Download 13th International Conference on Cochlear Implants and Other

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Transcript
P2-11-6
Vacuum delivery - needs extra consideration before potentially cochlear implantation?
1
Battelino S. , Kordis S.
1
1
University Medical Centre Ljubljana, Otorhinolaryngology, Ljubljana, Slovenia
Introduction: Vacuum extraction has largely replaced forceps delivery. Still it is used up to 1/12 of all births
during the vaginal delivery, also in developed countries. In all instrumental assisted vaginal deliveries some local
trauma on the surface and in subcutaneous tissue of the head could be detected.
Methods: Ten months old deaf boy planed for cochlear implantation is presented. Parents reported no history
regarding and possible cause resulting with deafness. After confirming his deafness with negative ElCochl and
after positive EABR the all standard preoperative testing, including the computer tomography (CT) of the
temporal bone at his age of six months were normal. Timpanometry (TY) result was A - normal. At his 10 months
the cochlear implantation on his right side was planed. During the surgery mastoid cavity was filed with grey
mass, tympanic cavity also totally filed with tissue and our working diagnosis was a latent OMA. Biopsy was
sending for histological examination and total removal of the mass from mastoid cavity (mastoidectomy) and
partially from middle ear cavity was performed. Systemic antibiotics were introduced for 14 days. The first
histology result was; suspected for rhabdomiosarcoma. After two weeks the second surgery was performed, the
mastoid cavity was again filed with gray tissue and it was largely removed from mastoid and from middle ear
cavity only small part was removed. The second histological diagnosis was confirmed as cranial fasciitis.
According to the literature data cranial fasciitis is described as mass that grew rapidly, meningothelial origin,
especially in young boys. The advised therapy is surgery and also where there is no total removal possible,
spontain remission of small left over is described and is almost always connected with trauma of the head in
babies with forceps delivery. The third surgery was performed in his right ear, the tumor was totally removed
from mastoid and also from middle ear cavity, and only some thin »unpeeling part« was left on the second genus
of the facial nerve and he was implanted with cochlear implant on the left side. After our precise questioning of
the parents they recall that there was used vacuum help during vaginal delivery but the perinatologists informed
them that this is no risk for any condition.
Result: Three months after surgery the tympanic membrane is microscopically normal, TY is type A and no
problems on his right side. The CT reveals only small soft tissue over the exposed second genus of the right
facial nerve with no functional disturbances. He is starting to use more than 20 words and he is using his CI on
the left side all the time and no problems on his right auricular area.
Conclusion: There are some conditions, which cannot be preoperatively predicted and discussed with the
patient before the surgery.
Learning outcome: Also detail history regarding instrumental vaginal delivery without any detected neurological
complications should be taken.
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