Ahmed Mehanna is Lecturer of ENT at Alexandria University in Egypt. He has received his MBBCH degree in September 1999 and Master degree of Otorhinolaryngology and Head and Neck Surgery in 2004. He has received his Doctorate degree of Otolaryngology in 2009 from Alexandria University. He has served as House officer (Intern) at Alexandria University Hospital (2000-2001). He has worked as a Clinical and Research ENT Fellow in The Royal Prince Alfred Hospital, Westmead Children Hospital and Sydney Cochlear Implant Centre. He has also worked in The Matter Hospital with Prof. Gibson in his private operative work. He has attended several international conferences and has 4 publications. His research interests include otology and cochlear implant surgerypediatric otolaryngology and airway management.


Objectives: The aim of this study was to assess the incidence of CSF gusher during cochlear implantation in children with and without congenital inner-ear malformation and to establish a simple stepwise algorithm for managing CSF gusher at the time of cochleostomy.

Materials & Methods: A total of 54 congenitally deaf children were included in a retrospective study between January 2012 and December 2013. All cases underwent classical cochlear implantation surgeries via mastoidectomy and posterior tympanostomy approach.

Results: Nine patients developed gusher at the time of the cochleostomy. Among the nine cases, only one child did not show any preoperative radiologic evidence of any bony cochleovestibular malformation, whereas the remaining eight cases had different congenital inner-ear malformations with known risk for intraoperative gusher during surgery.

Conclusion: We concluded that the CSF gusher is a surgical difficulty or an intraoperative challenge rather than a bad prognostic determinate for the postoperative audiologic performance and in cases of congenital cochleovestibular malformation that develop gusher, a high degree of congenital anomaly of the cochlea and not the degree or the amount of gusher is correlated to the poor patient performance. Finally, we were able to achieve a simple stepwise algorithm for the management of gusher during cochlear implantation.