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Di Bari M, Law-Ye B, Bernardeschi D, Lahlou G, Sterkers O, Colombo G, Mosnier I, Alciato L. Long-term clinical and radiological results for fat graft obliteration in subtotal petrosectomy and cochlear implant surgery: a retrospective clinical study. Eur Arch Otorhinolaryngol 2024; 281:1789-1798. [PMID: 37906365 DOI: 10.1007/s00405-023-08297-y] [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: 08/02/2023] [Accepted: 10/17/2023] [Indexed: 11/02/2023]
Abstract
PURPOSE The study aimed to evaluate the long-term clinical, radiological, and functional results for subtotal petrosectomy and cochlear implant surgery with closure of the external auditory canal and fat obliteration. METHODS We retrospectively included all consecutive cases of simultaneous subtotal petrosectomy and cochlear implant surgery performed at a tertiary referral center between 2009 and 2016 using the same surgical technique. All patients underwent postoperative high-resolution computed tomography (HRCT) and annual audiological assessments. A 5-year minimum clinical, radiological, and audiological follow-up was performed. The early and late postoperative results were compared. The main outcome measures were complications, postauricular retraction, fat graft reabsorption, and audiological outcomes. RESULTS Twenty-nine procedures performed in 23 patients (six bilateral) met the inclusion criteria. The mean age of the patients was 67 ± 13.4 years and mean follow-up duration was 7.5 ± 2 years. At follow-up, postauricular retraction was detected in 24 cases (82.8%), including five cases (17.1%) with subcutaneous protrusion of implant and array. Fat graft volume was significantly reduced at late-HRCT in terms of maximum diameter (2.24 ± 1.0 cm vs 3.69 ± 0.7 cm; p < 0.0005) and surface area (1.88 ± 1.2 vs 4.24 ± 1.6 cm2, p < 0.0005). Six patients had extracochlear electrodes at late-HRCT (3/6 had an increased number of extracochlear electrodes), with a lowering of this group's performance of - 15% (p < 0.005) in the follow-up speech comprehension test. CONCLUSIONS Subtotal petrosectomy with cochlear implantation is an effective long-term technique in selected cases. Fat grafts showed significant reabsorption at long-term follow-up with reaeration of the middle ear spaces. Prolonged clinical and radiological follow-up is recommended for monitoring implant performances and late complications.
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Affiliation(s)
- Matteo Di Bari
- Unité Fonctionnelle Implants Auditifs, ORL, Service d'Oto-Rhino-Laryngologie, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, 75013, Paris, France
- Humanitas University, Via Rita Levi Montalcini, 4, 20090, Pieve Emanuele, MI, Italy
| | - Bruno Law-Ye
- AP-HP, Neuroradiology Department, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, 75013, Paris, France
| | - Daniele Bernardeschi
- Unité Fonctionnelle Implants Auditifs, ORL, Service d'Oto-Rhino-Laryngologie, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, 75013, Paris, France.
| | - Ghizlène Lahlou
- Unité Fonctionnelle Implants Auditifs, ORL, Service d'Oto-Rhino-Laryngologie, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, 75013, Paris, France
- Technologies et therapie genique pour la Surdité, Institut de l'audition, Institut Pasteur/Inserm/Université Paris Cité, 75012, Paris, France
| | - Olivier Sterkers
- Unité Fonctionnelle Implants Auditifs, ORL, Service d'Oto-Rhino-Laryngologie, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, 75013, Paris, France
| | - Giovanni Colombo
- Humanitas University, Via Rita Levi Montalcini, 4, 20090, Pieve Emanuele, MI, Italy
- Otorhinolaryngology, Head and Neck Department, Ospedale Nuovo di Legnano, ASST Ovest Milanese, Via Papa Giovanni Paolo II, 20025, Legnano, MI, Italy
| | - Isabelle Mosnier
- Unité Fonctionnelle Implants Auditifs, ORL, Service d'Oto-Rhino-Laryngologie, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, 75013, Paris, France
- Technologies et therapie genique pour la Surdité, Institut de l'audition, Institut Pasteur/Inserm/Université Paris Cité, 75012, Paris, France
| | - Lauranne Alciato
- Unité Fonctionnelle Implants Auditifs, ORL, Service d'Oto-Rhino-Laryngologie, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, 75013, Paris, France
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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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Pepe G, Franzini S, Guida M, Falcioni M. Subtotal petrosectomy and cochlear implantation: Revision surgery. Am J Otolaryngol 2022; 43:103333. [PMID: 34922779 DOI: 10.1016/j.amjoto.2021.103333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 12/09/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Giovanni Pepe
- Otolaryngology and Otoneurosurgery Department, Azienda Ospedaliero-Universitaria di Parma, Italy.
| | - Sebastiano Franzini
- Otolaryngology and Otoneurosurgery Department, Azienda Ospedaliero-Universitaria di Parma, Italy
| | - Maurizio Guida
- Otolaryngology and Otoneurosurgery Department, Azienda Ospedaliero-Universitaria di Parma, Italy
| | - Maurizio Falcioni
- Otolaryngology and Otoneurosurgery Department, Azienda Ospedaliero-Universitaria di Parma, Italy
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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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Gülhan Yaşar N, Karamert R, Tutar H, Uğur MB, Hazır B, Bayazıt YA. Cochlear Implantation in Chronic Otitis Media with and without Cholesteatoma: Surgical Considerations and Auditory Outcomes. ORL J Otorhinolaryngol Relat Spec 2021; 83:280-285. [PMID: 33784673 DOI: 10.1159/000513890] [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: 09/26/2020] [Accepted: 12/17/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Cochlear implant (CI) surgery is a safe and standardized procedure in the presence of normal temporal bone anatomy. However, in the surgery of patients with chronic otitis media (COM), the surgeon may encounter several problems. The aim of this study was to evaluate the impact of COM with and without cholesteatoma on surgical and auditory outcomes of CIs. METHODS The study group consisted of 39 patients with COM who received CIs. Age- and gender-matched 38 standard CI patients served as controls. The surgical techniques and complications, pure tone audiometry (PTA) scores, speech discrimination scores (SDS), and the International Outcome Inventory for Hearing Aids (IOI-HA) questionnaire results of the groups were compared. RESULTS The presence of COM was associated with a higher rate of complication than controls. Staging the surgeries, presence or absence of cholesteatoma, and type of surgical technique were not associated with surgical outcomes and complications (p > 0.05). There was no significant difference between the groups in terms of postoperative PTA scores, SDS, and IOI-HA scores (p > 0.05). CONCLUSION Postoperative complications like device failure and skin breakdown are increased in cases of COM compared to standard CI surgeries. However, that increase is not associated with staging the surgeries, presence or absence of cholesteatoma, and type of ear surgery performed. It is advocated to close the external ear canal and eustachian tube without mastoid obliteration in the presence of a radical mastoidectomy cavity, which will decrease the postoperative complication rates and allow for radiological follow-up with computed tomography for the possibility of cholesteatoma recurrence. The auditory benefits of CI in patients with and without COM are comparable.
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Affiliation(s)
- Nagihan Gülhan Yaşar
- Department of Otolaryngology, Faculty of Medicine, Gazi University, Ankara, Turkey.,Department of Otolaryngology, Ankara City Hospital, Ankara, Turkey
| | - Recep Karamert
- Department of Otolaryngology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Hakan Tutar
- Department of Otolaryngology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Mehmet Birol Uğur
- Department of Otolaryngology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Burak Hazır
- Department of Otolaryngology, Faculty of Medicine, Gazi University, Ankara, Turkey
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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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Lyutenski S, El‐Saied S, Schwab B. Impact of occlusive material and cochlea-carotid artery relation on eustachian tube occlusion in subtotal petrosectomy. Laryngoscope Investig Otolaryngol 2020; 5:1140-1146. [PMID: 33364405 PMCID: PMC7752035 DOI: 10.1002/lio2.478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 09/09/2020] [Accepted: 10/10/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To evaluate the success rate of eustachian tube (ET) occlusion in subtotal petrosectomy relative to the occlusive material used and to the varying protympanum anatomy, by means of standardized alignment of the cochlea-carotid artery relation on computed tomography images. PATIENTS AND METHODS All cases of subtotal petrosectomy carried out by the same surgeon at a tertiary care referral center were retrospectively evaluated. Only cases with available computed tomography prior to second stage cochlear or middle ear implantation were included. The occlusive material was either muscle tissue or oxidized regenerated cellulose in combination with bone wax. On 3D multiplanar image reconstruction, the varying topographic interrelation of the cochlea and the petrous carotid artery was measured and categorized into two groups: detachment or overlapping. RESULTS In 9 (31%) of the 29 included cases there was insufficient occlusion of the ET. In none of these cases was an infection of the fat filling in the obliterated cavity observed during the implantation procedure on second stage (average 10 months interval). The failure rate of both occlusion materials was almost the same (using muscle tissue, in 4 (33.3%) of 12 or oxidized regenerated cellulose, in 5 (29.4%) of 17 cases). It was also similar for both materials in each of the anatomic variation groups. CONCLUSIONS An incomplete occlusion of the ET alone does not appear to lead to an infection of the obliterated cavity. Autologous muscle tissue and oxidized regenerated cellulose had similar rates of ET occlusion failure. The topographical variance of the protympanum appears to have no direct influence on the success of the ET occlusion.
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Affiliation(s)
- Stefan Lyutenski
- Department of OtorhinolaryngologyHannover Medical SchoolHannoverGermany
- Department of OtorhinolaryngologyHelios Hospital Berlin‐BuchBerlinGermany
| | - Sabri El‐Saied
- Department of OtorhinolaryngologyHannover Medical SchoolHannoverGermany
- Department of Otolaryngology ‐ Head and Neck SurgerySoroka University Medical CenterBe'er ShevaIsrael
| | - Burkard Schwab
- Department of OtorhinolaryngologyHannover Medical SchoolHannoverGermany
- Department of OtorhinolaryngologyHelios Hospital HildesheimHildesheimGermany
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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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Kurkure R, Rayamajhi P, Castellino A, Dharmarajan S, Dham R, Natarajan K, Kameswaran M. Subtotal Petrosectomy in Cochlear Implant Surgery: Our Experience. Indian J Otolaryngol Head Neck Surg 2020; 72:320-325. [PMID: 32728542 DOI: 10.1007/s12070-020-01819-8] [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: 01/18/2020] [Accepted: 02/07/2020] [Indexed: 11/24/2022] Open
Abstract
Aims Subtotal petrosectomy (SP) with cochlear implant (CI) is required in certain specific situations in the management of patients who are candidates for cochlear implants. To study and review the indications, surgical issues, and complications of this procedure. Materials and Methods Retrospective review of all patients who underwent subtotal petrosectomy with cochlear implant during the period January 2010-December 2016 at a tertiary care and referral centre. Results 19 patients underwent 20 subtotal petrosectomy with cochlear implant during this period. One patient had simultaneous bilateral implantation. The indications were previous mastoid cavity in 7 patients, 5 patients had chronic otitis media, inner ear malformations in 3,ossified cochlea in 3 and unfavourable anatomy in 2 patients. Fat or musculoperiosteal flaps were used to obliterate the cavity. Ninety percent of patients underwent single stage surgery and ten percent underwent two stage procedure.Complications were seen in three patients (15%). Conclusion SP helps in isolating the cavity from external environment after removal of disease, improves the exposure and access, reduces risk of infection and cerebrospinal fluid (CSF) leaks and facilitates CI. Meticulous surgical technique will reduce the complications and long term follow up is needed to detect entrapped cholesteatoma. Subtotal petrosectomy with blind sac closure of external ear canal is required in certain specific situations. It is a safe and effective surgery with acceptable rate of complications.
