TYPE OF SURGERY Cochlear implant surgery PLANNED SURGERY MED EL Flex Soft cochlear implantation for Partial Deafness Treatment (left ear) SURGICAL TECHNIQUE 6 steps Skarzynski Surgical Procedure – Round Window Approach The 8 th LION Global Broadcast May 16 th, 2013 LION TV CHANNEL 2 SURGEON: HENRYK SKARZYNSKI World Hearing Center of the Institute of Physiology and Pathology of Hearing Warsaw/Kajetany (Poland) World Hearing Center of the Institute of Physiology and Pathology of Hearing, Warsaw/Kajetany CASE 1/2 (09h15 – 10h15)

CLINICAL 23 y.o. lady progressive sensory – neural hearing loss for 10 years, bilateral HA user for 7 years, for last 3 years – no benefit, bilateral tinnitus, no other complaints. OTOSCOPY bilateral normal CT-scan CT-scan no anomalies in anatomy Henryk Skarzynski. Cochlear Implantation. Left Ear The 8 th LION Global Broadcast May 16 th, 2013 LION TV CHANNEL 2 World Hearing Center of the Institute of Physiology and Pathology of Hearing, Warsaw/Kajetany

6 STEPS SKARZYNSKI SURGICAL PROCEDURE STEP 1 – ANTROMASTOIDOTOMY STEP 2 – POSTERIOR TYMPANOTOMY TO ALLOW VISUALIZATION OF THE ROUND WINDOW NICHE STEP 3 – PUNCTURE AND INCISION OF THE ROUND WINDOW MEMBRANE STEP 4 – APPROACH TO THE SCALA TYMPANI DIRECTLY THROUGH THE ROUND WINDOW MEMBRANE (PARTIAL INSERTION OF THE ELECTRODE ARRAY) STEP 5 – ELECTRODE FIXATION IN THE ROUND WINDOW NICHE WITH FIBRINE GLUE (MEMBRANE MUST BE PARTIALLY UNCOVERED TO PRESERVE ITS MOBILITY) STEP 6 – FIXATION OF THE DEVICE IN THE WELL IN TEMPORAL BONE Henryk Skarzynski. Cochlear Implantation. Left Ear The 8 th LION Global Broadcast May 16 th, 2013 LION TV CHANNEL 2 World Hearing Center of the Institute of Physiology and Pathology of Hearing, Warsaw/Kajetany

PURE-TONE AUDIOMETRY RIGHT EAR LEFT EAR The 8 th LION Global Broadcast May 16 th, 2013 LION TV CHANNEL 2 World Hearing Center of the Institute of Physiology and Pathology of Hearing, Warsaw/Kajetany Henryk Skarzynski. Cochlear Implantation. Left Ear

FREE FIELD SPEECH AUDIOMETRY The 8 th LION Global Broadcast May 16 th, 2013 LION TV CHANNEL 2 World Hearing Center of the Institute of Physiology and Pathology of Hearing, Warsaw/Kajetany

TYPE OF SURGERY Surgery for CSOM without cholesteatoma PLANNED SURGERY Explorative tympanotomy with ossiculoplasty or stapedotomy (left ear) SURGICAL TECHNIQUE Intracanal approach, possible glass-ionomeric cement use, or stapes prosthesis The 8 th LION Global Broadcast May 16 th, 2013 LION TV CHANNEL 1 SURGEON: HENRYK SKARZYNSKI World Hearing Center of the Institute of Physiology and Pathology of Hearing Warsaw/Kajetany (Poland) World Hearing Center of the Institute of Physiology and Pathology of Hearing, Warsaw/Kajetany CASE 2/2 (11h00 – 11h45)

CLINICAL 25 years old man with left ear hypoacussis for about 10 years, history of heard trauma in adolescence, no progression of hearing impairement, family history as for hypoaccussis non-contributory, no tinnitus, no vertigo. OTOSCOPY Both sides – normal Henryk Skarzynski. Ossiculoplasty. Left Ear The 8 th LION Global Broadcast May 16 th, 2013 LION TV CHANNEL 1 World Hearing Center of the Institute of Physiology and Pathology of Hearing, Warsaw/Kajetany

Henryk Skarzynski. Ossiculoplasty. Left Ear The 8 th LION Global Broadcast May 16 th, 2013 LION TV CHANNEL 1 World Hearing Center of the Institute of Physiology and Pathology of Hearing, Warsaw/Kajetany PURE-TONE AUDIOMETRY RIGHT EAR LEFT EAR