Yoon Young Hoon, Lee Jong Bin, Chung Jee-Hye, Park Ki Wan, Kim Bong Jik, Choi Jin Woong
Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Chungnam National University, Daejeon, Republic of Korea.
Department of Otorhinolaryngology, College of Medicine, Konyang University, Daejeon, Republic of Korea.
Audiol Neurootol. 2020;25(3):151-157. doi: 10.1159/000505509. Epub 2020 Feb 4.
Chronic suppurative otitis media (CSOM) was considered as a contraindication of cochlear implantation (CI) in the past. Recently, various surgical options have been adopted for CI in CSOM patients with showing a low complication rate.
To evaluate surgical outcomes of CI in patients with CSOM and to propose a management algorithm for those patients.
Thirty-six consecutive patients with CSOM who underwent single stage or staged CI were enrolled. Speech performance, including Categories of Auditory Performance (CAP) test and sentence score, and complications were retrospectively analyzed.
The average follow-up was 3.1 years (range 0.5-9.2 years). Postoperative median CAP and sentence scores were 6 and 78%, respectively. Three (8.3%) of the 36 patients had postoperative complications. One experienced breakdown of the ear canal closure. Recurrence of the pars tensa retraction was observed in another patient with adhesive otitis media who underwent CI and cartilage tympanoplasty as a single stage operation. Electrode extrusion occurred in another patient who underwent staged CI with maintenance of a previous open cavity. Subtotal petrosectomy and cavity obliteration were used to manage the latter 2 complications. All implant patients with good mastoid pneumatization exhibited no complications. There were no significant differences in postoperative speech performance and complication rates between single stage CI and staged CI. Based on these current findings, a management algorithm was proposed according to type of CSOM, presence of open cavity, and mastoid pneumatization.
Patients with CSOM show good postoperative speech performance after CI. Proper surgical options according to type of CSOM, presence of open cavity, and mastoid pneumatization may help in reducing complications.
慢性化脓性中耳炎（CSOM）在过去被认为是人工耳蜗植入（CI）的禁忌证。最近，针对CSOM患者采用了各种手术方案进行CI，并发症发生率较低。
评估CSOM患者CI的手术效果，并为这些患者提出一种管理算法。
纳入36例连续接受单阶段或分期CI的CSOM患者。回顾性分析言语表现，包括听觉表现类别（CAP）测试和句子得分，以及并发症。
平均随访3.1年（范围0.5 - 9.2年）。术后CAP中位数和句子得分分别为6分和78%。36例患者中有3例（8.3%）出现术后并发症。1例耳道封闭失败。另1例粘连性中耳炎患者单阶段接受CI和软骨鼓膜成形术，观察到紧张部回缩复发。另1例分期CI且保留先前开放腔隙的患者发生电极脱出。采用颞骨次全切除术和腔隙闭塞术处理后2种并发症。所有乳突气化良好的植入患者均无并发症。单阶段CI和分期CI术后言语表现和并发症发生率无显著差异。基于当前这些发现，根据CSOM类型、开放腔隙的存在情况和乳突气化提出了一种管理算法。
CSOM患者CI术后言语表现良好。根据CSOM类型、开放腔隙的存在情况和乳突气化选择合适的手术方案可能有助于减少并发症。