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Affiliation(s)
- Rahul Kurkure
- Department of Otorhinolaryngology and Head-Neck Surgery, Army College of Medical Sciences and Base Hospital, Delhi Cantt, New Delhi, 110010 India
| | - Pabina Rayamajhi
- Madras ENT Research Foundation (Pvt) Ltd, 1, First Cross Street, Off Second Main Road, RA Puram, Chennai, Tamil Nadu 600028 India
| | - Ashish Castellino
- Madras ENT Research Foundation (Pvt) Ltd, 1, First Cross Street, Off Second Main Road, RA Puram, Chennai, Tamil Nadu 600028 India
| | - Sandhya Dharmarajan
- Madras ENT Research Foundation (Pvt) Ltd, 1, First Cross Street, Off Second Main Road, RA Puram, Chennai, Tamil Nadu 600028 India
| | - Ruchima Dham
- Madras ENT Research Foundation (Pvt) Ltd, 1, First Cross Street, Off Second Main Road, RA Puram, Chennai, Tamil Nadu 600028 India
| | - Kiran Natarajan
- Madras ENT Research Foundation (Pvt) Ltd, 1, First Cross Street, Off Second Main Road, RA Puram, Chennai, Tamil Nadu 600028 India
| | - Mohan Kameswaran
- Madras ENT Research Foundation (Pvt) Ltd, 1, First Cross Street, Off Second Main Road, RA Puram, Chennai, Tamil Nadu 600028 India
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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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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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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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Hernández S, Ospina JC, Gutiérrez-Gómez E, Rodríguez-Ruiz MT, Trujillo JG. Alternative techniques in cochlear implant surgery: Subtotal petrosectomy. Am J Otolaryngol 2020; 41:102338. [PMID: 31732318 DOI: 10.1016/j.amjoto.2019.102338] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 10/30/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To report and analyze three cases of subtotal petrosectomy (SP) in cochlear implant surgery at our institution, and establish the indications, surgical technique and complications encountered. MATERIALS AND METHOD A retrospective descriptive study is proposed, analyzing a series of three clinical cases of subtotal petrosectomy as surgical technique for cochlear implant surgery at San Ignacio University Hospital (Bogotá, Colombia) from year 2004 to 2019. RESULTS A total of three cases of subtotal petrosectomy as surgical technique in cochlear implant candidates were analyzed. The indications were the presence of a wide mastoid cavity after canal wall down mastoidectomy, extrusion of the electrode into the external auditory canal with a wide mastoid cavity and erosion of the posterior wall of the ear canal, and the presence of cholesteatoma in a cophotic ear with previous surgery. The ear canal was defunctionalized in all three cases; in two of them with obliteration of the Eustachian tube and in none of the cases the mastoid was obliterated. There was a single complication associated with the procedure corresponding to a small retention cholesteatoma in the skin of the obliterated duct sac, that didn't required surgical intervention. CONCLUSION Subtotal petrosectomy is a surgical alternative for cochlear implant surgery in patients with chronic ear pathology, wide cavities or cochlear implant extrusion, not associated to significant complications.
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Affiliation(s)
- Santiago Hernández
- Otolaryngology and Maxillofacial Surgery Department, San Ignacio University Hospital, Pontificia Universidad Javeriana, Bogotá, Colombia.
| | - Juan C Ospina
- Otolaryngology and Maxillofacial Surgery Department, San Ignacio University Hospital, Pontificia Universidad Javeriana, Bogotá, Colombia.
| | - Elisa Gutiérrez-Gómez
- Otolaryngology and Maxillofacial Surgery Department, San Ignacio University Hospital, Pontificia Universidad Javeriana, Bogotá, Colombia.
| | - María Teresa Rodríguez-Ruiz
- Otolaryngology and Maxillofacial Surgery Department, San Ignacio University Hospital, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Juan G Trujillo
- Otolaryngology and Maxillofacial Surgery Department, San Ignacio University Hospital, Pontificia Universidad Javeriana, Bogotá, Colombia
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Balk M, Schwarz D, Wolber P, Anagiotos A, Gostian AO. Cochlear implantation after canal wall down mastoidectomy — Outcomes after partial mastoid obliteration. Auris Nasus Larynx 2019; 46:487-492. [DOI: 10.1016/j.anl.2018.10.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 10/09/2018] [Accepted: 10/29/2018] [Indexed: 11/29/2022]
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Gao S, Jiang Y, Wang GJ, Li BC, Yuan YY, Gao B, Zhang D, Li J, Yu Q, Dai P. Cochlear implantation in patients with canal wall down mastoidectomy cavities. Acta Otolaryngol 2018; 138:993-997. [PMID: 30776266 DOI: 10.1080/00016489.2018.1500713] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Safe cochlear implantation (CI) is challenging in patients with a canal wall down (CWD) mastoidectomy cavity. OBJECTIVES We reviewed the outcomes of CI and proposed surgical management principles according to the presentation status of CWD mastoidectomy cavity. MATERIAL AND METHODS The cases of eight patients (nine ears) with CWD mastoidectomy cavity who underwent CI were retrospectively reviewed. The basis of the surgical decision, postoperative complications, and postimplant auditory performance were analysed. RESULTS In seven patients (eight ears), implantation was performed in a single stage; in six ears, the external auditory canal (EAC) was oversewn. In two patients with ossification, the electrode array was inserted into the scala tympani by drilling of the basal turn or in the second turn of the cochlea through a drill-out procedure. Seven patients had a follow-up of 12-50 months and one patient was lost to follow-up. None of the followed-up seven patients suffered complications. CONCLUSIONS CI is safe and effective in patients with profound hearing loss after radical mastoidectomy. In patients with CWD mastoidectomy cavity, CI does not cause a higher rate of postoperative complications relative to standard CI procedures. The outcome is excellent and comparable to that in the general CI population.
