Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology · 2012
Cochlear implantation via the middle fossa approach: surgical and programming considerations.
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Bento Ricardo Ferreira, Bittencourt Aline Gomes, Goffi-Gomez Maria Valéria Schmidt, Samuel Paola, Tsuji Robinson Koji, de Brito Rubens
Аннотация
OBJECTIVES: To report the results of cochlear implantation via the middle fossa approach in 4 patients, discuss the complications, and present a detailed description of the programming specifications in these cases.
STUDY DESIGN: Retrospective case review.
SETTING: Tertiary-care referral center with a well-established cochlear implant program.
PATIENTS: Four patients with bilateral canal wall down mastoid cavities who underwent the middle fossa approach for cochlear implantation.
INTERVENTIONS: Cochlear implantation and subsequent rehabilitation. A middle fossa approach with cochleostomy was successfully performed on the most superficial part of the apical turn in 4 patients. A Nucleus 24 cochlear implant system was used in 3 patients and a MED-EL Sonata Medium device in 1 patient. The single electrode array was inserted through a cochleostomy from the cochlear apex and occupied the apical, middle, and basal turns. Telemetry and intraoperative impedance recordings were performed at the end of surgery. A CT scan of the temporal bones was performed to document electrode insertion for all of the patients.
MAIN OUTCOME MEASURES: Complications, hearing thresholds, and speech perception outcomes were evaluated.
RESULTS: Neural response telemetry showed present responses in all but 1 patient, who demonstrated facial nerve stimulation during the test. Open-set speech perception varied from 30% to 100%, despite the frequency allocation order of the MAP.
CONCLUSION: Cochlear implantation via the middle cranial fossa is a safe approach, although it is a challenging procedure, even for experienced surgeons.
STUDY DESIGN: Retrospective case review.
SETTING: Tertiary-care referral center with a well-established cochlear implant program.
PATIENTS: Four patients with bilateral canal wall down mastoid cavities who underwent the middle fossa approach for cochlear implantation.
INTERVENTIONS: Cochlear implantation and subsequent rehabilitation. A middle fossa approach with cochleostomy was successfully performed on the most superficial part of the apical turn in 4 patients. A Nucleus 24 cochlear implant system was used in 3 patients and a MED-EL Sonata Medium device in 1 patient. The single electrode array was inserted through a cochleostomy from the cochlear apex and occupied the apical, middle, and basal turns. Telemetry and intraoperative impedance recordings were performed at the end of surgery. A CT scan of the temporal bones was performed to document electrode insertion for all of the patients.
MAIN OUTCOME MEASURES: Complications, hearing thresholds, and speech perception outcomes were evaluated.
RESULTS: Neural response telemetry showed present responses in all but 1 patient, who demonstrated facial nerve stimulation during the test. Open-set speech perception varied from 30% to 100%, despite the frequency allocation order of the MAP.
CONCLUSION: Cochlear implantation via the middle cranial fossa is a safe approach, although it is a challenging procedure, even for experienced surgeons.
Предметные рубрики MeSH
AdultAuditory ThresholdChemoradiotherapyCholesteatoma, Middle EarCochlear ImplantationCranial Fossa, MiddleEar DiseasesFacial NerveFemaleHearing LossHearing Loss, BilateralHumansMaleMastoidMiddle AgedMonitoring, PhysiologicNasopharyngeal NeoplasmsOtologic Surgical ProceduresPostoperative ComplicationsRetrospective StudiesSpeech PerceptionTelemetryTemporal BoneTomography, X-Ray ComputedTreatment Outcome