Management of Chronic Otitis Media for Cochlear Implantation and Other Implantable Devices.

Abstract

Learning Objectives: The presence of Chronic Otitis media presents a significant management challenge in patients who are candidates for, or who have, a Cochlear Implant or other Implantable Hearing device. Permanent eradication of middle ear disease, including cholesteatoma and infection, is required together with reconstruction to provide robust cover of the implanted device or secure separation from the external environment. This can be achieved with either staged or primary surgery depending on the nature and extent of the chronic otitis media. Procedures include: routine Tympanoplasty with or without Intact Canal Wall Mastoidectomy; Blind Sac Closure of the external auditory canal with removal of all squamous epithelium from the canal, tympanic membrane and middle ear cleft, with or without obliteration of the mastoid or plugging of the Eustachian tube. This paper presents an algorithm for the management of such cases based on the Melbourne Cochlear Implant Clinic experience and provides an overview of the aims and surgical techniques utilized in patients with Chronic Otitis Media for the eradication disease and creation of safe stable ears with Cochlear Implants and various other implantable devices.