Comparison of the Pediatric Cochlear Implantation Using Round Window and Cochleostomy

Document Type : Original


1 Department of Otorhinolaryngology, Tabriz University of Medical Sciences, Tabriz, Iran.

2 Department of Pediatrics, Tabriz University of Medical Sciences, Tabriz, Iran.


Cochlear implantation (CI) is now regarded as a standard treatment for children with severe to profound sensor neural hearing loss. This study aimed to compare the efficacy of the round window approach (RWA) and standard cochleostomy approach (SCA) in the preservation of residual hearing after CI in pediatric patients.
Materials and Methods:
This double-blind randomized controlled trial was conducted on 97 pediatric patients receiving CI with 12-month follow-up. The study population was divided into two groups according to the surgical approaches they received, including RWA and SCA. Consequently, the patients were evaluated based on the Categories of Auditory Performance scale (CAP) and Speech Intelligibility Rating (SIR) test 45-60 days and 3, 6, 9, and 12 months post-surgery.
The CAP and SIR mean scores increased in both groups during the 12-month follow-up. This upward trend was significant in both groups (P<0.001). There was no significant difference between the two treatment groups in any of the follow-up stages regarding the CAP mean score. The mean SIR score (P=1.14±0.40) was significantly higher in the RWA group 3(P=0.001), 6(P=0.008), and 9(P=0.006) months after the surgery. However, there was no significant difference between the RWA and SCA groups, regarding 1-year SIR (P=0.258).
The CI with either RWA or SCA could improve hearing and speech performance in pediatric patients. Although mid-term speech intelligibility was better for RWA, there was no significant difference in the 1-year outcome between these two methods.


  1. Addams-Williams J, Munaweera L, Coleman B, Shepherd R, Backhouse S. Cochlear implant electrode insertion: in defense of cochleostomy and factors against the round window membrane approach. Cochlear implants international. 2011 Aug 1; 12(sup2):S36-9.
  2. Cheng X, Wang B, Liu Y, Yuan Y, Shu Y, Chen B. Comparable Electrode Impedance and Speech Perception at 12 Months after Cochlear Implantation Using Round Window versus Cochleostomy: An Analysis of 40 Patients. ORL. 2018 Aug 17:1-1.
  3. Havenith S, Lammers MJ, Tange RA, Trabalzini F, della Volpe A, van der Heijden GJ. et al. Hearing preservation surgery: cochleostomy or round window approach? A systematic review. Otology & Neurotology. 2013 Jun 1; 34(4):667-74.
  4. Gantz BJ, Hansen MR, Turner CW, Oleson JJ, Reiss LA, Parkinson AJ. Hybrid 10 clinical trial. Audiology and Neurotology. 2009;14(Suppl.1):32-8.
  5. Gstoettner WK, Helbig S, Maier N, Kiefer J, Radeloff A, Adunka OF. Ipsilateral electric acoustic stimulation of the auditory system: results of long-term hearing preservation. Audiology and Neurotology. 2006; 11(Suppl. 1):49-56.
  6. Lenarz T, Stöver T, Buechner A, Lesinski-Schiedat A, Patrick J, Pesch J. Hearing conservation surgery using the Hybrid-L electrode. Audiology and Neurotology. 2009; 14(Suppl. 1):22-31.
  7. Skarżyński H, Lorens A, Piotrowska A, Podskarbi-Fayette R. Results of partial deafness cochlear implantation using various electrode designs. Audiology and Neurotology. 2009; 14 (Suppl. 1): 39-45.
  8. Skarzynski H, Lorens A, Piotrowska A, Anderson I. Preservation of low frequency hearing in partial deafness cochlear implantation (PDCI) using the round window surgical approach. Acta oto-laryngologica. 2007 Jan 1; 127(1):41-8.
  9. Gstoettner W, Kiefer J, Baumgartner WD, Pok S, Peters S, Adunka O. Hearing preservation in cochlear implantation for electric acoustic stimulation. Acta oto-laryngologica. 2004 May 1; 124(4):348-52.
  10. Jiam NT, Limb CJ. The impact of round window vs cochleostomy surgical approaches on interscalar excursions in the cochlea: Preliminary results from a flat-panel computed tomography study. World journal of otorhinolaryngology-head and neck surgery. 2016 Sep 1; 2(3):142-7.
  11. Richard C, Fayad JN, Doherty J, Linthicum Jr FH. Round window versus cochleostomy technique in cochlear implantation: Histological findings. Otology & neurotology: official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology. 2012 Sep; 33(7):1181.
  12. Fan X, Xia M, Wang Z, Zhang H, Liu C, Wang N, et al. Comparison of electrode position between round window and cochleostomy inserting approaches among young children: a cone-beam computed tomography study. Acta Oto-Laryngologica. 2018 Jun 21:1-7.
  13. Kim LS, Jeong SW, Lee YM, Kim JS. Cochlear implantation in children. Auris Nasus Larynx. 2010 Feb 1; 37(1):6-17.
  14. Vincenti V, Bacciu A, Guida M, Marra F, Bertoldi B, Bacciu S, et al. Pediatric cochlear implantation: an update. Italian journal of pediatrics. 2014 Dec; 40(1):72.
  15. Carlson ML, Patel NS, Tombers NM, DeJong MD, Breneman AI, Neff BA, et al. Hearing preservation in pediatric cochlear implantation. Otology & Neurotology. 2017 Jul 1; 38(6):e128-33.
  16. Korsager LE, Schmidt JH, Faber C, Wanscher JH. Vestibular Outcome After Cochlear Implantation Is Not Related to Surgical Technique: A Double Blinded, Randomized Clinical Trial of Round Window Approach Versus Cochleostomy. Otology & Neurotology. 2018 Mar; 39(3):306.
  17. Hassepass F, Aschendorff A, Bulla S, Arndt S, Maier W, Laszig R, et al. Radiologic results and hearing preservation with a straight narrow electrode via round window versus cochleostomy approach at initial activation. Otology & Neurotology. 2015 Jul 1; 36(6):993-1000.
  18. Archbold S, Lutman ME, Marshall DH. Categories of auditory performance. The Annals of otology, rhinology & laryngology. Supplement. 1995 Sep; 166:312-4.
  19. Zhou H, Chen Z, Shi H, Wu Y, Yin S. Categories of auditory performance and speech intelligibility ratings of early-implanted children without speech training. PloS one. 2013 Jan 21; 8(1): e53852.
  20. Santa Maria PL, Gluth MB, Yuan Y, Atlas MD, Blevins NH. Hearing preservation surgery for cochlear implantation: a meta-analysis. Otology & Neurotology. 2014 Dec 1; 35(10): e256-69.
  21. Adunka OF, Dillon MT, Adunka MC, King ER, Pillsbury HC, Buchman CA. Cochleostomy versus round window insertions: influence on functional outcomes in electric-acoustic stimulation of the auditory system. Otology & Neurotology. 2014 Apr 1; 35(4):613-8.
  22. Briggs RJ, Tykocinski M, Xu J, Risi F, Svehla M, Cowan R, et al. Comparison of round window and cochleostomy approaches with a prototype hearing preservation electrode. Audiology and Neurotology. 2006; 11(Suppl. 1):42-8.
  23. Jiam NT, Jiradejvong P, Pearl MS, Limb CJ. The effect of round window vs cochleostomy surgical approaches on cochlear implant electrode position: a flat-panel computed tomography study. JAMA Otolaryngology–Head & Neck Surgery. 2016 Sep 1; 142(9):873-80.