Is Mastoidectomy Indispensable in Cochlear Implant Surgery?
Bibliographic record
Abstract
OBJECTIVE: To challenge the need for mastoidectomy in cochlear implant (CI) surgery by comparing the advantages and disadvantages of the classic technique for CI, the mastoidectomy posterior tympanotomy approach (MPTA), with the suprameatal approach (SMA), a nonmastoidectomy approach. STUDY DESIGN AND SETTING: A retrospective study of 290 patients who underwent cochlear implantation in our department between 1989 and 2002. One hundred fifty-seven of them underwent the MPTA and 133 underwent the SMA. The ability of the electrode to expand in the MPTA patients who were reoperated on was examined, as was the influence of mastoidectomy on the course of chronic secretory otitis media (SOM) in a group of 56 children who suffered from chronic SOM prior to implantation. RESULTS: In all 4 reoperated children, in whom the MPTA was used, the mastoid was completely closed by bony regrowth on the cortical portion of the mastoid and the mastoid cavity was obliterated. The electrode had been embedded in dense fibrous tissue and bony spicule, preventing electrode expansion. Mastoidectomy was found to have no influence on the course of chronic SOM. The rate of postoperative SOM was found to be equal in 40 children who were operated on using the MPTA compared with 16 operated on using the SMA. CONCLUSION: Using a nonmastoidectomy approach, such as the SMA, provides a wide exposure of the middle ear and promontory and thus enables a well-controlled cochleostomy site and safe insertion of the electrode into the cochlea. Mastoidectomy in CI surgery is not indispensable; it may cause more disadvantages than advantages.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.010 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".