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Zwierz A, Masna K, Burduk P, Hackenberg S, Scheich M. Renewed Concept of Mastoid Cavity Obliteration with the Use of Temporoparietal Fascial Flap Injected by Injectable Platelet-Rich Fibrin after Subtotal Petrosectomy for Cochlear Implant Patients. Audiol Res 2024; 14:280-292. [PMID: 38525686 PMCID: PMC10961696 DOI: 10.3390/audiolres14020025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 02/01/2024] [Accepted: 02/27/2024] [Indexed: 03/26/2024] Open
Abstract
Background: The subtotal petrosectomy procedure may be useful for cochlear implantation in selected patient groups. Although it is highly effective, complications can arise, which may have economic implications for the patient due to the high cost of the device. Therefore, several authors have attempted to identify the most effective concept for obliteration. Methods: We present a pilot descriptive study of application techniques for obliterating cavities after subtotal petrosectomy using a temporoparietal fascial flap (TPFF) modified with injectable platelet-rich fibrin (IPRF+) for three cochlear implant (CI) patients. Results: Our concept preserves important anatomical structures, such as the temporalis muscle, which covers the CI receiver-stimulator. Injection of IPRF+ also increases the available tissue volume for obliteration and enhances its anti-inflammatory and regenerative potential. Conclusions: To the best of our knowledge, the use of TPFF for filling the cavity has not been adopted for CI with SP and for blind sac closure. Our literature review and our experience with this small group of patients suggest that this procedure, when combined with IPRF+ injections, may reduce the risk of potential infection in the obliterated cavity, particularly when used with CI. This technique is applicable only in cases when the surgeons are convinced that the middle ear cavity is purged of cholesteatoma.
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Affiliation(s)
- Aleksander Zwierz
- Department of Otolaryngology, Phoniatrics and Audiology, Faculty of Health Sciences, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, 85-067 Bydgoszcz, Poland; (K.M.); (P.B.)
| | - Krystyna Masna
- Department of Otolaryngology, Phoniatrics and Audiology, Faculty of Health Sciences, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, 85-067 Bydgoszcz, Poland; (K.M.); (P.B.)
| | - Paweł Burduk
- Department of Otolaryngology, Phoniatrics and Audiology, Faculty of Health Sciences, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, 85-067 Bydgoszcz, Poland; (K.M.); (P.B.)
| | - Stephan Hackenberg
- Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital Würzburg, 97080 Würzburg, Germany; (S.H.); (M.S.)
| | - Matthias Scheich
- Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital Würzburg, 97080 Würzburg, Germany; (S.H.); (M.S.)
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Nocini R, Soloperto D, Arietti V, De Cecco F, Fulco G, Monzani D, Marchioni D, Sacchetto L. Subtotal Petrosectomy: Pictorial Review of Clinical Indications and Surgical Approach. Indian J Otolaryngol Head Neck Surg 2024; 76:224-236. [PMID: 38440666 PMCID: PMC10909040 DOI: 10.1007/s12070-023-04131-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 07/31/2023] [Indexed: 03/06/2024] Open
Abstract
Subtotal petrosectomy (STP) is characterized by obliteration of the middle ear and occlusion of the external auditory canal. The advent of the endoscope has allowed a reduction in morbidity for some conditions such as cholesteatoma and other middle ear disorders, but STP still plays an important role. A retrospective review of medical records and videos of patients who had undergone STP was performed. Perioperative data and images were collected from various clinical cases who had undergone subtotal petrosectomy at our tertiary referral university hospital in Verona. We confronted our experience with a review of the literature to present the main indications for this type of procedure. STP allows a variety of diseases to be managed effectively as it offers the possibility of a definitive healing with radical clearance of temporal bone. Moreover, it can be safely combined with other procedures with a very low complication rate. Although the endoscope represents a revolution in ear surgery, STP, when indicated, is nowadays a surgical option that should be included in the otosurgeon's portfolio.
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Affiliation(s)
- Riccardo Nocini
- Unit of Otolaryngology - Head and Neck Department, University of Verona, P.le L.A. Scuro 10, 37134 Verona, Italy
| | - Davide Soloperto
- Unit of Otolaryngology - Head and Neck Department, University of Verona, P.le L.A. Scuro 10, 37134 Verona, Italy
| | - Valerio Arietti
- Unit of Otolaryngology - Head and Neck Department, University of Verona, P.le L.A. Scuro 10, 37134 Verona, Italy
| | - Francesca De Cecco
- Unit of Otolaryngology - Head and Neck Department, University of Verona, P.le L.A. Scuro 10, 37134 Verona, Italy
| | - Gianfranco Fulco
- Unit of Otolaryngology - Head and Neck Department, University of Verona, P.le L.A. Scuro 10, 37134 Verona, Italy
| | - Daniele Monzani
- Unit of Otolaryngology - Head and Neck Department, University of Verona, P.le L.A. Scuro 10, 37134 Verona, Italy
| | - Daniele Marchioni
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Luca Sacchetto
- Unit of Otolaryngology - Head and Neck Department, University of Verona, P.le L.A. Scuro 10, 37134 Verona, Italy
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Jahangiri R, Hashemi SB, Kohan E, Babaei A. Cochlear Implantation with a Combined Approach: A Case Report. IRANIAN JOURNAL OF OTORHINOLARYNGOLOGY 2024; 36:377-380. [PMID: 38259692 PMCID: PMC10800144 DOI: 10.22038/ijorl.2023.75088.3520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 12/23/2023] [Indexed: 01/24/2024]
Abstract
Introduction Ear symptoms of granulomatosis with polyangiitis can range from ear fullness and otalgia to conductive or sensory neural hearing loss and sudden deafness. Cochlear implantation in these patients faces two challenges: access to the round window and control of mastoid and middle ear inflammation. The combined approach in cochlear implantation is a classic trans-facial recess approach facilitated by a trans-canal view. Case Report In this case report, we present the "combined approach" in a 20-year-old lady with granulomatosis with polyangiitis who underwent cochlear implantation successfully using the combined approach. Conclusion Post-operative results suggest that the "combine approach" seems to be a safe, easy, and fast cochlear implantation technique for chronic otitis media with an atelectatic middle ear and retracted tympanic membrane or narrow facial recess space. It is a single-stage surgery that has no need for the obliteration of the ear and has less morbidity.
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Affiliation(s)
- Reza Jahangiri
- Otolaryngology Research Center, Department of Otolaryngology, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Seyed Basir Hashemi
- Otolaryngology Research Center, Department of Otolaryngology, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Elahe Kohan
- Otolaryngology Research Center, Department of Otolaryngology, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Amirhossein Babaei
- Otolaryngology Research Center, Department of Otolaryngology, Shiraz University of Medical Sciences, Shiraz, Iran.