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Affiliation(s)
- Song Gao
- Department of Otolaryngology-Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China
- Department of Otolaryngology, the 175th Hospital of PLA, South-East Hospital Affiliated to Xiamen University, Zhangzhou, China
| | - Yi Jiang
- Department of Otolaryngology-Head and Neck Surgery, Fujian Provincial Hospital, Fuzhou, China
| | - Guo-Jian Wang
- Department of Otolaryngology-Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China
| | - Bei Cheng Li
- Department of Otolaryngology-Head and Neck Surgery, Chinese PLA General Hospital Hainan Branch, Sanya, China
| | - Yong-Yi Yuan
- Department of Otolaryngology-Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China
| | - Bo Gao
- Department of Otolaryngology-Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China
| | - Dejun Zhang
- Department of Otolaryngology-Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China
| | - Jianan Li
- Department of Otolaryngology-Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China
| | - Qian Yu
- Department of Otolaryngology-Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China
| | - Pu Dai
- Department of Otolaryngology-Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China
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Lenarz T. Cochlear implant - state of the art. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2018; 16:Doc04. [PMID: 29503669 PMCID: PMC5818683 DOI: 10.3205/cto000143] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Cochlear implants are the treatment of choice for auditory rehabilitation of patients with sensory deafness. They restore the missing function of inner hair cells by transforming the acoustic signal into electrical stimuli for activation of auditory nerve fibers. Due to the very fast technology development, cochlear implants provide open-set speech understanding 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.
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Affiliation(s)
- Thomas Lenarz
- Department of Otolaryngology, Head & Neck Surgery, Hannover Medical School, Hannover, Germany
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21
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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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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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Stevens SM, Crane R, Pensak ML, Samy RN. Middle Ear Obliteration with Blind-Sac Closure of the External Auditory Canal for Spontaneous CSF Otorrhea. Otolaryngol Head Neck Surg 2016; 156:534-542. [PMID: 28248604 DOI: 10.1177/0194599816678211] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Outcome Objectives To (1) identify unique features of patients who underwent middle ear/mastoid obliteration with blind-sac closure of the external auditory canal for spontaneous cerebrospinal fluid (CSF) otorrhea and (2) explore outcomes. Study Design Case series with chart review. Setting Tertiary care center. Subjects and Methods Adults treated for spontaneous cerebrospinal fluid otorrhea from 2007 through 2015 were reviewed and stratified into 2 groups based on the surgery performed: (1) 11 patients underwent middle ear/mastoid obliteration with blind-sac closure of the external auditory canal and (2) 26 patients underwent other procedures. Demographics, body mass index, revised cardiac risk index, Duke Activity Status Index scores, and anticoagulation use were documented. Audiologic data were gathered from pre- and postoperative visits. The primary outcome measure was leak recurrence. Complications were tabulated. Results Poor preoperative hearing was a relative indication for obliteration. Obliteration patients had higher body mass index (43.2 vs 34.9 kg/m2; P < .05), incidence of super-morbid obesity (45% vs 7.6%; P = .015), anticoagulation usage (36% vs 0%; P = .004), cardiac risk scores (1.2 vs 0.1 dB; P < .0004), and Duke Activity Status Index scores. There was 1 leak recurrence (9%). Major and minor complication rates were 9% and 36%, respectively. Mean follow-up was 30.8 ± 8.6 months. Conclusion Middle ear and mastoid obliteration with blind-sac closure of the external auditory canal is effective for treating spontaneous CSF otorrhea. The small cohort reviewed did not experience any major perioperative morbidity. The technique may be best suited for patients with poor hearing, the infirm, and those in whom craniotomy is contraindicated.
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Affiliation(s)
- Shawn M Stevens
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, USA.,2 Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati (UC) College of Medicine and Neurosensory Disorders Center at UC Gardner Neuroscience Institute, University of Cincinnati, Cincinnati, Ohio, USA
| | - Ryan Crane
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, USA.,2 Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati (UC) College of Medicine and Neurosensory Disorders Center at UC Gardner Neuroscience Institute, University of Cincinnati, Cincinnati, Ohio, USA
| | - Myles L Pensak
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, USA.,2 Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati (UC) College of Medicine and Neurosensory Disorders Center at UC Gardner Neuroscience Institute, University of Cincinnati, Cincinnati, Ohio, USA
| | - Ravi N Samy
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, USA.,2 Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati (UC) College of Medicine and Neurosensory Disorders Center at UC Gardner Neuroscience Institute, University of Cincinnati, Cincinnati, Ohio, USA
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The Use of Temporoparietal Fascial Flap to Eliminate Wound Breakdown in Subtotal Petrosectomy for Chronic Discharging Ears. Otol Neurotol 2016; 37:248-51. [PMID: 26808557 DOI: 10.1097/mao.0000000000000959] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To find out if the use of the vascularized temporo-parietal fascial flap (TPFF) reduces postoperative infection or wound breakdown in subtotal petrosectomy for chronic discharging ears. PATIENTS A retrospective review on 26 subtotal petrosectomies with blind pit closures on chronic discharging ears performed by a single surgeon between 2000 and 2015 was performed. All patients had a minimum follow-up period of 6 months. INTERVENTION Eleven mastoid cavities were obliterated with abdominal fat, and 15 cavities were obliterated with TPFF. There was no concomitant cochlear implant or middle ear implant. MAIN OUTCOME MEASURE(S) All postoperative wound infections or delay in wound healing were recorded into a database. The complication rates of the fat obliteration group were compared using Fisher's exact test with those for the TPFF obliteration group. RESULTS In the fat obliteration group, 4 out of 11 patients had documented postoperative complications. Three had wound breakdown with exposure of the fat that required revision surgery. Another patient had postauricular abscess without the wound actually broken down. On the other hand, all the ears in the TPFF obliteration group (100%) were completely free of wound infection, wound breakdown, or any complication. The difference between the two groups was statistically significant (p = 0.022). CONCLUSION Many authors have encountered postoperative infection or wound breakdown in subtotal petrosectomy with fat obliteration in the treatment of chronic otitis media. Using a richly vascularized temporo-temporal fascial flap to protect the blind pit closure in such patients reduces postoperative infection and wound breakdown.
