Cochlear Implantation after Bacterial Meningitis in Infants Younger Than 9 Months

Table 4

Problem solving during cochlear implantation in postmeningitic infants.

Problem	When	Suggested technique
Superficial course of facial nerve	At incision	Less pressure on the knife and more superior incision.
Bilateral “symmetrical” position of the implant	At incision	Drawing of the position of the implant on a blueprint and copy at the contralateral side (Figure 3).
Profuse bleeding because of bone marrow filled mastoid	During mastoidectomy	Use diamond burrs and close off the mastoid cells with bone wax.
“Thick” implant and thin skull cortex	During creation of the implant bed	Create a bony island over the dura (Figure 4).
Round window in a more horizontal plane	Before cochleostomy	Make the posterior tympanotomy as wide as possible, and drill towards stapes to find round window.
Ossification of the cochlea	At cochleostomy and electrode insertion	Drill-out of basal turn of the cochlea, partial electrode insertion, scala vestibuli insertion, or split electrode insertion.
Hematoma at the first implanted ear	At closure of first side	Place surgical drain superficial of the musculoperiosteal flap, remove after head bandage.
Electrode can dislocate out of the cochlea	During development of the mastoid process	Position and fixation of the electrode lead in the round window, posterior tympanotomy, but not in the mastoid tip region. Ensure there is enough lead on the electrode to allow for development of temporal bone.