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Gowrishankar SV, Fleet A, Tomasoni M, Durham R, Umeria R, Merchant SA, Shah SFH, Muzaffar J, Mohammed H, Kuhn I, Tysome J, Smith ME, Donnelly N, Axon P, Bance M, Borsetto D. The Risk of Meningitis After Cochlear Implantation: A Systematic Review and Meta-Analysis. Otolaryngol Head Neck Surg 2023; 169:467-481. [PMID: 36864717 DOI: 10.1002/ohn.309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/05/2023] [Accepted: 02/08/2023] [Indexed: 03/04/2023]
Abstract
OBJECTIVE This study aims to estimate the rate of postoperative meningitis (both immediate and long-term) in patients following cochlear implants (CIs). It aims to do so through a systematic review and meta-analysis of published studies tracking complications after CIs. DATA SOURCES MEDLINE, Embase, and Cochrane Library. REVIEW METHODS This review was performed in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies tracking complications following CIs in patients were included. Exclusion criteria included non-English language studies and case series reporting <10 patients. Bias risk was evaluated using the Newcastle-Ottawa Scale. Meta-analysis was performed through DerSimonian and Laird random-effects models. RESULTS A total of 116/1931 studies met the inclusion criteria and were included in the meta-analysis. Overall, there were 112 cases of meningitis in 58,940 patients after CIs. Meta-analysis estimated an overall rate of postoperative meningitis of 0.07% (95% confidence interval [CIs], 0.03%-0.1%; I2 = 55%). Subgroup meta-analysis showed this rate had 95% CIs crossing 0% in implanted patients who received the pneumococcal vaccine, antibiotic prophylaxis, those with postoperative acute otitis media (AOM), and those implanted less than 5 years. CONCLUSION Meningitis is a rare complication following CIs. Our estimated rates of meningitis after CIs appear lower than prior estimates based on epidemiological studies in the early 2000s. However, the rate still appears higher than the baseline rate in the general population. The risk was very low in implanted patients who received the pneumococcal vaccine, antibiotic prophylaxis, received unilateral or bilateral implantations, developed AOM, those implanted with a round window or cochleostomy techniques, and those under 5 years.
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Affiliation(s)
- Shravan V Gowrishankar
- Department of Otolaryngology-Head and Neck Surgery, Cambridge University Hospitals NHS Trust, Cambridge, UK
- Department of Clinical Medicine, University of Cambridge, School of Clinical Medicine, Cambridge, UK
| | - Alex Fleet
- Department of Otolaryngology-Head and Neck Surgery, Cambridge University Hospitals NHS Trust, Cambridge, UK
- Department of Clinical Medicine, University of Cambridge, School of Clinical Medicine, Cambridge, UK
| | - Michele Tomasoni
- Department of Otolaryngology-Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Rory Durham
- Department of Clinical Medicine, University of Cambridge, School of Clinical Medicine, Cambridge, UK
| | - Rishi Umeria
- Department of Clinical Medicine, University of Cambridge, School of Clinical Medicine, Cambridge, UK
| | - Serena A Merchant
- Department of Clinical Medicine, University of Cambridge, School of Clinical Medicine, Cambridge, UK
| | - Syed F H Shah
- Department of Clinical Medicine, University of Cambridge, School of Clinical Medicine, Cambridge, UK
| | - Jameel Muzaffar
- Department of Otolaryngology-Head and Neck Surgery, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Hassan Mohammed
- Department of Otolaryngology-Head and Neck Surgery, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Isla Kuhn
- Cambridge University Medical Library, Cambridge, UK
| | - James Tysome
- Department of Otolaryngology-Head and Neck Surgery, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Matthew E Smith
- Department of Otolaryngology-Head and Neck Surgery, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Neil Donnelly
- Department of Otolaryngology-Head and Neck Surgery, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Patrick Axon
- Department of Otolaryngology-Head and Neck Surgery, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Manohar Bance
- Department of Otolaryngology-Head and Neck Surgery, Cambridge University Hospitals NHS Trust, Cambridge, UK
- Department of Clinical Medicine, University of Cambridge, School of Clinical Medicine, Cambridge, UK
| | - Daniele Borsetto
- Department of Otolaryngology-Head and Neck Surgery, Cambridge University Hospitals NHS Trust, Cambridge, UK
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Canzi P, Berrettini S, Albera A, Barbara M, Bruschini L, Canale A, Carlotto E, Covelli E, Cuda D, Dispenza F, Falcioni M, Forli F, Franchella S, Gaini L, Gallina S, Laborai A, Lapenna R, Lazzerini F, Malpede S, Mandalà M, Minervini D, Pasanisi E, Ricci G, Viberti F, Zanetti D, Zanoletti E, Benazzo M. Current trends on subtotal petrosectomy with cochlear implantation in recalcitrant chronic middle ear disorders. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2023; 43:S67-S75. [PMID: 37698103 PMCID: PMC10159642 DOI: 10.14639/0392-100x-suppl.1-43-2023-09] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 01/17/2023] [Indexed: 09/13/2023]
Abstract
Objective To establish the safety and effectiveness of subtotal petrosectomy with cochlear implantation in patients affected by chronic middle ear disorders to refractory to previous surgical treatments. Methods A multicentre, retrospective study was conducted on patients affected by recalcitrant chronic middle ear disorders who underwent cochlear implantation in combination with subtotal petrosectomy. Patients' details were collected from databases of 11 Italian tertiary referral centres. Additionally, a review of the most updated literature was carried out. Results 55 patients were included with a mean follow-up time of 44 months. Cholesteatoma was the most common middle ear recurrent pathology and 50.9% of patients had an open cavity. 80% of patients underwent a single stage surgery. One case of explantation for device failure was reported among the 7 patients with post-operative complications. Conclusions Subtotal petrosectomy with cochlear implantation is a benchmark for management of patients with recalcitrant chronic middle ear disorders. A single stage procedure is the most recommended strategy. Optimal follow-up is still debated. Further studies are required to investigate the role of this surgery in paediatric patients.
