Minimally-invasive Cochlear Implantation. Four-year results with the Bremen Approach

Introduction 

Minimally-invasive cochlear implantation (MiCI) techniques allow a more atraumatic surgery . The authors report their four year results with the Bremen approach.

Patients and Methods 

During 2016 and 2020 a prospective study was performed in n=100 patients (105 implants, aged 2-84 yrs).. All CI brands were implanted. Follow-up period was at least 180 days. We surveyed operation time, size of mastoidectomy, size of retroauricular cutaneous incision and learning curve. Postop hearing improvement using 4- frequency PTA and speech understanding applying Freiburg monosyllable test were monitored. Pain was recorded with a visual analogue scale (VAS ). All complications were monitored .

Results 

Mean operation time was 84 (SD  + 20.9)mins. Mean duration in the first 25 pats. was 110min per site. In the succeeding 75 pats. this was 79 mins. (p<0.05). The mean size of the mastoidectomy was <2cm² (SD+7.3mm²). The mean size of the retroauricular incision was 29,25 (SD+2.3)mm. Hearing threshold in 4-requency PTA was mean 38 dB, monosyllable understanding 60%. Postoperative pain score gained 3.6 . Most common complaint was postop vertigo (14%).

Discussion 

As expected hearing results and complications were the same as with a conventional approach. Preoperative imaging has a high significance. Individuals with anatomical variations or syndromes, with a hypopneumatisation, a radical cavity and obese patients with a thick temporal soft tissue layer are unsuitable candidates. The atraumatic approach generates a high patient satisfaction.

Conclusion 

MiCI with the Bremen approach demonstrated to be a safe and atraumatic technique in the hands of the experienced surgeon. This technique is a sound alternative to conventional surgery for many patients.

Publication History

Article published online:
24 May 2022