Revision Cochlear Implantation via Middle Turn Insertion in Post-Traumatic Basal Turn Ossification

Background Complete ossification of the basal turn of the cochlea represents a major challenge inrevision cochlear implantation, particularly in post-traumatic cases. Otic capsule violating temporal bone fractures need to be carefully managed to avoid future possible meningeal infections. Objective To describe our surgical technique of middle turn cochleostomy combined with subtotal petrosectomy for revision cochlear implantation in the setting of total basal turn ossification due to an otic capsule-violating temporal bone fracture. Methods We report a case of failed primary cochlear implantation due to post-traumatic ossification of the basal turn. Revision surgery was performed using subtotal petrosectomy to achieve wide exposure of the promontory. After removal of the previous device and confirmation of complete ossification of both scala tympani and scala vestibuli at the basal turn, promontory drilling was extended superiorly to identify and open the middle turn of the cochlea, allowing full electrode insertion. Results Complete insertion of the new electrode array was achieved through the middle turn. Postoperative imaging confirmed appropriate positioning, facial nerve function was preserved, and the patient experienced improvement in auditory thresholds. Conclusions In cases of total basal turn ossification, middle turn cochleostomy following subtotal petrosectomy represents a feasible and safe alternative to enable cochlear implantation in selected revision cases.