الفهرس 
· Chapter I: Historical reviewOnly 14 pages are availabe for public view
 |  | from | 153 |  |  |
| | | from | 153 | | |
Abstract
The cochlear implantation has radically changed the outlook for profoundly deaf adults and children. The cochlear implant can provide sufficient hearing sensations to enable most severely or profoundly deafened persons to continue communicating using speech as their primary means of communication.
In Classic cochlear implantation, C-shaped incision was almost always performed, then a portion of the skull as flat as possible should be selected for placement of the receiver-stimulator, then , mastoidectomy is done to help retain the electrode leads within the confines of the mastoid cavity. Then the facial recess should be widely opened followed by cochleostomy which is followed by insertion of the electrode array. Fixation of the receiver-stimulator to the skull base must be done after that. Closure should be accomplished in layers.
For cochlear implantation, the suprameatal approach can be an alternative safe surgical technique. Typical conventional mastoidectomy and posterior tympanotomy are not necessary. It is simple, safe and effective procedure; Chorda tympani nerve is preserved in all cases and there is no danger for the facial nerve.
The combination of minimal access surgery with suprameatal approach provides the surgeon with a simple and safe technique with minimal drilling and improved esthetic results.
In this study, Forty-one patients underwent cochlear implantation at Zagazig University hospital in ORL Department were included. Patients were 27 males and 14 females, their age ranged from 2 years to 18 years and all complained of profound sensori-neural hearing loss. In pre-operative preparations we found 3 cases had congenital anomalies, 3 cases had otitis media, one case had right 8th cranial Aplasia, one case had Atrial septal defect, one case had juvenile Diabetes Mellitus and one case had post meningitis cochlear ossification.
After applying exclusion criteria, only 34 patients were included for evaluation in the study that was divided into 2 groups: (group A) underwent cochlear implantation by classic approach (28cases), and (group B) underwent cochlear implantation by suprameatal approach (6 cases).
Postoperatively, we found that: total number of cases who had one or more major complication was 2 cases out of 28 cases (7.1%) in group (A) and 2 cases out of 6 cases (33.3%) in group (B). Those complications were: 2 cases had facial nerve paralysis from group (A) (28 cases), one case had electrode extrusion and one case had device failure from group (B) (6 cases).
Total number of cases who had one or more minor complication was 11 cases out of 28 cases (39.3%) in group (A) and 3 cases out of 6 cases (50%) in group (B). Those complications were 6 cases had chorda tympani nerve injury from group (A) (28 cases) and one case had chorda tympani nerve injury from group (B) (6 cases). 4 cases had post operative fever from group (A) (28 cases) and one case had post operative fever from group (B) (6 cases). 4 cases had post operative hematoma from group (A) (28 cases). 5 cases had post operative vomiting from group (A) (28 cases) and one case had post operative vomiting from group (B) (6 cases). 3 cases had post operative vertigo from group (A) (28 cases) and one case had post operative vertigo from group (B) (6 cases). 2 cases had post operative wound infection from group (A) (28 cases) and one case had post operative wound infection from group (B) (6 cases). 3 cases had device migration from group (A) (28 cases) and one case had device migration from group (B) (6 cases).
After comparison with similar studies we found that:
Patients underwent cochlear implantation via posterior tympanotomy approach showed higher incidence of facial nerve and chorda tympani nerve injuries and fewer incidences of minor complications than patients underwent cochlear implantation via suprameatal approach.
Patients underwent cochlear implantation with electrode insertion via round window showed no significant difference from patients underwent cochlear implantation with electrode insertion via cochleostomy regarding surgical complications.
Although our CI project is just started, the major and minor complications of CI are comparable to those in the literature.
Surgical approaches, way of electrode insertion and type of devices should be developed to facilitate surgery and improve outcomes. Our CI project should be developed to have more experience.