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Affiliation(s)
- Pietro Canzi
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Department of Otorhinolaryngology, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Stefano Berrettini
- Otolaryngology, Audiology and Phoniatrics Unit, University of Pisa, Pisa, Italy
| | - Andrea Albera
- Division of Otorhinolaryngology, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Maurizio Barbara
- Department of Neuroscience, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Luca Bruschini
- Otolaryngology, Audiology and Phoniatrics Unit, University of Pisa, Pisa, Italy
| | - Andrea Canale
- Division of Otorhinolaryngology, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Elena Carlotto
- Department of Otorhinolaryngology, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Edoardo Covelli
- Department of Neuroscience, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Domenico Cuda
- Department of Otolaryngology, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Francesco Dispenza
- Department of Biomedicine, Neuroscience and Advanced Diagnostics, Azienda Ospedaliera Universitaria Policlinico “Paolo Giaccone’’, University of Palermo, Palermo, Italy
| | - Maurizio Falcioni
- Otorhinolaryngology and Otoneurosurgery Department, University Hospital of Parma, Italy
| | - Francesca Forli
- Otolaryngology, Audiology and Phoniatrics Unit, University of Pisa, Pisa, Italy
| | - Sebastiano Franchella
- Department of Neuroscience DNS, Otolaryngology Section, Padova University, Padova, Italy
| | - Lorenzo Gaini
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Salvatore Gallina
- Department of Biomedicine, Neuroscience and Advanced Diagnostics, Azienda Ospedaliera Universitaria Policlinico “Paolo Giaccone’’, University of Palermo, Palermo, Italy
| | - Andrea Laborai
- Department of Otolaryngology, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Ruggero Lapenna
- Department of Surgical and Biomedical Sciences, Section of Otorhinolaryngology, University of Perugia, Perugia, Italy
| | - Francesco Lazzerini
- Otolaryngology, Audiology and Phoniatrics Unit, University of Pisa, Pisa, Italy
| | - Stefano Malpede
- Department of Otorhinolaryngology, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Marco Mandalà
- Department of Otology and Skull Base Surgery, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Domenico Minervini
- Department of Otorhinolaryngology, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Enrico Pasanisi
- Otorhinolaryngology and Otoneurosurgery Department, University Hospital of Parma, Italy
| | - Giampietro Ricci
- Department of Surgical and Biomedical Sciences, Section of Otorhinolaryngology, University of Perugia, Perugia, Italy
| | - Francesca Viberti
- Department of Otology and Skull Base Surgery, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Diego Zanetti
- Audiology Unit, Department of Specialistic Surgical Sciences Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico Milan, Italy
- Department of Clinical Sciences and Community Health University of Milan, Milan, Italy
| | - Elisabetta Zanoletti
- Department of Neuroscience DNS, Otolaryngology Section, Padova University, Padova, Italy
| | - Marco Benazzo
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Department of Otorhinolaryngology, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Canzano F, Di Lella F, Guida M, Pasanisi E, Govoni M, Falcioni M. Revision cochlear implant surgery for clinical reasons. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2023; 43:65-73. [PMID: 36860152 PMCID: PMC9978301 DOI: 10.14639/0392-100x-n2096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 09/15/2022] [Indexed: 03/03/2023]
Abstract
Objective To report the authors' experience in a series of patients treated with cochlear implant (CI) revision surgery due to medical problems. Methods Revision CI surgeries performed in a tertiary referral centre for medical reasons not related to skin conditions were reviewed; patients were included if device removal was required. Results 17 cochlear implant patients were reviewed. The main reasons requiring revision surgery with device removal were: retraction pocket/iatrogenic cholesteatoma (6/17), chronic otitis (3/17), extrusion in previous canal wall down procedures (2/17) or in previous subtotal petrosectomy (2/17), misplacement/partial array insertion (2/17) and residual petrous bone cholesteatoma (2/17). In all cases surgery was performed through a subtotal petrosectomy. Cochlear fibrosis/ossification of the basal turn was found in 5 cases and uncovered mastoid portion of the facial nerve in 3 patients. The only complication was an abdominal seroma. A positive difference was observed between the number of active electrodes and comfort levels before and after revision surgery. Conclusions In CI revision surgeries performed for medical reasons, subtotal petrosectomy offers invaluable advantages and should be considered as first choice during surgical planning.
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Affiliation(s)
- Federica Canzano
- Department of Otorhinolaryngology, Azienda Ospedaliera di Pescara, Pescara, Italy,Correspondence Federica Canzano Department of Otorhinolaryngology, Azienda Ospedaliera di Pescara, via Fonte Romana 8, 65010 Pescara, Italy Tel. +39 0854252413; +39 0854252682 E-mail:
| | - Filippo Di Lella
- University of Parma, Department of Medicine and Surgery, Department of Otorhinolaryngology and Otoneurosurgery, Parma, Italy
| | - Maurizio Guida
- University of Parma, Department of Medicine and Surgery, Department of Otorhinolaryngology and Otoneurosurgery, Parma, Italy
| | - Enrico Pasanisi
- University of Parma, Department of Medicine and Surgery, Department of Otorhinolaryngology and Otoneurosurgery, Parma, Italy
| | - Marzo Govoni
- University of Parma, Department of Medicine and Surgery, Department of Otorhinolaryngology and Otoneurosurgery, Parma, Italy
| | - Maurizio Falcioni
- Department of Otorhinolaryngology and Otoneurosurgery, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
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Bako P, Kovacs M, Uzsaly J, Burian A, Bodzai G, Nemeth A, Toth A, Szanyi I, Gerlinger I. Subtotal Petrosectomy and Cochlear Implantation in Children With Chronic Suppurative Otitis Media: A Single Institutional Experience. J Audiol Otol 2022; 26:214-222. [PMID: 36285467 PMCID: PMC9597276 DOI: 10.7874/jao.2022.00220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 09/09/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Chronic suppurative otitis media (CSOM) with or without cholesteatoma is a frequent chronic inflammatory condition in children, which may lead to severe hearing loss that affects speech development. Treatment of recurrent CSOM associated with unserviceable hearing requires a specialized approach with regard to disease eradication and hearing rehabilitation. In this study, we investigated the advantages of subtotal petrosectomy (SP) combined with cochlear implantation (CI) in children with CSOM associated with unserviceable hearing and describe our experience with regard to the efficacy of this method, together with a literature review. SUBJECTS AND METHODS SP with sequential or simultaneous CI was performed in three children (four ears), and postoperative audiometric data were recorded. RESULTS The study included two male and one female patient. Mean age at the time of SP was 10.75 years (7-13 years). Sequential implantation was performed in three ears. Facial nerve palsy occurred after SP in one patient. The latest word recognition scores of Cases 1, 2, and 3 were 80% (at 60 dB), 75% (at 60 dB), and 70% (at 50 dB) and 90% (at 50 dB), respectively. CONCLUSIONS SP with CI may be safe and reliable in children with CSOM associated with unserviceable hearing.
