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Methods
After obtaining Institutional Review Board approval, a retrospective chart review
of all patients undergoing ipsilateral subtotal petrosectomy with mastoid obliteration and
cochlear implantation between 1990 and 2012 was performed. The overall
meanstandard deviation (SD) age was 40.730. 5 years. The mean age for the pediatric
group (<18years old) was 4.083.36 years. For adults (≥18years old), the mean age was
59.917.8 years. Only ears undergoing both procedures were studied. Three patients
received SPMO and CI on both ears for a total of 36 patients and 39 ears. Patient
demographics, operative details, pre- and postoperative clinical course were collected.
Statistical analysis of outcomes based on the number of ears was performed using
GraphPad QuickCalcs Web site: http://graphpad.com/quickcalcs/contingency1 (accessed
October 2012).
Patient selection
All implanted ears were treated at a single tertiary care hospital. An experienced
neurotologist (BG or MH) performed both SPMO and CI for all ears. SPMO and CI were
performed in CI candidate ears with evidence of COM or in ears with anatomic
deformity. Pediatric candidates with a significant history of RAOM confirmed on
examination by a neurotologist were typically managed by initial SPMO rather than MT
placement. Adult and pediatric patients presenting with pre-existing tympanotomy tubes
without history of recurrent drainage (i.e. dry ears) underwent removal and fat patch
myringoplasty at the time of CI without SPMO. These patients were not included in the
current study while those with persistent or recurrent drainage from previously placed
tympanotomy tubes were managed by SPMO and were included. Adult ears with COM
were managed with medical therapy and clinic debridement prior to surgery.
Surgical technique
Procedures were either staged or performed simultaneously, typically depending
on whether there was evidence of chronic/active infection or if there was no evidence of
infection, respectively. Mastoid ablation techniques used either abdominal fat, temporalis
muscle or bone pate. SPMO and CI were performed as previously described with
occasional variation in management.[3, 8] In SPMO, a complete mastoidectomy was
performed and the tympanic membrane, malleus and incus were removed. Canalplasty
was performed to clear skin medial to the bony cartilaginous junction and the mucosa of
the middle ear was removed. The lateral canal skin was then completely everted and
closed with interrupted sutures. The mucosa in the Eustachian tube was removed with a
diamond burr, and the Eustachian tube was plugged with bone wax and muscle. For CIs,
electrode insertion was performed through a standard cochleostomy anterior and inferior
to the round window niche except for two cases involving abnormal anatomy and
cochlear ossification requiring cochlear drill out. Clarion (Advanced Bionics
Corporation, Sylmar CA) and Nucleus (Cochlear Corporation, Lane Cove NSW,
Australia) devices were implanted.