The rehabilitation of profoundly deaf patients by means of cochlear im
plants has become a well established form of therapy. Recently,large s
cale studies have pointed out a variety of surgical complications. A m
ultiplicity of new implant types are each placing more specific demand
s on the surgeons. Based on the experience with about 160 cochlear imp
lantations in total,the most suitable surgical technique for the impla
ntation of the Combi 40 cochlear implant which has been used in 41 cas
es is presented. An extended retroauricular incision is made and a cau
dally based flap is fashioned. The implant bed is drilled 0.5-1 cm beh
ind and above the mastoid cavity. Between the implant bed and the mast
oid cavity a groove for the electrodes is drilled cranial of the impla
nt site in the right ear and caudal in the left ear. Access to the sca
la tympani is gained by a promontory cochleostomy via a posterior tymp
anotomy of 2x3 mm. Videocontrolled microendoscopes are used to inspect
the scala tympani prior to electrode insertion. Electrode insertions
depths of up to 30 mm are usually achieved. The electrode and the impl
ant are secured with ionomer-based cement. The described technique has
up to now been successfully performed in 30 adults and 11 children.