Professional Video On Cochlear Implantation

Standard Cochlear Implantation – through Facial Recess Approach with Full Round Window Insertion, Intraoperative Stapedial Reflex Elicitation, and Straight Multi-Channel Electrode

Introduction:
Cochlear implantation is a surgical procedure aimed at treating severe to profound sensorineural hearing loss. We will conduct a standard cochlear implantation surgery using the facial recess approach and full round window insertion. Throughout the procedure, we will also highlight the intraoperative elicitation of the stapedial reflex and the utilization of a standard straight multi-channel electrode.

The surgery was performed by Dr Akbar Abbas who is one of the best ENT specialist in Karachi, Pakistan. He specializes in otolaryngology, cochlear implants, ear surgery and is one of the few experts on pituitary and head and neck cancer surgery in Pakistan.

Step 1: Preoperative Preparation
Before the surgery, the patient is placed under general anesthesia, and appropriate monitoring devices are attached. The head is appropriately positioned and secured. Sterile preparation and draping are then carried out, ensuring a sterile environment throughout the procedure.

Step 2: Incision and Temporalis Muscle Dissection
An inverted “question mark” or “C-shaped” incision is made behind the ear to expose the mastoid region, and the periosteum is elevated. The temporalis muscle is dissected, and a muscle hook is used to retract the muscle further posteriorly, allowing access to the mastoid bone.

Step 3: Mastoidectomy and Facial Recess Approach
Using a high-speed drill and appropriate burrs, a cortical mastoidectomy is performed to expose the mastoid antrum, sigmoid sinus, and facial nerve. Care is taken to maintain a safe distance from these vital structures. The dissection extends into the facial recess, exposing the oval window, round window niche, and cochleariform process.

Step 4: Round Window Exposure and Electrode Insertion
The round window membrane is carefully exposed and perforated using a micro-pick or small round diamond burr. A standard straight multi-channel electrode array is advanced through the round window under direct visualization. The proper placement of the electrode is confirmed via intraoperative testing.

Step 5: Stapedial Reflex Elicitation
To verify the electrode’s intracochlear position, the stapedial reflex is elicited intraoperatively. Electrical stimulation is applied through the electrode array, causing contraction of the stapedius muscle. The reflex response is monitored and observed through electromyography (EMG) or by direct visualization. This step confirms the electrode’s appropriate location within the scala tympani.

Step 6: Wound Closure
Once all necessary tests have been performed, the wound is thoroughly irrigated with saline and meticulously closed in layers. Hemostasis is ensured, and the surgical site is protected with sterile dressings.

Conclusion:
Standard cochlear implantation through the facial recess approach with full round window insertion is a procedure that offers the potential for significant hearing improvement in patients with severe to profound sensorineural hearing loss. Intraoperative elicitation of the stapedial reflex is an important step that helps ensure correct electrode placement. The utilization of a standard straight multi-channel electrode allows for optimal auditory stimulation and rehabilitation in these patients.

Empowering Auditory Rehabilitation: Full Round Window Insertion In Cochlear Implants: The technique describes standard cochlear implantation through facial recess approach and full round window insertion. Stapedial reflex elicited intraoperatively. We used a standard straight, multi-channel electrode during this procedure.

In summary, the facial recess approach with full round window insertion, effectively restores hearing in individuals with severe to profound sensorineural hearing loss. During the surgery, the observation of an elicited stapedial reflex assures us of the intact auditory pathway, increasing the potential for a successful cochlear implantation procedure.

This is an educational video for students and patients for making informed decisions about their own and others health. The surgery was performed by Dr Akbar Abbas who is one of the best ENT specialist in Karachi, Pakistan. He specializes in otolaryngology, cochlear implants, ear surgery and is one of the few experts on pituitary and head and neck cancer surgery in Pakistan. Presently serving at Aga Khan University Hospital.