Cochlear implantation in patients with chronic otitis media: 7 years’ experience in Maastricht

1. Cochlear implantation in patients with chronic otitis media:7 years’ experience in Maastricht POSTELMANS, J. Et. Al.. Eur Arch Otorhinolaryngol (2009) 266:1159–1165 POSTELMANS, J. Et. Al.. Eur Arch Otorhinolaryngol (2009) 266:1159–1165

2. Introduction • Cochlear implantation has been accepted as a safe and effective method for audiological rehab for hearing-impaired patient • One of the causes of sever sensorineural hearing loss is Chronic Otitis Media • Implantation may lead to colonization and subsequent implant extrusion or meningitis

3. Materials and Methods • Population consists of the patients who underwent cochlear implantation for COM between 2000 and Jan 2007 in Maastricht, • All patients were done by one surgeon • Candidates were evaluated for COM by a review of history, otoscopy, tympanometry and imaging techniques • Inactive forms of COM were defined as otologic evidences but no clinical and radiological evidence POSTELMANS, J. Et. Al.. Eur Arch Otorhinolaryngol (2009) 266:1159–1165

4. Active forms had a history of COM with clinical and radiological evidence of recent or current infection 6 months prior implantation • Patients were assessed with “Major” complications • Requiring further surgery • Hospitalization for treatment • And “minor” complications • Can be overcome by medical or audiological management POSTELMANS, J. Et. Al.. Eur Arch Otorhinolaryngol (2009) 266:1159–1165

5. Surgical management • All patients received antibiotic therapy based on ear swabs POSTELMANS, J. Et. Al.. Eur Arch Otorhinolaryngol (2009) 266:1159–1165

6. Results • Consisted of 6 males and 7 females • 2 patients had active inflammation with cholestatoma • Underwent combined approach tympanotomy with posterior tympanotomy to eradicate cholesteatoma prior to implantation • 3 patients had inactive form of COM • Underwent single staged cochlear implantation POSTELMANS, J. Et. Al.. Eur Arch Otorhinolaryngol (2009) 266:1159–1165

7. Results • 6 patients with radical mastoid cavity (RMC) inactive form • Underwent subtotal petrosectomy and single stage cochlear implantation • 2 patients with RMC active form • Cochlear implant 6 months after subtotal petrosectomy POSTELMANS, J. Et. Al.. Eur Arch Otorhinolaryngol (2009) 266:1159–1165

8. Major Complications • Single procedure inactive form • 1 case • Complained of ear pain and was considered skin infection • Initially treated with IV antibiotics • Exploration done when antibiotic therapy failed • Implant rotated cranially under musculustemporalis • Wound dehiscence occurred due to persistent infection • Implant was explanted POSTELMANS, J. Et. Al.. Eur Arch Otorhinolaryngol (2009) 266:1159–1165

9. Minor Complication • 1 case of otitisexterna • Inactive form • Experienced otitisexterna 1 year post implant POSTELMANS, J. Et. Al.. Eur Arch Otorhinolaryngol (2009) 266:1159–1165

10. Conclusion • Cochlear implantation may be used as an alternative management for COM • In patients with active forms, staged procedure must be done. • In patients with inactive forms, single stage procedure may be done • Despite the stability of inactive forms of COM, Major complications may still occur in our patients POSTELMANS, J. Et. Al.. Eur Arch Otorhinolaryngol (2009) 266:1159–1165