The Role of Subtotal Petrosectomy in Cochlear Implant Surgery–A Report of 32 Cases and Review on Indications

Free, Rolien; Falcioni, Maurizio; Trapani, Giuseppe Di; Giannuzzi, Anna Lisa; Russo, Alessandra; Sanna, Mario

doi:10.1097/mao.0b013e318289841b

Cited by 88 publications

(104 citation statements)

References 41 publications

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“…Usually, the inflammation process is eradicated with the result of inflammation-free local circumstances so that an implant loss due to infection or inflammatory reactions can be avoided in most of the cases. A unilateral procedure is only recommended for absolutely inconspicuous and inflammation-free radical cavities [48], [49].…”

Section: Chronic Otitis Mediamentioning

confidence: 99%

Cochlear Implant – State of the Art

2017

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Cochlear implants are the treatment of choice for auditory rehabilitation of patients with sensory deafness. They restore the missing function of Thomas Lenarz 1 inner hair cells by transforming the acoustic signal into electrical stimuli in the majority of patients including the use of the telephone. Children can achieve a near to normal speech and language development provided their deafness is detected early after onset and implantation is performed quickly thereafter. The diagnostic procedure as well as the surgical technique have been standardized and can be adapted to the individual anatomical and physiological needs both in children and adults. Special cases such as cochlear obliteration might require special measures and re-implantation, which can be done in most cases in a straight forward way. Technology upgrades count for better performance. Future developments will focus on better electrode-nerve interfaces by improving electrode technology. An increased number of electrical contacts as well as the biological treatment with regeneration of the dendrites growing onto the electrode will increase the number of electrical channels. This will give room for improved speech coding strategies in order to create the bionic ear, i.e. to restore the process of natural hearing by means of technology. The robot-assisted surgery will allow for high precision surgery and reliable hearing preservation. Biological therapies will support the bionic ear. Methods are bio-hybrid electrodes, which are coded by stem cells transplanted into the inner ear to enhance auto-production of neurotrophins. Local drug delivery will focus on suppression of trauma reaction and local regeneration. Gene therapy by nanoparticles will hopefully lead to the preservation of residual hearing in patients being affected by genetic hearing loss. Overall the cochlear implant is a very powerful tool to rehabilitate patients with sensory deafness. More than 1 million of candidates in Germany today could benefit from this high technology auditory implant. Only 50,000 are implanted so far. In the future, the procedure can be done under local anesthesia, will be minimally invasive and straight forward. Hearing preservation will be routine.Keywords: cochlear implant, sensory deafness, diagnostics, surgical procedure, results, complications, future developments SummaryCochlear implants are electronical stimulus prostheses for the functional replacement of the inner ear. Because of the rapid technical development and the good results, they could be established as standard therapy for sensory deafness. Cochlear implantation requires an interdisciplinary team and a quality-controlled concepts that reaches from the indication to the life-long control and that is fixed in the AWMF guideline on cochlear implant [1]. Current cochlear implant systems are partially implantable and equipped with a multitude of additional functions similar to hearing aids for sound pre-processing and noise elimination. The intracochlear position of the electrode allows fo...

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Section: Chronic Otitis Mediamentioning

confidence: 99%

Cochlear Implant – State of the Art

2017

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“…This case was drained under general anesthesia, and recovery was provided through parenteral antibiotic therapy uneventfully. Some authors suggest that abdominal fat tissue should be washed with "rifampicin" before being placed into the cavity in order to minimize the risk for infection in the cavity (7). Three complications associated with skin necrosis of the external auditory canal were observed in our series of 44 cases.…”

Section: Discussionmentioning

confidence: 75%

“…In our series, 8 of the patients already had a radical cavity or ongoing chronic otitis media. For this patient group, the main purpose of cavity obliteration and the advantage that is aimed to be gained are to minimize the risk for infection, to prevent possible escape of the cerebrospinal fluid, and to decrease the risk for recurrent meningitis (7). The aim of the procedure of subtotal petrosectomy and cavity obliteration and cochlear or active middle ear implantation was also the same in our clinic.…”

Section: Discussionmentioning

confidence: 99%

“…Each of these 3 cases was revised under local anesthesia. In the literature, it is recommended (especially in revision cases where the skin of the external auditory canal should be sutured as "stratified" (skin and subsurface skin separately) without stretching when possible (7,11). In our cases, during suture of the external auditory canal, we prefer to decollate the anterior wall skin of the external auditory canal as completely as possible and to suture using a horizontal matrix technique with Vicryl without stretching.…”

Section: Discussionmentioning

confidence: 99%

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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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“…The surgical access to the round window was enhanced following subtotal petrosectomy. Similar approach has been described for 2 malformed cochleae in a study by Free RH et al in 2013. In case of difficult situations, subtotal petrosectomy provides excellent visibility and access in difficult anatomy or in drill-out procedures.…”

Section: Discussionmentioning

confidence: 87%

Cochlear implant in patients with incomplete partition type II: surgical considerations

Takhellambam¹,

Venkataramani²,

Natarajan³

et al. 2017

Int J Otorhinolaryngol Head Neck Surg

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Background: This study presents our experience on surgical aspects, complications and outcome of cochlear implants in incomplete partition type II patients.Methods: 7 children in the age group of 1 to 5 years with incomplete partition type II, 5 females and 2 males were studied retrospectively from the database of tertiary care centre from February 2015 to December 2016. Results: 5 patients had conventional transmastoid facial recess approach of which one patient had removal of incudal buttress, incus and stapes suprastructure to facilitate middle turn cochleostomy. 2 patients had subtotal petrosectomy. Complete insertion of electrode was achieved in all patients; by middle turn cochleostomy in 1 patient, cochleostomy in another patient, extended round window in 3 patients and round window in 2 patients. Med-el Synchrony + Form 19 were used in all patients and complete insertion was achieved in all. 4 patients had CSF leak which was sealed with soft tissue. One patient had device failure. 5 children show improvement in CAP and SIR score. One had device failure and was subsequently explanted and re-implanted.Conclusions: Cochlear implantation in patients with incomplete partition type II is challenging and thorough knowledge of anatomy is essential. One must be competent enough to expedite different surgical approaches and manage the associated complications. Prior counselling for guarded outcome and eventualities are necessary in such patients.

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The Role of Subtotal Petrosectomy in Cochlear Implant Surgery–A Report of 32 Cases and Review on Indications

Cited by 88 publications

References 41 publications

Cochlear Implant – State of the Art

Cochlear Implant – State of the Art

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

Cochlear implant in patients with incomplete partition type II: surgical considerations

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