Implantation of the completely ossified cochlea: An image-guided approach

OBJECTIVES: To report a novel modification of the cochlear drill-out procedure that uses customized microstereotactic frames as drill guides. PATIENT(S): A 34-year-old man with an 18-year history of profound bilateral hearing loss and completely ossified cochleae that underwent a previous unsuccessful conventional cochlear drill-out procedure in the contralateral ear. INTERVENTIONS: Image-guided cochlear implantation using customized microstereotactic frames to drill linear basal and apical cochlear tunnels. MAIN OUTCOME MEASURES: Transfacial recess cochlear drill-out procedure with full electrode insertion. RESULTS: Two linear paths were drilled using customized microstereotactic frames targeting the proximal and distal basal turn followed by a full split array insertion. Postoperative imaging confirmed 2 cochlear tunnels straddling the modiolus with adequate clearance of the facial nerve and internal carotid artery. The patient received auditory benefit with device use and did not experience any surgical complication. CONCLUSION: Successful cochlear implantation in the setting of total scalar obliteration poses a significant challenge. Image guidance technology may assist in navigating the ossified cochlea facilitating safe and precise cochlear tunnel drilling.