RESUMEN
OBJECTIVES/HYPOTHESIS: The preservation of residual hearing has become a high priority in cochlear implant surgery. This study was designed to substantiate whether conservation of residual hearing can be preserved after cochlear implantation using the suprameatal approach. STUDY DESIGN: Retrospective chart review. METHODS: Retrospective chart review was performed in 109 severely to profoundly hearing impaired cochlear recipients who had some measurable hearing preoperatively. Subsequently, the pre- and postoperative pure-tone thresholds were analyzed by three different analyses to observe the degree of hearing preservation. RESULTS: Single-subject results showed a complete conservation of residual hearing (change in pure-tone average [ΔPTA] ≤ 10 dB) in 27 of 109 patients (24.7%). Partial conservation of residual hearing (ΔPTA > 10 dB) was observed in 77 patients (70.6%), but these percentages have been affected severely by ceiling effects. Furthermore, group-subject results demonstrated that the median postoperative PTA was 11.7 dB worse than the preoperative PTA. For individual frequencies, the median deteriorations were 15, 20, 10, and 5 dB at 250, 500, 1,000, and 2,000 Hz, respectively. Stratification for the absence of postoperative hearing thresholds showed a conservation of measurable postoperative hearing levels in 17.4% of all study patients. CONCLUSIONS: The results of this study demonstrate that complete preservation of residual hearing is possible in a limited number of patients using the suprameatal approach technique for cochlear implantation. For a reliable analysis of the audiometric effects of cochlear implant surgery, it is important to take into account the ceiling effects, therefore using different calculation methods to estimate the accurate deterioration of hearing thresholds.
Asunto(s)
Umbral Auditivo , Implantación Coclear/métodos , Sordera/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Audiometría de Tonos Puros , Sordera/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
OBJECTIVE: To report on surgical complications arising postoperatively in 104 patients undergoing cochlear implantation surgery using the suprameatal approach (SMA). Second, to examine the advantages and disadvantages of the SMA technique compared with the classic mastoidectomy using the posterior tympanotomy approach. STUDY DESIGN: Retrospective study assessing surgical complications in deaf adults and children undergoing cochlear implantation. SETTING: Tertiary referral center for cochlear implantation (Academic Medical Centre). PATIENTS: The mean age at the time of surgery was 39.6 years (1.0-82.3 yr), and the mean duration of deafness was 26.3 years (0.3-66.0 yr). The main cause was a congenital hearing loss (30.8%) and a progressive sensorineural hearing loss e.c.i. (25.0%), followed by meningitis (12.5%) and otosclerosis (6.7%). The mean duration of follow-up after surgery was 25.7 months (range, 3.0-59.0 mo). RESULTS: The overall major complication rate was 3.7% (4 of 107). All complications developed postoperatively. The major complications consisted of extrusion of the implant due to wound infection (n = 2), a wrong route for the electrode (n = 1), and device failure (n = 1). The minor complication rate was 23.4% (25 of 107). The mean time taken for cochlear implantation was 111.7 minutes (range, 60.0-261.1 min). CONCLUSION: This study confirms the SMA is a safe, simple, and quick technique that is feasible for cochlear implantation in most cases. Although the stretching of the electrode array when it enters the scala tympani and a low-lying dura could present a potential restriction for the SMA technique, our results do not support this hypothesis.
Asunto(s)
Implantación Coclear/métodos , Procedimientos Quirúrgicos Otológicos/métodos , Adolescente , Adulto , Edad de Inicio , Anciano , Niño , Preescolar , Cóclea/anatomía & histología , Cóclea/cirugía , Implantación Coclear/efectos adversos , Implantes Cocleares , Sordera/etiología , Sordera/cirugía , Femenino , Humanos , Lactante , Masculino , Apófisis Mastoides/cirugía , Persona de Mediana Edad , Procedimientos Quirúrgicos Otológicos/efectos adversos , Estudios Retrospectivos , Infección de la Herida Quirúrgica/epidemiología , Infección de la Herida Quirúrgica/patología , Adulto JovenRESUMEN
OBJECTIVES/HYPOTHESIS: Our study was designed to compare two surgical approaches that are currently employed in cochlear implantation. METHODS: There were 315 patients who were divided into two groups according to the surgical technique used for implantation. The suprameatal approach (SMA) was followed for 104 patients (107 implantations) in Amsterdam, whereas the mastoidectomy with posterior tympanotomy approach (MPTA) was adhered to for 211 (214 implantations) in Maastricht. The outcome variables of interest were duration of surgery and peri- or postoperative complications. RESULTS: In the SMA group the incidence of major and minor complications was 3.7% (4/107) and 23.4% (25/107), respectively, whereas it was 6.5% (14/214) and 22.4% (48/214), respectively, in the MPTA group. A chi-square statistic of 1.096 (P = .295) and 0.021 (P = .884) for minor and major complications, respectively, indicated no statistically significant differences between the two techniques. Mean duration of surgery was significantly shorter (P < .0005) in the SMA (111.7 minutes) than in the MPTA (132.2 minutes) group. CONCLUSIONS: The suprameatal approach is clearly a good alternative to the classical surgery technique for cochlear implantation.
Asunto(s)
Implantación Coclear/métodos , Oído Interno/cirugía , Apófisis Mastoides/cirugía , Membrana Timpánica/cirugía , Adolescente , Adulto , Distribución de Chi-Cuadrado , Niño , Preescolar , Implantación Coclear/efectos adversos , Implantes Cocleares , Femenino , Estudios de Seguimiento , Pérdida Auditiva/cirugía , Humanos , Modelos Logísticos , Masculino , Monitoreo Intraoperatorio/métodos , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/epidemiología , Probabilidad , Sistema de Registros , Estudios Retrospectivos , Medición de Riesgo , Resultado del Tratamiento , Adulto JovenRESUMEN
The purpose of this paper is to propose management options for cochlear implantation in chronic otitis media (COM) based on our 7-year experience. Thirteen patients with COM who were candidates for cochlear implantation were identified. COM was divided in an inactive and an active form based on clinical and radiological findings. One major complications and one minor complication were identified in the study group. In case of an active infection or in case of a unstable cavity we advise cochlear implantation as a staged procedure. A single stage procedure is recommended in case of patients with COM presenting with a dry perforation or a stable cavity.