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Scala Tympani Cochleostomy II: Topography and Histology

Authors

  • Oliver F. Adunka MD,

    Corresponding author
    1. Department of Otolaryngology–Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A.
    • Oliver F. Adunka, MD, Department of Otolaryngology–Head and Neck Surgery, University of North Carolina at Chapel Hill, G0412 Neuroscience Hospital, CB # 7070, Chapel Hill, NC 27599-7070, U.S.A
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    • o.f.a. and a.r. contributed equally to this manuscript.

  • Andreas Radeloff MD,

    1. Department of Otolaryngology, Bavarian Julius Maximilians University, Wuerzburg, Germany
    2. Department of Otolaryngology, J.W. Goethe University Frankfurt am Main, Germany
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  • Wolfgang K. Gstoettner MD,

    1. Department of Otolaryngology, J.W. Goethe University Frankfurt am Main, Germany
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  • Harold C. Pillsbury MD,

    1. Department of Otolaryngology–Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A.
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  • Craig A. Buchman MD

    1. Department of Otolaryngology–Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A.
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Abstract

Objective: To assess intracochlear trauma using two different round window-related cochleostomy techniques in human temporal bones.

Methods: Twenty-eight human temporal bones were included in this study. In 21 specimens, cochleostomies were initiated inferior to the round window (RW) annulus. In seven bones, cochleostomies were drilled anterior-inferior to the RW annulus. Limited cochlear implant electrode insertions were performed in 19 bones. In each specimen, promontory anatomy and cochleostomy drilling were photographically documented. Basal cochlear damage was assessed histologically and electrode insertion properties were documented in implanted bones.

Results: All implanted specimens showed clear scala tympani electrode placements regardless of cochleostomy technique. All 21 inferior cochleostomies were atraumatic. Anterior-inferior cochleostomies resulted in various degrees of intracochlear trauma in all seven bones.

Conclusion: For atraumatic opening of the scala tympani using a cochleostomy approach, initiation of drilling should proceed from inferior to the round window annulus, with gradual progression toward the undersurface of the lumen. While cochleostomies initiated anterior-inferior to the round window annulus resulted in scala tympani opening, many of these bones displayed varying degrees of intracochlear trauma that may result in hearing loss. When intracochlear drilling is avoided, the anterior bony margin of the cochleostomy remains a significant intracochlear impediment to in-line electrode insertion.

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