RIGHT: Cochlear implant
surgery for young infants (ages 9 months and older) and
children take approximately one to two hours and is done
in an outpatient setting, and occasionally, only an overnight
stay is required. Pediatric CI surgery is usually less complicated
than adult CI surgery due to the smaller incisions, no need
for hair shaving, and more straightforward access to the
cochlea. A cochlear abnormality, such as a Mondini malformation
or a scarred cochlea from meningitis, can make the surgery
more difficult, but these situations are uncommon.
For both pediatric and adult cochlear implants,
a mastoidectomy is required to access the facial recess
(posterior tympanotomy approach). This opening gives the
surgeon access to the round window and cochlea. A tiny opening,
called a cochleostomy, is made into the scala tympani of
the cochlea. The multichannel electrode, shown here, is
fully inserted using a gentle, off-stylet technique.
Above: Sagittal view X-ray of the skull showing a right-sided cochlear implant.
Pediatric cochlear implant surgery - right ear
Right cortical mastoidectomy
Widening of the antrum and exposure of the incus
Thinning of the bony posterior external auditory canal
Identification and opening of the facial recess - the landmarks are the chorda tympani nerve, incus buttress, and the vertical segment of the facial nerve
Exposure of the incudostapedial joint, cochlear, and round window niche
Creation of the cochleostomy anterior and inferior to the round window niche in order to enter the scala tympani and avoid injury to the basilar membrane
Healon is instilled into scala tympani
Gentle insertion of the electrode into the scala tympani
Careful sealing of the cochleostomy around the hub of the electrode with fascia
