Far-advanced otosclerosis and cochlear implantation

Far-advanced otosclerosis and cochlear implantation. Problems/objectives: To report the radiographic and surgical findings, speech perception performance, and complications of cochlear implantation for patients who were affected by far-advanced otosclerosis. Methodology: Five patients, 2 males and 3 females, with a family history of otosclerosis and who previously underwent stapedectomy to improve hearing were included in this study. CT scans of all ears were graded according to Rotteveel’s grading system. All patients underwent cochlear implantation according to standard procedures. A control group of 10 non-otosclerotic postlingual implanted adults matched for age was used. Results: On CT scanning, one patient had solely fenestral disease (type 1), 3 patients had localized retrofenestral disease (type 2), and 1 had diffuse retrofenestral disease with loss of the normal architecture of the cochlea (type 3). In all otosclerotic patients, the electrode array was fully inserted. However, in two patients (type 2 and 3) a thickened otic capsule was present and required more drilling than normal. One patient (type 3) experienced postoperatively facial nerve stimulation with normal fitting parameters. Otosclerotic patients showed excellent speech perception after implantation and obtained similar results to those achieved by the non-otosclerotic patients. Conclusions: Patients suffering from far-advanced otosclerosis may benefit from cochlear implantation and achieve speech performance scores comparable to non-otosclerotic implantees. Regarding surgery and facial nerve stimulation, attention should be taken to these cases in which the extension of otosclerosis is more severe on CT scanning (type 2 and mainly 3). Postoperative facial nerve stimulation can be managed successfully by resetting the current levels for comfort level.