Patients with radical mastoid cavities due to previous cholesteatoma, develop severe to profound hearing loss. Would you share your experience regarding implanting such patients. What is the best technique you perform, oplitrative (open) or non-opliterative (closed) technique?
Patients with bilateral radical mastoid cavities due to previous cholesteatoma, develop severe to profound hearing loss. These patients undergoes cochlear implant & preferable technique in such situation is CI without obliterating the mastoid cavity. Most of patients develop early or late recurred otorrhea with electrode extrusion.
Article: Cochlear Implantation in Patients with Radical Mastoid Cavities.
Mohammed S. Attallah, Hamad S. Al-Muhaimeed, Hazem Y. Abdelwahed
Saudi Journal of Oto-Rhino-Laryngology Head and Neck Surgery (SJORLHNS). 01/2013; 15(1):1-5.
Are there any experience regarding the other technique in which CI is associated with mastoid cavity obliteration e.g. closed sac technique obliterating mastoid cavity, ET & EEC?
This is a very important subject in our communities with quite a number of patients with aggressive complicated cholesteatoma. In my opinion, the most convenient way to implant these patients is a two stage subtotal petrosectomy .obliterate the mastoid in the first stage and, 3-6 months later implant the patient. In this situation the cavity is stable and the electrode is protected by your original fat graft of the obliteration. The problem of follow-up of recurrence of cholesteatoma is a problem as you are only left with CT scanning but actually because of the cavity, small pearl like recurrence are insignificant
Thanks prof. Badr for your comment. Do you have an experience of implanting such cases by closed blind sac technique (obliterating mastoid cavity, ET & EEC)?
Thanks again. Dear prof. Badr, the article, mentioned below is my institute experience regarding implanting radical mastoid cavities, either by non-obliterative technique or partially obliterating the mastoid cavity & the results was comparable with the world wide results. Do you think that CT-Scan alone is enough to follow up implanting such cases by your preferable blind sac technique? We noted that the partially obliterated case had longer interval than the non-obliterative other case. Would you mention the outcomes of your blind sac cases.
Article: Cochlear Implantation in Patients with Radical Mastoid Cavities.
Mohammed S. Attallah, Hamad S. Al-Muhaimeed, Hazem Y. Abdelwahed
[Detail of the article is present in my researchgate website.]
Abstract: In the past, cochlear implantation was a contraindicated procedure in profoundly deaf patients with radical mastoid cavities. This was due to high risk of infection spread into cochlea with possible destruction of the remained surviving cochlear neural elements. We report on King Abdulaziz University Hospital experience in managing by cochlear implantation two postlingual profoundly deaf patients (both male and adult) with radical mastoid cavities due to chronic cholesteatomatous otitis media. Two different open techniques were used, cochlear implantation with (in the first patient) and without (in the second patient) obliteration of the pre-existed mastoid cavity. One patient (first) suffered infection of mastoid cavity with extrusion of electrode, 55 months post-implantation. The infection could not be controlled without explantation, so the patient was explanted. The other (second) patient suffered facial nerve twitching, ear discharge and later failure of the implant as proved by integrity testing, 22 months post-implantation. The infection was subsided after explantation. We recommend regular clinical and audiological follow-up of such patients in the same cochlear implantation center to avoid any complications which may lead to implant failure or electrode extrusion. This is also useful to discover and treat early any potential recurrent infection or cholesteatoma. High-resolution computed tomography scan of temporal bone is a good tool in the follow-up of patient with post-implantation complications or those implanted with closed blind sac technique which may be a better alternative technique than the open technique. Key words: Radical mastoid cavities, Bilateral profound sensorineural hearing loss, Cochlear implantation, Open technique.
Saudi Journal of Oto-Rhino-Laryngology Head and Neck Surgery (SJORLHNS). 01/2013; 15(1):1-5.
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