RESUMO
Authors report on a so far undescribed bilateral inner ear malformation with congenital deafness where a defect of both the medial and lateral bony labyrinthine wall allowed the herniation of a cerebrospinal fluid-filled endosteum sac into the tympanic cavity. The story of cochlear implantation in this ear and the series of following meningitis demonstrates the dilemma of indicating implantation in labyrinthine dysplasia and the difficulties of treating postimplantation meningitis. Routes of bacterial invasion from inner ear to intracranium is discussed regarding normal, dysplastic and surgically "disturbed" inner ear anatomy.
Assuntos
Implante Coclear/efeitos adversos , Perda Auditiva/terapia , Meningites Bacterianas/etiologia , Vestíbulo do Labirinto/anormalidades , Pré-Escolar , Contraindicações , Perda Auditiva/diagnóstico , Perda Auditiva/etiologia , Humanos , Masculino , RecidivaRESUMO
A case is presented where the authors carried out a cochlear implantation on a girl whose deafness was induced by cytostatic agents. The normally hearing child was diagnosed with Langerhans cell histiocytosis at the age of 3 years and received polychemotherapy for almost 2 years. By her 5th year, she started to develop a bilateral, progressive sensorineural hearing loss, necessitating a hearing aid in both ears. While her histiocytosis was cured, her hearing ultimately deteriorated to total deafness on the right and profound hearing loss on the left ear. After 3 years, her hearing aids no longer provided adequate hearing for the postlingually deafened girl. At the age of 14, a cochlear implantation was performed on her right ear with excellent results.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Implante Coclear , Perda Auditiva Bilateral/induzido quimicamente , Perda Auditiva Neurossensorial/induzido quimicamente , Histiocitose de Células de Langerhans/tratamento farmacológico , Adolescente , Implantes Cocleares , Feminino , Perda Auditiva Bilateral/cirurgia , Perda Auditiva Neurossensorial/cirurgia , Humanos , Percepção da Fala , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
We present the case of a successful pediatric cochlear implantation that was carried out following bilateral perilingual deafness caused by meningitis during the treatment of a childhood malignant tumor. A rhabdomyosarcoma localized in the frontobasal area was removed from the child at the age of 2 years. He then received 11 months of postoperative cytostatic treatment. A purulent meningitis developed at the end of the chemotherapy, resulting in a major-grade, bilateral sensorineural hearing loss (practically a perilingual deafness). After 6 tumor-free years and a meticulous preoperative assessment, a Nucleus 24 M cochlear implant was successfully implanted in the child's left ear. Two years after the operation, the child shows excellent hearing results and moderate speech development.