Report of endoscopic cochlear implantation.

OBJECTIVES: To report patient outcomes after transcanal endoscopic cochlear implantation for sensorineural hearing loss. PATIENTS: Males and female subjects more than 7 years old with sensorineural hearing loss (confirmed with audiologic studies) were selected. CT imaging was used to rule out any anatomic anomalies of the temporal bone. Smaller pediatric patients whose canal might still be growing and who might have a higher incidence of otitis media and otitis externa were excluded. Obese adults whose canal skin was too thick to allow good access down the ear canal were also excluded. INTERVENTION(S): Surgical (therapeutic). Endoscopic cochlear implantation using a transcanal approach. MAIN OUTCOME MEASURE(S): Implant position and function. Postoperative complications specifically related to transcanal approach and use of the endoscope. RESULTS: Twenty-five endoscopic cochlear implantations were performed in 24 ears on 11 female and 10 male subjects aged 7-65 years. Eight patients were implanted in Brazil, and 13 patients (17 yr) were implanted in the United States. All implants were fully inserted into the scala tympani, and 24 functioned normally with appropriate thresholds. Mean time of follow-up was 16 months (SD, ±7.2). The chorda tympani was sacrificed in 2 of 25 procedures, 12 EAC/TM tears occurred which healed by the second follow-up visit. No injury to the facial nerve was observed. One postoperative wound infection and 1 otitis externa each resolved with 1 week of antibiotics. Implant array was visible through the EACs skin but not exposed in 6 of 24 ears. CONCLUSION: Endoscopic cochlear implantation may become a viable, safe, and feasible alternative to the standard open transmastoid approach.

Combined use of fibrin tissue adhesive and acellular dermis in dural repair.

BACKGROUND: The management of cerebrospinal fluid (CSF) leaks can be challenging. Acellular dermal grafts derived from human cadavers can be used as a replacement material when autogenous materials are unavailable. Fibrin tissue adhesive (FTA) is a wound support product that has been used for hemostatic and tissue fixation purposes. The combined use of acellular dermis in conjunction with FTA for dural repair remains a subject of study. The aim of this study was to evaluate wound healing and tissue compatibility characteristics of acellular dermal substitute material when used both with and without FTA, for repair of a dural tear in a chinchilla model. METHODS: Forty-nine chinchillas were included in this randomized case-control study. The squamous portion of the temporal bone was removed to expose the tegmen. A 2 x 2 mm dural defect was removed to create an iatrogenic CSF leak. Then, animals were randomly assigned to one of three treatment groups: group 1, acellular dermis alone; group 2, acellular dermis with FTA; group 3, fibrinogen, acellular dermis, and FTA. Surgical sites were examined grossly at 1- and 2-week intervals. Temporal bones were examined histologically. RESULTS: Grossly, groups 2 and 3 had significantly less visible CSF leak and brain herniation noted at both 1- and 2-week intervals when compared with group 1. Histological results confirmed the gross results showing the best seal in group 2 and 3. CONCLUSION: Acellular dermis combined with FTA provided superior support compared with acellular dermis alone in repair of induced dural defects.