From the Research
It is generally reasonable to proceed with cochlear implantation in an ear with a dry tympanic membrane perforation, but the perforation should be repaired either before or during the implant surgery. The preferred approach is to perform a tympanoplasty (eardrum repair) as part of the same surgical procedure as the cochlear implantation, as seen in the study by 1, which reported a high success rate with loop underlay tympanoplasty for anterior, subtotal, and total tympanic membrane perforations. This combined approach is efficient and prevents delays in hearing rehabilitation. The tympanic membrane perforation must be completely dry with no active infection for at least 3-6 months prior to surgery, as any active middle ear infection could spread to the inner ear during implantation and potentially cause serious complications, as noted in the study by 2. Preoperative treatment with topical antibiotic drops like ciprofloxacin 0.3% or ofloxacin 0.3% for 7-10 days before surgery may be recommended as a precaution, as suggested by the study by 3. The surgeon will typically use a temporalis fascia or cartilage graft to repair the perforation during the procedure. This approach is justified because an intact tympanic membrane helps maintain proper middle ear function, prevents contamination of the implant, and optimizes sound transmission. Additionally, repairing the perforation reduces the risk of postoperative infection and implant extrusion, as reported in the study by 4. Some key points to consider when proceeding with cochlear implantation in an ear with a dry tympanic membrane perforation include:
- Ensuring the perforation is completely dry and free of active infection
- Using a combined approach of tympanoplasty and cochlear implantation
- Administering preoperative antibiotic prophylaxis
- Selecting the appropriate graft material for tympanoplasty
- Monitoring for postoperative complications and providing effective nursing intervention, as emphasized in the study by 5.