Top

European Archives of Oto-Rhino-Laryngology

Published in:

30-09-2023 | Cholesteatoma | Otology

Acquired cholesteatoma after cochlear implants: case series and literature review

Authors: Vittoria Sykopetrites, Flavia Di Maro, Eleonora Sica, Eliana Cristofari

Published in: European Archives of Oto-Rhino-Laryngology | Issue 3/2024

Abstract

Purpose

To assess the prevalence and management of acquired cholesteatoma after cochlear implantation in pediatric and adult patients.

Methods

Retrospective case review of pediatric and adult cochlear implants (CI) followed at a tertiary referral center and literature review of acquired cholesteatoma after CI surgery, to identify its prevalence, cause, and treatment.

Results

Nine pediatric CIs were diagnosed with cholesteatoma in seven patients after 6.4 ± 4 years from CI surgery, and two adults after 11.3 and 21.7 years from CI surgery. Thirty-four pediatric cases and 26 adult cases are described in the literature. Cholesteatoma has a prevalence of 0.54% in pediatric CIs, and 1.79% in adult CIs (case series and literature). Adult cases were diagnosed significantly later compared to pediatric cases (Mann–Whitney test, p = 0.0460). Three pediatric cholesteatomas were treated with conservative surgery and preservation of the CI; they all developed recurrent disease. The remaining pediatric cases underwent subtotal petrosectomy with simultaneous CI explantation and staged reimplantation. Only one case recurred. The adult cases underwent simultaneous subtotal petrosectomy, explantation, and reimplantation. Similarly, 33.3% of cases treated with conservative/reconstructive surgery in the literature required revision surgery or conversion to subtotal petrosectomy against 6.2% of subtotal petrosectomies in the literature.

Conclusions

Cholesteatoma after CI is a rare and late-onset complication of CIs. It is more prevalent in the adult CI population, although it affects children significantly earlier. The treatment of choice is subtotal petrosectomy and CI explantation with simultaneous or staged reimplantation.

European consensus statement on cochlear implant failures and explantations (2005) Otol Neurotol 26(6):1097–1099

Terry B, Kelt RE, Jeyakumar A (2015) Delayed complications after cochlear implantation. JAMA Otolaryngol Head Neck Surg 141(11):1012–1017. https://doi.org/10.1001/jamaoto.2015.2154CrossRefPubMed

Yoshida S, Seki S, Sugiyama T, Kikuchi S, Yoshida N, Iino Y (2022) Comparative study on adhesive otitis media and pars tensa cholesteatoma in children. Auris Nasus Larynx 49(5):790–796. https://doi.org/10.1016/j.anl.2022.02.007CrossRefPubMed

Kuo CL, Yen YC, Chang WP, Shiao AS (2017) Association between middle ear cholesteatoma and chronic rhinosinusitis. JAMA Otolaryngol Head Neck Surg 143(8):757–763. https://doi.org/10.1001/jamaoto.2017.0130CrossRefPubMedPubMedCentral

Kuo CL, Shiao AS, Wen HC, Chang WP (2018) Increased risk of cholesteatoma among patients with allergic rhinitis: a nationwide investigation. Laryngoscope 128(3):547–553. https://doi.org/10.1002/lary.26220CrossRefPubMed

Djurhuus BD, Skytthe A, Faber CE, Christensen K (2015) Cholesteatoma risk in 8,593 orofacial cleft cases and 6,989 siblings: a nationwide study. Laryngoscope 125(5):1225–1229. https://doi.org/10.1002/lary.25022. (Epub 2014 Nov 12)CrossRefPubMed

Lin YS (2009) Management of otitis media-related diseases in children with a cochlear implant. Acta Otolaryngol 129(3):254–260. https://doi.org/10.1080/00016480801901741CrossRefPubMed

Bort A, Portmann D, Guindi S (2015) Cholesteatoma presenting as a late complication of cochlear implant surgery: case report and literature review. Rev Laryngol Otol Rhinol (Bord) 136(2):67–71PubMed

Bhatia K, Gibbin KP, Nikolopoulos TP, O’Donoghue GM (2004) Surgical complications and their management in a series of 300 consecutive pediatric cochlear implantations. Otol Neurotol 25(5):730–739. https://doi.org/10.1097/00129492-200409000-00015CrossRefPubMed

10.

Jeong J, Choi HS (2023) Intratympanic membrane cholesteatoma after traumatic tympanic membrane perforation: a case report. J Med Case Rep 17(1):78. https://doi.org/10.1186/s13256-023-03757-9CrossRefPubMedPubMedCentral

11.

