My Tips and Tricks in Hearing preservation
- - Before RWM Exposure
◦ Ask the anesthetist to inject intravenously high dose of steroids
◦ During Mastoidectomy avoid touching incus short process (to avoid ossicular vibration)
◦ In case of drilling RW niche overhang if needed:
▪ Use drill at very low speed below 5000 (Avoid acoustic trauma)
▪ Perform minimal drilling at postero superior area (at cochlear hook region) since the distance between the RWM and the OSL is 0.1 mm.
- - Before RWM opening
◦ Place Gelfoam with Steroids over RWM for round window diffusion during skull bed preparation
◦ Finish all bone work including bed drilling.
◦ The Bed & middle ear rinsed thoroughly with saline solution.
◦ Careful haemostasis over RW area
- - After opening RWM
◦ If crista semilunaris is present it should be removed to allow proper insertion of the electrode without deflection towards the modiolus. Its removal is suggested by using curettes and hooks.
◦ Once RWM opened:
▪ Do not use suction near RW
▪ Avoid entrance of blood and dust in cochlea
- - Electrode Insertion
◦ Use flexible small diameter
◦ The array is to be inserted in slow-continuous fashion over a period of NO less than 30 seconds into the scala tympani to the point of first resistance.
◦ Seal RW opening adequately:
▪ If opening is small seal it with fresh blood to avoid tissue reaction
▪ If opening is large seal it gently with fascia with No over packing.