Professional Video on Cochlear Implant with Slim Straight Electrode

Cochlear Implant Surgery with Slim Straight Electrode

Dr. Akbar Abbas presents a detailed walkthrough of a cochlear implantation surgery. The patient is a one-year-old child with pre-lingual bilateral profound deafness. The surgical procedure involves using a slim straight electrode for the cochlear implant.

Initial Steps

The surgery begins with a cortical mastoidectomy, followed by the raising of a superiorly based muscle and periosteal flap. The short process of the incus is exposed, and the posterior canal wall is thinned. Noting the direction of the canal wall, whether straight or curved, is crucial for navigating to the facial recess and ensuring a clear view of the round window.

Opening the Facial Recess

Dr. Abbas uses a 2 mm diamond burr to open the facial recess. Initially, he preferred a smaller opening, but with experience, he finds a larger opening provides better access. The facial recess should be wide enough, typically 3.5 to 4.5 mm in anterior-posterior diameter.

Drilling the Facial Recess

Following the air cells and staying anterior to the short process of the incus, Dr. Abbas ensures the drill shaft does not touch the facial nerve canal. The subiculum is exposed and needs to be removed to provide a clear view of the round window.

Identifying Middle Ear Landmarks

Identifying landmarks in the middle ear, such as the pyramidal process, the short process of the incus, and the posterior crus of the stapes, is crucial for the accurate identification of the round window.

Exposing the Round Window

The subiculum is carefully drilled out to expose the round window. The round window membrane is then removed to allow entry into the basal turn of the cochlea.

Inserting the Electrode

The electrode is inserted slowly and gently to avoid trauma to the cochlea. A muscle plug is used to cover the round window and secure the electrode in place.

Creating the Implant Bed

A bed for the implant is created using a diamond burr. A cotton patty is used to cover the area and prevent bone dust and irrigation fluid from entering the middle ear cavity.

Final Placement and Closure

The ground electrode is inserted between the bone and the temporalis muscle, and the electrode is carefully placed in the mastoid cavity to prevent it from springing out. Once the electrode is secure, the surgical site is closed.

Dr. Abbas uses a two-layer closure technique, starting with the superiorly based flap to cover the electrode completely. The skin is closed using a continuous running intradermal (CRI) technique without sutures.

This overview of cochlear implantation surgery with a slim straight electrode by Dr. Akbar Abbas provides valuable insights into the procedure and techniques used. For other similar surgery video, click here.

This educational video is for students and patients to make informed decisions about their own and others’ health. Dr Akbar Abbas performed the surgery, one of the best ENT specialists in Karachi, Pakistan. He specializes in otolaryngology, cochlear implants, and 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.