Almofada HS, Almutairi NK, Timms MS (2023) Long-term complications of the transmeatal approach (Open Transcanal) in cochlear implants: a follow-up study. J Otol 18(1):33–37. https://doi.org/10.1016/j.joto.2022.12.002CrossRefPubMed

12.

Colletti V, Carner M, Miorelli V, Guida M, Colletti L, Fiorino FG (2005) Cochlear implantation at under 12 months: report on 10 patients. Laryngoscope 115(3):445–449. https://doi.org/10.1097/01.mlg.0000157838.61497.e7CrossRefPubMed

13.

De Raeve L, Archbold S, Lehnhardt-Goriany M, Kemp T (2020) Prevalence of cochlear implants in Europe: trend between 2010 and 2016. Cochlear Implants Int 21(5):275–280. https://doi.org/10.1080/14670100.2020.1771829. (Epub 2020 May 31)CrossRefPubMed

14.

Canzano F, Di Lella F, Guida M, Pasanisi E, Govoni M, Falcioni M (2023) Revision cochlear implant surgery for clinical reasons. Acta Otorhinolaryngol Ital 43(1):65–73. https://doi.org/10.14639/0392-100X-N2096CrossRefPubMedPubMedCentral

15.

Migirov L, Yakirevitch A, Kronenberg J (2006) Surgical and medical complications following cochlear implantation: comparison of two surgical approaches. ORL J Otorhinolaryngol Relat Spec 68(4):213–219. https://doi.org/10.1159/000091817. (Epub 2006 Mar 3)CrossRefPubMed

16.

Cronin SJ, El-Kashlan HK, Telian SA (2014) Iatrogenic cholesteatoma arising at the bony-cartilaginous junction of the external auditory canal: a late sequela of intact canal wall mastoidectomy. Otol Neurotol 35(8):e215–e221. https://doi.org/10.1097/MAO.0000000000000481CrossRefPubMed

17.

Poliner A, Mahomva C, Williams C, Alfonso K, Anne S, Musso M, Liu YC (2022) Prevalence and surgical management of cholesteatoma in Down Syndrome children. Int J Pediatr Otorhinolaryngol 157:111126. https://doi.org/10.1016/j.ijporl.2022.111126CrossRefPubMed

18.

Gowrishankar SV, Fleet A, Tomasoni M, Durham R, Umeria R, Merchant SA, Shah SFH, Muzaffar J, Mohammed H, Kuhn I, Tysome J, Smith ME, Donnelly N, Axon P, Bance M, Borsetto D (2023) The risk of meningitis after cochlear implantation: a systematic review and meta-analysis. Otolaryngol Head Neck Surg. https://doi.org/10.1002/ohn.309. (Epub ahead of print)CrossRefPubMed

19.

van Oorschot HD, Helleman HW, Smit AL (2023) Chronic meningitis due to otitis media with cholesteatoma in a five-year-old child with a cochlear implant. J Audiol Otol 27(2):110–114. https://doi.org/10.7874/jao.2022.00045CrossRefPubMed

20.

Lloyd RV, Gibbin KP, O’Donoghue GM (1995) Pediatric cochlear implants. Surgical aspects: the Nottingham pediatric cochlear implant programme. Rev Laryngol Otol Rhinol (Bord) 116(2):85–87PubMed

21.

Kempf HG, Johann K, Lenarz T (1999) Complications in pediatric cochlear implant surgery. Eur Arch Otorhinolaryngol 256(3):128–132. https://doi.org/10.1007/s004050050124CrossRefPubMed

22.

Kempf HG, Tempel S, Johann K, Lenarz T (1999) Komplikationen der Cochlear Implant-Chirurgie bei Kindern und Erwachsenen [Complications of cochlear implant surgery in children and adults]. Laryngorhinootologie 78(10):529–537. German. https://doi.org/10.1055/s-1999-8753

23.

Kumar A, Mugge R, Lipner M (1999) Surgical complications of cochlear implantation: a report of three cases and their clinical features. Ear Nose Throat J 78(12):913–919CrossRefPubMed

24.

Mylanus EA, van den Broek P (2003) Clinical results in paediatric cochlear implantation. Cochlear Implants Int 4(3):137–147. https://doi.org/10.1179/cim.2003.4.3.137CrossRefPubMed

25.

Kaila R, Evans RA (2005) Cochlear implant infection due to cholesteatoma. Cochlear Implants Int 6(3):141–146. https://doi.org/10.1179/cim.2005.6.3.141CrossRefPubMed

26.

Arnoldner C, Baumgartner WD, Gstoettner W, Hamzavi J (2005) Surgical considerations in cochlear implantation in children and adults: a review of 342 cases in Vienna. Acta Otolaryngol 125(3):228–234CrossRefPubMed

27.

Migirov L, Muchnik C, Kaplan-Neeman R, Kronenberg J (2006) Surgical and medical complications in paediatric cochlear implantation: a review of 300 cases. Cochlear Implants Int 7(4):194–201. https://doi.org/10.1179/cim.2006.7.4.194CrossRefPubMed

28.

Migirov L, Dagan E, Kronenberg J (2009) Surgical and medical complications in different cochlear implant devices. Acta Otolaryngol 129(7):741–744. https://doi.org/10.1080/00016480802398954CrossRefPubMed

29.

Loundon N, Blanchard M, Roger G, Denoyelle F, Garabedian EN (2010) Medical and surgical complications in pediatric cochlear implantation. Arch Otolaryngol Head Neck Surg 136(1):12–15. https://doi.org/10.1001/archoto.2009.187CrossRefPubMed

30.

Farinetti A, Ben Gharbia D, Mancini J, Roman S, Nicollas R, Triglia JM (2014) Cochlear implant complications in 403 patients: comparative study of adults and children and review of the literature. Eur Ann Otorhinolaryngol Head Neck Dis 131(3):177–182. https://doi.org/10.1016/j.anorl.2013.05.005CrossRefPubMed

31.

Googe BJ, Carron JD (2016) Analyzing complications of minimally invasive pediatric cochlear implantation: a review of 248 implantations. Am J Otolaryngol 37(1):44–50. https://doi.org/10.1016/j.amjoto.2015.09.002CrossRefPubMed

32.

Mishu C, Klodd DA, Redleaf M (2017) Cochlear implant electrode array exposure: a delayed complication. Ear Nose Throat J 96(7):E40–E43. https://doi.org/10.1177/014556131709600708CrossRefPubMed

33.

Baruah P, Hanvey K, Irving R, Tzifa K (2017) Impact of chronic suppurative otitis media in pediatric cochlear implant recipients—insight into the challenges from a Tertiary Referral Center in UK. Otol Neurotol 38(5):672–677. https://doi.org/10.1097/MAO.0000000000001372CrossRefPubMed

34.

Halawani R, Aldhafeeri A, Alajlan S, Alzhrani F (2019) Complications of post-cochlear implantation in 1027 adults and children. Ann Saudi Med 39(2):77–81. https://doi.org/10.5144/0256-4947.2019.77CrossRefPubMedPubMedCentral

35.

Low WK, Pok WN, Ng WN, Tan J (2020) Accidental explantation of a cochlear implant in a child who developed cholesteatoma as a late complication of cochlear implantation. Case Rep Otolaryngol 2020:6353706. https://doi.org/10.1155/2020/6353706CrossRefPubMedPubMedCentral

36.

Rayamajhi P, Kurkure R, Castellino A, Kumar S, Ha M, Nandhan R, Kameswaran M (2021) A clinical profile of revision cochlear implant surgery: MERF experience. Cochlear Implants Int 22(2):61–67. https://doi.org/10.1080/14670100.2020.1823128. (Epub 2020 Sep 29)CrossRefPubMed

Title: Acquired cholesteatoma after cochlear implants: case series and literature review
Authors: Vittoria Sykopetrites
Flavia Di Maro
Eleonora Sica
Eliana Cristofari
Publication date: 30-09-2023
Publisher: Springer Berlin Heidelberg
Keywords: Cholesteatoma
Cochlear Implant
Tympanotomy
Published in: European Archives of Oto-Rhino-Laryngology / Issue 3/2024
Print ISSN: 0937-4477
Electronic ISSN: 1434-4726
DOI: https://doi.org/10.1007/s00405-023-08251-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Acquired cholesteatoma after cochlear implants: case series and literature review

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 3/2024

Diagnostic significance of peripheral blood indices for eosinophilic chronic rhinosinusitis in Chinese adults

Speech intelligibility and its relation to auditory temporal processing in Czech and Swiss German subjects with and without tinnitus

One-stage combined ENT and dental surgical treatment of odontogenic sinusitis: a prospective study

Risk factor analysis of distant metastases in patients with primary medullary thyroid cancer: a population-based study

Comparison of the efficacy and adverse effects of unilateral or bilateral botulinum toxin injections for adductor spasmodic dysphonia: a systematic review and meta-analysis

Digital live imaging of intraoperative electrocochleography during cochlear implantation: the first 50 patients