Long-term follow-up results of facial nerve schwannoma with good facial nerve function: a multicenter study.

PURPOSE: Facial nerve schwannomas (FNSs) are rare intracranial tumors, and the optimal management of these tumors remains unclear. We investigated the long-term follow-up results of FNS with good facial nerve function. METHODS: At nine medical centers in the Korean Facial Nerve Study Group, 43 patients undergoing observation periods longer than 12 months for FNS with good facial nerve function (House-Brackmann grade ≤ II) were enrolled, and clinical and radiographic data were obtained for these cases. RESULTS: The mean follow-up period was 63 months. In the majority of cases, tumors involved multiple segments (81.4%) and only eight cases were confined to a single site. There were no cases where the tumor was confined to the extratemporal region. Tumor size increased slightly, with an average estimated change of 0.48 mm/year. Twenty (46.5%) of 43 patients showed no change in tumor size. Seven patients (16.3%) showed worsening House-Brackmann (H-B) grade, of which two patients deteriorated from H-B grade I to II, four worsened to grade III, and one deteriorated to grade IV. The remaining 36 patients (83.7%) showed no change in facial nerve function. There was no difference in H-B grade according to tumor size at the time of diagnosis or change in tumor size. CONCLUSION: We conducted a large-scale observational study of FNS with good facial nerve function. Our study showed that many patients maintained facial nerve function during long-term follow-up. Conservative management with regular examination and imaging can be an appropriate option for managing FNS with good facial nerve function.

Investigating ischemia and reperfusion-induced organ damage in severe cardiac arrest: A comprehensive proteomics perspective.

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Treatment Efficacy of Various Maneuvers for Lateral Canal Benign Paroxysmal Positional Vertigo With Apogeotropic Nystagmus: A Randomized Controlled Trial.

OBJECTIVES: The aim of this study was to determine the most effective treatment approach by comparing the impacts of various otolith reduction techniques in patients with apogeotropic lateral semicircular canal benign paroxysmal positional vertigo (LC-BPPV). METHODS: We performed a multicenter randomized prospective study from January to December 2015, involving 72 consecutive patients with apogeotropic LC-BPPV. The patients were divided into three treatment groups: therapeutic head-shaking (group A), the Gufoni-Appiani maneuver (group B), and the cupulolith repositioning maneuver (CuRM; group C). Each group underwent evaluation and treatment up to the fourth week. Treatment success was defined as the disappearance of positional vertigo and nystagmus. RESULTS: This study included 72 patients (49 male and 23 female), with a mean (±standard deviation) age of 55.4±13.5 years. The mean duration of vertigo experienced prior to treatment was 3.9±4.4 days. The mean latency and duration of nystagmus were 2.7±3.0 seconds and 47.9±15.8 seconds, respectively. The overall treatment frequency was 2.0±0.9. The number of treatments differed significantly among the three groups (P<0.05). After 4 weeks, the success rates for groups A, B, and C were 90.5%, 92.3%, and 100%, respectively. No significant difference was observed in the success rate across treatment. METHODS: and periods (P>0.05). However, CuRM was the only method with a 100% treatment success rate. CONCLUSION: While no clear difference was observed among the three treatments for LC-BPPV, CuRM was found to be superior to the other approaches in the long term.

Bilateral Congenital Ossicular Anomalies: Are the Anomalies Symmetric for Both Ears?

OBJECTIVE: To evaluate whether bilateral congenital ossicular anomalies (COAs) differ regarding ossicular anomalies and hearing loss severities between the ears of the individual. STUDY DESIGN: Retrospective case review. SETTING: Tertiary referral academic center. METHODS: Between March 2012 and December 2022, 7 consecutive patients (14 ears) with surgically confirmed bilateral COAs were included in the study. Preoperative pure-tone thresholds, COA classification according to the Teunissen and Cremers system, surgical procedures, and postoperative audiometric results were compared between the 2 ears of each patient. RESULTS: The median age of the patients was 11.5 (range: 6-25) years. Both ears of each patient were categorized based on the same classification. Three patients possessed class III COAs and the other 4 had class I COAs. The interaural differences in preoperative bone and air conduction thresholds were within 15 dB for all patients. Differences in postoperative air-bone gaps between ears were not statistically significant. The surgical procedures required for ossicular reconstruction were almost identical for both ears. CONCLUSION: The severity of ossicular abnormalities and hearing loss in patients with bilateral COAs were symmetrical between ears, thereby enabling prediction of the characteristics of the contralateral ear based on the findings observed in 1 ear. These symmetric clinical features can aid surgeons when operating on the contralateral ear.

