Learning Objectives: Management of cholesteatoma in auditory implants Management of retraction pocket disease in auditory implants.

Introduction: Cholesteatoma is a rare condition. In the presence of an auditory implant, the principal concern is damage to the internal device either through the disease process or through surgery to remove the disease.

Methods: A retrospective analysis was performed all implant recipients at the Richard Ramsden Centre for Auditory Implants and the management of patients with a retraction pocket or cholesteatoma was reviewed.

Results: Five patients with cochlear implants were identified with cholesteatoma – one adult and four paediatric patients. Four presented with otorrhoea and wound breakdown, one was an incidental finding of congenital cholesteatoma at time of implantation. Two patients required device replacement, one was removed without reimplantation. Cholesteatoma was managed by canal wall down mastoidectomy and blind sac closure.

Five patients were identified with retraction pockets – two adults, one adolescent, two paediatric patients. Two presented with recurrent otorhoea and were managed with cartilage tympanoplasty to cover exposed electrodes. Two presented with imbalance and one was noted as an incidental finding. These three patients were managed conservatively with recurrent microsuction in the outpatient clinic. None of these patients required removal of reimplantation of their device.

Conclusions: Device failure or damage is common in cholesteatoma either as a result of disease itself or surgery. Reimplantation should occur at time of electrode explantation where possible to prevent obliteration of the cochlear duct. Cochlear implants in retraction pockets generally do not result in device failure and require surgical intervention only if symptoms dictate.