Pneumatocoele after cochlear implantation with lateral petrosectomy: A minor complication?

Abstract

Objective: To illustrate the clinical features and management of pneumatocoele presenting with a trap-valve mechanism after cochlear implantation with lateral petrosectomy (LP) in comparison with literature.

Introduction: Pneumatocoele is a rare complication of cochlear implant (CI) surgery, generally managed with conservative treatments.

Methods: We describe a progressively increasing pneumatocoele with a trap-valve mechanism occurring one year after CI with LP, successfully managed with revision surgery. Literature review was performed on this topic.

Results: Our case was the second ever reported in literature. It appeared consequently to forceful nose-blowing in a patient with refractory nasal polyposis. Unlike the pneumatocoeles reported after standard CI, we advised revision surgery as well as in the case of pneumatocoele after staged LP and CI. In both the patients subcutaneous air collection occurred as a late complication and an insufficient Eustachian tube closure was disclosed, which is considered a complication of LP itself. Surgical management was necessary in consideration of the risk of ascending infections associated with Eustachian tube patency in LP with CI.

Conclusion: We consider surgical treatment mandatory in pneumatocoele after CI with LP, it is indeed the sentinel of the restoration of Eustachian tube patency and the potential prelude to major complications.

Keywords: Cochlear implant; Complication; Eustachian tube; Lateral petrosectomy; Pneumatocoele; Pneumocoele; Revision surgery; Trap-valve.