The traditional access route for
cochlear implantation was initially proposed by William House in 1961. Alternatives to this surgical approach have been suggested by many authors. The combined approach technique (CAT) is a variation of the traditional
mastoidectomy-posterior tympanotomy method, which uses a transcanal approach to cochleostomy combined with a small
mastoidectomy and an equally small posterior tympanotomy for the insertion of
electrodes. This paper presents a detailed description of this alternative procedure, reporting our experience with 50 cases, and adds our contribution regarding possible advantages and implications of using a transcanal cochleostomy. The subjects had profound and severe
bilateral hearing loss and had not benefited from external
hearing aids. They underwent
cochlear implantation at Hospital de Clinicas de Porto Alegre from May 2003. The median follow-up was 29 months. All cases were successfully implanted using CAT. No major complications, such as
facial paralysis or
paresis,
meningitis,
cholesteatoma, or
cerebrospinal fluid leaks, were observed in any patient. The CAT is a safe and efficient variation of
cochlear implantation surgery, which is especially appropriate if cochlear calcification or malformations are present, or whenever cochleostomy has to be performed anteriorly, and when the position of the facial nerve prevents an adequate posterior tympanotomy.