Blind Sac Approach Using Silastic Block for Cochlear Implantation in Patients with Cholesteatoma

Abstract

Cochlear implant (CI) surgery in cholesteatoma is challenging because of the risk of residual or recurrent infection. Although CI could be done with subtotal petrosectomy in single or staged surgery, this surgery needed additional surgical procedures to obliterate the mastoid cavity. This paper describes a new surgical technique for CI surgery in cholesteatoma without external auditory canal closure.

Evaluation of Subtotal Petrosectomy Technique in Difficult Cases of Cochlear Implantation

“…It also eliminates the need for life-long cavity care and water avoidance [Postelmans et al, 2009]. The procedure is feasible even in meatoplasty cases, and although some authors associate it with an esthetic disadvantage [Lyu and Park, 2017], we did not register any complaints in this regard, and observed that it can be even less obvious than the previous large opening [Szymański et al, 2016].…”

“…For CMOM cases, some authors advocate the use of simple tympanoplasty (TPL)/tympanomastoidectomy with CI, usually performed in 2 stages [Axon et al, 1995;Incesulu et al, 2004;Roehm and Gantz, 2006;Leung and Briggs, 2007;Hellingman and Dunnebier, 2009;Postelmans et al, 2009;Vincenti et al, 2014b;Yoo et al, 2014]. This approach may be hazardous due to the possibility of disease relapse [Vincenti et al, 2014b], or biofilm persistence [Lyu and Park, 2017] with consequent infection. Specifically, additional surgery is frequently required in such cases to control the disease [Barañano et al, 2013], including STP, MO, or EAC closure.…”

“…Initial implantation efforts encountered a high rate of complications [Free et al, 2013] owing to: the risk of array extrusion through the thin epithelial lining [Issing et al, 1998;Free et al, 2013], external exposure and infection [Altuna et al 2017], and damage to the epithelium/electrode following regular cavity-cleaning maneuvers [Sanna et al, 2016]. Various surgical strategies have been proposed as a means of safe implantation including: cleft obliteration with bone chips and posterior-wall reconstruction [Tamura et al, 1997;Kojima et al, 2010]; partial obliteration and covering the electrode with full-thickness skin, cartilage, muscle, or periosteal flaps .1159/000507419 berg, 1997;Meyerhoff et al, 1988;Schlöndorff et al, 1989;Babighian, 1993;El-Kashlan et al, 2003]; reinforcing the neotympanum with a silastic block [Lyu and Park, 2017]; and a transcanal [Jang et al, 2012], subfacial [Olgun et al, 2005], or MCF approach [Colletti et al, 1998]. Despite the reasonable argument for deploying these techniques (e.g., the ease of monitoring a cholesteatoma relapse) and the favorable outcomes reported, they also present several drawbacks: the lack of proper endorsement due to the limited number of cases, the high risks associated with electrode exposure/migration, the technically difficult and time-consuming reconstruction of the posterior wall [Postelmans et al, 2009], and the ongoing middle-ear disease experienced with bypass techniques.…”

“…The use of an extended temporalis flap [Szymański et al, 2016;Yung, 2016] with a retroauricular S-shape incision [Szymański et al, 2016] would seem more appropriate here. Another causal possibility is biofilm persistence that could lead to disease flare-up, even in clinically inactive cholesteatoma [Lyu and Park, 2017] or after a long time [Bernardeschi et al, 2015]. Comprehensive exclusion of all tympanomastoid mucosa, secure closure of the ET/EAC, and proficient antibiotic coverage are paramount for good surgical outcomes.…”