Comparison of Complications of the Suprameatal Approach and Mastoidectomy with Posterior Tympanotomy Approach in Cochlear Implantation: A Meta-Analysis

Abstract

Background: Cochlear implantation (CI) is a popular procedure to preserve hearing in patients with severe-to-profound hearing loss. Evidence shows that the suprameatal approach (SMA) may help reducing the risk of the incidence of complications and shortening the surgery time, but there is still dispute. Objectives: The aim of this study was to compare the incidence of complications of SMA and the mastoidectomy with posterior tympanotomy approach (MPTA), and to find whether SMA yields better outcomes than MPTA. Methods: We searched PubMed, the Cochrane Library, the Web of Science and Chinese Biomedical Literature databases, Chinese National Knowledge Infrastructure, the Chinese Science and Technology Journal Full-Text database, and Wangfang database. The latest data was accessed in March 2013. Review Manager 5.1 software was used for comprehensive quantification data analysis. Results: Three studies were included in the meta-analysis, composed of 799 participants and reporting major and minor complications. The meta-analysis indicated no statistically significant difference in major and minor complications between the two approaches, except for facial nerve and chorda tympani injuries (OR = 0.13; 95% CI: 0.02, 0.67; p = 0.02; I² = 0%). Conclusions: Current evidence suggests that SMA may be clearly a good alternative to the classical surgery technique for CI in terms of reducing the incidence of facial nerve injury and chorda tympani sacrifice.

Non-mastoidectomy Cochlear Implant Approaches: A Literature Review

“…The rate of device failure was 2%; therefore, the unwanted outcomes requiring surgery were 4.66%, while 10% reported minor complication rate. 19 Xu et al, 20 in a meta-analysis study of 799 cases, reported no statistically significant difference in major and minor complications between the two approaches, except for facial nerve and chorda tympani injuries, favoring SMA. 20 Migirov et al 21 operated 300 cases of CI and reported a rate of 3% major complications and 25.7% minor complications.…”

“…19 Xu et al, 20 in a meta-analysis study of 799 cases, reported no statistically significant difference in major and minor complications between the two approaches, except for facial nerve and chorda tympani injuries, favoring SMA. 20 Migirov et al 21 operated 300 cases of CI and reported a rate of 3% major complications and 25.7% minor complications. 21 Júnior et al, 8 in a study of 250 cases, reported 13 cases (5.2%) of major postoperative complications and 20 cases (8%) of minor complications.…”

Systematic Review of Nontumor Pediatric Auditory Brainstem Implant Outcomes

“…Xu et al found major complication rates of 4.48% and 7.76% after cochlear implantation through suprameatal approach and mastoidectomy with posterior tympanotomy approach respectively. 45 The most common complications reported in the pediatric ABI studies included CSF leak and mild/transitory cerebellar edema, which occurred in up to 8.5% and 9.2% of patients, respectively. The prevalence of CSF leaks is comparable to the leak rate following primary vestibular schwannoma surgery via retrosigmoid craniotomy (10.6%) 46 and lower than that in NF2 adults who received an ABI (17.6%, 6 of 34).…”

Retrospective complication rate comparison between surgical techniques in paediatric cochlear implantation

“…A meta‐analysis by Xu et al . revealed no difference in postoperative complication rates between SMA and MPTA patients.…”