Inner ear therapy by local drug delivery

Cochlear implantation in patients with rare intracochlear schwannomas has been reported in case reports or case series. The applied techniques have varied considerably ranging from extended cochleostomy, ‘‘push-through’’ and ’’pull-through’’ techniques, partial and subtotal cochlectomy to cochlear implant (CI) insertion through the tumor. Based on personal experience in large number of cases, we here illustrate the surgical technique of subtotal cochlectomy for tumor removal, single stage cochlear implantation, and cochlear defect reconstruction while preserving function of all five vestibular receptors. With this technique, surprisingly good results with respect to hearing rehabilitation with CI are observed, partly based on the observation of a reduced spread of electrical field and close approximation of the electrodes to the spiral ganglion cells in Rosenthal’s canal, both facilitated by the demonstrated surgical procedure.

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