Otosclerosis: selection of ear for cochlear implantation.

OBJECTIVES: 1. To examine whether speech perception after implantation is correlated with the total duration of deafness, the duration of deafness in the implanted ear, or age at implantation. 2. To examine whether the rate of facial nerve stimulation postoperatively is correlated with the type of electrode used.

STUDY DESIGN: Retrospective case note review.

SETTING: Tertiary referral center.

PATIENTS: Fifty-nine adults with profound postlingual sensorineural hearing loss due to otosclerosis.

INTERVENTION: Cochlear implantation with the Nucleus device using either a straight (n = 35) or Contour (n = 29) electrode array.

MAIN OUTCOME MEASURES: Speech perception scores for patients at 3, 6 and 12 months postimplantation were correlated against duration of deafness in the implanted ear, duration of total deafness, and age at implantation. Data on facial nerve stimulation rates postoperatively were collected.

RESULTS: Implantation in the shortest deafened ear conferred an initial advantage for speech perception 3 months after surgery; however, this effect was lost by 6 months. There were no significant correlations between the duration of bilateral deafness and hearing outcomes. Age at implantation was negatively correlated with outcome at 3 months, but not at 6 and 12 months. Fourteen of 35 patients with straight electrodes and 0 of 24 patients with Contour electrodes experienced facial nerve stimulation during mapping sessions (p < 0.005, chi).

CONCLUSION: Patients with otosclerosis are not disadvantaged in the long term by implantation in the longest deafened ear. Increasing age at implantation did not predict poorer outcomes. A perimodiolar design of electrode should be used in otosclerotic patients when possible to reduce the risk of facial nerve stimulation.