title: Long-term results of external auditory canal closure and mastoid obliteration in cochlear implantation after radical mastoidectomy: a clinical and radiological study.
abstract: Cochlear implant candidates with mastoid cavity present a significant challenge to safe cochlear implantation because of possible spread of infection to the inner ear as well as an increased risk of electrode array extrusion. Closure of the external auditory canal is one of the several surgical techniques utilized to block the potential entry routes for infection and to protect the implanted device. The main concern after external auditory canal closure is the risk of developing a cholesteatoma, which can lead to an asymptomatic erosion of the temporal bone and/or cochlear implant failure. In this study we present the results of very long-term (mean 12 years) clinical and radiological follow-up in 12 patients who underwent external auditory canal closure associated with mastoid and Eustachian tube obliteration to facilitate cochlear implantation. To date, with a mean ± SD follow-up of 12 ± 4.7 years (range 5-21 years), the only complication experienced was the breakdown of the EAC closure in one patient, successfully treated by performing a rotation skin flap. The results of this study confirmed that external auditory canal closure is a reliable technique in cochlear implantation after radical mastoidectomy provided that a rigorous surgical technique is performed. A right balance between the need to reduce costs and to avoid unnecessary doses of radiation to patients and the task of a radiological surveillance may be represented by performing computed tomography 12-18 months postoperatively and then, only if clinically warranted.
authors.affiliation: Department of Clinical and Experimental Medicine, Unit of Audiology and Pediatric Otorhinolaryngology, University of Parma, Via Gramsci 14, 43126, Parma, Italy, vincenzo.vincenti@unipr.it.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Vincenti
authors.forename: Enrico
authors.initials: E
authors.lastname: Pasanisi
authors.forename: Andrea
authors.initials: A
authors.lastname: Bacciu
authors.forename: Salvatore
authors.initials: S
authors.lastname: Bacciu
mesh_terms: D000328:Adult; D018424:Cholesteatoma, Middle Ear / Q000209:etiology / Q000517:prevention & control; D019929:Cochlear Implantation / Q000009:adverse effects / Q000379:methods; D004424:Ear Canal / Q000503:physiopathology / Q000601:surgery; D007758:Ear, Inner / Q000000981:diagnostic imaging / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008416:Mastoid / Q000601:surgery*; D008875:Middle Aged; D013506:Otologic Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D011183:Postoperative Complications / Q000517:prevention & control*; D012189:Retrospective Studies; D013995:Time; D014057:Tomography, X-Ray Computed / Q000379:methods; D014433:Tympanoplasty / Q000009:adverse effects / Q000379:methods
references.citation: Eur Arch Otorhinolaryngol. 2009 Feb;266(2):171-6
references.pmid: 18853171
references.citation: Eur Arch Otorhinolaryngol. 1998;255(4):169-74
references.pmid: 9592672
references.citation: Otol Neurotol. 2013 Aug;34(6):1033-40
references.pmid: 23856625
references.citation: Otol Neurotol. 2008 Jun;29(4):499-501
references.pmid: 18520585
references.citation: J Laryngol Otol. 2004 Jan;118(1):3-7
references.pmid: 14979963
references.citation: Acta Otolaryngol. 2004 Nov;124(9):1033-8
references.pmid: 15513546
references.citation: Eur Arch Otorhinolaryngol. 2005 Oct;262(10):852-5
references.pmid: 15756568
references.citation: Otol Neurotol. 2003 May;24(3):404-8
references.pmid: 12806292
references.citation: Otolaryngol Head Neck Surg. 2002 Nov;127(5):432-6
references.pmid: 12447237
references.citation: Otol Neurotol. 2002 May;23(3):341-5
references.pmid: 11981392
references.citation: Otol Neurotol. 2007 Apr;28(3):330-4
references.pmid: 17414038
references.citation: J Laryngol Otol. 1999 Oct;113(10):881-4
references.pmid: 10664700