Cochlear implantation in the obliterated cochlea.

Area of Science:

• Otolaryngology
• Neurosurgery
• Medical Imaging

Background:

• Acquired deafness presents challenges for cochlear implantation, particularly when cochlear obliteration is present.
• Radiological assessment, including CT scanning, is used to evaluate the degree of cochlear patency before surgery.
• Choosing the most radiologically favorable side for implantation is a common surgical consideration.

Observation:

• Three cases of acquired deafness with obliterated cochleas undergoing cochlear implantation are presented.
• Unexpected intraoperative findings of extensive cochlear obliteration occurred despite favorable preoperative imaging.
• Complications included partial insertion, facial nerve stimulation, and the need for revision surgery or contralateral implantation.

Findings:

• Partial electrode insertion due to unexpected cochlear obliteration can lead to suboptimal outcomes and complications.
• Contralateral cochlear implantation, when the primary side is unexpectedly obliterated, can yield excellent results.
• A department's learning curve demonstrated a shift in surgical philosophy towards prioritizing contralateral exploration over partial insertion.

Implications:

• Preoperative imaging may not always accurately predict the extent of cochlear obliteration.
• Surgical planning for cochlear implantation in cases of acquired deafness with cochlear obliteration requires flexibility.
• Exploring the contralateral ear is a viable and often preferable strategy when encountering unexpected intraoperative challenges.