Cochleostomy site: Implications for electrode placement and hearing preservation

Conclusions. With recent increased interest in minimizing intracochlear trauma and preserving residual hearing during cochlear implantation, increased attention must be paid to the cochleostomy site. The results of this paper demonstrate that the cochleostomy must be made inferior, rather than anterior, to the round window to ensure scala tympani insertion and to decrease the likelihood of insertion-induced intracochlear damage during electrode insertion. Objective. To describe the complex anatomy of the hook region of the cochlea, specifically in relation to the optimal placement of the cochleostomy for cochlear implant electrode insertion to potentially achieve hearing preservation. The authors believe that previous industry recommendations and described surgical techniques have resulted in cochleostomies being placed in anatomical positions that possibly result in electrode insertions that damage the basilar membrane and/or other cochlear structures. Material and methods. The results of a number of temporal bone studies were reviewed with attention being paid to the anatomical relationship of the basilar membrane and spiral ligament to the round window membrane. For different cochleostomy sites the potential for damage to intracochlear structures, particularly the basilar membrane and organ of Corti, was assessed. Results. The review of electrode insertion studies into human temporal bones, as well as a post-mortem anatomical study of implanted temporal bones, showed an increased risk of scala vestibuli insertions and insertion-induced damage to intracochlear structures when the cochleostomy was performed more anterior to the round window. These results were endorsed by studies detailing the anatomy of the hook region of the cochlea.