A CASE OF CHOLESTEATOMA OCCURRING AFTER COCHLEAR IMPLANTATION

Yumi Ohta,1 Takayuki Kawashima,1 Taro Hasegawa,1 Atsuhiko Uno,1 Takao Imai,1 Tetsuo Morihana,1 Kayoko Higashi-Shingai,2 Takefumi Kamakura,1 Keiko Suwa,1 Masami Hanamoto,1 Takahiro Michiba,3 Katsumi Doi,4 Hidenori Inohara1

1Department of Otorhinolaryngology – Head and Neck Surgery, Osaka University Graduate School of Medicine, Osaka, Japan; 2Sumitomo Hospital, Osaka, Japan; 3Osaka Rousai Hospital, Osaka, Japan; 4Department of Otorhinolaryngology, Kinki University, Osaka, Japan

Introduction

In some cases, profound sensorineural hearing loss can be caused by chronic otitis media or cholesteatoma. Recently, even in such cases, cochlear implantation can be safely performed after the active middle-ear infection has settled down.1 However, the rate of complications after cochlear implantation is higher in cases with middle-ear disease than without disease.2,3 We report a case with cholesteatoma that occurred ten years after cochlear implantation.

Case history

A 69-years-old (in 2010), female suffered in 1996 from sudden deafness in the left ear. She was treated with steroids and batroxobin without effect.

In 1997, a tympanoplasty was performed in order to cure the adhesive otitis media of her right ear.

In 1998, a tympanoplasty with columella on the stapes was performed again because of adhesion of tympanic membrane and hearing loss. Insertion of the gromet tube was also performed. Cholesteatoma was seen. Just after surgery, she suffered from profound sensorineural hearing loss. She was treated with steroids without effect.

In 1999, a cochlear implantation was placed in the right ear. The mastoid was filled with granulation. There was a bone defect in the basal turn of cochlear. The electrode was inserted into this hole. Twenty-two active electrodes and five extra electrodes were inserted.

In 2009, cholesteatoma was identified (CT and tympanic membrane).

In 2010, a CT showed that the mass of mastoid had grown (Fig. 1). Surgery with the aim of removal of cholesteatoma was done.

We chose the canal-wall-down technique and removed the cholesteatoma from the matrix with the so-called Bondy technique. We could remove cholesteatoma without re-implantation. The electrodes were left as they were (Fig. 2).

Results

Three months after surgery, the electrodes are not exposed at either external ear canal or retro-auricle (Fig. 3). The cavity is almost free from maintenance. The post-operative hearing score is almost same as before (Fig. 4).

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Fig. 1. CT (2010).

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Fig. 2. Surgical findings (2010).

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Fig. 3. External ear canal (three months after surgery).

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Fig. 4. Hearing (CI-2004). *CI-2004: Test battery for the patient with a cochlear implant to assess the audiological phase. The components are lists of consonants, syllables, words and sentences (Japanese).

Discussion

In this case, although the ear drum tended to be adherent, the cochlear implantation was performed in the ordinary method. Therefore, cholesteatoma recurred from the pars flaccida.

The rate of complication after a cochlear implantation for patients with middle-ear disease is higher than that of patients without middle-ear disease.2,3 Especially the adhesive ear drum and poor aeration of tympanic cavity are factors of complications after cochlear implantation.

Therefore, when we plan cochlear implantation for the patients whose middle ear is difficult to aerate, some special considerations are required, such as, obliteration of mastoid and tympanic cavity (+ EAC closure),1,4,5 canal-wall-down technique to leave no possibility of retraction, covering of the electrodes with cartilage.6

References

1.Leung R, Briggs RJ. Indications for an Outcome of Mastoid Obliteration in Cochlear Implantation. Otol Neurotol 28:330–334, 2007

2.Olgun L, Batman C, Gultekin G, Kandogan T, Cerci U. Cochlear implantation in chronic otitis media. J Laryngol otol 119:946–949, 2005

3.Postelmans JT, Stokroos RJ, Linmans JJ, Kremer B. Cochlear implantation in patients with chronic otitis media: 7 years’ experience in Maastricht. Eur Arch Otorhinolaryngol 266:1159–1165, 2009

4.El-Kashlan HK, Arts HA, Telian SA. Cochlear Implantation in Chronic Suppurative Otitis Media. Otol Neurotol 23:53–55, 2002

5.Gray RF, Irving RM. Cochlear Implants in Chronic Suppurative Otitis Media. Am J Otol 16:682–686, 1995

6.Kim C, Chang S, Lee H, Shim W, Oh SH, Kim YH. Cochlear Implantation in Patients with a History of Chronic Otitis Media. Acta Otolaryngol 124:1033–1038, 2004

Address for correspondence: Yumi Ohta, MD, Address:2–2 Yamadaoka, Suita, Osaka, 565–0871, Japan. yota@ent.med.osaka-u.ac.jp

Cholesteatoma and Ear Surgery – An Update, pp. 377–380

Edited by Haruo Takahashi

2013 © Kugler Publications, Amsterdam, The Netherlands