COCHLEAR IMPLANTATION AFTER SUBTOTAL PETROSECTOMIES

Among cochlear implant candidates there are patients who have abnormal middle and/or inner-ear conditions that make them unsuitable for impl antation. Insertion of a foreign body may also be contraindicated in t he setting of an existing or potential intracranial communication, or when the ear is prone to infection. Five patients presented with such unfavorable conditions. These included a Mondini dysplasia with persis tent cerebrospinal fluid leak, an atretic mastoid with meningocele, ch ronic otitis media, a transverse petrous bone fracture, and a temporal bone adenoma. All patients underwent subtotal petrosectomies and coch lear implantations. In four cases implantation was performed concomita ntly with subtotal petrosectomy, while the remaining case required a t wo-stage procedure. No complications occurred. The technique is descri bed in detail, and the cases and the indications for surgery are discu ssed. By obliterating and isolating the tympanomastoid cleft from the outer environment and utilizing the technique of subtotal petrosectomy , a broader spectrum of patients can now be implanted safely.