Transcanal Endoscopic Stapedial and Tensor Tympani Tenotomy for Middle Ear Myoclonus: A Retrospective Case Series of Surgical Outcomes.

OBJECTIVE: To describe and analyze the surgical outcomes of transcanal endoscopic resection of the stapedial tendon (ST) and tensor tympani tendon (TT) in the management of middle ear myoclonus (MEM). STUDY DESIGN: A retrospective case series. SETTING: Tertiary academic center. PATIENTS: Seven consecutive patients (seven ears) with tinnitus were diagnosed with MEM. INTERVENTION: Transcanal endoscopic resection of both the ST and TT using either microinstruments or a laser. MAIN OUTCOME MEASURES: The symptom of tinnitus, based on visual analog scale and Tinnitus Handicap Inventory scores, was analyzed preoperatively and postoperatively for each patient. The intraoperative findings and postoperative complications were also evaluated. RESULTS: Amelioration of objective tinnitus with significant improvement in visual analog scale and Tinnitus Handicap Inventory scores was noted in all seven patients. The ST and TT were easily identified in the same endoscopic field, with minimal or no removal of the scutum. There was no need to perform an anterior tympanotomy to expose the TT. Resection of both the ST and TT and creating a gap between the cut edges were achieved by using either microinstruments or a laser under an endoscopic field. Conversion to or conjunction with the microscopic approach was unnecessary for any of the seven patients. No hearing loss or hyperacusis occurred postoperatively. CONCLUSIONS: Transcanal endoscopic resection of the ST and TT successfully ameliorated the symptom of tinnitus in patients with MEM. A transcanal endoscopic approach provides an alternative method to manage MEM, providing excellent visualization and minimal invasiveness.

A Giant Congenital Mastoid Cholesteatoma With Extension to the Occipital Condyle.

A congenital mastoid cholesteatoma (CMC) is a keratinizing epithelium originating from embryological epithelial tissue of the mastoid. It is often not diagnosed until it becomes large because of its rarity and indolent nature. Although there are a few reports on giant CMC, its exact extensions have not been well described, and detailed information regarding surgical methods is lacking, especially in giant CMC involving the occipital condyle and the middle and posterior cranial fossae. In this article, we report a case involving a 70-year-old woman with a giant CMC that extended inferiorly to the occipital condyle. The CMC eroded the middle and posterior cranial fossae, sigmoid sinus plate, and fallopian canal of the facial nerve. For complete removal, we used a subtotal petrosectomy in conjunction with an exposure of the cranial cervical junction and a wide decompression of the suboccipit. The boundaries of exposure were similar to those of a petro-occipital transsigmoid approach which is usually used for management of tumor involving the jugular foramen. The wide exposure allowed for complete removal of the lesion without any complications. Thus, we recommend this surgical approach for management of the giant CMC involving the occipital condyle and the middle and posterior cranial fossae.

Chorda tympani nerve course and feasibility of its preservation during atresiaplasty for congenital aural atresia.

Objectives: The association between the chorda tympani nerve (CTN) and atresiaplasty has not been investigated. This study aimed to describe the course of the CTN observed during atresiaplasty for congenital aural atresia (CAA) and explore the feasibility of CTN preservation. Methods: In this retrospective study, six consecutive patients who underwent atresiaplasty in a tertiary academic center were included. The course of the tympanic segment of the CTN and its preservation feasibility were evaluated. Atresiaplasty was performed using an anterior approach. The average Jahrsdoerfer score was 8.7 points (range, 8-9 points). Results: The CTN was located in the atretic plate in all patients. It emerged from an average of 5.6 mm (range, 5.2-6.1) inferior to the incus buttress and crossed the middle ear in an anterior-superior direction. The distance between the neck of the malleus and the CTN varied in the absence of the malleus handle. However, when the malleus handle developed, the CTN passed between the incus and the malleus handle. The CTN was preserved in two of the six patients. They had a Jahrsdoerfer score of 9 and grade I microtia. Conclusion: The CTN was located in the atretic plate, emerging from an average distance of 5.6 mm inferior to the incus buttress. The incus buttress might serve as a good anatomical landmark to identify and preserve the CTN. CTN preservation is feasible in atresiaplasty candidates with a Jahrsdoerfer score of 9 and auricular deformity of grade I. Level of Evidence: 4.

