Abstract
Objective
Patients with chronic otitis media with/without cholesteatoma present a significant challenge to safe cochlear implantation (CI). The aim of our study is to describe our experience and propose management options for CI in patients with chronic otitis media.
Study design
Retrospective case study.
Setting
Tertiary academic center.
Subject and methods
We enrolled the 9 ears of 8 subjects who received CI in the ear with chronic otitis media from 2006 to 2013 by a single surgeon. CI was performed as a single-stage or staged operation with mastoid surgery according to the activity of ear infection.
Results
Six patients had bilateral chronic otitis media and 2 patients had long history of sensorineural hearing loss at contralateral ear. CI was performed with simultaneous radical mastoidectomy with closure of the EAC as a single-stage in 3 ears with a history of previous open cavity mastoidectomy and no active discharge. Staged CI was performed in 6 ears, after radical mastoidectomy with closure of the EAC in 3 ears and after intact canal wall mastoidectomy in 3 ears, due to active inflammation or complications related to otitis media. In one patient, wound infection had occurred, and implant was removed along with implantation at contralateral ear. Other subjects showed no evidence of recurrence.
Conclusion
Decision whether implantation as a single-stage or staged operation depends on the presence of active inflammation. Single-stage CI with proper mastoid surgery can be performed in patients without active inflammation. Staged procedure need to be done in ears with active inflammation. Proper application of mastoid surgery leads to safe CI for patients with chronic otitis media.
1
Introduction
Cochlear implantation (CI) has become a safe and effective method for rehabilitation of profound sensorineural hearing loss. Nevertheless, CI in patients with chronic middle ear problem presents a significant challenge to the otologic surgeon. Profound hearing loss can be accompanied by or be the result of chronic otitis media (COM). It was suggested in the past that COM is a contraindication to CI because of the possible problems associated with inserting a foreign body through an infected mastoid or middle ear into a space with possible intracranial communication .
However, well established benefits of CI and improved surgical and radiological techniques in early reports have made CI feasible in the presence of COM, and CI in COM has been performed in many centers , but controversy still exists in the literature regarding the choice of staged operation or single stage operation , and there are also controversies about indications for radical mastoidectomy with closure of the EAC (RMCE), and appropriate approach for CI in COM .
This article describes our experience of CI in patients with chronic middle ear problems, and proposes management principles according to the presenting status of the ear.
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