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Retrograde cochlear implantation in postmeningitic basal turn ossification.

Abstract

OBJECTIVES/HYPOTHESIS
Postmeningitic basal turn ossification is a challenge for successful cochlear implantation despite the availability of sophisticated implants and advanced drill-out procedures. A less complex concept consisting of a cochleostomy near the apex with retrograde array insertion is evaluated clinically and experimentally with emphasis on imaging of intracochlear array morphology.
STUDY DESIGN
Retrospective case-control study.
METHODS
Outcome, hearing performance, and radiological findings including three-dimensional (3D) reconstructions were assessed in the long term in eight retrograde implanted ears of seven postmeningitic deaf patients and compared to an etiology- and device-matched control group of 17 basal turn implanted ears of 14 patients. Experimental insertions into three autopsy-derived human temporal bones were evaluated using high-resolution microtomography, 3D reconstruction, and histology.
RESULTS
No complications occurred. At the long-term follow-up, the average monosyllabic word test scores were 41% for the study group and 67% for the control group (P = .03). Radiological follow-up revealed insertion sites into either the apical or middle turn and frequent intracochlear array direction changes (n = 5). Experimental implantations in temporal bones resulted in folding-free, retrograde, middle turn insertions (n = 3).
CONCLUSIONS
The retrograde cochlear implantation is a safe and efficient alternative approach in basal turn ossification. Despite a high occurrence of intracochlear array direction changes, open set speech discrimination was achieved in all patients. Postoperative computed tomography is recommended for fitting the speech processor according to intracochlear array positions. The experimental insertion in temporal bones helped to optimize the approach.

Links

  • Publisher Full Text
  • Authors

    Senn P, Rostetter C, Arnold A, Kompis M, Vischer M, Häusler R, Ozdoba C, Mantokoudis G, Caversaccio M

    Source

    The Laryngoscope 122:9 2012 Sep pg 2043-50

    MeSH

    Adolescent
    Adult
    Auditory Threshold
    Case-Control Studies
    Child
    Child, Preschool
    Cochlear Implantation
    Cochlear Implants
    Female
    Follow-Up Studies
    Hearing Loss
    Humans
    Male
    Meningitis
    Middle Aged
    Otosclerosis
    Postoperative Care
    Retrospective Studies
    Speech Perception
    Temporal Bone
    Time Factors
    Tomography, X-Ray Computed
    Treatment Outcome
    Young Adult

    Pub Type(s)

    Comparative Study
    Journal Article

    Language

    eng

    PubMed ID

    22648482