The Role of Subtotal Petrosectomy in Persistent Chronic Otitis Media with Emphasize On CI Candidates who also have COM

Background: Persistent otitis media despite multiple mastoid operations is a challenging medical issue in general population, with special importance in cochlear implant candidates.

Objective: The aim of the study was to evaluate treatment outcomes in a large group of patients in whom subtotal petrosectomy with blind sac obliteration of the external ear canal and middle ear cleft was performed due to various reasons.

Methods: Retrospective study of clinical and hearing outcomes in patients undergoing subtotal petrosectomy for the treatment of various ear issues, including chronic discharging ears, cholesteatoma, cochlear implant candidates with chronic ears.

Results: 96 subtotal petrosectomies were performed between 1998-2017 (mean age: 51 years (range, 4.6-82.8). 42 ears underwent cochlear implantation. Post-operative short and long term course was uneventful in 91/96 patients. Blind sac closure dehiscence, retro-auricular wound dehiscence and seroma occurred in 1, 2 and 2 patients, respectively; all were solved promptly. 2 months postoperatively all patients reached a water proof ear. In 22 of the 42 patients who also received a cochlear implant, the two procedures were performed in one stage. Scores for monosyllabic words in quiet, sentences in quiet and sentences in noise (SNR +5dB) were 59%, 71%, and 27.4%, respectively.

Conclusions: subtotal petrosectomy with blind sac obliteration of the external ear canal and middle ear cleft offers a definite solution for unstable ears when other, less radical options, fail. It allows a safe cochlear implantation in these cases. Nevertheless, outcomes of cochlear implantation in these cases seems to be inferior to that of other post lingual straightforward adults; probably due to inconsistent use of hearing aids prior to implantation. Decisions in patients with unstable ears should be taken as early as possible for both the safety of the patient (and the ear) and the future of the patients’ hearing.