Cochlear implantation after subtotal petrosectomies

Bendet, Erez; Cerenko, Danko; Linder, Thomas; Fisch, Ugo

doi:10.1007/s004050050037

Cited by 65 publications

(62 citation statements)

References 17 publications

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“…The main concern of standard obliterative procedures is the risk of residual or recurrent cholesteatoma. For this reason, surgeons performing obliterative operations recommend a two-stage procedure if a cholesteatoma is present or if there is any doubt about removal of the squamous epithelium (Bendet et al, 1998;Gray et al, 1999). Colletti et al (1999) suggested cochlear implant insertion via a middle cranial fossa approach, although this may be considered by other surgeons as overtreatment with potential serious complications.…”

Section: Chronic Otitis Mediamentioning

confidence: 98%

Cochlear implant surgery in challenging cases

Nikolopoulos¹,

Kiprouli²

2004

Cochlear Implants Int.

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Expanding selection criteria and increasing numbers of cochlear implantations have revealed several challenging cases with regard to surgery and medical point of view. Cochlear implantation of congenitally deaf children with inner-ear malformations may involve difficulties in preoperative evaluation, surgical approach and postoperative follow-up. Cochlear nerve aplasia (as evidence of only one existing nerve in three dimensional magnetic resonance imaging) and hypoplastic cochleas are among the most difficult cases and sometimes children are considered unsuitable for cochlear implantation. However, there is always the possibility that hypoplastic cochleas may include ganglion cells and the only nerve in the internal auditory canal (facial nerve) may contain auditory fibres as well. A positive history of auditory experience and evidence of electrical auditory brainstem response or response to the promontory or round window electrical stimulation may imply that a functioning auditory system is in place. Malformations like common cavity deformity, isolated bilateral vestibular aqueduct enlargement and Mondini dysplasia are usually less challenging, although cerebrospinal fluid leak and postoperative meningitis may be a possibility. In cases of post-meningitic deaf patients, ossification (or obliteration) may be a serious problem even if computed tomography and MRI scan show a patent cochlea or minimal changes. Acoustic neuromas and neurofibromatosis type 2 are other challenging cases, as there is always the possibility that the sensorineural hearing loss is secondary to cochlear damage by interference of the tumour to cochlear blood supply. In conclusion, challenging cases are becoming more common as we are expanding selection criteria, and we should be prepared for alternative cochlear implant devices (straight electrode arrays, dual arrays, compressed arrays, etc.), increased rate of possible complications at, and following, surgery, and functional outcome that may vary considerably among implantees.

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Section: Chronic Otitis Mediamentioning

confidence: 98%

Cochlear implant surgery in challenging cases

Nikolopoulos¹,

Kiprouli²

2004

Cochlear Implants Int.

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“…Intraoperative lumbar drainage has also been used to effectively control the gusher and kept in postoperative period [17,20]. Subtotal petrosectomy with isolation and obliteration of the tympanomastoid cleft has been advocated in patients with cochlear dysplasia and CSF fistula [18,21]. It has also been advocated in intractable cases not responding to continuous lumbar drainage [12,14].…”

Section: Discussionmentioning

confidence: 99%

CSF Gusher in Cochlear Implant Surgery–does it affect surgical outcomes?

Vashist

Singh

2016

European Annals of Otorhinolaryngology, Head and Neck Diseases

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a b s t r a c tObjectives: The purpose of this prospective study was to measure surgical outcomes in cases of cerebrospinal fluid gusher in cochlear implant surgery. Materials and methods: Demographic, radiological, neurophysiological and surgical results were evaluated in nine cases of patients with cerebrospinal fluid gusher during cochlear implant surgery, out of 164 unilateral cochlear implant procedures. Review of literature and our management technique is discussed. Results: Nine cases had cerebrospinal fluid leak during surgery. Out of three cases of incomplete partition type II, two had cerebrospinal fluid gusher while one had milder ooze. Two cases with large vestibular aqueduct syndrome had intraoperative cerebrospinal fluid gusher. Four cases of gusher had no predictable risk factors on clinical history, examination or preoperative radiology. All cases were managed with meticulous packing of round window site without any other additional measures such as lumbar drain or use of tissue glue. These cases showed no symptoms or signs of cerebrospinal fluid leak in the follow-up period. Conclusion: We recommend careful meticulous packing of the round window around the electrode using periosteum until cerebrospinal fluid leak is controlled in all cases of cerebrospinal fluid gushers. We also recommend a very conservative approach to managing these patients in the immediate postoperative period.

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“…Similarly, the applications of an implanted hearing aid and active middle ear plant can offer correction of conductive and mixed-type hearing losses (3,4). These advantages have repopularized the procedure of "blind sac closure," especially in patients with cavity problems or with unavoidable ear infection despite multiple operations.…”

Section: Introductionmentioning

confidence: 99%

Subtotal Petrosectomy and Blind Sac Closure of the External Auditory Canal: Single-Center Experience with 44 Cases

Çatlı¹,

Çelik²,

Olgun³

2014

Turk Arch Otolaryngol

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Objective: This study aims to share our experiences with subtotal petrosectomy, cavity obliteration, and blind sac closure of the external auditory canal.Methods: A total of 44 patients who underwent subtotal petrosectomy and cavity obliteration between January 2009 and April 2013 were analyzed retrospectively. Indications of operation, surgical findings, and complications were recorded.Results: Twenty-three male and 21 female patients with a mean age of 42±18 (8-73) years were included in the study. The mean postoperative follow-up period was 22±11 (9-52) months. Seven patients underwent primary cavity obliteration (6 with supralabirentin cholesteatoma and 1 with facial nerve schwannoma; all had total sensorineural hearing loss on the operated side). Obliteration was performed as a secondary procedure in 19 patients who had uncontrolled otorrhea and unserviceable hearing. During the procedure, the implantation processes of a Carina device in 2 patients, active middle ear implant (Vibrant Soundbridge-VSB) in 4 patients, and cochlear implant in 8 patients who had dry mastoidectomy cavities were performed. Removal of the hearing devices was carried out simultaneously with the procedure in 4 patients who had been administered an auditory implant previously. The complications of cerebrospinal otorrhea and mastoid cavity infection developed in 1 patient on the 7 th postoperative day. This had been drained under general anesthesia, and recovery was obtained without any problems. Three patients had skin necrosis localized in the external auditory canal, which was repaired under local anesthesia. Conclusion:Subtotal petrosectomy and cavity obliteration procedure can be a good alternative to prevent recurrent infections and cavity problems in patients who have safe cavities with unserviceable hearing. Additionally, it is gaining more popularity in chronic otitis media patients to secure the implant electrode and to prevent cavity infection if they need to be rehabilitated with cochlear or active middle ear implants.

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Cochlear implantation after subtotal petrosectomies

Cited by 65 publications

References 17 publications

Cochlear implant surgery in challenging cases

Cochlear implant surgery in challenging cases

CSF Gusher in Cochlear Implant Surgery–does it affect surgical outcomes?

Subtotal Petrosectomy and Blind Sac Closure of the External Auditory Canal: Single-Center Experience with 44 Cases

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