Cochlear implant an option for unhappy stapes patients

By Sally Robertson, B.Sc.Sep 25 2012

Cochlear implantation is a safe and effective treatment option for patients with far advanced otosclerosis (FAO) who have not benefitted from stapedectomy, report US researchers.

The technique should be made available as a method of aural rehabilitation for FAO patients in whom other interventions have yielded dissatisfactory results, say Maroun Semaan (University Hospitals Case, Cleveland, Ohio) and team.

The researchers carried out a retrospective chart review of 30 patients with FAO and 30 age-matched controls who had been postlingually deafened by nonotosclerotic causes, all of whom underwent cochlear implantation due to dissatisfaction with their stapedectomy.

The team found that full electrode insertion was achieved in all patients.

In addition, no facial nerve stimulation was detected at the time of surgery or at short-term (<12 months postimplantation) or long-term (>12 months postimplantation) follow up in either group.

As reported in the American Journal of Otolaryngology, radiographic findings focusing on the presence of cochlear ossification and retrofenestral otosclerosis showed these abnormalities to be present in a significantly greater proportion of the FAO group compared with the control group, at 26.4% versus 6.2%. And intraoperative cochlear ossification was found in significantly more of the FAO patients than the controls, at 29.4% versus 9.4%.

However, the presence of radiographic abnormalities did not predict hearing outcome following implantation, with all patients experiencing significant improvements more than 12 months after implantation and no significant between-group differences observed for short- and long-term postoperative word scores, sentence scores, and speech reception thresholds.

"In patients with FAO, it is rational to offer stapes surgery prior to consideration of cochlear implantation," say Semaan et al.

However, "in the event that hearing loss continues to progress or the stapedectomy fails to improve hearing, cochlear implantation should be considered for hearing rehabilitation."

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