Chronic suppurative otitis media in adult cochlear implantation: a review of our experience

Abstract

Learning Objectives: Importance of the prompt treatment of CSOM post-CI. Recognition of surgical factors when performing CI to minimise the potential for future CSOM development: avoiding or correcting damage to posterior canal wall and annulus. In cases of pre-existing CSOM, steps should be taken to treat the disease and prevent recurrence. Chronic suppurative otitis media (CSOM), with or without the presence of cholesteatoma, may occur following cochlear implantation. At present, however, there is paucity of published data regarding the incidence and management of CSOM in adult cochlear implant (CI) recipients. Here we describe our experience of treating these patients and discuss important lessons learnt. Details of all CI recipients who underwent procedures for CSOM from January 2001 to December 2015 were identified. Information regarding the patient's case history, type and timing of the surgical procedure, post-operative complications and CI use were collected. Results: Eight CI patients with CSOM were identified (1.18% of patients undergoing CI during this period). The mean age at initial CI was 53 years. Two patients were identified as having pre-existing CSOM prior to CI and underwent simultaneous procedures. In the other 6 patients, CSOM developed post-CI with the main symptom being chronic otorrhoea. The mean time interval between CI and CSOM surgery was 5.6 years (range 3-11 years). Treatment included explant and blind sac closure, with reimplantation in 3 cases. One case of extensive cholesteatoma required a subtotal petrosectomy. Of the 8 patients, 4 patients required an average of 3 further procedures (range 2-5) to treat continuing CSOM symptoms. Implant outcomes were as follows: original CI retained and in use, n = 1; bilateral CI and use of contralateral non-affected side, n = 4; re-implantation and use of CI on affected side, n = 3. Conclusions: CSOM can occur, often several years, following CI. Recognition of symptoms together with prompt treatment may allow retention of the original CI and prevent further complications and multiple procedures. CSOM noted preceding CI should be treated adequately prior to or at the time of implantation and steps taken to prevent the recurrence of disease.