Dr Faculty of Medicine, Ain Shams University Cairo, EGY
Introduction: Cochlear implantation (CI) is considered a safe procedure with small complication rate. Perilymph gusher is a predictable incident that can occur in some cases with inner ear malformations. The control of this perilymph leak is crucial to decrease vertigo and occurrence of meningitis. In some cases, the leak is minimal resulting in an oozer that only lasts for few seconds, while in other cases it can be severe and continuous causing difficulties in electrode array insertion and in the leak control. In this study, we present our algorithm in the management of perilymph gusher in CI surgery in different situations
Methods: The charts of all cases of cochlear implantation operated upon our tertiary center from 2016 till 2022 were revised. The following patients were included in the study: those with radiological evidence of wide vestibular aqueduct, whether isolated or part of incomplete partition defect, and patients with inner ear anomalies and wide cochlear aperture. The surgical findings and postoperative care were reported regarding control of the perilymph leak. Patients with revision surgery, explantation or reimplantation were excluded.
Results: In all cases Medel® electrodes were used, whether Flex 28 or Form 24. Every effort to totally control the leak was done in all cases by the surgeon by packing around the electrode. Electrode choice, intraoperative, as well as postoperative medical treatment are also crucial for leak control. We formulated an algorithm for management of these cases depending on their perioperative and follow up data
Conclusions: Proper prediction and management of perilymph leakage in CI surgery has tremendous impact on outcome of surgery
