Piezoelectric shaping of radical mastoid cavity and dissection of ossified cochlea prior to cochlear implantation.

Cochlear implantation (CI) in radical cavities remains challenging due to the risk of postoperative electrode extrusion. We report a single-stage approach employing piezoelectric instrument (PEI) to optimize cavity osteoplasty, atraumatic cochlear access, and electrode stabilization in the setting of partial scala tympani ossification. A 72-year-old female with left profound sensorineural hearing loss and prior canal wall (CW)-down mastoidectomy underwent CI with posterior CW reconstruction. Angled and straight PEI inserts facilitated controlled bone removal over the facial nerve and creation of a bony slit with overhang to secure the electrode lead. Ossified segments of the scala tympani were carefully cleared, enabling full insertion of a perimodiolar electrode array, subsequently reinforced with double-layer cartilage. At 8-month follow-up, no clinical or electrophysiological evidence of electrode migration was observed. PEI is a promising tool for safe, atraumatic osteoplasty and stable electrode positioning in complex radical cavities.