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Affiliation(s)
- Peter Bako
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical School, University of Pécs, Pécs, Hungary,Regenerative Science, Sport and Medicine Research Group, Szentágothai Research Centre, University of Pécs, Pécs, Hungary,Address for correspondence Peter Bako, MD, PhD Department of Otorhinolaryngology, Head and Neck Surgery, Medical School, University of Pécs, 2 Munkacsy Street, H-7621 Pécs, Hungary Tel +36-72507312 Fax +36-72312151 E-mail
| | - Marton Kovacs
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical School, University of Pécs, Pécs, Hungary
| | - Janos Uzsaly
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical School, University of Pécs, Pécs, Hungary
| | - Andras Burian
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical School, University of Pécs, Pécs, Hungary
| | - Greta Bodzai
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical School, University of Pécs, Pécs, Hungary
| | - Adrienn Nemeth
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical School, University of Pécs, Pécs, Hungary
| | - Arnold Toth
- Department of Medical Imaging, Medical School, University of Pécs, Pécs, Hungary
| | - Istvan Szanyi
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical School, University of Pécs, Pécs, Hungary
| | - Imre Gerlinger
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical School, University of Pécs, Pécs, Hungary
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Subtotal Petrosectomy (SP) in Cochlear Implantation (CI): A Report of 92 Cases. Audiol Res 2022; 12:113-125. [PMID: 35314609 PMCID: PMC8938809 DOI: 10.3390/audiolres12020014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/13/2022] [Accepted: 02/17/2022] [Indexed: 12/10/2022] Open
Abstract
In most cases, cochlear implantation is a straightforward procedure. Nevertheless, there are clinical situations in which the presence of the middle ear may compromise access and/or the outcome in terms of complications. This article includes a series of patients for whom we eliminated the middle ear to facilitate placement of the electrode array of the implant and/or reduce potential complications. A total of 92 cases in 83 patients, managed by the senior author, are included in this series. Different indications are outlined that justify associating a subtotal petrosectomy technique with cochlear implantation. The steps of the technique are described. We include complications from this series that compare favorably with standard techniques.
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Issing PR, Atanasova-Koch S, Schneider J, Issing C. [The Impact of Subtotal Petrosectomy in Cochlea Implantation]. Laryngorhinootologie 2021. [PMID: 34798673 DOI: 10.1055/a-1675-3277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Cochlear Implantation (CI) in patients with chronic otitis media or existing open mastoid cavity can be challenging. Subtotal petrosectomy (STP) is an option to improve the safety of this procedure. MATERIAL AND METHODS Retrospective study with cases of STP prior CI. RESULTS 25 patients could be enrolled in this investigation. Over all 26 STP were performed approximately 6 months before CI. The majority of the patients suffered from a chronic otitis media or had a preexisting open cavity; in one case a complex temporal bone fracture with destruction of the external auditory canal was the reason for this technique. After STP we observed three times a delayed wound healing at the closure of the external auditory meatus and a bleeding at the periumbilical region after harvesting fat of the abdominal wall. All patients could be provided with a CI. A recurrence of a cholesteatoma did not appear so far. CONCLUSION With this method CI is feasible even in cases of concurrent chronic otitis media or canal wall down situation. We are in favour of a staged procedure, nevertheless a simultaneous STP and CI is justifiable in individual patients.
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Affiliation(s)
- Peter Rolf Issing
- Klinik für Hals-Nasen-Ohrenheilkunde, Klinikum Bad Hersfeld GmbH, Bad Hersfeld, Germany
| | | | - Jessica Schneider
- Klinik für Hals-Nasen-Ohrenheilkunde, Klinikum Bad Hersfeld GmbH, Bad Hersfeld, Germany
| | - Christian Issing
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
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D'Angelo G, Donati G, Bacciu A, Guida M, Falcioni M. Subtotal petrosectomy and cochlear implantation. ACTA ACUST UNITED AC 2021; 40:450-456. [PMID: 33558774 PMCID: PMC7889253 DOI: 10.14639/0392-100x-n0931] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 08/25/2020] [Indexed: 11/23/2022]
Abstract
Objective The objective of this study is to analyse surgical outcomes in a series of patients who underwent subtotal petrosectomy in combination with cochlear implantation. Methods Retrospective chart review. Thirty patients (32 ears) underwent subtotal petrosectomy and cochlear implantation in one stage. Indications for subtotal petrosectomy included the following: cholesteatoma, chronic otitis media, previous canal wall-down, osteoradionecrosis, revision surgery for clinical reasons, inner ear malformations, middle ear anatomical variations and severe cochlear ossification. Results Follow-up ranged from 2 to 54 months. Only 2 complications related to the subtotal petrosectomy (1 subcutaneous abdominal haematoma and 1 subcutaneous abdominal seroma) occurred in this series. Complete electrode insertion was achieved in all but 4 cases. Conclusions Subtotal petrosectomy is a safe procedure and can offer technical advantages in some cases of complex cochlear implantation.
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Affiliation(s)
- Giulia D'Angelo
- Otorhinolaryngology and Otoneurosurgery Department, University Hospital of Parma, Italy
| | - Giulia Donati
- Otorhinolaryngology and Otoneurosurgery Department, University Hospital of Parma, Italy
| | - Andrea Bacciu
- Otorhinolaryngology and Otoneurosurgery Department, University Hospital of Parma, Italy
| | - Maurizio Guida
- Otorhinolaryngology and Otoneurosurgery Department, University Hospital of Parma, Italy
| | - Maurizio Falcioni
- Otorhinolaryngology and Otoneurosurgery Department, University Hospital of Parma, Italy
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Seebacher J, Muigg F, Kühn H, Weichbold V, Galvan O, Zorowka P, Schmutzhard J. Cost-utility Analysis of Cochlear Implantation in Adults With Single-sided Deafness: Austrian and German Perspective. Otol Neurotol 2021; 42:799-805. [PMID: 33625194 DOI: 10.1097/mao.0000000000003103] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Single-sided deafness (SSD) is associated with a loss of binaural hearing. Major limitations of such patients are poor speech understanding in noisy environments and a lack of spatial hearing. To date, cochlear implantation is the most promising approach to overcome these deficits in this group of patients. OBJECTIVE Cost-effectiveness analyses of cochlear implantation in patients with unilateral deafness. The model targets Austrian and German SSD patients who can either opt for treatment with a cochlear implant (CI) or decide against a CI and stay without any treatment. METHODS A Markov model analyzed as microsimulation was developed using TreeAge Pro 2019 software. Pre- and postoperative utility values generated with HUI-3 were used to populate the model. Costs covered by the national insurance were considered. Costs and utilities were discounted by 3%. A model time horizon of 20 years was set. RESULTS According to Austrian base-case analysis, the incremental cost-utility ratio (ICUR) was €34845.2 per quality-adjusted life year gained when comparing the "CI strategy" to the "no treatment strategy." The ICUR is marginally lower when adapting a German cost perspective-it was €31601.25 per quality-adjusted life year gained. Sensitivity analyses showed that the cost-effectiveness results are stable. Analyses also showed that the longer the time horizon is set, the more favorable the cost-effectiveness result is. CONCLUSIONS Based on currently available data, the Markov microsimulation model suggests that cochlear implantation is cost-effective in Austrian and German patients with SSD if no other treatment option is considered within the model.
