Subtotal petrosectomy (SP) and obliteration of the middle ear in preparation for a cochlear implant (CI)

Introduction Chronic inflammatory pathologies of the middle ear (COM) pose a risk for cochlear implantation. To enable this safely, the option of SP prior to implant placement is available. Discussions include whether obliteration should be performed with abdominal fat, and whether the CI can be inserted one- or two-sided. We report on our patients who received a CI after SP.

Methods In a retrospective cohort study, all patients who received SP as preparation for a CI between 2007 and 2022 were evaluated. The reason for the SP as well as intra- or postoperative complications, and the postoperative word recognition score at 65dB were recorded.

Results 33 patients received a CI after SP in the designated period (m= 15, w=18). In 30 patients a COM was present. In 2 patients the procedure was performed as preparation for reimplantation with explantation due to superinfection with petrositis, one patient suffered from bony destruction of a bilateral ELS tumor. All patients underwent SP with obliteration of the middle ear with abdominal fat and closure of the tube and ear canal. All CIs were placed bilaterally after an interval of >3 months. We did not observe an increased specific complication rate after CI performed. Postoperative speech understanding was 58% on average.

Conclusion SP with obliteration is a safe surgical technique and allows consecutive CI even in high-risk cases. From our point of view, a two-stage procedure is preferable. Postoperative hearing is approximately in line with the reference values reported in the literature. A reliable negative predictor could not be identified.

Publication History

Article published online:
12 May 2023