Long-term outcome of cochlear implant in patients with chronic otitis media: one-stage surgery is equivalent to two-stage surgery

The Chronological Evolution of Cochlear Implant Contraindications: A Comprehensive Review

Cochlear implantation has emerged as a transformative intervention in addressing profound hearing loss, offering a paradigm shift in auditory rehabilitation for individuals with restricted auditory function. Throughout its history, the understanding of contraindications for cochlear implant (CI) surgery has evolved significantly. This review comprehensively analyzes the chronological advancements in the understanding of CI contraindications, examining studies conducted from historical timelines to the present. Recent research has revealed significant developments in the field, prompting a reevaluation of established criteria and resulting in expanded indications for CI. The chronological evolution of contraindications underscores the transformative nature of the field, offering potential improvements in outcomes and enhancing the quality of life for individuals with profound hearing loss. In conclusion, this narrative review emphasizes the dynamic nature of the field, where the reevaluation of contraindications has created new opportunities and broader indications for CI. The emerging prospects, including improved outcomes and enhanced quality of life, hold promise for individuals with profound hearing loss.

Cochlear Implantation in Chronic Otitis Media with and without Cholesteatoma: Surgical Considerations and Auditory Outcomes

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.

Blind Sac Approach Using Silastic Block for Cochlear Implantation in Patients with Cholesteatoma

Cochlear implant (CI) surgery in cholesteatoma is challenging because of the risk of residual or recurrent infection. Although CI could be done with subtotal petrosectomy in single or staged surgery, this surgery needed additional surgical procedures to obliterate the mastoid cavity. This paper describes a new surgical technique for CI surgery in cholesteatoma without external auditory canal closure.

Surgical approaches to treating otitis media in the only hearing ear of patients with contralateral hearing loss

The aim of this study was to retrospectively analyze the surgical procedures used to treat the only hearing ears of two patient cohorts diagnosed with otitis media in the last twenty years. Clinical, surgical, and follow-up data of 15 patients with otitis media in the only hearing ear who underwent middle ear surgery prior to 2000 (Cohort A) and 13 patients with a similar condition (Cohort B) who underwent middle ear surgery between 2000 and 2013 were retrospectively collected, analyzed, and compared. Mean preoperative air conduction (AC) and bone conduction of the patients in Cohort B was 61 ± 18.7 and 20 ± 15.7 dBHL, respectively. Mean preoperative and postoperative air bone gap was 43.21 ± 13.2 dBHL and 12.66 ± 3.93 dBHL, respectively. The success rate of the surgical procedures in this patient cohort was 85%. Surgery of the only hearing ear in patients with otitis media is safe and effective if performed carefully.