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Affiliation(s)
- Josef Seebacher
- Department for Hearing, Speech and Voice Disorders, Medical University of Innsbruck
| | | | - Heike Kühn
- Comprehensive Hearing Center, ENT University Clinic, Würzburg, Germany
| | - Viktor Weichbold
- Department for Hearing, Speech and Voice Disorders, Medical University of Innsbruck
| | | | - Patrick Zorowka
- Department for Hearing, Speech and Voice Disorders, Medical University of Innsbruck
| | - Joachim Schmutzhard
- Department of Otorhinolaryngology, Medical University of Innsbruck, Innsbruck, Austria
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12
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Posterior Tympanotomy Versus Subtotal Petrosectomy: A Comparison of Complications in Cochlear Implantation. Otol Neurotol 2021; 42:260-265. [PMID: 33026779 DOI: 10.1097/mao.0000000000002899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
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.
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Takata Y, Anzai T, Matsumoto F, Hara S, Ikeda K. Subtotal Petrosectomy With Preservation of Chorda Tympani for Petrous Bone Cholesteatoma: Case Report. EAR, NOSE & THROAT JOURNAL 2020; 101:NP279-NP283. [PMID: 33064026 DOI: 10.1177/0145561320964268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A petrous bone cholesteatoma (PBC) is a rare epidermoid cyst of the petrous portion of the temporal bone. The main treatment is subtotal petrosectomy (SP), which generally involves sacrificing the chorda tympani. We report a case of extensive supralabyrinthine PBC in an elderly patient undergoing hemodialysis that was treated by SP with anatomical preservation of the chorda tympani. To the best of our knowledge, preservation of the chorda tympani during SP has not been previously reported. For maintenance of postoperative taste and appetite, preservation of the chorda tympani is a meaningful maneuver whenever possible.
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Affiliation(s)
- Yusuke Takata
- Department of Otorhinolaryngology Head and Neck Surgery, 12847Juntendo University School of Medicine, Tokyo, Japan
| | - Takashi Anzai
- Department of Otorhinolaryngology Head and Neck Surgery, 12847Juntendo University School of Medicine, Tokyo, Japan
| | - Fumihiko Matsumoto
- Department of Otorhinolaryngology Head and Neck Surgery, 12847Juntendo University School of Medicine, Tokyo, Japan
| | - Satoshi Hara
- Department of Otorhinolaryngology Head and Neck Surgery, 12847Juntendo University School of Medicine, Tokyo, Japan
| | - Katsuhisa Ikeda
- Department of Otorhinolaryngology Head and Neck Surgery, 12847Juntendo University School of Medicine, Tokyo, Japan
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Yan F, Reddy PD, Isaac MJ, Nguyen SA, McRackan TR, Meyer TA. Subtotal Petrosectomy and Cochlear Implantation: A Systematic Review and Meta-analysis. JAMA Otolaryngol Head Neck Surg 2020; 147:2771743. [PMID: 33057602 PMCID: PMC7563667 DOI: 10.1001/jamaoto.2020.3380] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 08/05/2020] [Indexed: 01/21/2023]
Abstract
IMPORTANCE Subtotal petrosectomy (STP) has been more frequently performed to prepare ears with unfavorable conditions for cochlear implantation. OBJECTIVES To provide an overview of indications for and complications of STP and cochlear implantation and to compare outcomes between single vs multistage procedures and between pediatric vs adult populations. DATA SOURCES A search of PubMed, Scopus, Ovid, and the Cochrane Library was performed from the databases' inception to January 23, 2020, for studies evaluating STP for cochlear implantation. STUDY SELECTION Studies with a minimum follow-up of 3 months and no missing data regarding postoperative outcomes were included. Of the initial 570 studies identified, 27 (4.7%) met selection criteria. DATA EXTRACTION AND SYNTHESIS Two reviewers independently assessed study eligibility according to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines; discrepancies were resolved by a third reviewer. Extracted data included patient demographics, indications for STP, rates of complications, and cholesteatoma recidivism when applicable. Data were pooled using a random- or a fixed-effects model when appropriate. MAIN OUTCOMES AND MEASURES The primary study outcome was rate of global complications stratified by patient- and surgery-level characteristics. RESULTS Twenty-seven unique studies with 377 unique patients (54.2% male; mean age, 50.6 [range, 1-99] years) undergoing 397 STP procedures and cochlear implantation were included. Of these procedures, 299 of 394 cases with the information reported (75.9%) were single procedures and 95 (24.1%) were multistage procedures. Of the total 397 STP procedures, most common indications included chronic otitis media (220 cases [55.4%]), previous open mastoid cavity (141 [35.5%]), cholesteatoma (74 [18.6%]), and cochlear ossification (29 [7.3%]). The overall complication rate was 12.4% (95% CI, 9.4%-15.9%); overall cholesteatoma recidivism rate was 9.3% (95% CI, 4.3%-17.1%). Complication rates did not significantly differ based on stage or age of patients. Cases with cholesteatoma more often underwent multistage vs single-stage procedures (23 of 54 [42.6%] vs 35 of 174 [20.1%]). CONCLUSIONS AND RELEVANCE Across all age groups, STP has been shown to be an effective surgical operation in preparing an ear with unfavorable conditions for cochlear implantation. The potential indications for which cochlear implantation can be performed have expanded with the use of STP. Presence of cholesteatoma might indicate that a multistage procedure should be performed. Lastly, with complication rates comparable to those in adult patients, STP can be considered in children requiring cochlear implantation to minimize ear-related issues and allow benefit from cochlear implantation.
