Minimal access surgery for pediatric cochlear implantation

Objective: To develop a minimal access approach for pediatric cochlear implantation to improve the acceptability of the procedure for parents, children, and the wider community, and to reduce flap-related complications of the procedure. Study Design: Prospective evaluation of a new surgical technique. Method: A new approach was developed through a short, oblique, straight postauricular incision without shaving any hair. It involved drilling the bony well for the implant inside a small subperiosteal pocket. Patients: Twenty-three consecutively implanted children with the Nucleus implanted system, whose median age was 3.2 years (mean 4.1 years, range 1.6-11.2 years. Results: The technique proved feasible in all the 23 children, and no major complications were encountered. Three instances of wound edema were observed early in the series; by minimizing tissue elevation and overzealous retraction, these complications were not encountered subsequently. The approach was warmly endorsed by parents, children, and caregivers, who greatly appreciated the minimal impact of the approach. Conclusion: The proposed new approach is very well accepted by implanted children and their families, reduces the psychologic trauma of the intervention, and has less risks of flap complications.