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The role of subtotal petrosectomy in cochlear implantation. The Journal of Laryngology & Otology 2016; 130 Suppl 4:S35-40. [DOI: 10.1017/s0022215116000979] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractBackground:Subtotal petrosectomy combined with cochlear implantation is a procedure required in specific situations.Methods:A retrospective review of all cases of subtotal petrosectomy in cochlear implant surgery over a five-year period was performed. The indications, complications and outcomes for this procedure are outlined.Results:Sixteen patients underwent cochlear implantation in combination with subtotal petrosectomy and blind sac closure of the external auditory meatus from 2008 to 2013. Seventy-five per cent of these were completed as a two-stage procedure and 25 per cent as a single-stage procedure. The most common indications for the procedure were chronic otitis media, previous radical cavity, and for surgical access in challenging anatomy or in drill-out procedures. Mastoids were obliterated with fat or musculoperiosteal flaps. The complication rate relating to blind sac closure was 6 per cent. Cochlear implants were successfully placed in all cases and there was no incidence of device failure.Conclusion:For patients with chronic suppurative otitis media or existing mastoid cavities, subtotal petrosectomy with blind sac closure of the external auditory canal, closure of the eustachian tube, and cavity obliteration is an effective technique to facilitate safe cochlear implantation.
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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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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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Polo R, Del Mar Medina M, Arístegui M, Lassaletta L, Gutierrez A, Aránguez G, Prasad SC, Alonso A, Gavilán J, Sanna M. Subtotal Petrosectomy for Cochlear Implantation. Ann Otol Rhinol Laryngol 2015; 125:485-94. [DOI: 10.1177/0003489415620427] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: The purpose of this study was to review the indications for subtotal petrosectomy for cochlear implantation, report our management of complications, as well as review those technical factors that are critical for successful implantation. Methods: Patients (n = 104) that underwent subtotal petrosectomy with closure of the external auditory canal and obliteration of the cavity with abdominal fat in combination with cochlear implantation were analyzed. Results: The most frequent indication for subtotal petrosectomy was the existence of a previous canal wall down technique. Postoperative complications occurred in 13 patients (11.83%). Extrusion of the device took place in 5 cases (4.55%). Conclusions: Subtotal petrosectomy in cochlear implantation permits obtaining a cavity isolated from the external environment, and when needed, it improves the access and visibility during the surgical procedure. Subtotal petrosectomy is a safe technique, with a low rate of complications.
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Affiliation(s)
- Rubén Polo
- Otolaryngology Department, Hospital Ramón y Cajal, Madrid, Spain
| | | | - Miguel Arístegui
- Otolaryngology Department, Hospital Gregorio Marañón, Madrid, Spain
| | | | | | - Gracia Aránguez
- Otolaryngology Department, Hospital Gregorio Marañón, Madrid, Spain
| | | | - Antonio Alonso
- Otolaryngology Department, Hospital Ramón y Cajal, Madrid, Spain
| | - Javier Gavilán
- Otolaryngology Department, Hospital La Paz, Madrid, Spain
| | - Mario Sanna
- Otolaryngology Department, Gruppo Otologico, Piacenza, Italy
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Byaruhanga R, Roland JT, Buname G, Kakande E, Awubwa M, Ndorelire C, Namwagala J. A case report: the first successful cochlear implant in Uganda. Afr Health Sci 2015; 15:1342-8. [PMID: 26958040 DOI: 10.4314/ahs.v15i4.38] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
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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Affiliation(s)
- Richard Byaruhanga
- Department of Otolaryngology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - J Thomas Roland
- Department of Otolaryngology, Professor and Chair, New York University School of Medicine
| | - Gustav Buname
- Department of Otolaryngology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Emily Kakande
- Department of Otolaryngology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Michael Awubwa
- Department of Otolaryngology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Chris Ndorelire
- Department of Otolaryngology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Justine Namwagala
- Department of Otolaryngology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
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Schwab B, Kludt E, Maier H, Lenarz T, Teschner M. Subtotal petrosectomy and Codacs™: new possibilities in ears with chronic infection. Eur Arch Otorhinolaryngol 2015; 273:1387-91. [PMID: 26092235 DOI: 10.1007/s00405-015-3688-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 06/10/2015] [Indexed: 10/23/2022]
Abstract
Subtotal petrosectomy combined with obliteration of the tympanomastoid is a standard procedure to treat temporal bones in patients with radical cavity and chronic infections. Currently, patients with profound-to-severe sensorineural hearing loss are often fitted with cochlear implants. In the case of profound mixed hearing loss, active middle ear implants have been used successfully. The new Codacs™ system provides an effective treatment for patients with severe-to-profound mixed hearing loss; however, only aerated middle ears have been treated with this device. The question arises whether the Codacs™ can be implanted in patients with radical cavity or ears with chronic otorrhea. Of the 41 patients who were implanted with the Codacs™ at the department, 4 received the device after subtotal petrosectomy and obliteration with abdominal fat. Clinical and audiological results were assessed. The device was implanted without any complications in the obliterated subtotal petrosectomy. The preliminary results of the first two patients showed stable bone conduction thresholds and indicated improved speech intelligibility in quiet and noise. Implanting the Codacs™ device after subtotal petrosectomy and obliteration with abdominal fat has been proven to be a feasible and suitable procedure for patients with radical cavity or chronic otorrhea. The speech intelligibility outcome directly after activation was comparable to patients with aerated middle ears.
