Single stage cochlear implantation in radical mastoid cavity- a surgical dilemma

Abstract

Objective: To describe the potential problems of cochlear implantation in mastoid cavity with possibilities of extrusion of electrode array by breakdown of epithelial lining or flap cover recurrent cholesteatoma and spread of infection to the implant. The issues with surgical management and subsequent follow up is discussed. Methods: In a Series of 170 Cochlear Implantations at our centre, four patients had Cochlear Implantation with Blind sac closure, complete removal of epithelium from the radical mastoid cavity, obliteration of the cavity with temporoparietal fascia flap and electrode insertion. Follow up ranging from 21 months up to 84 months is available. One patient during follow up had to undergo re implantation due to extrusion of the electrodes. Results: All the patients had good outcome regarding hearing improvement. One of the patients had to undergo exploration and re implantation of electrodes due to extrusion of electrodes through the external auditory canal. This patient had a canal cholesteatoma. Discussion: An important issue in single stage procedure is ensuring complete removal of fibro epithelial lining of the cavity. The advantage is cost reduction and minimizes the need for multiple general anesthesia. A follow up CT scan at regular intervals is required to detect recurrence. Conclusions: The patients undergoing cochlear implantation in a radical mastoid cavity require intensive follow up with computerized tomography to detect recidivism, Single stage cochlear implantation in radical mastoid cavity is an appropriate therapeutic decision by the cochlear implant surgeon.