STEP 1 AntromastoidotomySTEP 2 Posterior tympanotomy to allow visualization of the round windowPuncture and incision of the round window membraneApproach to the scala tympani directly through the round window mem-brane (partial insertion of the electrode array)Electrode fixation in the round window niche with fibrine glue (mem-brane must be partially uncovered to preserve its mobility)Fixation of the device in a well in the temporal boneSTEP 3 STEP 4 STEP 5 STEP 6 Source: Reprinted with permission from Skarzynski (2012). © Journal of Hearing Science.