Table 4: Problem solving during cochlear implantation in postmeningitic infants.

ProblemWhenSuggested technique

Superficial course of facial nerveAt incisionLess pressure on the knife and more superior incision.
Bilateral “symmetrical” position of the implantAt incisionDrawing of the position of the implant on a blueprint and copy at the contralateral side (Figure 3).
Profuse bleeding because of bone marrow filled mastoidDuring mastoidectomyUse diamond burrs and close off the mastoid cells with bone wax.
“Thick” implant and thin skull cortexDuring creation of the implant bedCreate a bony island over the dura (Figure 4).
Round window in a more horizontal planeBefore cochleostomyMake the posterior tympanotomy as wide as possible, and drill towards stapes to find round window.
Ossification of the cochleaAt cochleostomy and electrode insertionDrill-out of basal turn of the cochlea, partial electrode insertion, scala vestibuli insertion, or split electrode insertion.
Hematoma at the first implanted earAt closure of first sidePlace surgical drain superficial of the musculoperiosteal flap, remove after head bandage.
Electrode can dislocate out of the cochleaDuring development of the mastoid processPosition 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.