Site-Specific Glycan Microheterogeneity Evaluation of Aflibercept Fusion Protein by Glycopeptide-Based LC-MSMS Mapping.

The evaluation of the protein glycosylation states of samples of aflibercept obtained from three different regions was conducted by site-specific N-linked glycan microheterogeneity profiling. Glycopeptide-based nano-LC MSMS mapping of tryptic-digested samples of each aflibercept lot provided site-specific information about glycan microheterogeneity on each of the five N-glycosylation sites (two sites in the VEGFR-1 region, two sites in the VEGFR-2 region, and one site in the human IgG Fc region). Next, the glycopeptide-mapping results obtained from the three different aflibercept lots were compared to evaluate the similarity between the samples. Three aflibercept lots showed a high degree of similarity in glycan composition, fucosylation level, sialylation level, and branching, when all five N-glycosylation sites were assessed together as a group. On the other hand, noticeable variations between lots in the glycan types and sialylation levels on the two sites of the VEGFR-2 domain were observed when each of the five N-glycosylation sites were assessed using the glycopeptide-based method. The presence of N-glycolylneuraminic acid (NeuGc) glycans, which may mediate adverse immune reactions in antibody therapeutics, were also detected on the sites of VEGFR1 and VEGFR2 domains, but not on the IgG Fc domain site. These results imply that analyses of the glycosylation profiles of fusion proteins containing multiple N-glycosylation sites, such as aflibercept, being done as a part of quality control for the therapeutics manufacturing process or for biosimilar development, can be done with a more applicable outcome by assessing each site separately.

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.

Results of Active Middle Ear Implantation in Patients With Mixed Hearing Loss After Middle Ear Surgery: A Prospective Multicenter Study (the ROMEO Study).

OBJECTIVES: This study was conducted to evaluate the user satisfaction, efficacy, and safety of round window (RW) vibroplasty using the Vibrant Soundbridge (VSB) in patients with persistent mixed hearing loss after mastoidectomy. METHODS: The study included 27 patients (mean age, 58.7 years; age range, 28-76 years; 11 men and 16 women) with mixed hearing loss after mastoidectomy from 15 tertiary referral centers in Korea. The VSB was implanted at the RW. The Korean translation of the Abbreviated Profile of Hearing Aid Benefit (APHAB) questionnaire and the Korean version of the International Outcome Inventory for Hearing Aids (K-IOI-HA) questionnaire were used to evaluate user satisfaction as the primary outcome. The secondary outcome measures were audiological test results and complication rates. RESULTS: The mean scores for ease of communication (61.3% to 29.7% to 30.2%), reverberation (62.1% to 43.1% to 37.4%), and background noise (63.3% to 37.7% to 34.3%) subscales of the APHAB questionnaire significantly decreased after VSB surgery. The mean K-IOI-HA scores at 3 and 6 months after surgery were significantly higher than the mean preoperative score (18.6 to 27.2 to 28.1). The postoperative VSB-aided thresholds were significantly lower than the preoperative unaided and hearing aid (HA)-aided thresholds. There was no significant difference between preoperative unaided, preoperative HA-aided, and postoperative VSB-aided maximum phonetically balanced word-recognition scores. None of the 27 patients experienced a change in postoperative bone conduction pure tone average. One patient developed temporary facial palsy and two developed surgical wound infections. CONCLUSION: RW vibroplasty resulted in improved satisfaction and audiological test results in patients with mixed hearing loss after mastoidectomy, and the complication rate was tolerable.

Refining surgical techniques for efficient posterior semicircular canal gene delivery in the adult mammalian inner ear with minimal hearing loss.

Hearing loss is a common disability affecting the world's population today. While several studies have shown that inner ear gene therapy can be successfully applied to mouse models of hereditary hearing loss to improve hearing, most of these studies rely on inner ear gene delivery in the neonatal age, when mouse inner ear has not fully developed. However, the human inner ear is fully developed at birth. Therefore, in order for inner ear gene therapy to be successfully applied in patients with hearing loss, one must demonstrate that gene delivery can be safely and reliably performed in the mature mammalian inner ear. In this study, we examine the steps involved in posterior semicircular canal gene delivery in the adult mouse inner ear. We find that the duration of perilymphatic leakage and injection rate have a significant effect on the post-surgical hearing outcome. Our results show that although AAV2.7m8 has a lower hair cell transduction rate in adult mice compared to neonatal mice at equivalent viral load, AAV2.7m8 is capable of transducing the adult mouse inner and outer hair cells with high efficiency in a dose-dependent manner.

