The Suprameatal Approach: A Safe Alternative Surgical Technique for Cochlear Implantation

Objective: To report on surgical complications arising post-operatively in 104 patients undergoing cochlear implantation surgery using the suprameatal approach (SMA). Second, to examine the advantages and disadvantages of the SMA technique compared with the classic mastoidectomy using the posterior tympanotomy approach. Study Design: Retrospective study assessing surgical complications in deaf adults and children undergoing cochlear implantation. Setting: Tertiary referral center for cochlear implantation (Academic Medical Centre). Patients: The mean age at the time of surgery was 39.6 years (1.0-82.3 yr), and the mean duration of deafness was 26.3 years (0.3-66.0 yr). The main cause was a congenital hearing loss (30.8%) and a progressive sensorineural hearing loss e.c.i. (25.0%), followed by meningitis (12.5%) and otosclerosis (6.7%). The mean duration of follow-up after surgery was 25.7 months (range, 3.0-59.0 mo). Results: The overall major complication rate was 3.7% (4 of 107). All complications developed postoperatively. The major complications consisted of extrusion of the implant due to wound infection (n = 2), a wrong route for the electrode (n = 1), and device failure (n = 1). The minor complication rate was 23.4% (25 of 107). The mean time taken for cochlear implantation was 111.7 minutes (range, 60.0-261.1 min). Conclusion: This study confirms the SMA is a safe, simple, and quick technique that is feasible for cochlear implantation in most cases. Although the stretching of the electrode array when it enters the scala tympani and a low-lying dura could present a potential restriction for the SMA technique, our results do not support this hypothesis.