Download 13th International Conference on Cochlear Implants and Other

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Transcript
P2-11-26
The risk of „silent“ labyrinthitis in patients after cochlear implantation
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Gekeler J. , Gostian A.O. , Lang-Roth R. , Anagiotos A. , Huettenbrink K.B.
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University Hospital of Cologne, Ear Nose and Throat, Cologne, Germany
Introduction: A 69-years old woman presented to our department complaining about a draining ear on the right
side 1.5 years after cochlear implantation with preexisted canal-wall-down mastoid cavity. Examination of the ear
revealed a moist and not well arranged radical cavity with the electrode of the implant uncovered on the ground.
Revision surgery was performed and the cochlear implant removed. The electrode was cut off in the round
window and left as a dummy. A few weeks later the patient presented with facial nerve palsy on the same side.
Methods: An MRI with contrast agent showed an enhancement in the cochlea and the inner ear canal. The
radiologist assumed an acoustic neurinoma. Immediately revision surgery was performed with removal of the
remained electrode. A massive inflammatory change of the tympanic mucosa and the facial nerve was seen and
granulation tissue in the tympanic canal. Pseudomonas aeruginosa was detected and treated by intravenous
antibiotics.
Results: Facial nerve palsy was promptly diminishing. An MRI-scan 3 weeks after surgery showed reduced
enhancement of the inner ear canal. 4 weeks later signs for inflammation resolved also in the cochlea and
mastoid.
Discussion: In this patient the draining ear followed by facial nerve palsy was the only clinical sign for an acute
labyrinthitis. Enhancement of the cochlea and the inner ear canal in MRI scans indicated the inflammation of the
inner ear and even revealed progression towards the brain.
Conclusion: In deaf patients, especially after cochlear implantation, typical symptoms for labyrinthitis as vertigo
or hearing loss can easily be missing. The imminent risk of intracerebral spread, signed in our patient by the
enhancement of the inner ear canal, thus can easily remain unnoticed in the beginning.
Learning outcome: The appropriate assessment of the imaging and the crucial bit of information by the ENTspecialist is all the more important to avoid fatal misinterpretations or delay of therapy in case of complications
after cochlear implantation.
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