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Affiliation(s)
- Burkard Schwab
- Department of Otolaryngology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Eugen Kludt
- Department of Otolaryngology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Hannes Maier
- Department of Otolaryngology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Thomas Lenarz
- Department of Otolaryngology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Magnus Teschner
- Department of Otolaryngology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
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Szymański M, Ataide A, Linder T. The use of subtotal petrosectomy in cochlear implant candidates with chronic otitis media. Eur Arch Otorhinolaryngol 2015; 273:363-70. [PMID: 25708413 PMCID: PMC4733137 DOI: 10.1007/s00405-015-3573-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 02/17/2015] [Indexed: 11/28/2022]
Abstract
Cochlear implants (CI) candidates with chronic otitis media require special attention and management. The need of opening of the inner ear creates potential routes of spread of infection to subarachnoid spaces and lead to meningitis. The aim of the study was to analyse the technique and complications of subtotal petrosectomy (SP) in cochlear implant candidates with chronic otitis media at three different CI centres. A retrospective study was carried out in three Territory Referral Hospitals. The centres follow Fisch's philosophy and surgical techniques of SP. The study group consisted of 19 patients, 4 men and 15 women, aged 12-82 years. All patients underwent SP with either primary or staged CI implantation. Indications for single or a staged management, difficulties during surgery and complications were analysed. Skin and muscle flap design in primary and revision cases as well as imaging follow-up strategy are discussed. In 14 patients implantation was performed in a single stage and in 5 cases in two stages. Follow-up ranged from 8 months to 10 years. All the patients use their implants and there were no major nor minor complications. The use of subtotal petrosectomy with cochlear implants is a safe and efficient technique when strict surgical steps and rules are applied. Closure of the external ear canal after previous meatoplasty can be challenging and extreme care dissecting the skin flaps is required. In patients with extensive cholesteatoma, active discharge from the ear with resistant bacteria or an "unstable" situation, the procedure can be staged.
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Affiliation(s)
- Marcin Szymański
- Department of Otolaryngology, Head and Neck Surgery, Medical University of Lublin, Lublin, Poland.
| | - Andre Ataide
- Department of Otolaryngology, Pequeno Principe Children's Hospital, Curitiba, Brazil
| | - Thomas Linder
- Department of Otorhinolaryngology, Head and Neck Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
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Management options for cochlear implantation in patients with chronic otitis media. Am J Otolaryngol 2014; 35:703-7. [PMID: 25217370 DOI: 10.1016/j.amjoto.2014.08.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 07/29/2014] [Accepted: 08/14/2014] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Patients with chronic otitis media with/without cholesteatoma present a significant challenge to safe cochlear implantation (CI). The aim of our study is to describe our experience and propose management options for CI in patients with chronic otitis media. STUDY DESIGN Retrospective case study. SETTING Tertiary academic center. SUBJECT AND METHODS We enrolled the 9 ears of 8 subjects who received CI in the ear with chronic otitis media from 2006 to 2013 by a single surgeon. CI was performed as a single-stage or staged operation with mastoid surgery according to the activity of ear infection. RESULTS Six patients had bilateral chronic otitis media and 2 patients had long history of sensorineural hearing loss at contralateral ear. CI was performed with simultaneous radical mastoidectomy with closure of the EAC as a single-stage in 3 ears with a history of previous open cavity mastoidectomy and no active discharge. Staged CI was performed in 6 ears, after radical mastoidectomy with closure of the EAC in 3 ears and after intact canal wall mastoidectomy in 3 ears, due to active inflammation or complications related to otitis media. In one patient, wound infection had occurred, and implant was removed along with implantation at contralateral ear. Other subjects showed no evidence of recurrence. CONCLUSION Decision whether implantation as a single-stage or staged operation depends on the presence of active inflammation. Single-stage CI with proper mastoid surgery can be performed in patients without active inflammation. Staged procedure need to be done in ears with active inflammation. Proper application of mastoid surgery leads to safe CI for patients with chronic otitis media.
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VINCENTI V, PASANISI E, BACCIU A, BACCIU S, ZINI C. Cochlear implantation in chronic otitis media and previous middle ear surgery: 20 years of experience. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2014; 34:272-7. [PMID: 25210222 PMCID: PMC4157528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 02/13/2014] [Indexed: 11/23/2022]
Abstract
Cochlear implantation in the setting of chronic otitis media or previous middle ear surgery poses several problems for the surgeon: possible spread of infection to the cochlea and the subarachnoid spaces with consequent meningitis, risk of electrode array extrusion and possible recurrence of the original disease. Several surgical strategies have been proposed to overcome these problems. In the present study, clinical and functional results of cochlear implantation in 26 patients with chronic otitis media (8 cases) or previous middle ear surgery (18 cases) in the ear most suitable for implantation were retrospectively reviewed. Among the 8 patients with chronic otitis media, in 7 cases a subtotal petrosectomy associated with external auditory canal closure and mastoid and Eustachian tube obliteration was performed, while in the remaining patient cochlear implantation was done 6 months after a myringoplasty. The only complication observed was a reperforation of the tympanic membrane in this latter patient. Among the 18 patients with previous middle ear surgery, 2 had undergone intact canal wall tympanomastoidectomy and were implanted utilising the previous surgical approach. In the remaining 16 patients who had a radical cavity, an open technique was maintained in 3 cases; a cavity revision associated to external auditory canal closure, Eustachian tube and mastoid obliteration was performed in 12 patients, while in one case a middle cranial fossa approach was utilised. Two of the 3 patients in whom an open technique was maintained have experienced electrode array extrusion. The only complication observed in the remaining patients was the breakdown of the external auditory canal closure in one case. No problems were noted in patients who had undergone intact canal wall tympanomastoidectomy as well as in the subject implanted via the middle cranial fossa approach. All patients achieved and maintained good hearing performance over time. Subtotal petrosectomy associated with external auditory canal closure, Eustachian tube occlusion and mastoid obliteration is an effective procedure to facilitate cochlear implantation in presence of chronic otitis media. The open cavity technique offers the advantage of a close clinical examination, but may expose the patient to the risk of electrode array extrusion, mainly in the long-term period.
