Cochlear implantation in patients with chronic otitis media and radical mastoidectomy: A single-stage procedure.

BACKGROUND: We conducted a retrospective case review of patients with mastoid cavity and active or inactive chronic otitis media (COM) who underwent cochlear implantation and ear obliteration in a single-stage procedure. The objectives of this review are to assess the rates of complications and postoperative infections and to evaluate post-implantation audiologic performance. MATERIALS AND METHODS: All patients with COM and mastoid cavity, associated or not with active disease, who undergo cochlear implantation and obliteration of the ear as a single-stage procedure from November 2004 to April 2013, were included in the review. All the complications were recorded. Open-set sentence scores were used to evaluate the audiologic gain after implantation. RESULTS: Twenty-seven patients were included in our review: Ten with active COM and seventeen with inactive COM. Overall, nine patients (9/27) presented post-operative complications (7/9 were minor): three were amongst active COM patients (30%) as compared to six amongst inactive COM patients (35%), which included the two major complications. A mean gain of 55.9% on open-set sentence scores was obtained after cochlear implantation. DISCUSSION: We found that complications rate of the one-stage cochlear implantation was higher in patients with COM than in global implant population, but most complications were minors and there was no statistical difference between active and inactive COM. In addition, these patients had audiologic scores similar to those found in patients with normal temporal bone anatomy. CONCLUSION: Cochlear implantation performed as a one-stage procedure could be considered as an option of treatment to avoid staging in patients with active and inactive COM. Although these patients need a regular follow-up, they present good post-implantation audiometric scores.

[Validation of a clinical scale for the diagnosis of perilymphatic fistula]. / Validation de l'echelle clinique pour le diagnostic des fistules périlymphatiques.

INTRODUCTION: The diagnosis of perilymphatic fistula (PLF) is difficult because no single clinical situation gives the diagnosis for sure. The goal of this article is to study the clinical situations where you must suspect a PLF and to support a clinical scale described in a previous work (Bussières et al 2003). METHODS: Retrospective study of 15 patients that had an exploratory tympanotomy with a PLF not confirmed preoperatively. An analysis of the symptoms, signs and complementary exams were done. The surgical technique and findings and the postoperative evolution were noted. RESULTS: There is 66.7% of hypoacusis the most frequently symptom (postoperative improvement of 26.7%); after came vertigo present in 60% (postoperative improvement of 44.4%) and tinnitus present in 53.3% (postoperative improvement of 25%). The trauma history is always positive, most of then is typical (80%) and the other one are atypical (20%).The diagnosis of PLF has been determined in 5 patients in the follow-up according to the improvement of the symptoms. These patients had a score > 7 at the clinical scale. CONCLUSION: The sensibility and specificity scores of the clinical scale are respectively 100% and 70% in this study.

[When to suspect a perilymphatic fistula?]. / Quand suspecter une fistule périlymphatique?

INTRODUCTION: The diagnosis of perilymphatic fistula (PLF) is difficult since no single clinical situation gives the diagnosis for sure. The goal of this study is to clarify the clinical situations where you must suspect a PLF. METHODS: Retrospective study of 20 patients that had an exploratory tympanotomy with a PLF confirmed peroperatively. An analysis of the symptoms, signs and complementary exams was done. The surgical findings and the postoperative evolution were noted. RESULTS: 100% of patients reported a hearing loss, 80% vertigo, 70% a tinnitus and 35% equilibrium problems. Every patient had an etiological event to explain the PLF (trauma 85%), stapedotomy (10%), other ear surgeries. Five patients had a positive fistula or Vasalva test. All patients except one had an hearing loss on the audiogram (sensorineural, mixte or conductive). 50% had a CT scan, 70% of which were abnormal. A VNG was done on 3 patients. The sites of the PLF were as follows: 90% oval window, 5% round window and 5% both windows. The hearing got better or was stabilised in 95% of patients after the operation. 64% saw an improvement of their tinnitus and 87% of their vertigo. CONCLUSION: The diagnosis of PLF is difficult and a high index of suspicion is mandatory. One must look for an etiologic situation to explain the PLF. The audiogram is almost always modified, a mixte hearing loss being common due to the high incidence of ossicular trauma associated with PLF. The clinical clinical situations where you must suspect a PLF were identified as follows: An old trauma, a recent trauma, a history of otologic surgery particularly on the stapes and a preexisting hearing loss that aggravates. A diagnosis scale to evaluate the risk of PLF, based on clinical situations, physical exam and complementary exams was done to help the clinician in the evaluation of PLF.