A 35-year-old woman with bilateral severe-to-profound sensorineural hearing loss (>90 dB HL) undergoes cochlear implantation. During surgery, the surgeon notes that the round window membrane is absent and there is severe cochlear ossification. Which surgical approach is most appropriate in this situation?
- A Abandon the procedure and fit bilateral hearing aids
- B Standard round window approach with partial electrode array
- C Drill-out technique with subtotal petrosectomy for full electrode insertion ✓
- D Transcochlear approach with cochleostomy anterior to the round window
Correct answer: C. Drill-out technique with subtotal petrosectomy for full electrode insertion
Explanation
Severe cochlear ossification (as occurs in post-meningitic deafness or labyrinthitis ossificans) prevents insertion through the standard round window or cochleostomy approach. The drill-out technique involves systematic removal of ossified cochlear turns to create a channel for electrode placement; subtotal petrosectomy may accompany this for field control. Standard approaches are inadequate because the lumen is obliterated by new bone. Hearing aids are ineffective in profound sensorineural loss of this magnitude.
Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.