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Cochlear Implantation in Chronic Otitis Media

Presenting Author: Clark Bartlett

Published online by Cambridge University Press:  03 June 2016

David Schramm ,
Clark Bartlett  and
Nader Aldajani
David Schramm
Affiliation:
University of Ottawa
Clark Bartlett
Affiliation:
Department of Otolaryngology - Head and Neck Surgery, University of Ottawa
Nader Aldajani
Affiliation:
Department of Otolaryngology - Head and Neck Surgery, University of Ottawa
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Abstract

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Learning Objectives: 1. Understand the necessity of initial management of chronic otitis media prior to cochlear implantation 2. Be aware of the advantages and limitations of simultaneous and staged surgical management of chronic otitis media and cochlear implantation 3. Appreciate the necessity of long-term follow-up of patients with chronic otitis media undergoing cochlear implantation.

Introduction: Cochlear implantation in patients with a history of chronic otitis media may present substantial surgical challenges. The purpose of this study was to review the management and surgical outcomes of adults at the University of Ottawa Auditory Implant Program undergoing cochlear implantation who have a history of chronic otitis media.

Methods: A retrospective chart review of adults undergoing cochlear implantation since 1992 was performed to identify those patients who had required surgical management of chronic otitis media with or without cholesteatoma prior to implantation. Medical records were reviewed to identify surgical procedures required for chronic otitis media management and ascertain long term outcomes after cochlear implantation.

Results: Seven patients (3 male, 4 female) were identified who required surgical management of chronic otitis media prior to cochlear implantation. The mean age at cochlear implantation was 66.4 years (39–80). Five patients required an intact wall mastoidectomy for management of chronic otitis media. Of these, two underwent a tympanoplasty for management of a tympanic membrane perforation and two required placement of a ventilation tube for chronic middle ear effusion. Two patients required mastoid obliteration and blind sac closure of the external auditory canal (subtotal petrosectomy). Cochlear implantation was performed approximately 6 months later. The mean length of follow-up is 3.7 years (11 months – 7 years). All patients derived substantial benefit from their cochlear implant without long-term complications.

Conclusions: All patients successfully first underwent surgery for chronic otitis media and subsequent cochlear implantation approximately 6 months later without long-term complications. Although simultaneous surgical management of chronic otitis media and cochlear implantation may be considered in selected cases, staged surgical management is a consistently effective option for this difficult condition.