Objective: To evaluate a modified suprameatal transepitympanic approach for cochlear implantation in bilateral simultaneous and sequential cochlear implantation. Study design: Retrospective study of 17 patients who were implanted sequentially (5) and simultaneously (12) with a functional cochlear implantation method in a university medical center. All clinical and surgical data were stored in a database and analyzed by microcomputer. Results: In all cases a total insertion could be performed. The average overall operation time was 3 : 26 ± 20 (hr:min) for the simultaneous cases. No major complications were encountered as a result of our modified implantation method. There were no taste disturbances, vertigo complaints or headache postoperatively. All patients benefit from a good hearing result after cochlear implantation. Discussion: Simultaneous and sequential bilateral cochlear implantation with the suprameatal non - mastoidectomy approach is our opinion safe and less time consuming method to implant a cochlear prosthesis compared with the classic mastoid approach. The method is less invasive and avoid the risk of facial nerve injury. Another great advantage of the suprameatal approach with all its variations is the possibility to switch over when needed to the classic surgical approach introduced many years ago. Submitted : 30 August 2010 Revised: 01 February 2011 Accepted : 02 February 2011 Introduction House introduced the classic surgical technique for cochlear implantation [1] . This surgical technique consists of a mastoidectomy and a posterior tympanotomy and this approach is still worldwide the most frequently used technique for cochlear implantation. This classic surgical technique uses a simple mastoidectomy. After the complete mastoidectomy a posterior tympanotomy is performed with special attention to the facial nerve (facial nerve monitoring is mandatory) and the chorda tympani. Through the large posterior tympanotomy a cochleostomy can be performed for electrode insertion. The classic technique has proven to be sufficient in the vast majority of cochlear implantations. Still complications concerning the facial nerve can occur. Perioperative facial nerve paralysis is rare but has been reported in the Cochlear Corporation and Clarion data. In all these cases the posterior tympanotomy was performed via the facial recess drilling within a millimeter of the facial nerve. [2,3] . To avoid negative side effects as a temporary or permanent injury to the facial nerve new cochlear implantation techniques were introduced by Kronenberg [4] and Kiratzidis [5] without a mastoidectomy and a posterior tympanotomy. It is a functional approach leaving the delicate structures of the pneumatized mastoid intact. It is almost impossible to injure the facial nerve or the chorda tympani with this approach. Bilateral simultaneous cochlear implantation using this alternative approach is possible demonstrated by Migirov & Kronenberg [6] .In the present study we present our experience with the suprameatal cochlear implantation technique in bilateral cochlear implantations in children and adults with a focus on the reduction of surgery time. 31 ORIGINAL ARTICLE Our Experience with Bilateral Cochlear Implantations Using a Suprameatal Approach Rinze A Tange, Yvette Smulders, Wilko Grolman Dept of Otorhinolaryngology, University Medical Center Utrecht, Utrecht the Netherlands (TRA, SYE, GW) Corresponding address: R.A.Tange University Medical Center Utrecht. Dept. Otorhinolaryngology. Heidelberglaan 100. 3584 CX Utrecht The Netherlands E-mail: R.A.Tange@umcutrecht.nl Copyright 2005 © The Mediterranean Society of Otology and Audiology Int. Adv. Otol. 2011; 7:(1) 31-34