Revision cochlear implantation for facial nerve stimulation in otosclerosis.
OBJECTIVE
To find if patients experiencing postsurgical facial nerve stimulation caused by underlying disease process (ie, otosclerosis) can improve their hearing performance with their cochlear implant by reimplantation and by an optimal programming strategy.


METHODS
Retrospective analysis.


METHODS
Academic tertiary referral center.


METHODS
Two cochlear otosclerosis patients with resistant facial nerve stimulation (FNS). Both patients were initially implanted with Nucleus 22 devices (Cochlear Corporation, Englewood, Colo) and they developed FNS after a period of use. Owing to the decreasing number of active electrodes, concurrent decreases in speech understanding occurred.


METHODS
Various programming approaches were used to address the FNS. Both subjects ultimately received Nucleus 24 devices. One was reimplanted in the same ear, and the other was implanted in the opposite ear. Both have been followed up for 8 months following the reimplantation.


METHODS
Cochlear implant programming levels, cochlear implant performance, and facial nerve stimulation.


RESULTS
The FNS was managed for more than 3 years through optimized programming. However, the FNS progressed until performance dropped below acceptable levels. Reimplantation was believed to be the only option for improvement. After reimplantation and programming, both subjects showed immediate improvement in speech discrimination. One user increased his consonant-nucleus-consonant word score from 12% preoperatively to 42%, and the other's performance increased from 0% to 86%.


CONCLUSIONS
Our results suggest that having more programming options with newer devices is critical in otosclerotic or ossified users who experience FNS. Also, reimplantation may be a useful tool to improve performance.
Polak
Marek
M
University of Miami Ear Institute, Miami, FL, USA. marek.polak@softhome.net
Ulubil
S Arif
SA
Hodges
Annelle V
AV
Balkany
Thomas J
TJ
D019929:Cochlear Implantation / Q000379:methods*; D003054:Cochlear Implants / Q000009:adverse effects*; D005155:Facial Nerve Diseases / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010040:Otosclerosis / Q000000981:diagnostic imaging / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery*; D017755:Prosthesis Fitting; D012086:Reoperation; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed