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Dr. Montasir Junaid, is an ENT specialist with special interest in otology and head and neck surgery. He has worked as Assistant professor in Pakistan and currently is a visiting faculty in Armed forces Hospital southern region, Saudia Arabia. Dr. Junaid has more than 25 publications and two books published as author and co-author. He is also an active member of Pakistan Cochlear implant Program where cochlear implants are being done free of charge on financially challenged pediatric patients with complete hearing loss.
Introduction: For infants and children with severe to profound hearing impairment,cochlear implantation is the widely accepted surgery of choice. There has been a recent shift of electrode array insertion from bony cochleostomy to round window membrane(RWM) insertion. Round window membrane is strategically placed which could be accessed after an optimal post tympanotomy . St.Thomas hospital (STH) classification is used to evaluate the accessibility of RWM insertion of electrode array and can be classified as Types I ,IIa , IIb and III. In type I RWM is 100% visible and insertion is straight forward while in type III RWM is not visualized at all and a bony cochleostomy is under taken. Material & Methods: A total of 190 pts were included with minimum age of 1.5 years and maximum of 4.1 with mean of 2.76, There were 48.2 % males and 50.3 % females in the group. Children with diagnosed syndromes or age more than 4.5 were not included in study. Results: The Cause of hearing loss in majority of cases was unknown (53.7% ) followed by low birth weight (14.7%), maternal infections(12.6%) , meningitis (6.3%), birth asphaxia & jaundice (5.3%) and non-inherited congenital (2.1%) All the type III pts underwent bony cochleostomies (2.1 %) while simple round window insertions were 65.3 % (32.2% in Type I, 54.8% in type II a and 12.9% in Type II b) and 32.6 % underwent extended round window insertion. (33.8% in type II a and 66.1% in Type II b ) Conclusion: STH classification is an easy way to assess the accessibility of RWM insertion in patients planned for cochlear implantation provided that a proper posterior tympanotomy has been undertaken.