Intraoperative surgical findings and difficulties of pediatric cochlear implantationDownload PDF
Objective: To assess the intraoperative surgical findings and difficulties of cochlear implantation in preschooler age group and how to overcome these difficulties.
Aims of the study: 1. To assess the intraoperative findings and difficulties of cochlear implantation in preschooler age group. 2. How to overcome these difficulties.
Study design: Cross sectional study.
Setting: This study was conducted in the department of otolaryngology in Al-Yarmook teaching hospital in Baghdad, from (April /2008) to (February /2015).
Patients selection: 426 patients between (18) months to the end of (6) years old, who had severe to profound S.N.H.L. were selected after no hearing improvement occurred with wearing of hearing aids for at least 6 months. A multidisciplinary team (otolaryngologist, audiologist, radiologist, pediatrician, psychiatrist, neurologist) was selected for assessment of the patients and subject them for the candidacy of patient for cochlear implantation, any patient not fulfilled the criteria of assessment was excluded. Unilateral cochlear implantation was done for all the patients. Data regarding the surgical findings and difficulties is designed according to the surgical steps of cochlear implantation ( mastoidectomy, bone well setting, posterior tympanotomy, middle ear cavity and cochleostomy or round window approach).
Results: The most common age group was 3-4 years. The study showed that (54%) of patients were females, while (46%) of patients were males, female to male ratio was 1.2:1. The most frequent finding and difficulty during mastoidectomy for cochlear implantation was presence of Koerner’s septum (29.81 %) while in bony well drilling, dural exposure (31.7%) was the most frequently encountered. During posterior tympanotomy, the most common finding was non-pneumatized antral threshold angle (40%). In the middle ear eight patients (1.87%) found to have O.M.E. The most common surgical finding and difficulty during cochleostomy or round window approach was abnormal round window niche position in postero-inferior direction (9.154%). The majority of these findings and difficulties had been overcome during surgery and successful C.I. was done for the patients, while only few cases were postponed.
Conclusion: 1- Cochlear implantation surgery had multiple steps with large number of difficulties, but most of these difficulties can be managed during surgery without complications. 2- Good assessment of patients by otolaryngeal examination, radiological and audiological investigations with good experience and multidisciplinary team work make cochlear implantation surgery with low rate of complications.
Keywords: Pediatric cochlear implantation, mastoidectomy, tympanotomy and cochleostomy