Cochlear Implantation in Patients with Chronic Otitis: Indications for Subtotal Petrosectomy and Obliteration of the Middle Ear

Issing, P. R.; Schönermark, Matthias P.; Winkelmann, S.; Kempf, H.-G.; Ernst, Arne; Lenarz, Thomas

doi:10.1055/s-2008-1058571

Cited by 64 publications

(90 citation statements)

References 9 publications

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“…Usually, the inflammation process is eradicated with the result of inflammation-free local circumstances so that an implant loss due to infection or inflammatory reactions can be avoided in most of the cases. A unilateral procedure is only recommended for absolutely inconspicuous and inflammation-free radical cavities [48], [49].…”

Section: Chronic Otitis Mediamentioning

confidence: 99%

Cochlear Implant – State of the Art

2017

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Cochlear implants are the treatment of choice for auditory rehabilitation of patients with sensory deafness. They restore the missing function of Thomas Lenarz 1 inner hair cells by transforming the acoustic signal into electrical stimuli in the majority of patients including the use of the telephone. Children can achieve a near to normal speech and language development provided their deafness is detected early after onset and implantation is performed quickly thereafter. The diagnostic procedure as well as the surgical technique have been standardized and can be adapted to the individual anatomical and physiological needs both in children and adults. Special cases such as cochlear obliteration might require special measures and re-implantation, which can be done in most cases in a straight forward way. Technology upgrades count for better performance. Future developments will focus on better electrode-nerve interfaces by improving electrode technology. An increased number of electrical contacts as well as the biological treatment with regeneration of the dendrites growing onto the electrode will increase the number of electrical channels. This will give room for improved speech coding strategies in order to create the bionic ear, i.e. to restore the process of natural hearing by means of technology. The robot-assisted surgery will allow for high precision surgery and reliable hearing preservation. Biological therapies will support the bionic ear. Methods are bio-hybrid electrodes, which are coded by stem cells transplanted into the inner ear to enhance auto-production of neurotrophins. Local drug delivery will focus on suppression of trauma reaction and local regeneration. Gene therapy by nanoparticles will hopefully lead to the preservation of residual hearing in patients being affected by genetic hearing loss. Overall the cochlear implant is a very powerful tool to rehabilitate patients with sensory deafness. More than 1 million of candidates in Germany today could benefit from this high technology auditory implant. Only 50,000 are implanted so far. In the future, the procedure can be done under local anesthesia, will be minimally invasive and straight forward. Hearing preservation will be routine.Keywords: cochlear implant, sensory deafness, diagnostics, surgical procedure, results, complications, future developments SummaryCochlear implants are electronical stimulus prostheses for the functional replacement of the inner ear. Because of the rapid technical development and the good results, they could be established as standard therapy for sensory deafness. Cochlear implantation requires an interdisciplinary team and a quality-controlled concepts that reaches from the indication to the life-long control and that is fixed in the AWMF guideline on cochlear implant [1]. Current cochlear implant systems are partially implantable and equipped with a multitude of additional functions similar to hearing aids for sound pre-processing and noise elimination. The intracochlear position of the electrode allows fo...

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Section: Chronic Otitis Mediamentioning

confidence: 99%

Cochlear Implant – State of the Art

2017

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“…In case of a radical cavity after surgical treatment for cholesteatoma, the electrode covered by the epithelial lining of the mastoid will likely become exposed or extruded. Under these circumstances some studies 6,7 ,have shown that the some of the following procedures can be done to protect the electrode. These include subtotal petrosectomy, obliteration of the middle ear cleft with abdominal fat, mastoid obliteration and the blindsac closure of the external ear canal before cochlear implantation.…”

Section: Discussionmentioning

confidence: 99%

A case report: the first successful cochlear implant in Uganda.

et al. 2016

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Hearing impairment is a significant disability. According to the World Health Organization (WHO), more than 80% of the world's approximately 120 million people with hearing impairment live in developing countries. Cochlear implant is the only therapeutic intervention for those with severe-profound sensorineural hearing loss. We are reporting an interesting case of the very first cochlear implant operation carried out in Uganda. The patient was a 23 year old male whose presenting complaint was inability to hear in the left ear for three and a half years and in the right ear for one year. He had been treated for TB(Tuberculosis) mastoiditis . After the 8 months of treatment, the otorrhea persisted and he underwent a tympanomastoidectomy on the same ear. He reported no familial history of hearing loss. On examination, ENT examination revealed a small pars flaccida retration pocket of the right tympanic membrane with cholesteatoma. The left ear had an intact tympanic membrane. Pure tone audiometry revealed profound sensorineural hearing loss in both ears( see attached PTA results), CT scan of the temporal bone showed normal inner ear anatomy bilaterally and mild sclerotic changes in both mastoid bones. He then had surgery on his right ear which included cochlear implantation. The cochlear implant (CI) was activated on the first postoperative day remotely via internet with the help of the cochlear implant team at New York University Cochlear Implant Center and the patient was immediately able to appreciate some sounds. He received a pneumococcal vaccine on the first postoperative day and was discharged the following day.

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“…Subtotal petrosectomy and middle cavity obliteration is another alternative technique for cochlear implantation. This technique can be used, particularly in patients who have chronic otitis media [14] .…”

Section: Discussionmentioning

confidence: 99%

Alternative Techniques in Cochlear Implantation

Sürmelioğlu¹,

Özdemir²,

Tarkan³

et al. 2016

Int Adv Otol

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OBJECTIVE:To review the alternative techniques in cochlear implantation and to compare the complications with different techniques. MATERIALS and METHODS:Patients who had undergone cochlear implantation were reviewed. Those patients who were operated using alternative techniques were selected and evaluated for the cause of their hearing loss and for the type of alternative technique that was utilized. Complication types and rates in these patients were evaluated. RESULTS:In total, 38 patients were operated using alternative techniques following preoperative or intraoperative findings. The mean age of the patients was 8.3 (1-51) years. There were 20 male and 18 female patients. Thirteen patients were operated with a suprameatal approach and 18 with a transcanal approach. Resection of the bony part of the external ear canal and reconstruction (canal wall down technique) was performed in seven patients. Postoperative complications included wound infection, hematoma, chorda tympani injury, and tympanic membrane perforation. CONCLUSION:Cochlear implantation is an effective method in the rehabilitation of sensorineural hearing loss. Complications are rare but can sometimes cause hematoma, taste impairment, tympanic membrane perforation, or wound infections. The standard procedure is not always suitable for patients with temporal bone abnormalities. Surgeons performing cochlear implantation should be aware of these variations and should be able to perform alternative implant techniques in these cases.

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Cochlear Implantation in Patients with Chronic Otitis: Indications for Subtotal Petrosectomy and Obliteration of the Middle Ear

Cited by 64 publications

References 9 publications

Cochlear Implant – State of the Art

Cochlear Implant – State of the Art

A case report: the first successful cochlear implant in Uganda.

Alternative Techniques in Cochlear Implantation

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