Cochlear Implantation in Patients with Eosinophilic Otitis Media

Masahiro Takahashi,Takahide Taguchi,Naoko Sakuma,Shin-Ichi Usami,Nobuhiko Oridate,Goshi Nishimura,Yasuhiro Arai,Satoshi Iwasaki,Daisuke Sano

doi:10.4236/ijohns.2015.41006

Abstract

It is known that cochlear implantation for deaf patients with eosinophilic otitis media (EOM) is safe and can provide good speech perception. However, the best timing of implant surgery in patients with EOM is not yet known. The aim of this case report is to suggest the appropriate timing of the surgery in EOM patients with deaf. Cochlear implantation was indicated in two patients with EOM. One underwent cochlear implantation in the absence of any ear discharge. In the other case, implant surgery was delayed for three years due to persistent ear discharge. No complications related to implant device or skin flap were observed in either case. The speech recognition score after implantation was good in the first case and poor in the second case. Perioperative complications were manageable even in the patient with persistent ear discharge. However, the delay in implant surgery due to the persistent ear discharge resulted in a poor speech recognition score. Early implantation should be considered even in EOM patients with ear discharge, although the presence of active middle ear inflammation is regarded as one of the contraindications for implantation according to the current Japanese guidelines.

Highlights

Eosinophilic otitis media (EOM) is an intractable middle ear disease with eosinophil-enriched middle ear effusion [1] [2]
High-tone hearing loss, in particular, is more frequent and more severe in EOM patients than in chronic otitis media (COM) patients [7], with 47% of EOM patients showing deterioration in bone conductive hearing level (BCHL), and 6% developing bilateral profound hearing loss according to the clinical survey of EOM in Japan [4]
The cause of deterioration in BCHL in cases of EOM remains unclear, but significantly higher concentrations of eosinophil cationic protein (ECP) and IgE have been detected in the middle ear effusion of EOM patients than in that of control patients [8]

Summary

Introduction

Eosinophilic otitis media (EOM) is an intractable middle ear disease with eosinophil-enriched middle ear effusion [1] [2]. Pure tone audiometry showed bilateral profound hearing loss (Figure 1) Her speech recognition score was 10% (Japanese monosyllable list) in both ears. In spite of anti-IgE therapy in combination with oral steroids, an anti-histaminergic agent and leukotriene receptor antagonist administration, her hearing threshold was gradually deteriorated, and she developed bilateral profound hearing loss at the age of 70 (Figure 5). Her speech recognition score was 20% (Japanese monosyllable list) in both ears. In spite of postoperative oral steroid administration, the tympanic membrane was re-perforated and ear discharge recurred three months post-surgery (Figure 6) Her speech recognition score was 20% (Japanese monosyllable list)

Discussion

Findings

Conclusion