The utilization of round window membrane surface tension in facilitating slim electrodes insertion during cochlear implantation

This is a prospective randomized study aimed to evaluate the round window membrane (RWM) surface tension in facilitating slim electrodes insertion during cochlear implantation. A total number of (118) children were included in this study (118 implantations). Mean age was 36.72 months (range from 18 to 60 months). This study was conducted from January 2015 to September 2016 at a cochlear implant centre in a tertiary referral hospital. Slit incision in the anterosuperior quadrant of the RWM was done in 70 cases, While RWM cruciate incision was done in 48 cases. Of the 48 patients who underwent RWM cruciate incision, 13 cases had no problem, while in 35 cases, we faced difficult insertion. When slit incision of the RWM was done (70 cases), 68 cases showed smooth insertion, meanwhile, we faced increased operative time due to flopping of the electrode in 2 cases only. Moreover, residual low-frequency hearing preservation was more achieved when slit incision of the RWM was done. Tensile strength of the round window membrane after slit incision of the RWM offers support to slim electrodes during introduction, decreasing incidence of kinking and floppiness, hence shortening the maneuver time and minimizing the number of trials. This facilitates easy smooth slim electrodes introduction, decreasing intracochlear trauma. Moreover, slit incision of the RWM may offer better residual hearing preservations than cruciate incision of the RWM during slim electrodes introduction.