Professional Video on Cochlear Implant Advance Bionics Slim J Electrode

Professional Video on Cochlear Implant Advance Bionics Slim J Electrode, by Dr Akbar Abbas ENT Surgeon

Welcome to this cochlear implantation surgery. Today, we will be performing the surgery on a one-year-old child with bilateral profound congenital hearing loss. After thorough audiological investigation, it was determined that cochlear implantation was the best course of action.

First, we will begin with a cortical mastoidectomy to expose the middle ear. This involves removing the remnant of the bony septum. We will start by using a 5 to 6 mm cutting bur to carefully drill through the bone. It is important to use irrigation during this process to keep the area clean and visible. As we drill, we will be able to see the short process of the incus, which serves as a landmark for the facial nerve. The facial nerve is crucial in this procedure, and its course can be identified by following the orientation of the short process of the incus, pointing towards the facial nerve like an index finger.

Next, we will create a small postauricular incision to create a pocket for the implant casing. A muscle flap has already been created and reflected superiorly. This exposes the short process of the incus and the facial nerve. We will continue drilling with a 5 mm cutting bur, being mindful of the canal wall direction. Following the canal wall is important as it guides our drilling into the middle ear cavity, also known as the retro-tympanum. It is important to avoid over saucerization of the cavity, as it can make it difficult to securely hold the electrode in place later on.

Once the drilling is complete, we switch to a 2 mm diamond bur to further refine the facial recess. This recess is marked by the chorda tympani anteriorly, the facial nerve posteriorly, and the incus buttress superiorly. As we drill, we may encounter air cells in the facial recess, which will lead us towards the retro-tympanum, specifically the area of the round window.

To create more space for the implant housing, we drill out the superior lip of the facial recess and make a small opening. This space should be approximately 1 mm deep to accommodate the implant. We will be using the Advanced Bionics high-res ultra slim J electrode for this procedure. It is a straight electrode, and we will insert it manually, taking care not to bend it.

Using the insertion tool, we slowly and gradually insert the electrode into the inferior part of the round window, avoiding the superior part that could lead to unintended locations within the cochlea. The insertion should be slow and steady to minimize trauma. Once the electrode is fully inserted, a blue mark indicates its position. A soft collar is used to secure the electrode in the round window. We may also use a muscle or fascia plug to further close the opening and prevent perilymph leakage.

After confirming the position of the electrode, we proceed with the closure. We previously created a muscle flap that can now be drawn as a curtain on top of the electrode to secure it in place. The wound closure is typically performed in two to three layers, avoiding sutures on the skin in pediatric cases. The patient will receive an oral antibiotic for one week to prevent infection. A gentle head bandage is applied for 24 hours and is removed in the clinic the following day. Patients typically go home the same day, as this is a daycare procedure and does not require admission.

Thank you for joining me during this cochlear implantation surgery using the Advanced Bionics slim J electrode. You can watch other related surgery here.

Info: This is an informative and educational video for the benefit of medical students and patients who want to take informed decisions about 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.