\s=b\In 1981, our group, as part of a Food and Drug Administration investigator team directed by William House, performed Illinois' first cochlear implantation. We have since performed cochlear implantations in ten other persons. Since May 1980, approximately 35 severely to profoundly deaf persons per year have been referred to our clinic for evaluation. A small number of these patients had far-advanced otosclerosis. In these cases, exploratory tympanotomy and stapedectomy followed by rehabilitation with a hearing aid was a more appropriate management than cochlear implantation. Case histories and a temporal bone study of far-advanced otosclerosis are presented. (Arch Otolaryngol Head Neck Surg 1987;113:299-302) Persons with postlingual, profound sensorineural deafness who can¬ not significantly benefit from hearing aids may be candidates for cochlear implantation. Since 1981, when we first performed the procedure, 11 of our patients have received singlechannel or multichannel devices with satisfactory results. A careful review of patients referred for possible implantation has confirmed Sheehy's observation1 that patients with faradvanced otosclerosis (FAO) are bet¬ ter suited to stapedectomy and hear¬ ing aid rehabilitation than to cochlear implantation. Physicians in cochlear implantation programs should be aware of the signs that may indicate FAO, a condition that frequently goes undiagnosed. Provided there is suffi¬ cient hair-cell function, peripheral axon, and ganglion cells, surgical exploration may be beneficial in a limited number of cases.
PATIENTS AND METHODSThe case records of 175 patients referred for cochlear implantation were reviewed to identify cases of FAO, defined as advanced otosclerosis where air conduction level exceeds 85 dB and bone conduction is not measurable in any of the speech frequen¬ cies on a standard clinical audiometer.2Patients with FAO are easily confused with those having conditions that may be successfully treated by cochlear implanta¬ tion, and FAO must be diagnosed with care.
REPORT OF CASESCase 1.-A 62-year-old woman had suf¬ fered a progressive hearing loss on the left side over several years. She had undergone a right-sided stapedectomy in 1977, with excellent results. Physical and otoscopie examinations were normal. A profound hearing loss was present bilaterally, with absent stapedial reflexes. The patient could, however, hear with a speaking tube in the left ear. Computed tomography of the left middle ear capsule revealed mar¬ ginal thickening of the stapes footplate with otosclerotic foci in the capsule of the basal turn of the cochlea, suggesting FAO.A left-sided stapedectomy was performed with an argon laser. Findings at surgery included a rather thick footplate. The post¬ operative audiogram showed considerable improvement, from a 100+-dB level with no discrimination to a 60-to 70-dB level with 60% discrimination (Fig 1).Case 2.-A 74-year-old man described bilateral, slowly progressive hearing loss, more pronounced on the right side. He also experienced bilat...
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