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Affiliation(s)
- Flora Yan
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - Priyanka D. Reddy
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - Mitchell J. Isaac
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - Shaun A. Nguyen
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - Theodore R. McRackan
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - Ted A. Meyer
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston
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Pseudo mastoid obliteration with conchal cartilage may be a safe alternative technique for cochlear implantation in canal wall down mastoidectomy with large meatoplasty. The Journal of Laryngology & Otology 2020; 134:493-496. [PMID: 32618542 DOI: 10.1017/s0022215120001139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Safe cochlear implantation is challenging in patients with canal wall down mastoid cavities, and the presence of large meatoplasties increases the risk of external canal overclosure. This paper describes our results of obliteration of the mastoid cavity with conchal cartilage as an alternative procedure in cases of canal wall down mastoidectomy with very large meatoplasty. METHODS The cases of seven patients with a canal wall down mastoidectomy cavity who underwent cochlear implantation were retrospectively reviewed. Post-operative complications were analysed. The mean follow-up duration was 4.5 years. RESULTS There was no hint of cholesteatoma recurrence and all patients have been free of symptoms during follow up. Only one patient showed cable extrusion six months after surgery, and implantation of the contralateral ear was needed. CONCLUSION Pseudo-obliteration of the mastoid cavity with a cartilage multi-layered palisade reconstruction covering the electrode may be a safe alternative in selected patients with a large meatoplasty.
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16
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Lee S, Lee JB, Chung JH, Park KW, Choi JW. Surgical outcomes of simultaneous cochlear implantation with subtotal petrosectomy. Auris Nasus Larynx 2020; 47:943-949. [PMID: 32518029 DOI: 10.1016/j.anl.2020.05.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 05/11/2020] [Accepted: 05/21/2020] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- Seulgi Lee
- Department of Otorhinolaryngology, Head and Neck Surgery, Chungnam National University, College of Medicine, South Korea
| | - Jong Bin Lee
- Department of Otorhinolaryngology, Konyang University, College of Medicine, South Korea
| | - Jee-Hye Chung
- Department of Rehabilitation medicine, College of Medicine, Chungnam National University, South Korea
| | - Ki-Wan Park
- Department of Otorhinolaryngology, Head and Neck Surgery, Chungnam National University, College of Medicine, South Korea
| | - Jin Woong Choi
- Department of Otorhinolaryngology, Head and Neck Surgery, Chungnam National University, College of Medicine, South Korea.
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17
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Kucharski A, Szymański M, Szymańska A, Rola R. Diagnosis and management of unilateral cholesteatoma and vestibular schwannoma. OTOLARYNGOLOGY CASE REPORTS 2020. [DOI: 10.1016/j.xocr.2020.100170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Grinblat G, Vlad D, Caruso A, Sanna M. Evaluation of Subtotal Petrosectomy Technique in Difficult Cases of Cochlear Implantation. Audiol Neurootol 2020; 25:323-335. [PMID: 32474562 DOI: 10.1159/000507419] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 03/23/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To assess the validity of the subtotal petrosectomy (STP) technique in problematic cases of cochlear implant (CI) surgery, and review indications, outcomes, and related controversies. STUDY DESIGN This is a retrospective review of data from a private quaternary referral center of otology and skull base surgery. PATIENTS AND METHODS A review of patients who underwent CI with STP (STP-CI) as the leading approach was performed. Demographics, indications, surgical details, and main outcomes were evaluated. The surgeries performed were usually single-stage procedures encompassing a comprehensive mastoidectomy, blind sac closure of the external auditory canal (EAC), and mastoid obliteration with autologous fat. RESULTS A total of 107 cases were included. Mean follow-up was 7.1 years (range 1-13 years). The most frequent indication for STP-CI was chronic otitis media with/without cholesteatoma (32.7%), followed by open mastoid cavity (26.1%), and cochlear ossification (17.7%). Other difficult conditions where STP facilitates successful implantation include inner-ear malformations, temporal-bone trauma, unfavorable anatomic conditions, and revision surgery. A planned staged procedure was performed in 3 cases. The rate of major complications was 5.6% (n = 6). Three patients developed postauricular wound dehiscence which eventually resulted in device extrusion. No cases of recurrent/entrapped cholesteatoma, EAC breakdown, or meningitis were encountered. This is the largest single-center series of STP-CI reported in the literature. CONCLUSIONS When CI is intended in technically challenging cases or associated with a high risk of complications, STP is effective and reliable. Safe implantation and excellent long-term outcomes can be achieved provided surgical steps are properly followed. Single-stage procedures can be performed in most cases, even when there is active middle-ear disease.
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Affiliation(s)
- Golda Grinblat
- Department of Otorhinolaryngology, Hillel Yaffe Medical Center Affiliated to the Technion University Haifa, Hadera, Israel, .,Gruppo Otologico, Quaternary Referral Center for Otology, Neurotology and Skull Base Surgery, Piacenza, Italy,
| | - Diana Vlad
- Gruppo Otologico, Quaternary Referral Center for Otology, Neurotology and Skull Base Surgery, Piacenza, Italy.,Second Department of Otolaryngology, University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania
| | - Antonio Caruso
- Gruppo Otologico, Quaternary Referral Center for Otology, Neurotology and Skull Base Surgery, Piacenza, Italy
| | - Mario Sanna
- Gruppo Otologico, Quaternary Referral Center for Otology, Neurotology and Skull Base Surgery, Piacenza, Italy
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Yoon Y, Lee J, Chung JH, Park K, Kim B, Choi J. Cochlear Implantation in Patients with Chronic Suppurative Otitis Media: Surgical Outcomes and a Management Algorithm. Audiol Neurootol 2020; 25:151-157. [DOI: 10.1159/000505509] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 12/17/2019] [Indexed: 11/19/2022] Open
Abstract
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.
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The Value of Diffusion-Weighted MRI in the Long-term follow-up After Subtotal Petrosectomy for Extensive Cholesteatoma and Chronic Suppurative Otitis Media. Otol Neurotol 2020; 40:e25-e31. [PMID: 30531639 DOI: 10.1097/mao.0000000000002049] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To report the long-term follow-up with diffusion-weighted magnetic resonance imaging (DW MRI) after subtotal petrosectomy (SP) with blind sac closure of the external auditory canal for extensive cholesteatoma and chronic suppurative otitis media. STUDY DESIGN Retrospective clinical record study. SETTING Tertiary referral center. PATIENTS Thirty-one patients (31 ears) with extensive cholesteatoma and 17 patients (19 ears) with chronic suppurative otitis media without cholesteatoma who underwent SP between July 1995 and December 2015. INTERVENTIONS All 48 patients were followed clinically and with DW MRI to rule out residual cholesteatoma. MAIN OUTCOME MEASURE Residual cholesteatoma, indicated by a marked hyperintensity on non-echoplanar (non-EP) DW MRI. RESULTS In the cholesteatoma group the mean interval between surgery and the latest DW MRI was 3.9 years. Seven patients presented with a residual cholesteatoma pearl. The mean interval between surgery and detection of residual disease was 3.7 years. In the chronic suppurative otitis media group the mean interval between surgery and the latest DW MRI was 5.3 years. Residual cholesteatoma was found in three patients. Mean interval between surgery and the detection of disease was 4.5 years. CONCLUSIONS This study shows the importance of DW MRI in the follow-up after SP for cholesteatoma and chronic suppurative otitis media. A little higher residual cholesteatoma rate was found compared with earlier studies, where patients were followed only clinically. One may wonder whether reintervention is always needed or whether in selected cases with small pearls, one may still observe these by a watchful waiting policy with DW MRI.
