Blind Sac Closure of the External Ear Canal in Cochlear Implant Surgery

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  • 外耳道閉鎖術を併用した人工内耳手術例
  • ガイジドウ ヘイサジュツ オ ヘイヨウ シタ ジンコウ ナイジ シュジュツレイ

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Abstract

Care must be taken to identify cochleovestibular malformations and facial nerve anomalies in the patients undergoing cochlear implantation (CI). Canal wall down mastoidectomy gives excellent visibility and access during surgery in difficult temporal bone anatomy. We present herein on a case of CI surgery where cochleovestibular malformations existed, and adequate surgical access for implantation was obtained using canal wall down mastoidectomy with blind sac closure of the external ear canal. Indications for performing canal wall down mastoidectomy+CI surgery are as follows: chronic otitis media with persistent otorrhea, presence of a radical cavity/canal wall down open mastoid technique, cochlear ossification/obliteration, inner ear malformations and/or facial nerve anomaly, fracture of temporal bone with inner ear involvement and unfavorable anatomic conditions for posterior tympanotomy. In cases with chronic otitis media and persistent inflammation, canal wall down and complete mastoidectomy are mandatory to eradicate infected middle ear mucosa. Contraindications are as follows: Only one absolute contraindication is when electroacoustic stimulation with EAS-CI system is to be used. A relative contraindication is cases with active infection of the middle ear or cavity. The procedure can be staged. At the first stage, complete mastoidectomy with total eradication of the infection has to be performed. Canal wall down mastoidectomy with blind sac closure of the external ear canal combined with CI is a good procedure required in specific situations as mentioned above.

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