Cochlear Implantation in Postirradiated Ears: Outcomes and Challenges

Low, Wong-Kein; Gopal, Kamakshi V.; Goh, L K; Fong, Kam Weng

doi:10.1097/01.mlg.0000225935.80559.11

Cited by 20 publications

(37 citation statements)

References 11 publications

(15 reference statements)

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“…One study by Low et al examined the retrocochlear pathways of nasopharyngeal cancer patients treated with radiation therapy and suggested that these auditory pathways remained intact at 2 years post‐treatment 18. A follow‐up study documented successful cochlear implantation in four postradiated nasopharyngeal cancer patients with postimplant performance scores similar to nonirradiated controls 19. In addition, the postimplant performance of the patients in this study support functionality of the retrocochlear auditory pathway after radiation.…”

Section: Discussionsupporting

confidence: 63%

“…In addition to audiologic monitoring, patients subjected to temporal bone radiation require both concurrent and long‐term otologic exams to identify and treat sequelae. Chronic ear disease following radiation therapy is a prevalent side effect and was seen in each of the three patients discussed in this article 19. Careful assessment and management of middle ear and mastoid manifestations, including aggressive treatment of infection, is essential preoperative preparation for implantation.…”

Section: Discussionmentioning

confidence: 96%

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Cochlear implantation following treatment for medulloblastoma

et al. 2009

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Objectives/Hypothesis: Medulloblastoma is the most common pediatric malignant tumor of the central nervous system in children. Treatment includes surgical excision, external beam radiation, and multiagent chemotherapy. Otologic sequelae are common and may result from radiation and/or chemotherapy. Profound sensorineural hearing loss (SNHL) is a known complication of neuro-oncologic treatment and may render these patients eligible for cochlear implantation (CI). Issues of CI in this population, including diagnosis, treatment of preoperative middle ear disease, operative and postoperative course, performance data, and long-term tumor surveillance are highlighted and reviewed.Study Design: Retrospective chart review. Methods: Three patients treated for pediatric medulloblastoma with surgical resection, postoperative hyperfractioned craniospinal radiotherapy, and multiagent adjuvant chemotherapy who underwent cochlear implantation were identified. Details of neuro-oncologic treatment and associated otologic complications are presented and analyzed. Primary outcome assessment includes treatment of middle ear pathology, perioperative cochlear implant course, and postimplantation performance data.Results: Each patient required surgical treatment of chronic ear disease 4 to 16 years after chemoradiation. All progressed to profound SNHL and were implanted 8 to 17 years post-neuro-oncologic treatment. There were no intraoperative complications, and full insertion of the cochlear implant electrode array was achieved in each patient. One patient developed postoperative wound dehiscence requiring operative closure. Postimplantation performance data support significant benefit in all patients.Conclusions: Patients treated for pediatric medulloblastoma develop otologic sequelae, including profound SNHL, and may require cochlear implantation. Successful management of middle ear and mastoid pathology involves consideration of potential future cochlear implantation. Postoperative performance data supports cochlear implantation in this population.

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Section: Discussionsupporting

confidence: 63%

Section: Discussionmentioning

confidence: 96%

Cochlear implantation following treatment for medulloblastoma

et al. 2009

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“…In the current literature, there are only a handful of case reports and case series that suggest cochlear implantation as an effective rehabilitative tool in mitigating hearing loss in patients who received RT to the head and neck (4-7). These observations were consistent with the finding that the retro-cochlear pathways were functionally spared in modern day radiotherapy of head and neck cancers (1).…”

Section: Introductionmentioning

confidence: 99%

Cochlear Implant Outcomes: A Comparison between Irradiated and Non-irradiated Ears

Soh

D'Souza

Sarepaka

et al. 2012

Clin Exp Otorhinolaryngol

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ObjectivesRadiotherapy for head and neck tumors is known to potentially induce sensorineural hearing loss, which is possibly due to damage to the cochlear and/or auditory pathways. Since the success of cochlear implantation depends on a functional auditory nerve, this paper aims to study the hearing outcomes of cochlear implantation in irradiated ears.MethodsA retrospective study of cochlear implant recipients from our institution who had previously received radiotherapy for head and neck cancers was performed. A control group with cochlear implants who did not receive radiotherapy was recruited. A review of case records, speech discrimination scores (SDS), and a validated subjective questionnaire in the form of the Abbreviated Profile of Hearing Aid Benefit (APHAB) was administered to the study group who fulfilled the inclusion criteria. Global and category scores in both groups were averaged and statistically compared via non-inferiority (NI) testing.ResultsWith the control group (n=8) as the reference, the -ΔNI was defined, and a one-tailed lower 95% confidence interval was used for the irradiated group (n=8). The APHAB degree of improvement (%) results were as follows: global, 28.9% (19.32%, -ΔNI=16.3%); ease of communication, 67.0% (58.36%, -ΔNI=37.5%); background noise, 53.2% (44.14%, -ΔNI=26.8%); reverberation, 41.7% (28.85%, -ΔNI=32.7%); and aversiveness, -46.2% (-67.80%, -ΔNI=-56.9%). The SDS was 66.9% (56.02%, -ΔNI=51.0%). From the results, lower 95% confidence interval limits of global APHAB, SDS, ease of communication, and background noise scores of the irradiated group were within the defined -ΔNI boundary and hence are not inferior to the control. The categories of reverberation and aversiveness could not be proven, however.ConclusionThis study demonstrated marked improvements in hearing measured both objectively and subjectively. The overall hearing outcomes after cochlear implantation for post-irradiated patients were not worse than patients who have had no prior irradiation to ear structures.

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“…Pressure mastoid dressing following operation may cause bloody fluid or mucus to collect in the environment between the wound and dressing, promoting bacterial proliferation (especially the pathogens Pseudomonas aeruginosa, Staphylococcus aureus and anaerobic organisms), and even increasing the incidence of wound infection [9,18]. Especially in patients with compromised healing such as post-irradiated ears [19] or significant medical comorbidities, decreased postoperative flap blood supply and infection may hinder wound healing.…”

Section: Discussionmentioning

confidence: 99%

Mastoid pressure dressing for cochlear implantation—Is it necessary?

Luo

et al. 2009

International Journal of Pediatric Otorhinolaryngology

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Cochlear Implantation in Postirradiated Ears: Outcomes and Challenges

Cited by 20 publications

References 11 publications

Cochlear implantation following treatment for medulloblastoma

Cochlear implantation following treatment for medulloblastoma

Cochlear Implant Outcomes: A Comparison between Irradiated and Non-irradiated Ears

Mastoid pressure dressing for cochlear implantation—Is it necessary?

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