Cochlear implantation at King Abdulaziz University Hospital, Riyadh, Saudi Arabia: a 12-year experience.

OBJECTIVE: This paper aims to report our experience with different multichannel cochlear implant devices, and to discuss the outcomes of our cochlear implant programme, together with the problems encountered. SETTING: Cochlear implantation was undertaken in 117 patients (35 post-lingual and 82 pre-lingual cases; 70 males and 47 females) over a 12-year period. Three cochlear implant systems were used: Nucleus (22 and 24), Med-El and Advanced Bionics Clarion. An extended endaural incision was used in 78 cases and a minimally invasive approach in 39 cases. RESULTS: Complications occurred in 16.2 per cent of patients. All patients showed a significant post-implantation improvement in their perception and discrimination of sound and speech. Better results were noted in pre-lingual patients under the age of six years. The cause of hearing loss was unknown in 81 per cent of patients. CONCLUSION: The outcomes of our cochlear implantation series are comparable to previous reports. The possibility of an abnormally rotated cochlea should be borne in mind when difficulty is encountered during cochleostomy.

Microbiology of chronic suppurative otitis media with cholesteatoma.

OBJECTIVE: To report the result of causative organisms in chronic suppurative otitis media with cholesteatoma. METHODS: Eighty eight patients clinically diagnosed with chronic suppurative otitis media with cholesteatoma, and confirmed intra-operatively and by histological examination were pre-operatively studied for the causative bacteria and fungi. RESULTS: A single isolate was obtained in 42 (48%) cases, no growth was isolated in 11 (12.5%) cases. Most common bacteria isolated were, Pseudomonas aeruginosa in 51%, Staphylococcus aureus in 31%, and Proteus species in 17%. Among the 15 fungal isolates, 9 (10%) were Aspergillus species and the remaining 6 (7%) were Candida albicans. CONCLUSION: Conventional ear swabs taken under direct vision using an operating microscope are reliable in establishing the microbiological profile of chronic suppurative otitis media.

Iatrogenic incudostapedial joint dislocation in transcanal tympanoplasty.

PURPOSE: To report the result of transcanal tympanoplasty using Lyodura as a graft. MATERIALS AND METHODS: One hundred thirty-seven patients with chronic suppurative otitis media with a dry perforation were considered for tympanoplasty. The transcanal permeatal approach was adopted. Lyodura as a ready-made graft was used. RESULTS: The success rate of the graft was 78%. Latrogenic incudostapedial joint dislocation was found in six patients (4.4%), and sensorineural hearing loss occurred in nine patients (6.5%). CONCLUSION: The use of thick dura as a graft for repair of the tympanic membrane may result in damage to the ossicular chain or dislocation of the incudostapedial joint when used as underlay. Excessive manipulation of the ossicles or drilling should be avoided.

Iatrogenic retained foreign body in the maxillary sinus.

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Revision tympanoplasty: surgical findings and results in Riyadh.

A report on the surgical findings and long-term results of 68 revision tympanoplasties performed at King Abdul Aziz University Hospital over a period of 7 years is presented. Temporalis fascia was used in all operations, with an overall success rate of 85% of graft take up, with significant improvement of hearing in the majority of cases. The causes of immediate failure were found to be due to faulty surgical techniques, however most of the late reperforations were due to infections and in some to atrophy of the graft. It is concluded that better surgical technique and improvement of medical facilities in most rural areas are of utmost importance in Saudi Arabia.

Hearing results in tympanoplasty in Riyadh.

In patients with chronic otitis media, the aims of surgery are to eradicate middle ear disease, prevent recurrent infections, and improve hearing. In most published papers about tympanoplasty, the surgical approaches receive more attention as compared to hearing results. A total of 2015 ears with CSOM but without cholesteatoma, operated upon in a period of 9 years at King Abdul Aziz University Hospital, were studied and analyzed. The results showed 78% perforations closure rate, 19% reperforation rate, and 74% objective audiometry air-bone closure. The results of graft taking and closure of air-bone gap to within 10 dB were better using temporalis fascia compared to dura grafts. Post operative SNHL at 4000 KHz was more in cases using dura graft 6% compared with temporalis fascia 1.9%. Skill, experience, and development of medical facilities in distant areas in developing countries may prove helpful in improving the final results.

Tympanoplasty in children--our experience in Riyadh, Saudi Arabia.

A seven years results of 75 cases of tympanoplasty without mastoidectomies in children is presented and analyzed. The study showed a perforation closure rate of 81.33%, hearing improvement to within 25 dB was 61.33%. The hearing did not improve in 18.66%. There is no higher incidence of recurrent perforation in children as compared to adults. In developing country such as Saudi Arabia experiences, skill, and proper development of facilities for management and post-operative care in distant areas may prove helpful in improving the results of tympanoplasty.