T. Himi et al., SURGICAL STRATEGY OF COCHLEAR IMPLANTATION IN PATIENTS WITH CHRONIC MIDDLE-EAR DISEASE, Audiology & neuro-otology, 2(6), 1997, pp. 410-417
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.