Cochlear Implantation in Patients with Chronic Suppurative Otitis Media: Surgical Outcomes and a Management Algorithm.

BACKGROUND: Chronic suppurative otitis media (CSOM) was considered as a contraindication of cochlear implantation (CI) in the past. Recently, various surgical options have been adopted for CI in CSOM patients with showing a low complication rate. OBJECTIVES: To evaluate surgical outcomes of CI in patients with CSOM and to propose a management algorithm for those patients. METHODS: Thirty-six consecutive patients with CSOM who underwent single stage or staged CI were enrolled. Speech performance, including Categories of Auditory Performance (CAP) test and sentence score, and complications were retrospectively analyzed. RESULTS: The average follow-up was 3.1 years (range 0.5-9.2 years). Postoperative median CAP and sentence scores were 6 and 78%, respectively. Three (8.3%) of the 36 patients had postoperative complications. One experienced breakdown of the ear canal closure. Recurrence of the pars tensa retraction was observed in another patient with adhesive otitis media who underwent CI and cartilage tympanoplasty as a single stage operation. Electrode extrusion occurred in another patient who underwent staged CI with maintenance of a previous open cavity. Subtotal petrosectomy and cavity obliteration were used to manage the latter 2 complications. All implant patients with good mastoid pneumatization exhibited no complications. There were no significant differences in postoperative speech performance and complication rates between single stage CI and staged CI. Based on these current findings, a management algorithm was proposed according to type of CSOM, presence of open cavity, and mastoid pneumatization. CONCLUSIONS: Patients with CSOM show good postoperative speech performance after CI. Proper surgical options according to type of CSOM, presence of open cavity, and mastoid pneumatization may help in reducing complications.

Radiological parameters related to success of the round window approach in cochlear implantation: A retrospective study.

OBJECTIVES: To evaluate the radiologic parameters related to success of round window (RW) approach for cochlear implantation (CI). DESIGN: A retrospective cohort study. SETTING: Academic-tertiary centre. PARTICIPANTS: Eighty-four consecutive patients without inner ear anomaly who underwent CI with the intent of the RW approach were included. The RW approach was performed through the facial recess after posterior tympanotomy (RW group). When the RW approach was not possible despite maximum effort to expose the RW, promontory cochleostomy (PC) was performed (PC group). MAIN OUTCOME MEASURES: The following radiologic parameters were compared between the two groups: (a) Width of the facial recess, (b) oblique distance between the cochlear basal turn (CBT) and facial nerve (FN), (c) anteroposterior distance between the posterior margin of the RW and FN and (d) angle between the EAC and CBT. RESULTS: Seventy patients (83.3%) were implanted using the RW approach, and 14 patients (16.7%) underwent the PC approach for CI. The anteroposterior distance between the posterior margin of the RW and FN and the angle between the EAC and CBT in the RW group were significantly longer and wider than those in the PC group (P < 0.001 and P = 0.001, respectively). Multivariate analysis revealed that these two parameters were independent parameters for success of the RW approach. CONCLUSIONS: The distance between the posterior margin of the RW and FN and the angle between the EAC and CBT are associated with success of RW approach. Therefore, preoperative radiologic analysis of the two parameters might help CI surgeons to select RW approach.

Susceptibility to Postoperative Changes in Music Appreciation in Elderly Cochlear Implant Recipients.

With the rise in life expectancy and the consequent increase in the elderly population, the use of cochlear implants (CI) in elderly patients with hearing loss is also increasing. The aim of this study was to investigate whether music appreciation in elderly CI users differs from that of non-elderly users. Forty-nine adult CI recipients participated in the study, and the Korean version of the Music Background Questionnaire was utilized preoperatively and postoperatively to evaluate music appreciation. The changes between the preoperative and postoperative values were compared after categorizing the participants into a non-elderly group (<65 years; n = 31) and an elderly group (≥65 years; n = 18). When compared to the non-elderly group, the elderly individuals exhibited a significant decrease in music listening times, without a significant change in the genre of music listened to following CI surgery. Moreover, the elderly group demonstrated significant decreases in music appreciation scores in terms of music quality and music elements, perceiving music as less natural, less clear, and more complex. They also exhibited significant changes in scores with respect to perception of rhythm, melody, timbre, and lyrics. This susceptibility to postoperative changes in music appreciation among elderly CI users should be considered in surgical counseling and music training programs.

Pneumolabyrinth as an Early Computed Tomographic Finding After Cochlear Implantation and its Clinical Significance.

OBJECTIVE: To determine the incidence and volume of pneumolabyrinth using early temporal bone computed tomography (TBCT) findings and evaluate the correlation between pneumolabyrinth and various clinical variables. STUDY DESIGN: Retrospective case review. SETTING: Tertiary academic center. PATIENTS: Fifty-three consecutive adult cochlear implantation (CI) recipients (53 ears) with normal inner ears who underwent high-resolution TBCT within 3 days after CI were included. INTERVENTION: Axial TBCT images were used for detection and measurement of pneumolabyrinth. MAIN OUTCOME MEASURES: Incidence and volume of pneumolabyrinth were evaluated. In addition, the following clinical variables were analyzed to evaluate the correlation with pneumolabyrinth volume: demographics, implant type, surgical approach, postoperative dizziness, and preservation of functional residual hearing. RESULTS: Pneumolabyrinth was present in all patients, and the average volume was 8.496 mm3. Pneumolabyrinth was confined to the cochlea (pneumocochlea) in all patients except for one who also had pneumovestibule. The pneumolabyrinth volume in patients with postoperative dizziness was significantly larger than that in patients without postoperative dizziness (10.435 mm3 vs. 8.016 mm3; p = 0.029). Multivariate analysis showed that a larger volume of pneumolabyrinth was significantly associated with postoperative dizziness (odds ratio, 1.420; 95% confidence interval, 1.114-1.808; p = 0.005). CONCLUSION: A certain volume of pneumolabyrinth was always present in the early stage after CI, and the volume of pneumolabyrinth measured using early TBCT findings was significantly associated with the occurrence of postoperative dizziness.

