Management of far advanced otosclerosis in the era of cochlear implantation

Objective: To evaluate issues pertaining to cochlear implantation in patien ts with far advanced cochlear otosclerosis. Study Design: Prospective cohort. Setting: Tertiary care referral center. Patients: Eight adult patients (18 years of age or older) referred for mana gement of profound hearing loss, the cause of which was determined to be ot osclerosis. Intervention: Cochlear implantation with multichannel cochlear implant devi ce. Main Outcome Measures: Benefit from cochlear implant as measured by CID sen tence scores, incidence and management of facial nerve stimulation, and tec hnical issues pertaining to cochlear implantation in this patient populatio n. Results: All patients demonstrated significant improvement in auditory func tion as measured by performance on CID sentence scores and ability to engag e in telephone conversation. Facial nerve stimulation was present in two of eight patients and was managed with deactivation of the stimulating electr odes. Ossification in the basal turn of the cochlea, detected on preoperati ve computed tomography, necessitated placement of the electrode into the sc ala vestibuli in two patients and use of a thinner electrode (Nucleus 24) i n a third patient. Conclusion: Patients with profound hearing loss secondary to otosclerosis d erive excellent benefits from cochlear implantation. Surgical implantation may be complicated by ossification of the cochlea, which can be detected on preoperative computed tomography. Electrode activation may be complicated by facial nerve stimulation, which can be addressed with programming strate gies.