The role of subtotal petrosectomy in cochlear implant recipients

Abstract

Describe the indications and outcome of subtotal petrosectomy for cochlear implant recipients. Tertiary care referral center. This is a retrospective study of all subtotal petrosectomies and cochlear implants performed between January 2012 and December 2014. We review the charts of these patients collecting the following data: age, gender, otologic history, audiologic tests, indication of subtotal petrosectomy, data of surgery, surgical and immediate complications, late complications and follow-up of for at least 2.5 years. 12 cases of subtotal petrosectomies with cochlear implantation in 11 patients were performed during this period; 2 children and 10 adults. The indication for a cochlear implant was in 10 cases bilateral severe to profound sensorineural hearing loss and in the remaining 2 cases was asymmetric hearing loss or unilateral hearing loss. The reason for performing a subtotal petrosectomy was chronic otitis media with or without cholesteatoma, radical cavities from previous surgeries or electrode extrusion of previously implanted devices. All cases were performed in one stage. One patient had an infectious complication that required revision surgery and finally an explantation. No other complications are described. Subtotal petrosectomy combined with cochlear implantation is a procedure required in certain situations. It is an effective and safe procedure for managing middle ear problems and creating a safe cavity to receive a cochlear implant either in adults and children.

Evaluation of Subtotal Petrosectomy Technique in Difficult Cases of Cochlear Implantation

“…Alongside this development, otologists are faced with a growing class of patients for which classic posterior tympanotomy (PT) may be technically challenging or there is a high risk of complications, e.g., in chronic otitis media (COM), previous open mastoidectomy, and inner-ear malformations (IEM). These conditions have been addressed with various surgical techniques; over time, subtotal petrosectomy (STP) has stood out as an efficient and reliable procedure [Gray et al, 1995;Issing et al, 1998;Kim et al, 2004;Leung and Briggs, 2007;Postelmans et al, 2009;Barañano et al, 2013;Free et al, 2013;Vincenti et al, 2014a;Bernardeschi et al, 2015;Casserly et al, 2016;Polo et al, 2016;Szymański et al, 2016;Altuna et al, 2017]. There are multiple benefits with this procedure including the eradication of middle-ear/mastoid disease, a safe/stable environment for CI, wide surgical exposure, an accurate identification of anatomical landmarks, enhanced array stability, optimal management of intraoperative adverse findings (e.g., cerebrospinal fluid [CSF] leak or meningoencephalic herniation [MEH]), and the elimination of the need for life-long cavity care.…”

“…Although results published thus far of STP with CI (STP-CI) are encouraging [Postelmans et al, 2009;Barañano et al, 2013;Free et al, 2013;Bernardeschi et al, 2015;Casserly et al, 2016;Polo et al, 2016;Szymański et al, 2016;Altuna et al, 2017], most include small case series and a particular focus on COM cases. The validity and widespread acceptance of this method as current standard practice as well as clear indications for STP in CI have yet to be established.…”

The role of subtotal petrosectomy in cochlear implant recipients: Our preliminary results

“…CI is an acknowledged method for hearing rehabilitation in patients with severe to profound SNHL with relatively low complication rate [2]. In difficult situations, such as malformed or ossified cochlea, middle ear or intralabyrinthine tumors, chronic suppurative otitis media (CSOM), cholesteatoma and radical cavity from previous surgeries and its postoperative secondary infections, it is recommended to perform simultaneous STP [1][2][3][4][5][6]. This surgical approach provides an excellent exposure of the cochlea during CI and enables total isolation of surgical cavity from the outside environment, preventing secondary infectious complications.…”

“…Though some recommend staging the surgery due to the risk of recurrence of cholesteatoma, it is not necessary in inactive cases where STP provides a wide exposure and enables definite removal of the disease. Radical removal of all mastoid cell tracts and underlying disease, as during STP, provides definitive solution and effectively prevents potential recurrences and multiple unnecessary reoperations [2,3]. Unfortunately, this patient gained very low WRS postoperatively.…”

“…The importance of simultaneous STP in CI has been highlighted in recent literature [1][2][3][4][5][6]. Candidates for CI may coincidentally have various middle ear inflammatory pathologies or challenging anatomical conditions, which make conventional CI very difficult to undertake.…”