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Lee JH. Healing acceleration of mastoidectomy through the external auditory canal incisionless approach. Eur Arch Otorhinolaryngol 2019; 276:2983-2990. [PMID: 31346720 DOI: 10.1007/s00405-019-05578-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 07/17/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To evaluate a surgical procedure of canal wall-up mastoidectomy without incision of the canal which enables accelerated healing and enhances hearing outcome. METHODS A total of 79 patients were enrolled. A canal-incisionless technique was used in 37 patients undergoing canal wall-up/down mastoidectomy (CWU/DM), explo-mastoidectomy, and cochlea implantation as staged operation after obliteration of the mastoid, and canal incision was used in the remaining 42 patients as comparison group. RESULTS Preoperative and postoperative pure tone audiometry/word recognition score and postoperative status including the healing time and complications were analyzed. Healing time of the canal-incisionless procedure (2.7 weeks) was shorter than that of conventional mastoidectomy with canal incision (5.7 weeks). Complication rate of the canal-incisionless procedure was lower than that of canal incision approach, even though statistical meaningless. CONCLUSION Despite the small sample size of our study, in patients undergoing CWDM, explo-mastoidectomy, and cochlea implantation, more acceptable healing was achieved using the canal-incisionless technique than with the canal incision technique. CWU/DM without canal incision is useful to achieve optimal surgical view, eliminate pathology of the middle ear, and accelerate healing time.
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Affiliation(s)
- Jun Ho Lee
- Department of Otorhinolaryngology and Head and Neck Surgery, Chucheon Sacred Heart Hospital, Hallym University College of Medicine, 77, Sakju-ro, Chuncheon, Gangwon-do, 200-704, Republic of Korea.
- Department of Otorhinolaryngology and Head and Neck Surgery, Hangang Sacred Heart Hospital, Hallym University Medical Center, Seoul, Republic of Korea.
- Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon, Republic of Korea.
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Cochlear Implantation in Chronic Otitis Media With Cholesteatoma and Open Cavities: Long-term Surgical Outcomes. Otol Neurotol 2018; 39:45-53. [PMID: 29227448 DOI: 10.1097/mao.0000000000001624] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate the long-term surgical outcomes of cochlear implantation (CI) in chronic otitis media (COM) with cholesteatoma and open cavities using subtotal petrosectomy (STP). To review device explantation (DE) patients and reimplantation considerations. STUDY DESIGN Retrospective review. SETTING Otology and skull base center. PATIENTS AND METHODS Charts of 35 patients (36 ears) with COM with cholesteatoma, including open cavities, who underwent CI were reviewed for surgical outcomes and DE. Patient demographics, pathologies, previous surgeries, staging of implantation, salient intraoperative findings at the time of implantation and follow-up were evaluated. Details of patients with DE were evaluated for cause, operative findings, and reimplantation considerations. RESULTS Mean age of patients was 65.94 years. Nineteen open cavities, 11 primary cholesteatomas, 3 petrous bone cholesteatomas, and 3 atelectatic middle ears represented the pathologies with 31 patients of CI with concurrent STP and 5 patients where implantation was staged. The mean follow-up was 7.16 years ranging from 2 to 13 years. Four patients (11%) had DE due to extrusion and cavity infection with three reimplanted in same or contralateral ear. All explantations occurred within 24 months of primary implantation. No residual or recurrent cholesteatoma was observed in any of the patients during follow-up. CONCLUSION CI is feasible in COM with cholesteatoma and open cavities with the use of STP and single-stage implantation can be performed in the absence of purulence. Despite low risk of residual cholesteatoma post meticulous disease removal, risk of DE remains, particularly in open cavity patients, and is higher than standard implantation. Reimplantation is often possible with careful considerations.
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24
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Altuna X, García L, Martínez Z, de Pinedo MF. The role of subtotal petrosectomy in cochlear implant recipients. Eur Arch Otorhinolaryngol 2017; 274:4149-4153. [DOI: 10.1007/s00405-017-4762-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 10/04/2017] [Indexed: 11/25/2022]
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Lyu AR, Park YH. Blind Sac Approach Using Silastic Block for Cochlear Implantation in Patients with Cholesteatoma. J Audiol Otol 2017; 21:152-155. [PMID: 28942633 PMCID: PMC5621791 DOI: 10.7874/jao.2017.00206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 08/22/2017] [Accepted: 08/22/2017] [Indexed: 11/22/2022] Open
Abstract
Cochlear implant (CI) surgery in cholesteatoma is challenging because of the risk of residual or recurrent infection. Although CI could be done with subtotal petrosectomy in single or staged surgery, this surgery needed additional surgical procedures to obliterate the mastoid cavity. This paper describes a new surgical technique for CI surgery in cholesteatoma without external auditory canal closure.
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Affiliation(s)
- Ah-Ra Lyu
- Department of Medical Science, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Yong-Ho Park
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Chungnam National University, Daejeon, Korea.,Brain Research Institute, College of Medicine, Chungnam National University, Daejeon, Korea
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26
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Prasad SC, Roustan V, Piras G, Caruso A, Lauda L, Sanna M. Subtotal petrosectomy: Surgical technique, indications, outcomes, and comprehensive review of literature. Laryngoscope 2017; 127:2833-2842. [DOI: 10.1002/lary.26533] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Revised: 01/18/2017] [Accepted: 01/23/2017] [Indexed: 11/11/2022]
Affiliation(s)
| | - Valeria Roustan
- Department of Otology and Skull Base Surgery; Otological Group; Piacenza-Rome Italy
| | - Gianluca Piras
- Department of Otology and Skull Base Surgery; Otological Group; Piacenza-Rome Italy
| | - Antonio Caruso
- Department of Otology and Skull Base Surgery; Otological Group; Piacenza-Rome Italy
| | - Lorenzo Lauda
- Department of Otology and Skull Base Surgery; Otological Group; Piacenza-Rome Italy
| | - Mario Sanna
- Department of Otology and Skull Base Surgery; Otological Group; Piacenza-Rome Italy
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Impact of Chronic Suppurative Otitis Media in Pediatric Cochlear Implant Recipients-Insight into the Challenges from a Tertiary Referral Center in UK. Otol Neurotol 2017; 38:672-677. [PMID: 28333779 DOI: 10.1097/mao.0000000000001372] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Analyze the presentation and evolution of chronic suppurative otitis media (CSOM) in children with cochlear implants (CI) and explore the merit of early intervention. STUDY DESIGN Retrospective patient review. SETTING Tertiary referral hospital and cochlear implant programme. PATIENTS Children with a CI who developed CSOM. INTERVENTION Tympanoplasty. MAIN OUTCOME MEASURES Disease control, recurrence of cholesteatoma, cochlear implant preservation. RESULTS Eight children fit our inclusion criteria with a mean follow up of 8 years. Onset of CSOM symptoms was observed on an average of 5 years after implantation (range, 2-13 yr) and led to surgical intervention in an average of 15.6 months following symptom onset. Cholesteatoma was found in four of the eight patients. Of these, one patient underwent a subtotal petrosectomy and explantation with reimplantation at the same stage but the reimplant failed to function and was explanted subsequently. One patient was initially managed by a canal wall up mastoidectomy and explantation but went on to require subtotal petrosectomy and labyrinthectomy for recurrent disease. One patient underwent a subtotal petrosectomy with explantation and is awaiting a reimplantation. The fourth patient had limited disease around the electrodes that was excised without compromising the implant. In the group of patients with CSOM without cholesteatoma, one underwent an explantation due to recurrent ear infections and a subsequent cartilage tympanoplasty for a retracted eardrum. The remaining three patients underwent successful excision of retraction pockets and repair of eardrums using cartilage with the implant in situ. A mean follow up of 2 years after the implant preservation surgeries shows good functioning of the CI. CONCLUSION Early recognition of CSOM is paramount in patients with CI as delay in treatment can result in the infection spreading via the cochleostomy resulting in loss of the cochlea. Recurrent ear infections in an implanted ear should prompt early examination to exclude the presence of middle ear disease, which may require anesthesia in a young child.
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Hunter JB, Haynes DS, Fernando SJ, Bennett ML, Wanna GB. Response to Cochlear Implants in Canal Wall-Down Mastoidectomies. Otolaryngol Head Neck Surg 2017; 156:583-584. [PMID: 28248605 DOI: 10.1177/0194599816686945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Linder TE. Cochlear Implants in Canal Wall-Down Mastoidectomies. Otolaryngol Head Neck Surg 2017; 156:583. [PMID: 28248606 DOI: 10.1177/0194599816686944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Hunter JB, O’Connell BP, Wanna GB. Systematic Review and Meta-analysis of Surgical Complications following Cochlear Implantation in Canal Wall Down Mastoid Cavities. Otolaryngol Head Neck Surg 2016; 155:555-63. [DOI: 10.1177/0194599816651239] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 05/03/2016] [Indexed: 11/15/2022]
Abstract
Objective We sought to assess the complication rates following cochlear implantation in canal wall down mastoid cavities in adults and children. Data Sources A systematic review of English articles from PubMed, Web of Science, EMBASE, and the Cochrane Library. Additional studies were identified by reviewing the reference lists of the originally identified studies. Review Methods Studies were included that reported on surgical outcomes following cochlear implantation in canal wall down mastoid cavities. Two authors, using predefined data fields, independently reviewed all articles while tabulating study quality indicators. A meta-analysis of proportions was conducted on select cohorts to determine weighted complication rates. Results Forty-two articles were included that accounted for 424 patients and described surgical outcomes following cochlear implantation in canal wall down mastoid cavities. In a comparison of the postoperative complication rates, overclosing the external auditory meatus had significantly fewer global complications than did maintaining a canal wall down mastoid cavity ( P = .027). In a comparison of the complication rates (1) between staging the cochlear implantation and performing external auditory meatus overclosure simultaneously with cochlear implantation and (2) between pediatric and adult cochlear implantation recipients with external auditory meatus overclosure, there were no significant differences ( P = .085 and P = .92, respectively). Conclusion Overclosing the external auditory meatus at the same time of cochlear implantation leads to significantly fewer complications when compared with maintaining a canal wall down mastoid cavity with soft tissue coverage of the electrode array.
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Affiliation(s)
- Jacob B. Hunter
- The Otology Group, Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Brendan P. O’Connell
- The Otology Group, Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - George B. Wanna
- The Otology Group, Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Sugimoto H, Hatano M, Noda M, Hasegawa H, Yoshizaki T. Cochlear implantation in deaf patients with eosinophilic otitis media using subtotal petrosectomy and mastoid obliteration. Eur Arch Otorhinolaryngol 2016; 274:1173-1177. [DOI: 10.1007/s00405-016-4091-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 05/06/2016] [Indexed: 10/21/2022]
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Lyutenski S, Schwab B, Lenarz T, Salcher R, Majdani O. Impact of the surgical wound closure technique on the revision surgery rate after subtotal petrosectomy. Eur Arch Otorhinolaryngol 2016; 273:3641-3646. [DOI: 10.1007/s00405-016-4005-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 03/21/2016] [Indexed: 11/28/2022]
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Hunter JB, Fernando SJ, Bennett ML, Haynes DS, Wanna GB. Cochlear Implantation in Canal Wall Down Mastoid Cavities. Otolaryngol Head Neck Surg 2016; 155:312-6. [PMID: 26980904 DOI: 10.1177/0194599816641064] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 02/02/2016] [Indexed: 11/17/2022]
Abstract
Cochlear implantation in canal wall down mastoid (CWD) cavities is fraught with the issue of how best to manage the mastoid cavity. Decision points include whether the external auditory meatus should be overclosed, whether the implantation should be staged, or even if the eustachian tube should be plugged. Given these options, we sought to describe our experience of cochlear implantation in CWD cavities. Among evaluation of subjects ≥18 years of age, 9 had cochlear implants placed in CWD mastoid cavities, 7 of which had the external auditory meatus overclosed, while 2 maintained open cavities following implantation. With an average follow-up of 36.7 months (median, 22.8 months), 2 subjects who had overclosure developed meatal dehiscences requiring further intervention, while no complications were observed in the 2 patients who maintained open cavities.
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Affiliation(s)
- Jacob B Hunter
- The Otology Group, Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Shanik J Fernando
- The Otology Group, Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Marc L Bennett
- The Otology Group, Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - David S Haynes
- The Otology Group, Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - George B Wanna
- The Otology Group, Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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