Identification of Nucleolin as a Novel AEG-1-Interacting Protein in Breast Cancer via Interactome Profiling.

Breast cancer is one of the most common malignant diseases worldwide. Astrocyte elevated gene-1 (AEG-1) is upregulated in breast cancer and regulates breast cancer cell proliferation and invasion. However, the molecular mechanisms by which AEG-1 promotes breast cancer have yet to be fully elucidated. In order to delineate the function of AEG-1 in breast cancer development, we mapped the AEG-1 interactome via affinity purification followed by LC-MS/MS. We identified nucleolin (NCL) as a novel AEG-1 interacting protein, and co-immunoprecipitation experiments validated the interaction between AEG-1 and NCL in breast cancer cells. The silencing of NCL markedly reduced not only migration/invasion, but also the proliferation induced by the ectopic expression of AEG-1. Further, we found that the ectopic expression of AEG-1 induced the tyrosine phosphorylation of c-Met, and NCL knockdown markedly reduced this AEG-1 mediated phosphorylation. Taken together, our report identifies NCL as a novel mediator of the oncogenic function of AEG-1, and suggests that c-Met could be associated with the oncogenic function of the AEG-1-NCL complex in the context of breast cancer.

Occult parotid involvement in early-stage squamous cell carcinoma of the external auditory canal.

BACKGROUND: The importance of elective parotidectomy in early-stage squamous cell carcinoma (SCC) of the external auditory canal (EAC) is not well established. METHODS: A retrospective study of 43 patients with early-stage SCC of the EAC who underwent parotidectomy in conjunction with lateral temporal bone resection at three centers. RESULTS: Overall occult parotid involvement (OPI) rate in early-stage SCC of the EAC was 13.9% (6/43). When considering both the anteroposterior position and the bony-cartilaginous position, patients with SCC in both the anterior wall and cartilaginous portion exhibited significantly higher OPI than other locations (37.5% vs. 0%, p = 0.001), with an increase in the OPI predictive value. CONCLUSION: SCC located in either the anterior wall of the EAC or the cartilaginous portion of the EAC or both simultaneously showed a high prevalence of OPI, and elective parotidectomy should be considered in those patients.

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.

Management of an Inappropriately Treated Case of Auricular Hematoma.

Othematoma is a condition in which blood collects beneath the perichondral layer of the pinna. Recurrent auricular hematoma can be a challenging medical problem, with complications resulting in ear deformity, therefore, appropriate management is important. Improper treatment can result in a deformity known as 'cauliflower ear' or 'wrestler's ear.' We report a case of othematoma that was inappropriately treated and present a review of current treatment options.

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.

Potential benefits of salvage intratympanic dexamethasone injection in profound idiopathic sudden sensorineural hearing loss.

PURPOSES: To compare hearing recovery levels after initial treatment or salvage intratympanic dexamethasone injection (ITDI), and to find the prognostic factor on salvage ITDI therapy in profound ISSNHL. METHODS: We retrospectively reviewed 115 patients with profound ISSNHL. All patients were treated with combination or systemic steroid therapy as the initial treatment. Next, we used salvage ITDI therapy on patients who showed slight or no improvement according to Siegel's criteria. To find the prognostic factors for the effectiveness of salvage ITDI therapy, we analyzed clinical data, such as, age, sex, vertigo, symptom duration, diabetes, hypertension, initial PTA, pre-salvage PTA, and treatment methods, using multiple regression analyses. RESULTS: The rate of serviceable hearing recovery were 10.4% (12/115) in the initial-treatment group and 20.4% (21/103) in the salvage group. The difference was statistically significant (p = 0.041). Pre-salvage PTA, diabetes mellitus, and symptom duration were affective factors for the effectiveness of salvage ITDI therapy in profound ISSNHL refractory to initial treatment, with odds ratios of 1.169 (95% confidence interval, 1.088-1.256), 0.069 (95% confidence interval, 0.005-0.889), and 9.242 (95% confidence interval, 1.079-79.146). CONCLUSIONS: Salvage therapy should be considered for profound ISSNHL, which is expected to result in poor prognosis or hearing recovery: ITSI therapy might be an effective treatment as salvage therapy.

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.