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Otopathology of Unilateral Cochlear Implantation in Patients With Bilateral Temporal Bone Fracture

Trakimas, Danielle R.*,†,‡,§; Knoll, Renata M.*,†; Ishai, Reuven*; Lee, Daniel J.*,†; Jung, David H.*,†; Nadol, Joseph B. Jr*,†; Remenschneider, Aaron K.*,†,‡,§; Kozin, Elliott D.*,†

doi: 10.1097/MAO.0000000000002057

Objective: Audiometric outcomes following cochlear implantation (CI) in patients with temporal bone fracture (TBF) are variable and the pathophysiology is not well understood. Herein, we describe otopathologic findings in two such cases to provide insight into pathophysiology and outcomes.

Patients: Two patients had a history of head trauma resulting in bilateral TBF and sudden, profound, sensorineural hearing loss.

Intervention: Both cases underwent unilateral CI following head trauma.

Main Outcome Measures: Both TBs from each patient were harvested postmortem and histologically analyzed to determine fracture lines, intralabyrinthine fibroosseous changes, and spiral ganglion neuron (SGN) counts. Clinical histories and audiometric outcomes were also reviewed.

Results: In both cases, the implanted TB showed extensive intracochlear ossification, which was greater when fracture involved the cochlea. In contrast, the nonimplanted cochleae were patent with small osseous deposits at the round window membrane. Interaural SGN counts were lower on the implanted side and hearing results were moderate to poor.

Conclusions: Otopathologic analyses of patients with a CI after bilateral TBF are rare. Based on otopathology of two patients with bilateral TBF and subsequent CI, implanted TBs show extensive intracochlear fibroosseous changes greater than the nonimplanted side. Findings have implications for auditory rehabilitation after TBF.

*Department of Otolaryngology, