Cochlear implantation after bilateral transverse temporal bone fractures

Bilateral Cochlear Implantations in Temporal Bone Fracture: A Viable Treatment Option

OBJECTIVES/HYPOTHESIS

Although it is surgically more challenging, patients with bilateral temporal bone fractures (TBFs) are potential candidates for successful bilateral cochlear implantation (CI). This study aimed to investigate the feasibility of bilateral implantation in patients with sustained bilateral TBFs.

STUDY DESIGN

Retrospective database study.

METHODS

Seven patients with bilateral cochlear implants who were diagnosed with TBFs were included in this study. Preoperative radiological and audiological evaluations were performed. The outcomes of the CI were also investigated.

RESULTS

Hearing levels were restored to the mild-moderate range (<40 dB) for nearly all patients and they reported an improved quality of life.

CONCLUSIONS

CI in patients with TBF is safe and offers a solution for the restoration of hearing in a population who may experience sudden bilateral deafness. However, preoperative confirmation of intact auditory nerves and patent cochlea is essential to maximize the success of CI in this population.

LEVEL OF EVIDENCE

4 Laryngoscope, 2021.

A Systematic Review of Cochlear Implantation in Temporal Bone Fractures and the Significance of Otic Capsule Involvement

OBJECTIVE

Head trauma can cause deafness in cases with and without a skull base fracture. Anatomic disruption can occur with skull base fractures, but inner ear structures can also be damaged by the concussive forces of the trauma even without fracture. It is thought that negative prognostic indicators for successful cochlear implantation (CI) for hearing rehabilitation include fractures involving the otic capsule or ossification of the cochlea. This review evaluates success of CI in posttrauma patients.

DATA SOURCES

PubMed/MEDLINE, Cochrane, and Embase.

STUDY SELECTION

Search terms used were "cochlear implant" AND ("trauma" OR "fracture"). Studies including preoperative computed tomography or magnetic resonance imaging and patient-level outcome data were included.

DATA EXTRACTION

Study design, perioperative and postoperative outcomes, and complications were reported. Success rates of CI were compared using χ analysis.

DATA SYNTHESIS

Twenty-three studies encompassing 88 patients who experienced posttraumatic deafness and received subsequent CI were included. CI was reported as successful for 28 of 34 patients (82%) with otic capsule-involving fracture, as compared with 17 of 22 (77%) in those who had an otic capsule-sparing temporal bone fracture, and 15 of 17 (88%) of patients without evidence of fracture (i.e., concussive inner ear injury).

CONCLUSIONS

In patients with posttraumatic hearing loss, success rates do not significantly differ between cases that do or do not involve fractures of the otic capsule. CI for posttraumatic hearing loss is generally successful.

Long-term cochlear implantation outcomes in patients following head injury

OBJECTIVE

In cases of a severe to profound sensorineural hearing loss following head injury, the cochlear implant (CI) is the primary option for auditory rehabilitation. Few studies, however, have investigated long-term CI outcomes in patients following head trauma, including those without temporal bone fracture (TBF). Herein, the aim of this study is to examine CI outcomes following cases of head injury with and without TBF.

METHODS

Audiometric outcomes of patients who received a CI due to a head injury resulting in severe to profound hearing loss at two tertiary care hospitals were analyzed. Patients were divided into those who received a CI in a fractured temporal bone (group A, n = 11 patients corresponding to 15 ears) and those who received a CI in a non-fractured temporal bone (group B, n = 8 patients corresponding to nine ears). Primary outcomes included duration of deafness prior to CI and postoperative consonant-nucleus-constant whole word (CNC) scores.

RESULTS

Nineteen patients (84% male), corresponding to 24 CIs, were identified. Fifteen CI were performed on ears with TBF (group A), and nine CI were performed on ears without TBF (group B). No patients had an enlarged vestibular aqueduct (EVA). The mean duration of deafness was 5.7 and 11.3 years in group A and group B, respectively. The mean duration of CI follow-up (CI experience) was 6.5 years in group A and 2.1 years in group B. The overall mean postoperative CNC score for all subjects was 68.6% (±21.2%, n = 19 with CNC testing). There was no difference in CNC score between group A and group B (69.8% and 66% respectively, P = .639).

CONCLUSION

The study is among the largest series examining long-term outcomes of CI after head injury. CI is an effective method for auditory rehabilitation in patients after head injury.

LEVEL OF EVIDENCE

IV.

Hearing Restoration with Cochlear Implantation in Patients Deafened after Blunt Head Trauma

OBJECTIVES

The objective of the study was to assess the outcomes of cochlear implantation in patients deafened following blunt head trauma.

MATERIAL AND METHODS

Retrospective case series review of seven patients post-lingually deafened following blunt head trauma and aided with cochlear implants. The following data were analyzed: Cause of injury, computed tomography results, surgical information, intra- and post-implantation complications, audiometric and speech perception assessment, processor mapping, and data from follow-up appointments.

RESULTS

The median age of patients at the time of cochlear implantation was 29 years. The median time elapsed between head trauma and cochlear implantation was 5.77 months (minimum 0.8 and maximum 6.73 months). The median post-implantation follow-up time was 11.97 years. No facial nerve stimulation was observed in any case. All patients significantly improved their audiology and speech perception performances within a short time following cochlear implantation and CI performance did not decrease with long-term follow-up in any case.

CONCLUSION

The results of this study showed that cochlear implantation is an effective treatment method for patients deafened following blunt head trauma.

Facial nerve stimulation associated with cochlear implant use following temporal bone fractures

OBJECTIVE

To describe the incidence and management of patients with facial nerve stimulation (FNS) associated with cochlear implant (CI) use in the setting of a prior temporal bone fracture.

PATIENTS

One adult CI recipient is reported who experienced implant associated FNS with a history of a temporal bone fracture. Additionally, a literature search was performed to identify similar patients from previous descriptions of CI related FNS.

MAIN OUTCOME MEASURES

Presence of FNS after implantation and ability to modify implant programming to avoid FNS.

RESULTS

The patient in the present report experienced FNS for middle and basal electrodes during intraoperative neural response telemetry (NRT) in the absence of any surgical exposure or manipulation of the facial nerve. FNS was absent during device activation, but it recurred during follow-up programming sessions. However, additional programming has prevented further FNS during regular implant use. Four other patients with FNS after temporal bone fracture were identified from the literature, and the present case represents the one of two cases in which reprogramming allowed for implant use without FNS.

CONCLUSIONS

CI associated FNS is uncommon in patients with a history of a temporal bone fracture, but it is likely that fracture lines provide a lower impedance pathway to the adjacent facial nerve and thus reduce the threshold for FNS. The present report suggests that, in the setting of a prior temporal bone fracture, NRT is not always a reliable predictor of FNS during implant use, and programming changes can help to mitigate FNS when it occurs.

A case of cochlear implantation targeting preserved cerebral cortex in severe traumatic brain injury

Temporal bone fracture and blunt head trauma was once considered as contraindication for the surgery. Increasing numbers of successful cochlear implantation are being reported. However, the outcome of cochlear implantation in severe damaged brain is unclear. A multichannel cochlear implant was successfully implanted in a 33-year-old man who had both sensorineural deafness, left hemiplegia due to bilateral transverse temporal bone fractures and severe right brain damage after a traffic accident.

Cochlear implantation versus auditory brainstem implantation in bilateral total deafness after head trauma: personal experience and review of the literature

OBJECTIVE

To determine the effectiveness of cochlear implant (CI) in hearing restoration after temporal bone (TB) fractures and investigate the adequacy of auditory brainstem implant (ABI) indication for TB fractures.

STUDY DESIGN

Retrospective clinical study; a systematic review of the literature in PubMed was also performed to identify all published cases of bilateral TB fractures or bilateral deafness after head trauma treated by means of CI or ABI.

SETTINGS

Quaternary otology and skull base surgery referral center.

PATIENTS

Eleven consecutive patients presented with bilateral severe-to-profound sensorineural hearing loss after head trauma.

INTERVENTIONS

CI as primary intervention or following a previous treatment.

MAIN OUTCOME MEASURES

CI performances were evaluated in the auditory-only condition in both closed-set and open-set formats.

RESULTS

Fourteen CI were placed, 11 as primary treatment and 3 after ABI failure. At the last follow-up, all patients gained useful open-set speech perception. In secondary CI, all patients obtained better auditory results with the CI if compared with ABI. CI performance did not decrease with time in any case.

CONCLUSION

Cochlear implantation after TB fractures has proved to have excellent audiometric results. The aim of the initial evaluation of a patient with bilateral anacoustic ears from head trauma should always be to rehabilitate their hearing with a CI. The incidence of labyrinthitis ossificans, negative electrophysiologic testing, the risk of postoperative meningitis or facial nerve stimulation should not be the determinant factors that favor ABI placement.

Cochlear implantation in posttraumatic bilateral temporal bone fracture

Temporal bone (TB) fractures can cause loss of audiovestibular function. Four cases of profound hearing impairment following bilateral TB fracture are presented in this report. All patients received a cochlear implant. All 4 patients became regular users of their implants. None of the patients experienced facial nerve stimulation. Implant-aided audiometry demonstrated a hearing threshold of 28 dB HL. The performance in speech understanding was comparable to standard postlingual adult patients implanted. We believe that cochlear implantation in patients suffering from profound sensorineural hearing losses secondary to TB fractures can be an effective tool for rehabilitation.

Bilateral cochlear implantation in a patient with bilateral temporal bone fractures

With the emphasis on bilateral hearing nowadays, bilateral cochlear implantation has been tried out for bilateral aural rehabilitation. Bilateral sensorineural hearing loss caused by head trauma can get help from cochlear implantation. We present the case of a 44-year-old man with bilateral otic capsule violating temporal bone fractures due to head trauma. The patient demonstrated much improved audiometric and psychoacoustic performance after bilateral cochlear implantation. We believe bilateral cochlear implantation in such patient can be a very effective tool for rehabilitation.