A limited access 'keyhole' cochlear implantation (CI) surgical technique is presented. The surgery employs a 15-18 mm diameter C-incision on the rear of the auricle. The implant is retained in a snug pericranial pocket. A bony retention well is avoided. Minimal mastoid cell clearance is used. The surgery is brief, atraumatic and well suited to small infant cases. Used in 315 sequential routine CI cases from 1997-2007, the complication rates compare favourably with past reports. The outcomes of the series question the use of larger incisions and implant retention wells. Current implant designs should be modified for better adaptation to the cranial contours.
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