Anteroposterior approach with split ear canal for cochlear implantation in severe malformations

Objective: To present an anteroposterior approach with split ear canal technique in severe malformed ears in which cochlear implantation is not possible through the standard facial recess approach. Setting: The operation was performed at Hacettepe University Medical Faculty, which is a tertiary care center. Study Design: Case report. Patient: A 4-year-old female patient with severe Mondini malformation whose facial nerve was completely dehiscent and overlying the stapes and round window. Intervention: The anteroposterior approach was used, and the middle ear was entered after the tympanomeatal flap was elevated. The posterior wall of the ear canal was split longitudinally with a diamond drill. The electrode was inserted easily through the ear canal and then transferred into the mastoid. Conclusion: The anteroposterior approach with split ear canal method may be used if, during facial recess, the landmarks in the middle ear (stapes, stapedius tendon, round window, and promontory) cannot be identified clearly because of an abnormal facial nerve (coursing anteriorly, preventing the use of a drill). It is an alternative for the canal wall down procedure.