Piezoelectric shaping of radical mastoid cavity and dissection of ossified cochlea prior to cochlear implantation

Source: PubMed Central Open Access, NCBI / U.S. National Library of Medicine

Abstract Cochlear implantation (CI) in radical cavities remains challenging due to the risk of postoperative electrode extrusion. We report a single-stage approach employing piezoelectric instrument (PEI) to optimize cavity osteoplasty, atraumatic cochlear access, and electrode stabilization in the setting of partial scala tympani ossification. A 72-year-old female with left profound sensorineural hearing loss and prior canal wall (CW)-down mastoidectomy underwent CI with posterior CW reconstruction. Angled and straight PEI inserts facilitated controlled bone removal over the facial nerve and creation of a bony slit with overhang to secure the electrode lead. Ossified segments of the scala tympani were carefully cleared, enabling full insertion of a perimodiolar electrode array, subsequently reinforced with double-layer cartilage. At 8-month follow-up, no clinical or electrophysiological evidence of electrode migration was observed. PEI is a promising tool for safe, atraumatic osteoplasty and stable electrode positioning in complex radical cavities.