No abstract

Patients with unilateral VS (sporadic or those affected with NF2) whose tumor status was stable, benefited from cochlear implantation in their tumor-affected ear. Patients who had radiotherapy also benefited from CI, but their outcomes were variable.

Objective: To investigate outcomes of cochlear implantation (CI) in patients with Ménière's disease (MD) with and without surgical labyrinthectomy. Study Design: Retrospective study. Setting: Multiple tertiary referral centers. Subjects: Thirty one ears from 27 patients (17 men, 10 women, aged 42–84) with CI in ipsilateral MD ear. Intervention: CI in ears with intact labyrinths (Group 1), CI with simultaneous surgical labyrinthectomy (Group 2), and CI sequential to surgical labyrinthectomy (Group 3). Main Outcome Measure: Within-subject improvement on Bamford Kowal Bench test or City University of New York open set sentence tests. Results: Majority of ears achieved excellent open-set speech recognition by 12 months post-CI, irrespective of intervention group. Preoperative details including patient age and sex, implant, MD and previous intervention, and audiological test results did not significantly affect outcomes. Patients with MD undergoing CI only may experience vestibular dysfunction which may cause long-term concerns. Incidental finding was noted of eight ears with fluctuating symptoms in ipsilateral ear during 12-month period post-CI, with five of eight ears showing objective fluctuating impedances and mapping. Conclusion: CI in MD can yield good hearing outcomes in all three groups and this is possible even after a long delay after labyrinthectomy. Bilateral MD patients are complex and prospective quality of life (QoL) measures would be beneficial in being better able to manage the vestibular outcomes as well as the audiological ones.

The primary aim of treatment of cholesteatoma is to attain a dry, safe, stable ear, free of disease. Maintaining or improving hearing is important but the pursuit of a hearing result should not compromise this primary aim. This study reviews the long-term outcome of 133 patients, suffering from advanced disease, who underwent modified radical mastoidectomy between 1995 and 2000. Of these, 49 per cent had had previous mastoid surgery elsewhere. A dry, waterproof ear was attained in 95 per cent of patients. In 77 per cent of patients, hearing was unchanged or improved. In this period, there were two cases of significant post-operative loss in bone conduction, including one dead ear secondary to suppurative labyrinthitis. There were epithelial pearls on follow up in two per cent. These results indicate that when properly performed, modified radical mastoidectomy provides safe surgical access and clears disease with low recurrence rates while mostly maintaining or improving hearing.