Cochlear implants in patients with radical cavity

Treatment of patients with severe bilateral hearing loss by cochlear implants usually requires normal temporal bone anatomy. The authors report one case in which the electrophysiological criteria for cochlear implant were fulfilled. However, the patient showed unfavourable anatomy because of a radical mastoid cavity on the suitable side and a congenital anomaly on the opposite side. As a first step the radical cavity was opened from a retroauricular incision and completely de-epithelialized. Thereafter, a retroauricular full-thickness skin flap was formed and rotated into the cavity; the retroauricular incision was not closed. Six months later a cochlear implant (Clark-Nucleus system) was positioned after undermining the flap described above. This surgical technique allows us to provide patients with radical cavities with implants under the usual sterile conditions and avoids contact of the implant with the body surface.