title: Management of far advanced otosclerosis in the era of cochlear implantation.
abstract: OBJECTIVE
  To evaluate issues pertaining to cochlear implantation in patients with far advanced cochlear otosclerosis.
  
  
  METHODS
  Prospective cohort.
  
  
  METHODS
  Tertiary care referral center.
  
  
  METHODS
  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.
  
  
  METHODS
  Cochlear implantation with multichannel cochlear implant device.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
authors.forename: M J
authors.initials: MJ
authors.lastname: Ruckenstein
authors.forename: K O
authors.initials: KO
authors.lastname: Rafter
authors.forename: M
authors.initials: M
authors.lastname: Montes
authors.forename: D C
authors.initials: DC
authors.lastname: Bigelow
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003051:Cochlea / Q000000981:diagnostic imaging / Q000601:surgery; D019929:Cochlear Implantation; D003638:Deafness / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D004558:Electric Stimulation / Q000295:instrumentation; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013506:Otologic Surgical Procedures / Q000379:methods*; D010040:Otosclerosis / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D011446:Prospective Studies; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed