Learning Objectives: Possible solution to restore the hearing using bone conduction implants and middle ear implants solutions. The presentation illustrates different situations, in patients where the hearing loss changed post cholesteatoma's surgery.
The hearing loss in patients with history of Cholesteatoma,have multifarious features that depend either by the damaging disease activity or by the result of the surgery. The majority of them suffer from conductive hearing losses because the ossicles have been destroyed by the disease or surgically removed. The hearing has to be restored, reconstructing the ossicular chain(ossiculoplasty)or, in other cases, with hearingimplants. Frequently patients with previous cholesteatoma, show a mixed hearing loss, due to the aging or toxicity of the disease. A limited number presents a profound deafness, or anacusis due to a cholesteatoma's invasion into the labyrinth or by iatrogenic damage during the surgery. All these outcomes can be corrected with auditory implants inserted either in the middle ear or in the cochlea. Subjects that have CWU and CWD tympanoplasty done and good bone hearing threshold were treated with BONEBRIDGE device in the retro-sigmoid site, in order to avoid any future contamination in case of a disease recurrence or infections in the middle ear. In mixed hearing losses, a Vibrabt Soundbridge system has been preferred to place the FMT over the stapes, if present, or onto the footplate or on the round window. In CWD cases the round window membrane has been always the site of choice. When the cavity is completely clean and dry a VSB could be implanted with the FMT on the RW pays attention of the positioning of the conductor link, far from the diseased area and in a channel covered with bone pâté. Doing a cholesteatoma removal and a middle ear implantation on the same surgical session is not always the best option. There are situations where the procedure requires two steps: cholesteatoma removal first and implantation later. Always an open external ear canal is mandatory in order to check with otoscopy the condition of the middle ear cavity in the next visits.Finally,in patients with profound hearing losses, a cochlear implant was implanted via retro-sub-facial approach.
