A modified hook-assisted transmuscular technique to optimise cochlear implant coupling in patients with thick scalp flaps

BACKGROUND: Achieving adequate coupling between the internal and external components of a cochlear implant is essential for optimal device performance and depends in part on scalp thickness. AIMS/OBJECTIVES: Suboptimal cochlear implant coupling may occur in patients with increased scalp thickness, leading to impaired magnetic retention and signal transmission. This study describes a modified hook-assisted transmuscular technique designed to address this issue while preserving soft tissue integrity. MATERIAL AND METHODS: This retrospective single-centre case series included adult patients undergoing cochlear implantation with scalp thickness >7 mm. The technique involves two parallel muscle incisions and the use of a custom-designed hook to elevate the temporalis muscle under direct visualisation, allowing controlled implant placement without the need for skin flap thinning. RESULTS: The method was applied in 15 adult patients with a follow-up period of 1 to 6 months. Mean scalp thickness was reduced from 10.7 mm to 4.3 mm. No cases of flap necrosis or infection were observed. Operative time was comparable to conventional procedures, and no patients required revision surgery or high-strength magnets during follow-up. CONCLUSIONS AND SIGNIFICANCE: This technique appears to be a feasible and practical option for improving cochlear implant coupling in patients with thick scalp flaps. Further studies are required to assess long-term outcomes.