SURGICAL STRATEGY OF COCHLEAR IMPLANTATION IN PATIENTS WITH CHRONIC MIDDLE-EAR DISEASE

We report 10 postlingually deafened adults in whom the electrophysical criteria for cochlear implant were fulfilled, except that they showed the following unfavorable middle ear lesions: otitis media with effus ion, chronic perforative otitis media, cholesteatoma and previous radi cal ear operation. Staged operations for cochlear implant were perform ed in 8 cases, and 2 patients who had undergone radical ear operation had a single-stage operation. As a first step, one of the following wa s performed in each patient as surgically indicated: myringoplasty wit h or without mastoidectomy, mastoidectomy with reconstruction of the p osterior wall of the external canal, mastoidectomy with the insertion of a ventilation tube, radical mastoidectomy or surgical cleansing of the radical cavity. From 6 months to 2.5 years after the first operati on, the actual cochlear implant was performed in the second or third s tage. There was no major complication as a result of electrode inserti on into the cochlea and the results of speech perception in these case s were not different from those in patients with normal middle ears. I n our experience, it was considered that the staged operations would e nable successful cochlear implants in selected patients with pathologi cal middle ear lesions even if they had previously been diagnosed as c ontraindicated for this procedure. In a case with radical ear cavity a single-stage operation could be performed when there was no cavity pr oblem.