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Cochlear Implantation in Children with Congenital Inner Ear Malformations

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Abbas A. M., Hamed M. S., Ahmed A. S.
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2022
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vol. 11
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issue 4
1-12
EN
Introduction: Cochlear Implantation has proven beneficial in patients with profound congenital hearing impairments. Performing cochlear implantation in patients with inner ear malformation has always been a matter of dispute as congenitally deaf ears may have anatomical malformations and thus meet difficulties during operation. Therefore, it is important to focus on problems and complications encountered by surgeons performing such operations. Aim: To evaluate problems and surgical difficulties encountered in patients with congenital inner ear malformation, who underwent cochlear implantation. Material and methods: A series of 21 pediatric cochlear implant (CI) patients with known inner ear malformations determined on computed tomography (CT) of the temporal bone who underwent cochlear implantation in the Department of Otolaryngology of Martyr Ghazi Al-Hariri and AL-Yarmouk Teaching Hospital, Baghdad, Iraq, from January 2018 to January 2021. The study aimed to determine intraoperative adverse effects of these anomalies regarding electrode array insertion depths, predisposition to cerebrospinal fluid (CSF) leak through the cochleostomy, and associated facial nerve anomalies that can create problems with access to scala tympani. Results: The most common inner ear anomalies were wide vestibular aqueduct (15 patients, which makes 71.4%), incomplete partitions (5 patients, 23.8%), and common cavity (1 patient, 4.8%). As concerns CSF leak, the most common was CSF ooze (11 patients, 52.4%), CSF gusher (6 patients, 28.6%), and no CSF leak (4 patients, 19%). Among facial nerve anomalies there was only one case (4.8%) of abnormal position (more superficial and not injured) and 20 cases (95.2%) in which no anomaly was detected. As concerns electrode insertion depth, full insertion was achieved in 17 patients (81%), while incomplete insertion in 4 patients (19%). Conclusion: Cochlear implant can be successfully and safely inserted in patients with selected congenital inner ear anomalies. Surgery can be challenging in certain cases of gusher and facial nerve abnormalities, but proper radiology and good surgical technique will help avoid complications.
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