Cochlear implantation in patients with chronic otitis: Indications for subtotal petrosectomy and obliteration of the middle ear

Normally, active chronic suppurative otitis media is regarded as a contra-i ndication for cochlear implantation. In case of a radical cavity after surg ical treatment for cholesteatoma, the electrode covered by the epithelial l ining of the mastoid will likely become exposed or extruded. Under these ci rcumstances we suggested the subtotal petrosectomy, obliteration of the mid dle ear cleft with abdominal fat, and the blindsac closure of the external ear canal before cochlear implantation. Fourteen patients with chronic otitis media were successfully implanted wit h an intra-cochlear multichannel cochlear implant. After an average follow- up of 28 months a temporary facial palsy in one patient and an insufficient closure of a retroauricular fistula over the mastoid cavity in two cases w ere observed as postoperative complications. One patient with a tumefactive inflammatory pseudotumor developed a massive inflammation in the implants ear 2 months after surgery which could not be controller by conservative tr eatment. The implant had to be removed and after administration of cyclopho sphamide she could be successfully reimplanted 7 months later. Implantation of a foreign body in a potentially infected space which commun icated with the endocranium means a surgical challenge which can be managed by obliteration of the middle ear. In the case of massive inflammation we prefer a two-staged procedure.