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Affiliation(s)
- V. VINCENTI
- Address for correspondence: Vincenzo Vincenti, Unit of Audiology and Pediatric Otorhinolaryngology, Department of Clinical and Experimental Medicine, University of Parma, Via Gramsci 14, 43126 Parma, Italy. Tel. +39 0521 703204. Fax: +39 0521 290157. E-mail:
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Subtotal petrosectomy and mastoid obliteration in adult and pediatric cochlear implant recipients. Otol Neurotol 2014; 34:1656-9. [PMID: 24136310 DOI: 10.1097/mao.0b013e3182a006b6] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate the effect of subtotal petrosectomy and mastoid obliteration (SPMO) on the overall success of adult and pediatric cochlear implant (CI) recipients. STUDY DESIGN Retrospective case series. SETTING Tertiary care referral center. PATIENTS Thirty-nine ears in 36 patients (23 adults and 13 children) received both surgeries between 1990 and 2012. INTERVENTION CI candidates underwent SPMO to permit implantation and minimize the risks of infectious complications in the recipient ear. SPMO was performed before (69.3%), at the time of (25.6%), and after CI (5.13%). Mastoids were obliterated with fat (30.8%), muscle (66.7%), and bone pate (2.56%). MAIN OUTCOME MEASURE Feasibility, complications, and success of SPMO and CI were assessed with standard statistical analysis and Fisher's exact test with 2-sided p values. RESULTS Ear disease was definitively managed, and CI was successfully placed in all but one case. Complications including abscess (n = 3), subcutaneous emphysema (n = 1), ear canal granulation formation (n = 1), and electrode extrusion (n = 1) occurred in 15.4% of patients. Predisposing syndromes were present in children more often than adults (43.8% versus 13.0%, p = 0.0598). Adults more often than children had previous mastoid surgery for middle ear disease (30.4% versus 0.0%, p = 0.0288). CIs were placed under local anesthetic and sedation (n= 3) and after radiation treatment for nasopharyngeal cancer (n = 2) in adult ears. CONCLUSION SPMO is an effective and safe procedure for definitively managing middle ear disease and implanting adult and pediatric CI candidates.
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Active Middle Ear Implant After Lateral Petrosectomy and Radiotherapy for Ear Cancer. Otol Neurotol 2014; 35:e146-52. [DOI: 10.1097/mao.0b013e31829e16bb] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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The role of subtotal petrosectomy in cochlear implant surgery--a report of 32 cases and review on indications. Otol Neurotol 2014; 34:1033-40. [PMID: 23856625 DOI: 10.1097/mao.0b013e318289841b] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To report and review 32 cases of subtotal petrosectomy (SP) in cochlear implant (CI) surgery and to define the indications and contraindications for this procedure. STUDY DESIGN Retrospective case review + case reports. SETTING Tertiary skull base center. PATIENTS Cochlear implant database: 32 subtotal petrosectomies in 31 patients. INTERVENTIONS Subtotal petrosectomy with blind sac closure of the external auditory canal, closure of Eustachian tube, and abdominal fat obliteration in combination with cochlear implantation. RESULTS Indications for SP in CI surgery were as follows: chronic otitis media (n = 4), previous radical cavity (n = 13), previous subtotal petrosectomy (n = 4), ossification of the cochlea (n = 5), malformation of the inner ear (n = 2), and temporal bone fracture (n = 4). One patient was simultaneously bilaterally implanted; 2 cases were revisions. All procedures were performed in 1 stage. In 2 cases, complications were encountered (6%), one of which lead to reoperation (3%). None of the patients was explanted. CONCLUSION Subtotal petrosectomy combined with cochlear implantation is a procedure required in specific situations and lowers the risk of repetitive ear infections, CSF leakage, and meningitis by closing off all connection with the external environment. Additionally, it gives excellent visibility and access in difficult anatomy or in drill-out procedures. The complication rate of 6% is comparable with normal cochlear implantation. Preservation of residual hearing can be considered the only absolute contraindication as an open external meatus is necessary for use of electroacoustic stimulation. Risks of the SP+CI procedure are infection of the abdominal fat, breakdown of the blind sac closure, and entrapped cholesteatoma. Follow-up with CT imaging is therefore mandatory.
