Ann Otol Rhinol Laryngol 108:1999 USING THE CLARION® COCHLEAR IMPLANT IN COCHLEAR OSSIFICATION PHILIP A. BIRD, MD STACY BUTTS, MA THOMAS J. BALKANY, MD ORLANDO GOMEZ, PHD MIAMI, FLORIDA ANNELLE V. HODGES, PHD DAVID LEE, PHD This paper is a retrospective review of 5 patients with various degrees of cochlear ossification who were implanted with the CLARION® Multi-Strategy™ Cochlear Implant. Preoperative computed tomography scans, intraoperative findings, surgical tech- nique, and hearing outcomes are discussed in a case report format. Full implantation was achieved in all cases by a systematic approach that included drill-through of proximal obstruction (2 cases), scala vestibuli insertion (2 cases), and complete drill-out (1 case). The only complication was delayed wound healing in a patient with sickle cell disease, chronic active hepatitis, and steroid dependency on antimetabolite therapy. Early results show that the 4 patients with at least 3 months of experience have a mean open- set sentence recognition score of 55% and a mean open-set word recognition score of 24%. The conclusion is that implantation of the Clarion device in ossified cochleas can be successful in all degrees of ossification and can provide significant hearing benefit. KEY WORDS — cochlear implant, deafness, hearing loss, ossified cochlea. INTRODUCTION Ossification of cochlear scalae was once consid- ered a contraindication to cochlear implantation. Over the past decade, however, techniques have been developed to enable successful implantation of all cochleas, regardless of the degree of ossification. Balkany et al 1 described excellent results in partially ossified cochleas. For the completely ossified coch- lea, Gantz et al 2 described the total drill-out proce- dure. Cohen and Waltzman 3 described the short infe- rior tunnel insertion, and Steenerson et al 4 described scala vestibuli insertion. On the basis of all of these techniques, Balkany et al 5 subsequently suggested a systematic approach to surgery of the ossified co- chlea. To date, most reports of implantation of the ossi- fied cochlea have been with the Nucleus cochlear implant (Cochlear Corporation, Englewood, Colo). The purpose of this report is to describe our experi- ence with the CLARION® Multi-Strategy™ Coch- lear Implant (Advanced Bionics Corporation, Syl- mar, Calif) in the presence of cochlear ossification. METHODS Subjects. Five patients with cochlear ossification who were implanted with Clarion devices were iden- tified from the cochlear implant database at the Uni- versity of Miami Ear Institute. Details of their clini- cal presentation, operative findings, radiologie stud- ies, and audiologic testing were reviewed. Speech Testing. All postoperative speech testing was performed in an American National Standards Institute-approved calibrated sound suite with com- pact disk or audiotape recordings of test materials. Speech reception threshold (SRT) or speech aware- ness threshold (SAT) was evaluated with recorded spondee words. Speech recognition was assessed with Central In- stitute for the Deaf Everyday Sentences Test (CID sentences) and Northwestern University Phonetically Balanced Monosyllable Word Test (NU6 word) lists. Test materials were presented at 70 dB sound pres- sure level (SPL) in a sound field, with the patient setting the device to the preferred listening level. Face-to-face communication benefit from the im- plant was assessed with the Visual Enhancement sub- test of the Minimal Auditory Capabilities Battery. These measures were presented in a quiet room with the tester seated approximately 1 m in front of the patient. Materials were presented at normal conversa- tional speech levels in both implant-off and implant- on conditions. For all speech tests, the most recent scores are reported here. Surgical Technique. Surgical technique followed the manufacturer's recommendations through the co- chleostomy step. 6 To summarize, the implantable co- chlear stimulator (ICS) was placed in a deep bony seat and fixed with bone-anchored, nonabsorbable suture, the facial recess was widely opened, the co- chleostomy was elongated to 3 mm to facilitate con- trolled insertion of the electrode, and the cable was fixed in a 1-mm-slot "split bridge" drilled in the in- cus buttress to prevent electrode extrusion. 7 From the Departments of Otolaryngology (Bird, Balkany, Hodges, Butts) and Epidemiology and Public Health (Gomez, Lee), University of Miami Ear Institute, Miami, Florida. CORRESPONDENCE — Thomas J. Balkany, MD, University of Miami Ear Institute, PO Box 016960 (D-48), Miami, FL 33101. 31