Cochlear patency problems in cochlear implantation

Sensory deafness may be associated with partial or total obliteration of the cochlear scalae. Before undertaking cochlear implant surgery, a preoperative assessment of cochlear patency with high‐resolution computed tomography (CT) is indicated. To determine the accuracy of pre‐implant CT, a review of the radiographic and surgical findings in 36 implanted ears was performed. An abnormal CT scan was found to be a reliable predictor of compromised cochlear patency at operation. These findings help the surgeon to select the side most favorable for implantation and to anticipate problems that may be encountered during device insertion. A normal pre‐implant CT scan, however, does not exclude the possibility of compromised cochlear patency. A 46% false negative rate was encountered, presumably because subtle degrees of osseous or fibrous obliteration of the cochlea are beyond the resolution by current generation CT scanners. In our opinion, the radiographic finding of cochlear ossification is not a contraindication to an attempt at cochlear implantation. The only assured way of determining the extent of cochlear patency is by performing an ‘exploratory cochleostomy’ with fenestration of the basal cochlear turn. Drilling anteriorly through an ossified basal scala tympani will often expose an adequate lumen and permit insertion of even a long multichannel electrode into a partially ossified cochlea. Nevertheless, it is essential that the implant team be prepared with devices appropriate for whatever existing or surgically created lumen may be available.