EVALUATION OF THE RESULTS OF DIFFERENT PROCEDURES IN COCHLEAR IMPLANTATION

Abstract

The cochlear implantation has radically changed the outlook for profoundly deaf adults and children. The cochlear implant can provide sufficient hearing sensations to enable most severely or profoundly deafened persons to continue communicating using speech as their primary means of communication .In Classic cochlear implantation; mastoidectomy is done to help retain the electrode leads within the confines of the mastoid cavity. Then the facial recess should be widely opened followed by cochleostomy which is followed by insertion of the electrode array. Minimally invasive cochlear implant surgery has become the mainstay of most experienced centers. Aim of work: to evaluate the results of using different procedures in cochlear implantation. Patients and methods: The study carried out on 41 patients underwent cochlear implantation, starting from April 2011 till April 2014. Patients were 27 males and 14 females, their age ranged from 2 years to 18 years and all complained of profound sensori-neural hearing loss.
We excluded postlingual adults (n=2) and children with congenital anomalies (n=3), post-meningitis cochlear ossification (n=1) and children with chronic suppurative otitis media (n=1). Total number of excluded cases is 7 patients and remains 34 patients. The patients were divided into two groups: the 1st group of patients were implanted by classic approach (n=28) the 2nd group of patients were implanted by the SMA (n =6) and another comparison in which, the patients were divided into patients was implanted by PULSAR ci100 device (5 cases) and the patients were implanted by HI-RES 90K device (29cases); all patients were subjected to full preoperative assessment, and full postoperative assessment of complications (major and minor complications). Results: there is significant relation between the two groups regarding major complications in favor to classic approach but there is significant danger of facial nerve, chorda tympani nerve injury in classic approach, there is no significant difference between the ways of insertion regarding the major complications and there is significant difference between the 2 groups as regard to device migration, electrode extrusion and device malfunction in favor to Hi-res 90k device. Conclusion: classic approach has fewer incidences of major and minor complications than SMA, but there is significant danger of facial nerve, chorda tympani nerve injury in classic approach, Hi-res 90k device is better than PULSAR ci100 device as regard to device migration, electrode extrusion and device malfunction, We still need more assessment for surgical approaches, way of electrode insertion, type of devices.
Keywords: Cochlear implantation, Suprameatal approach, Posterior tympanotomy approach.