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:

• Pneumatocoele
• Pneumocoele
• Cochlear implant
• Lateral petrosectomy
• Complication
• Trap-valve
• Eustachian tube
• Revision surgery

Additional information

Notes on contributors

Canzi Pietro

Canzi Pietro is Associate Professor in Otorhinolaryngology at the University of Pavia. Currently practicing as Otolaryngologist at the tertiary otologic referral centre of Pavia University Hospital, IRCCS Policlinico San Matteo Foundation, Department of Otolaryngology, with special interest in otoneurosurgery and deafness surgery.

Carlotto Elena

Carlotto Elena is currently Otolaryngologist at Department of Otolaryngology, S. Croce Hospital, Cuneo, Italy, with special interest in otoaudiology and vestibology. Previously Otolaryngology resident, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy. She obtained her medical degree at University of Turin, Turin, Italy.

Minervini Domenico

Minervini Domenico is currently Otolaryngologist, practicing at Department of Otolaryngology, IRCCS Policlinico San Matteo Foundation, Italy, with special interest in otology and in pediatric audiology. Previously Otolaryngology resident, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia. He obtained his medical degree at University of Bari, Bari, Italy.

Simoncelli Anna

Simoncelli Anna is currently Neuroradiologist, practicing at Department of Diagnostic Radiology- Neuroradiology, IRCCS Policlinico San Matteo Foundation, Italy, with special interest in otoneuroradiology.

De Iasio Andrea

De Iasio Andrea is currently Otolaryngologist, Department of Otolaryngology, G. Salvini Hospital, Garbagnate Milanese, Milan, Italy, with special interest in otology. Previously Otolaryngology resident, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy. He obtained his medical degree at University of Campania, Luigi Vanvitelli, Caserta, Italy.

Ottoboni Ilaria

Ottoboni Ilaria is currently resident Otolaryngology, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy. She obtained her medical degree at University of Padua, Padua, Italy in 2019.

Chiapparini Luisa

Chiapparini Luisa is currently Head of Department of Diagnostic Radiology- Neuroradiology, IRCCS Policlinico San Matteo Foundation, Italy. Previously Neuroradiologist, Department of Diagnostics and Applied Technology, Neuroradiology Unit, Carlo Besta Neurological Institute, Milan, Italy.

Benazzo Marco

Benazzo Marco is Full Professor in Otorhinolaryngology at the University of Pavia. Currently Head of Department of Otolaryngology, IRCCS Policlinico San Matteo Foundation, Italy.