J Korean Med Sci.  2015 Jan;30(1):82-87. 10.3346/jkms.2015.30.1.82.

Long-term Outcome of Cochlear Implant in Patients with Chronic Otitis Media: One-stage Surgery Is Equivalent to Two-stage Surgery

• Jang JH
• Park MH
• Song JJ
• Lee JH
• Oh SH
• Kim CS
• Chang SO

• KMID: 2155451
• DOI: http://doi.org/10.3346/jkms.2015.30.1.82

Abstract

This study compared long-term speech performance after cochlear implantation (CI) between surgical strategies in patients with chronic otitis media (COM). Thirty patients with available open-set sentence scores measured more than 2 yr postoperatively were included: 17 who received one-stage surgeries (One-stage group), and the other 13 underwent two-stage surgeries (Two-stage group). Preoperative inflammatory status, intraoperative procedures, postoperative outcomes were compared. Among 17 patients in One-stage group, 12 underwent CI accompanied with the eradication of inflammation; CI without eradicating inflammation was performed on 3 patients; 2 underwent CIs via the transcanal approach. Thirteen patients in Two-stage group received the complete eradication of inflammation as first-stage surgery, and CI was performed as second-stage surgery after a mean interval of 8.2 months. Additional control of inflammation was performed in 2 patients at second-stage surgery for cavity problem and cholesteatoma, respectively. There were 2 cases of electrode exposure as postoperative complication in the two-stage group; new electrode arrays were inserted and covered by local flaps. The open-set sentence scores of Two-stage group were not significantly higher than those of One-stage group at 1, 2, 3, and 5 yr postoperatively. Postoperative long-term speech performance is equivalent when either of two surgical strategies is used to treat appropriately selected candidates.

Keyword

Cochlear Implantation; Otitis Media; Tympanomastoidectomy; Speech Performance

MeSH Terms

Adult
Aged
Cholesteatoma, Middle Ear/epidemiology
Chronic Disease/therapy
Cochlear Implantation/*adverse effects
Cochlear Implants/*adverse effects
Female
Hearing Loss, Sensorineural/*surgery
Humans
Inflammation/epidemiology
Male
Middle Aged
Otitis Media/*surgery
Retrospective Studies
*Speech Articulation Tests
Treatment Outcome
Young Adult

Figure

• 

  Fig. 1 The surgical algorithm used to plan cochlear implantation in patients with chronic otitis media. *Open cavity tympanomastoidectomy was performed in two patients to ensure mastoid obliteration. CI, cochlear implantation; CC, closed cavity tympanomastoidectomy; OC, open cavity tympanomastoidectomy; STP, subtotal petrosectomy; Rev, revision.

Reference

1. Belal A Jr. Contraindications to cochlear implantation. Am J Otol. 1986; 7:172–175.

2. Xenellis J, Nikolopoulos TP, Marangoudakis P, Vlastarakos PV, Tsangaroulakis A, Ferekidis E. Cochlear implantation in atelectasis and chronic otitis media: long-term follow-up. Otol Neurotol. 2008; 29:499–501.

3. Postelmans JT, Stokroos RJ, Linmans JJ, Kremer B. Cochlear implantation in patients with chronic otitis media: 7 years' experience in Maastricht. Eur Arch Otorhinolaryngol. 2009; 266:1159–1165.

4. Leung R, Briggs RJ. Indications for and outcomes of mastoid obliteration in cochlear implantation. Otol Neurotol. 2007; 28:330–334.

5. Kim CS, Chang SO, Lee HJ, Shim WS, Oh SH, Kim YH. Cochlear implantation in patients with a history of chronic otitis media. Acta Otolaryngol. 2004; 124:1033–1038.

6. Gray RF, Irving RM. Cochlear implants in chronic suppurative otitis media. Am J Otol. 1995; 16:682–686.

7. El-Kashlan HK, Arts HA, Telian SA. Cochlear implantation in chronic suppurative otitis media. Otol Neurotol. 2002; 23:53–55.

8. Donnelly MJ, Pyman BC, Clark GM. Chronic middle ear disease and cochlear implantation. Ann Otol Rhinol Laryngol Suppl. 1995; 166:406–408.

9. Basavaraj S, Shanks M, Sivaji N, Allen AA. Cochlear implantation and management of chronic suppurative otitis media: single stage procedure? Eur Arch Otorhinolaryngol. 2005; 262:852–855.

10. Kojima H, Sakurai Y, Rikitake M, Tanaka Y, Kawano A, Moriyama H. Cochlear implantation in patients with chronic otitis media. Auris Nasus Larynx. 2010; 37:415–421.

11. Matsuda Y, Kurita T, Ueda Y, Ito S, Nakashima T. Effect of tympanic membrane perforation on middle-ear sound transmission. J Laryngol Otol Suppl. 2009; 81–89.

12. Wright D, Safranek S. Treatment of otitis media with perforated tympanic membrane. Am Fam Physician. 2009; 79:650. 654.

13. Jang JH, Song JJ, Yoo JC, Lee JH, Oh SH, Chang SO. An alternative procedure for cochlear implantation: transcanal approach. Acta Otolaryngol. 2012; 132:845–849.

14. Gray RF, Ray J, McFerran DJ. Further experience with fat graft obliteration of mastoid cavities for cochlear implants. J Laryngol Otol. 1999; 113:881–884.

15. Free RH, Falcioni M, Di Trapani G, Giannuzzi AL, Russo A, Sanna M. The role of subtotal petrosectomy in cochlear implant surgery: a report of 32 cases and review on indications. Otol Neurotol. 2013; 34:1033–1040.

16. Bhatia K, Gibbin KP, Nikolopoulos TP, O'Donoghue GM. Surgical complications and their management in a series of 300 consecutive pediatric cochlear implantations. Otol Neurotol. 2004; 25:730–739.

17. Harada T, Ishida K, Endo M, Takahashi M, Sakai M. Recurrent extrusion of cochlear implant at an interval of 5 years. Otol Neurotol. 2003; 24:83–85.

18. El-Kashlan HK, Arts HA, Telian SA. External auditory canal closure in cochlear implant surgery. Otol Neurotol. 2003; 24:404–408.

19. Parnes LS, Gagne JP, Hassan R. Cochlear implants and otitis media: considerations in two cleft palate patients. J Otolaryngol. 1993; 22:345–348.

20. Incesulu A, Kocaturk S, Vural M. Cochlear implantation in chronic otitis media. J Laryngol Otol. 2004; 118:3–7.

21. Wong MC, Shipp DB, Nedzelski JM, Chen JM, Lin VY. Cochlear implantation in patients with chronic suppurative otitis media. Otol Neurotol. 2014; 35:810–814.