**2.4 Drilling a bony well for the RS**

In classic CI, fixation of the device is achieved mainly by drilling a custom-fit bony well "seat or bed" for accommodation of the thick part, the titanium case, of the RS of the selected implant. This well must be designed with the same configuration of the RS and should be deep enough so that the package rests in the well stably without the possibility of sliding or rocking and without protrusion outside the skull as a swelling [5].

**123**

**2.5 Cochleostomy**

**Figure 3.**

**Figure 2.** *Palva flap in CI.*

**2.6 Electrode insertion**

**2.7 Confirm device fixation**

important for further stabilization [7].

slightly anterior to the RW membrane [6].

*Advances in Surgical and Anesthetic Techniques for Cochlear Implantation*

The RW niche is lowered down by drilling the tegmen and pillars of the RW till good exposure of the RW membrane is achieved, and then cochleostomy is performed. In classic CI, cochleostomy is drilled as a separate opening inferior and

*(a) Classic MPTA showing good visualization of the RW niche and false membrane that cover true RW* 

*membrane. (b) After removal of the false membrane, RW membrane is now well visualized.*

The device is brought up to the surgical field, and then the electrode is inserted

The RS should be positioned in its drilled well "Seat or bed." Its stability in the well should be ensured. Sewing the periosteum together over the implant is also

The distal end of the electrode array should be secured and fixed. This is performed routinely by sealing off the cochleostomy site through harvesting a small

into the cochlea either by using the fine-tipped micro forceps or by using the specific instruments manufactured for insertion of the selected electrode type.

*DOI: http://dx.doi.org/10.5772/intechopen.88380*

**Figure 1.** *Minimal access postauricular incision.*

*Advances in Surgical and Anesthetic Techniques for Cochlear Implantation DOI: http://dx.doi.org/10.5772/intechopen.88380*

**Figure 2.** *Palva flap in CI.*

*Advances in Rehabilitation of Hearing Loss*

basic surgical steps are the following:

**2.2 Elevation of periosteal flaps**

or bed" for the receiver/stimulator (RS).

**2.4 Drilling a bony well for the RS**

most common used incision for CI [4] (**Figure 1**).

**2.3 Mastoidectomy posterior tympanotomy approach**

**2.1 Skin incision**

(**Figure 3**).

skull as a swelling [5].

**2. Surgical technique of "classic" cochlear implantation**

The surgical technique of classic CI was described in detail by House [3]. The

Postauricular incision is the originally described incision for CI, and also it is the

A "U"-shaped anterior-based periosteal flap or Palva flap (**Figure 2**) is performed to expose both the mastoid bone and the planed site for drilling a well "seat

MPTA is performed using both the surgical microscope and otologic drill. Widening of the posterior tympanotomy in an inferior direction with removal of excess bone in front of the facial nerve is an essential step for good exposure of RW niche and membrane, taking care that RW membrane may be obscured by a false membrane (false RW membrane) that should be removed first by sharp instrument

In classic CI, fixation of the device is achieved mainly by drilling a custom-fit bony well "seat or bed" for accommodation of the thick part, the titanium case, of the RS of the selected implant. This well must be designed with the same configuration of the RS and should be deep enough so that the package rests in the well stably without the possibility of sliding or rocking and without protrusion outside the

**122**

**Figure 1.**

*Minimal access postauricular incision.*

**Figure 3.**

*(a) Classic MPTA showing good visualization of the RW niche and false membrane that cover true RW membrane. (b) After removal of the false membrane, RW membrane is now well visualized.*
