Restoring functional hearing in patients with profound sensorineural hearing loss remains one of the major challenges of contemporary otolaryngology. Cochlear implantation via the transmastoid approach through the facial recess is currently regarded as the gold standard treatment. However, surgical management becomes more complex in the presence of chronic inflammatory middle ear disease, particularly in cases associated with cholesteatoma, where complete eradication of pathology prior to implantation is mandatory.

Subtotal petrosectomy represents one of the surgical options in such patients.

Considering the high cost of cochlear implant devices and the delicate nature of electrode arrays, adequate protection of the postoperative cavity and the implant itself is, in our opinion, essential. Therefore, we introduced an obliterative technique using a temporoparietal fascial flap augmented with injectable platelet-rich fibrin (iPRF+), which was applied in three patients undergoing cochlear implantation following subtotal petrosectomy.

This approach preserves important anatomical structures, including the temporalis muscle covering the cochlear implant receiver–stimulator. Furthermore, injection of iPRF+ increases the available tissue volume for obliteration and enhances the anti-inflammatory and regenerative potential of the flap, representing a valuable alternative to classical subtotal petrosectomy with fat obliteration.

Based on our clinical experience, this technique not only provides effective protection of the cochlear implant, but the additional presence of platelet-rich fibrin may also reduce the risk of postoperative infection within the surgical cavity, which is particularly relevant in patients receiving implantable hearing devices

Krystyna Masna is a graduate of the Medical Faculty of the Collegium Medicum at Nicolaus Copernicus University in Bydgoszcz, Poland. From 2017 to 2023, she completed her specialist training at the Department of Otolaryngology, Laryngological Oncology, and Maxillofacial Surgery at Dr. Jan Biziel University Hospital No. 2 in Bydgoszcz, where she continues to collaborate in both clinical and academic roles.

Her clinical and research interests are centered on temporal bone and skull base surgery. She has completed advanced surgical training through multiple certified courses and international fellowships, including placements in Würzburg and Singapore.

She is currently pursuing doctoral research focused on methods for effective temporal bone obliteration following extensive otologic surgery, with particular emphasis on the comparative use of allogeneic and autologous materials.