Management of far advanced otosclerosis in the era of Cochlear implantation

• Published in: Otology & neurotology Vol. 22; no. 4; pp. 471 - 474
• Main Authors: RUCKENSTEIN, Michael J, RAFTER, Kristine O, MONTES, Michelle, BIGELOW, Douglas C
• Format: Conference Proceeding Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01-07-2001
• Subjects: Adolescent; Adult; Aged; Biological and medical sciences; Cochlea - diagnostic imaging; Cochlea - surgery; Cochlear Implantation; Deafness - diagnosis; Deafness - etiology; Deafness - surgery; Ear, auditive nerve, cochleovestibular tract, facial nerve: diseases, semeiology; Electric Stimulation - instrumentation; Equipment Design; Female; Head and neck surgery. Maxillofacial surgery. Dental surgery. Orthodontics; Humans; Male; Medical sciences; Middle Aged; Non tumoral diseases; Otologic Surgical Procedures - methods; Otorhinolaryngology. Stomatology; Otosclerosis - complications; Otosclerosis - diagnosis; Otosclerosis - surgery; Prospective Studies; Severity of Illness Index; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the ear, the auditive nerve and the facial nerve; Tomography, X-Ray Computed; Human; Prospective; Treatment; Surgical implantation; Surgery; Internal ear disease; Cohort study; Cochlea; ENT disease; Advanced stage; Genetic disease; Otosclerosis
• ISSN: 1531-7129; 1537-4505
• DOI: 10.1097/00129492-200107000-00010

To evaluate issues pertaining to cochlear implantation in patients with far advanced cochlear otosclerosis.
Prospective cohort.
Tertiary care referral center.
Eight adult patients (18 years of age or older) referred for management of profound hearing loss, the cause of which was determined to be otosclerosis.
Cochlear implantation with multichannel cochlear implant device.
Benefit from cochlear implant as measured by CID sentence scores, incidence and management of facial nerve stimulation, and technical issues pertaining to cochlear implantation in this patient population.
All patients demonstrated significant improvement in auditory function as measured by performance on CID sentence scores and ability to engage in telephone conversation. Facial nerve stimulation was present in two of eight patients and was managed with deactivation of the stimulating electrodes. Ossification in the basal turn of the cochlea, detected on preoperative computed tomography, necessitated placement of the electrode into the scala vestibuli in two patients and use of a thinner electrode (Nucleus 24) in a third patient.
Patients with profound hearing loss secondary to otosclerosis derive excellent benefits from cochlear implantation. Surgical implantation may be complicated by ossification of the cochlea, which can be detected on preoperative computed tomography. Electrode activation may be complicated by facial nerve stimulation, which can be addressed with programming strategies.