Posterior Tympanotomy Versus Subtotal Petrosectomy: A Comparison of Complications in Cochlear Implantation.

OBJECTIVE: To compare the postoperative complications between posterior tympanotomy cochlear implantation (PTCI) and subtotal petrosectomy cochlear implantation (SPCI). STUDY DESIGN: A retrospective cohort study. SETTING: Two tertiary referral centers. PATIENTS: Two hundred ninety-eight patients who underwent PTCI and 33 who underwent SPCI. INTERVENTIONS: Cochlear implantation using either posterior tympanotomy or subtotal petrosectomy. MAIN OUTCOME MEASURES: Postoperative complications between the two groups were compared after categorization into minor complications (requiring conservative management) and major complications (requiring surgical revision or hospitalization treatment). RESULTS: Dizziness was the most common complication in both groups. The major complication rate in the SPCI group was significantly higher than in the PTCI group (12.1% [4 of 33] versus 1.3% [4 of 298], p = 0.004), while the minor complication rate was similar between the two groups. Among the major complications, device migration was significantly more common when SPCI was performed (9.1% [3 of 33] versus 0.3% [1 of 298], p = 0.003). CONCLUSIONS: Major complication rate of SPCI was higher than that of PTCI; particularly, device migration was more commonly observed after SPCI than PTCI. Therefore, special attention should be paid to device placement and fixation during SPCI.

Preimplant Hearing Threshold: An Important Predictor of Hearing Preservation in Cochlear Implantation With Lateral Wall Electrodes.

OBJECTIVE: To evaluate the outcomes and association factors of long-term hearing preservation (HP) in cochlear implantation with lateral wall (LW) electrode arrays. STUDY DESIGN: Retrospective case review. SETTING: Tertiary academic center. PATIENTS: Thirty-four consecutive ears from 32 patients with a ≤ 80 dB HL preoperative low-frequency pure-tone average of 250 to 500 Hz were included. INTERVENTION: Cochlear implantation with LW electrode arrays and the intention of achieving HP. MAIN OUTCOME MEASURES: HP classifications according to the HEARRING group and functional HP methods (≤ 85 dB HL of pure-tone threshold at 250 Hz) at 1 year postoperatively. RESULTS: Based on the HEARRING classification, complete, partial, and minimal HP was achieved in 7 ears (21%), 12 ears (35%), and 4 ears (12%), respectively. Under functional classification, 14 ears (41%) exhibited functional hearing after surgery. The average threshold shift was 17.1 dB HL (SD = 16.9 dB HL). Among various clinical features, a ≤ 60 dB HL preimplant pure-tone threshold of 250 Hz was associated with HP outcome in both classifications (OR = 12.95, 95% CI = 1.29-130.01, p = 0.029 in HEARRING classification; OR = 14.36, 95% CI = 1.07-191.40, p = 0.044 in functional classification). The following parameters were not associated with HP (p > 0.05): patient demographics, surgical aspects (insertion route and depth), electrode array size, scalar electrode position, and presence of comorbidity. CONCLUSION: With LW electrode arrays, HP was achieved in 68% of HEARRRING group patients and 41% of functional classification patients. A ≤ 60 dB HL preimplant pure-tone threshold of 250 Hz was significantly associated with an increased rate of long-term HP.

Surgical outcomes of simultaneous cochlear implantation with subtotal petrosectomy.

OBJECTIVE: To evaluate the surgical outcomes of simultaneous cochlear implantation (CI) with subtotal petrosectomy (SP). METHODS: Medical records of thirty-one patients (31 ears) who underwent simultaneous CI with SP in two tertiary referral centers for management of profound hearing loss secondary to chronic suppurative otitis media, cholesteatoma, previous open cavity, temporal bone fracture, and temporal bone irradiation were retrospectively analyzed. Pre and postoperative speech performances and related complications requiring surgical correction were evaluated. RESULTS: Significant improvement in postoperative speech performance was observed in all 31 patients compared to preoperative result. Of the 31 patients, complications occurred in three patients (9.6%). One patient exhibited the breakdown of blind sac closure of the external auditory canal and two others exhibited the migration of the receiver-stimulator cochlear implant. The migrations occurred despite tie-down fixation of the device to the skull. The migrated devices were repositioned using revision surgery. CONCLUSIONS: Simultaneous CI with SP is an effective and safe surgical method with relatively low complication incidence. However, particular attention should be paid to prevent certain complications. The receiver-stimulator may be predisposed to migrate to abnormal position because it can be placed with lack of tight subperiosteal support at a more superior or posterior location of the skull where the skull curvature changes abruptly than can conventional CI using limited mastoidectomy and posterior tympanotomy approach.