CI Library

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.
Fatthi Abdelbaki

Prof. Fatthi Abdelbaki