Surgical outcomes of simultaneous subtotal petrosectomy and cochlear implantation: a single institutional study

To report our institution’s experience with patients who underwent subtotal petrosectomy (STP) for refractory ear disease who are candidates for cochlear implant (CI) and to highlight simultaneous STP with CI its advantages, surgical outcomes, post-operative complications management, and considerations for staging a procedure.

A retrospective study was performed in a single tertiary referral university hospital. The medical records of seventy patients (70 ears) who underwent STP for refractory ear disease who were candidates for CI were retrospectively evaluated.

Seventy adults (age range 30–85) underwent STP with a median follow-up of 4.8 years (range 1.5–18.2). Twenty-seven (38.5%) had previous mastoid surgeries before STP. Most patients underwent simultaneous STP and CI (n = 36, 51.5%), followed by STP only (n = 28, 40%), with a smaller group having staged CI after STP (n = 6, 8.5%).

Patients who underwent simultaneous STP and CI showed significant improvements in several measures, with mean pre-operative pure tone audiometry (PTA) of 98.7 dB HL (range 85–118; SD: ± 9.2) improving to 39.3 dB HL post-operatively (range 25–50; SD: ± 9.3, p < 0.001), mean pre-operative categories of auditory performance (CAP) score of 1.6 (range 0–4; SD: ± 1.3), increasing to 5.6 post-operatively (range 4–7; SD: ± 1.3, p < 0.001), and mean pre-operative open-set adult sentence score of 6.8% (range 0–40%), improving to 78.4% post-operatively (range 40–100%, p < 0.001). Three of the 36 patients (8.3%) who had simultaneous STP and CI developed post-operative complications (median follow-up: 4.2 years). No disease recurrence was reported.

STP is an effective intervention for refractory middle ear and mastoid diseases. It allows for a thorough disease removal and prepares the ear for subsequent implantation procedures. Simultaneous STP and CI provide the advantage of hearing rehabilitation, disease control, and a comparable complication rate to that of conventional CI procedures.