  24. 24.
    Skinner MW, Holden TA, Whiting BR et al (2007) In vivo estimates of the position of advanced bionics electrode arrays in the human cochlea. Ann Otol Rhinol Laryngol Suppl 197:2–24CrossRefPubMedGoogle Scholar
  25. 25.
    Adunka OF, Radeloff A, Gstoettner WK et al (2007) Scala tympani cochleostomy II: topography and histology. Laryngoscope 117:2195–2200. doi: 10.1097/MLG.0b013e3181453a53 CrossRefPubMedGoogle Scholar
  26. 26.
    Finley CC, Skinner MW (2009) Role of electrode placement as a contributor to variability in cochlear implant outcomes. Otol Neurotol 29:920–928. doi: 10.1097/MAO.0b013e318184f492.Role CrossRefGoogle Scholar
  27. 27.
    Shi L, Wang D, Chu WCW et al (2011) Automatic MRI segmentation and morphoanatomy analysis of the vestibular system in adolescent idiopathic scoliosis. Neuroimage 54(Suppl 1):S180–S188. doi: 10.1016/j.neuroimage.2010.04.002 CrossRefPubMedGoogle Scholar
  28. 28.
    Reda FA, McRackan TR, Labadie RF et al (2014) Automatic segmentation of intra-cochlear anatomy in post-implantation CT of unilateral cochlear implant recipients. Med Image Anal 18:605–615. doi: 10.1016/ CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    James C, Albegger K, Battmer R et al (2005) Preservation of residual hearing with cochlear implantation: how and why. Acta Otolaryngol 125:481–491CrossRefPubMedGoogle Scholar
  30. 30.
    Richard C, Fayad JN, Doherty J, Linthicum FH (2012) Round window versus cochleostomy technique in cochlear implantation: histologic findings. Otol Neurotol 33:1181–1187. doi: 10.1097/MAO.0b013e318263d56d CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Addams-Williams J, Munaweera L, Coleman B et al (2011) Cochlear implant electrode insertion: in defence of cochleostomy and factors against the round window membrane approach. Cochlear Implants Int 12(Suppl 2):S36–S39. doi: 10.1179/146701011X13074645127478 CrossRefPubMedGoogle Scholar
  32. 32.
    Shapira Y, Sultan AA, Kronenberg J (2011) The insertion trajectory in cochlear implantation—comparison between two approaches. Acta Otolaryngol 131:958–961. doi: 10.3109/00016489.2011.584903 CrossRefPubMedGoogle Scholar
  33. 33.
    Breinbauer HA, Praetorius M (2015) Variability of an ideal insertion vector for cochlear implantation. Otol Neurotol 36:610–617. doi: 10.1097/MAO.0000000000000719 CrossRefPubMedGoogle Scholar
  34. 34.
    Postelmans JTF, Stokroos RJ, van Spronsen E et al (2014) Comparison of two cochlear implantation techniques and their effects on the preservation of residual hearing. Is the surgical approach of any importance? Eur Arch Otorhinolaryngol 271:997–1005. doi: 10.1007/s00405-013-2438-8 CrossRefPubMedGoogle Scholar
  35. 35.
    Tóth M, Alpár A, Bodon G et al (2006) Surgical anatomy of the cochlea for cochlear implantation. Ann Anat 188:363–370. doi: 10.1016/j.aanat.2006.01.015 CrossRefPubMedGoogle Scholar
  36. 36.
    Jeon E-J, Jun B, Song J-N et al (2013) Surgical and radiologic anatomy of a cochleostomy produced via posterior tympanotomy for cochlear implantation based on three-dimensional reconstructed temporal bone CT images. Surg Radiol Anat. doi: 10.1007/s00276-012-1061-5 Google Scholar
  37. 37.
    Leong AC, Jiang D, Agger A, Fitzgerald-O’Connor A (2013) Evaluation of round window accessibility to cochlear implant insertion. Eur Arch Otorhinolaryngol 270:1237–1242. doi: 10.1007/s00405-012-2106-4 CrossRefPubMedGoogle Scholar
  38. 38.
    Briggs RJS, Tykocinski M, Xu J et al (2005) Cochleostomy site: implications for electrode placement and hearing preservation. Acta Otolaryngol 125:870–876. doi: 10.1080/00016480510031489 CrossRefPubMedGoogle Scholar
  39. 39.
    Pau HW, Just T, Bornitz M et al (2007) Noise exposure of the inner ear during drilling a cochleostomy for cochlear implantation. Laryngoscope 117:535–540. doi: 10.1097/MLG.0b013e31802f4169 CrossRefPubMedGoogle Scholar
  40. 40.
    Li PMMC, Wang H, Northrop C et al (2007) Anatomy of the round window and hook region of the cochlea with implications for cochlear implantation and other endocochlear surgical procedures. Otol Neurotol 28:641–648. doi: 10.1097/mao.0b013e3180577949 CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Perlman HB (1952) Experimental occlusion of the inferior cochlear vein. Ann Otol Rhinol Laryngol 61:33–44CrossRefPubMedGoogle Scholar
  42. 42.
    Adunka OF, Buchman CA (2007) Scala tympani cochleostomy I: results of a survey. Laryngoscope 117:2187–2194. doi: 10.1097/MLG.0b013e3181453a6c CrossRefPubMedGoogle Scholar
  43. 43.
    Iseli C, Adunka OF, Buchman CA (2014) Scala tympani cochleostomy survey: a follow-up study. Laryngoscope 124:1928–1931. doi: 10.1002/lary.24609 CrossRefPubMedGoogle Scholar
  44. 44.
    Richter B, Aschendorff A, Lohnstein P et al (2001) The nucleus contour electrode array: a radiological and histological study. Laryngoscope 111:508–514. doi: 10.1097/00005537-200103000-00023 CrossRefPubMedGoogle Scholar
  45. 45.
    Adunka O, Gstoettner W, Hambek M et al (2004) Preservation of basal inner ear structures in cochlear implantation. ORL J Otorhinolaryngol Relat Spec 66:306–312. doi: 10.1159/000081887 CrossRefPubMedGoogle Scholar
  46. 46.
    Tarkan Ö, Tuncer Ü, Özdemir S et al (2013) Surgical and medical management for complications in 475 consecutive pediatric cochlear implantations. Int J Pediatr Otorhinolaryngol 77:473–479. doi: 10.1016/j.ijporl.2012.12.009 CrossRefPubMedGoogle Scholar
  47. 47.
    Jeppesen J, Faber CE (2013) Surgical complications following cochlear implantation in adults based on a proposed reporting consensus. Acta Otolaryngol 133:1012–1021. doi: 10.3109/00016489.2013.797604 CrossRefPubMedPubMedCentralGoogle Scholar
  48. 48.
    Brito R, Monteiro TA, Leal AF et al (2012) Surgical complications in 550 consecutive cochlear implantation. Braz J Otorhinolaryngol 78:80–85CrossRefPubMedGoogle Scholar
  49. 49.
    Qiu J, Chen Y, Tan P et al (2011) Complications and clinical analysis of 416 consecutive cochlear implantations. Int J Pediatr Otorhinolaryngol 75:1143–1146. doi: 10.1016/j.ijporl.2011.06.006 CrossRefPubMedGoogle Scholar

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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