Application Of Cochlear Implantation In Deaf-Mutism With Otitis Media, LVAS, And White Matter Maldevelopment

Objective Through the analysis of clinical data of patients who underwent cochlear implantation, to discuss the application of cochlear implantation in otitis media, LVAS, and white matter maldevelopment.Materials and methods During the period of January 2002 to March 2010, a total of 124 cases of cochlear implantation were performed in patients with bilateral profound sensorineural hearing loss (SNH) in Xiangya Hospital of Central South University, during which there're 9 cases of otitis media,6 cases of LVAS, and 5 cases of white matter maldevelopment.20 patients with only deaf-mutism were randomly selected using random number method. All patients were evaluated by clinical examination, audiology, imagology, effect of hearing aids, lingual skill, intelligence and psychology. The patients were operated via mastoidectomy with posterior tympanotomy approach (MPTA), using products from Cochlear company. Impedance of the electrodes and NRT were tested during the operation. X-ray was performed 3 days after the operation, and fitting procedures started one month after the operation. Electrode impedance and speech recognition score were followed up.Results All 40 cases had profound SNH, proved by ABR, ASSR, DPOAE. The cochlear implantations were successful in all cases. In 9 cases with deaf-mutism and otitis media, the mucosa of mastoid air cell and tympanic cavity thickened, in which light yellow jelly-like secretion could be seen. During operations for 6 cases with LVAS, stapedial gusher was encountered. The electrodes were inserted smoothly, and stapedial gusher stopped after sealing with soft tissue. There were no complications for all cases. The electrodes were confirmed in the cochlear by postoperative X-rays 3 days after the operations. Fitting procedures began one month after operations, showing that the hearing recovered completely; and all patients started language recovery training. There's no statistic significances between patients with only deaf-mutism or with some combined diseases, concerning electrodes impedance and speech recognition score.. Conclusions Chronic secretory otitis media, and LVAS are not contraindications for cochlear implant, but we should prevent infection during perioperative period of patients with chronic secretory otitis media; and dealing with stapedial gusher carefully doesn't affect the insertion of electrodes. Maldevelopment of brain white matter is not contraindication for cochlear implantation either; in the short term, it may not affect patients' recovery after operations, but in the long term, the patients' hearing and mental conditions may depend on the severity of the disease itself.