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Bittencourt AG, Tsuji RK, Tempestini JPR, Jacomo AL, Bento RF, Brito RD. Cochlear implantation through the middle cranial fossa: a novel approach to access the basal turn of the cochlea. Braz J Otorhinolaryngol 2013; 79:158-62. [PMID: 23670319 PMCID: PMC9443918 DOI: 10.5935/1808-8694.20130028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2011] [Accepted: 01/13/2013] [Indexed: 11/20/2022] Open
Abstract
UNLABELLED The classic approach for cochlear implant surgery includes mastoidectomy and posterior tympanotomy. The middle cranial fossa approach is a proven alternative, but it has been used only sporadically and inconsistently in cochlear implantation. OBJECTIVE To describe a new approach to expose the basal turn of the cochlea in cochlear implant surgery through the middle cranial fossa. METHOD Fifty temporal bones were dissected in this anatomic study of the temporal bone. Cochleostomies were performed through the middle cranial fossa approach in the most superficial portion of the basal turn of the cochlea, using the meatal plane and the superior petrous sinus as landmarks. The lateral wall of the internal acoustic canal was dissected after the petrous apex had been drilled and stripped. The dissected wall of the inner acoustic canal was followed longitudinally to the cochleostomy. RESULTS Only the superficial portion of the basal turn of the cochlea was opened in the fifty temporal bones included in this study. The exposure of the basal turn of the cochlea allowed the visualization of the scala tympani and the scala vestibuli, which enabled the array to be easily inserted through the scala tympani. CONCLUSION The proposed approach is simple to use and provides sufficient exposure of the basal turn of the cochlea.
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Indications and outcome of subtotal petrosectomy for active middle ear implants. Eur Arch Otorhinolaryngol 2012; 270:1243-8. [DOI: 10.1007/s00405-012-2113-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 07/05/2012] [Indexed: 11/26/2022]
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Bartoszewicz R, Niemczyk K, Morawski K, Bruzgielewicz A, Sokołowski J. [Lateral petrosectomy in pathology of the temporal bone]. Otolaryngol Pol 2010; 64:81-6. [PMID: 21171318 DOI: 10.1016/s0030-6657(10)70016-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Certain problems in ear surgery are caused by temporal bone cholestetoma and chronic otitis media complicated by deafness, facial nerve dysfunction, vertigo or meningcephalocele. Lateral petrosectomy offers possibility of radical treatment and prevention of temporal bone destruction and following complications. AIM OF STUDY It is an analysis of indications for lateral petrosectomy and it's results as a treatment of otitis media and temporal bone cholesteatoma. The possibility of synchronous cochlear implantation is noted. MATERIAL Retrospective analysis of 62 patients after lateral petrosectomy, operated in the Department of Otolaryngology at the Medical University of Warsaw in 2001-2009. The group consisted of thirty one men and thirty one women. RESULTS Thirty two patients suffered from chronic granuloma or chronic choleateatoma otitis media or temporal bone cholesteatoma. Seventeen patients suffered from deafness prior surgery. Cochlear implantation was possible in five patients: two of them after cranium fracture, two with deafness caused by chronic otitis media and one with deafness caused by osteoradionecrosis. Intraoperative CSF leak was observed of eight patients. In one case lateral perosectomy was used as a treatment of CSF leak after removal of cerebellopontine tumor. There was no evidence of CSF leak after surgery. Facial nerve dysfunction was observed in fifteen cases. CONCLUSIONS Lateral petrosectomy offers possibility of radical treatment in same patients with chronic otorrhea. The total removal of cholesteatoma prevents intracranial and intratemporal complications in case of chronic otitis media. Patients after lateral petrosectomy require systematic ENT and radiological (CT, NMR) examination.
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Kang WS, Song CI, Yoon TH. Cochlear implantations in patients with Cochlear fistulae. Otolaryngol Head Neck Surg 2010; 143:463-4. [PMID: 20723791 DOI: 10.1016/j.otohns.2010.04.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2010] [Revised: 04/06/2010] [Accepted: 04/16/2010] [Indexed: 10/19/2022]
Affiliation(s)
- Woo Seok Kang
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Postelmans JTF, Stokroos RJ, Linmans JJ, Kremer B. Cochlear implantation in patients with chronic otitis media: 7 years' experience in Maastricht. Eur Arch Otorhinolaryngol 2008; 266:1159-65. [PMID: 18982340 PMCID: PMC2704949 DOI: 10.1007/s00405-008-0842-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2008] [Accepted: 10/04/2008] [Indexed: 11/24/2022]
Abstract
The purpose of this paper is to propose management options for cochlear implantation in chronic
otitis media (COM) based on our 7-year experience. Thirteen patients with COM who were candidates for cochlear implantation were identified. COM was divided in an inactive and an active form based on clinical and radiological findings. One major complications and one minor complication were identified in the study group. In case of an active infection or in case of a unstable cavity we advise cochlear implantation as a staged procedure. A single stage procedure is recommended in case of patients with COM presenting with a dry perforation or a stable cavity.
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Affiliation(s)
- Job T F Postelmans
- Department of Otolaryngology, Maastricht University Medical Centre, The Netherlands.
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Pasanisi E, Vincenti V, Bacciu A, Guida M, Berghenti T, Barbot A, Zini C, Bacciu S. Multichannel cochlear implantation in radical mastoidectomy cavities. Otolaryngol Head Neck Surg 2002; 127:432-6. [PMID: 12447237 DOI: 10.1067/mhn.2002.129822] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We report on our experience in cochlear implantation in patients with radical mastoidectomy cavities. Study Design, Setting, and Methods: Retrospectively, records of patients from the Department of Otolaryngology, University of Parma between December 1991 and March 2000 were reviewed, and 6 postlingually deafened adults who received a cochlear implant in a radical cavity were identified. Speech performances were evaluated in terms of bisyllabic word and sentence recognition and common phrase comprehension. RESULTS To date, with a follow-up of 1 to 9 years, no patient has experienced extrusion of electrodes or other local or intracranial complications. Mean bisyllabic word and sentence recognition scores were 74% and 80%, respectively. Mean comprehension score for common phrases was 86%. CONCLUSION By obliterating and isolating the radical mastoidectomy cavity from the outer environment, patients who previously had undergone radical surgery of the middle ear can be safely implanted with satisfactory hearing results.
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