Emphyseme nach Cochlea-Implantation – Risikofaktoren und Therapieoptionen

Zusammenfassung

Hintergrund Im Rahmen der Cochlea-Implantation (CI) zählen Serom- und Hämatombildung, Wundinfektion oder Schwindel zu den seltenen, aber typischen postoperativen Komplikationen. Emphyseme werden dagegen selten beobachtet. Sie können sowohl in der postoperativen Heilungsphase als auch Jahre später auftreten. Ein Therapiealgorithmus existiert bisher nicht.

Methodik Wir berichten von 3 Patient*innen mit subkutanem Emphysem im Bereich des Signalprozessors aus dem eigenen Patientenkollektiv. In einem unsystematischen Review werden anschließend alle Studien mit Beschreibungen von Emphysemen nach CI hinsichtlich möglicher Risikofaktoren und therapeutischer Optionen untersucht.

Ergebnisse Bei den vorgestellten Patient*innen entwickelte sich 2–11 Monate postoperativ ein subkutanes Emphysem nach heftigem Schnäuzen bzw. im Rahmen einer cPAP-Therapie. In der Literatur finden sich weitere 35 Fälle von Emphysemen nach CI. Luftinsufflation über die Tube ist die häufigste Ursache. Erkrankungen der Nase und Nasennebenhöhlen, Tubenfunktionsstörungen und obstruktives Schlafapnoesyndrom sind potenzielle Risikofaktoren. Druckverband, Punktion und Paukendrainage gelten als gängige Behandlungsmethoden. In therapieresistenten Fällen oder bei ausgedehnten Emphysemen kann eine operative Revision sinnvoll sein.

Schlussfolgerung Die meisten Emphysembildungen sind durch konservative Maßnahmen beherrschbar. Punktionen sollten wegen möglicher Infektionen vermieden werden. Der prophylaktische Einsatz von Antibiotika scheint entbehrlich. Die operative Revision sollte bei Pneumozephalus mit Verdacht auf Leckage im Bereich der Dura erwogen werden. Die Abdeckung der Mastoidektomie mit einem Knochendeckel kann bei Risikokonstellation eine sinnvolle Maßnahme zur Prophylaxe postoperativer Emphyseme darstellen. 

Abstract

Objective In case of cochlear implantation seroma, hematoma, local wound infections or vertigo are rare but typical complications. In contrast, emphysema is seldom reported. They can occur after cochlear implantation both in the postoperative healing phase and years later. A therapeutic algorithm does not yet exist.

Methods We report on 3 patients with subcutaneous emphysema in the area of the receiver-stimulator. An unsystematic review of the literature of cases with emphysema after cochlear implantation highlights possible risk factors and the therapeutic options.

Results The 3 cases developed subcutaneous emphysema 2–11 month after cochlear implantation due to nose blowing or CPAP therapy in obstructive sleep apnea. The current literature reports another 35 cases of emphysema after cochlear implantation. Air insufflation via the Eustachian tube is the most frequently described cause. Diseases of the nose and sinuses, tube dysfunction and obstructive sleep apnea are potential risk factors. Pressure bandage, puncture, tympanic tubes, and surgical revision are common treatments.

Conclusions Most emphysema can be controlled by conservative methods such as pressure bandaging and behavioral instruction. Punctures should be avoided due to the risk of upcoming infections. The prophylactic use of antibiotics seems dispensable. Surgical revision should be considered especially in cases of pneumocephalus with suspected leakage in the dura. The coverage of the mastoidectomy by a bony cap can be precautious and beneficial in cases with risk factors.

Schlüsselwörter

Cochlea Implantation - Komplikationen - Emphysem - Pneumolabyrinth - Pneumocephalus

Keywords

cochlear implantation - complications - emphysema - pneumolabyrinth - pneumocephalus

Publication History

Received: 18 February 2022

Accepted after revision: 30 June 2022

Article published online:
17 November 2022

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