Combined Endoscopic/Microscopic Cochlear Implantation Through the Oval Window

Abstract

Standard round window (RW) cochlear implantation is a well-described technique. Implantation might be difficult in patients with inner and middle ear anomalies, in some cases because of not achieving adequate exposure to the RW, with a related higher risk of complications such as facial nerve injury. It is proposed a combined microscopic/endoscopic oval window approach in a 63 year old man affected by bilateral Meniere disease, with bilateral severe sensorineural hearing loss, speech discrimination score for bysillabic words under 40% and a hidden RW by anomalous facial nerve course. All electrodes entered the cochlear with good free-field thresholds and auditory ability results. A partial marginalis nerve palsy occurred at the second postoperative day and completely reversed at 2 months from surgery. Endoscopic-assisted oval window cochlear implantation may be a safe alternative surgical technique in cases where surgeons are not able to access RW.