Mastoidectomy dimensions for direct acoustic cochlear implantation: a human cadaveric temporal bone study.

The objective of the present paper was to acquire information about the mastoidectomy size necessary to obtain an optimal placement of the direct acoustic cochlear implant actuator and fixation system. Ten human cadaveric temporal bones were dissected and implanted with direct acoustic cochlear implant. Mastoidectomy size was determined after implantation in each temporal bone. A bone bed for the receiver/stimulator, mastoidectomy and a large posterior tympanotomy were drilled out. The mastoidectomy was progressively enlarged posteriorly in small steps until the actuator template was judged adequately oriented to enable passage of the rod through the posterior tympanotomy without any contact with the bony walls. The distance between different landmarks in the mastoidectomy was measured. All measured values showed a high degree of consistency, with limited median absolute deviation values. One of the most critical measure, i.e. the distance between the posterior margin of the mastoidectomy to the superior rim of the bony external ear canal wall, ranged from 13 to 16 mm with a median value of 15 mm. Prior knowledge of the ideal size of the mastoidectomy for direct acoustic cochlear implant facilitates the positioning of the fixation system and may save time during implant surgery.