RESPONSE TO A LETTER TO EDITOR BASED ON OUR ARTICLE "COMPLICATIONS AND PITFALLS OF COCHLEAR IMPLANTATION IN OTOSCLEROSIS: A 6-YEAR FOLLOW-UP"

Abstract

In Reply: We wish to thank the journal and the editors for the opportunity to answer the letter about our article "Complications and pitfalls of cochlear implantation in otosclerosis: a 6-year follow-up" published in the December 2009 issue. As clearly indicated in the title and introduction, the aims of the article were to "describe and discuss the mid-term complications and pitfalls reported in patients with otosclerosis who had received a cochlear implant" (1) and not to assess the effectiveness of cochlear implants in this patient group, which was the aim of the previous article published in Audiology and Neurotology (2). Having previously presented the benefits of cochlear implantation in otosclerosis, our intention was to focus on the complications occurring during surgery and fitting, and those caused by progression of the disease, in order to make a better assessment of implantation and the progress of cochlear-implanted patients. Focusing on these aims, we considered that preimplantation hearing skills or previous surgical attempts did not influence the rate of complications or risks with cochlear implantation for otosclerosis, so these data were ignored in the study, unlike in the previous one (2). Nevertheless, some future research could probably be carried out based on the point that was raised. We also agree that "patients with otosclerosis can be treated well using conventional amplification techniques, even in cases of mixed hearing loss". Furthermore, owing to our 15 years of experience and the findings presented in literature (3), we actually recommend all far-advanced otosclerosis patients experiencing sensorineural hearing loss to use nonlinear amplification hearing aids, and we always test word recognition in the best-aided conditions before planning any cochlear implant surgery. Unfortunately, the final stage for some patients is electrical stimulation to remedy the lack of discrimination. In accordance with international standards for cochlear implantation (4-6), we indicate cochlear implant surgery under certain conditions of anatomy, speech, and hearing, which include lack of word recognition. The word recognition cutoff point used in our clinic is set at below 60% for open-set sentence recognition or below 40% for 2-syllabic word recognition, at 65 dB hearing loss in the best-assisted conditions. Further studies should indeed be performed to improve assessment of indications and possible complications in cochlear-implanted patients experiencing otosclerosis.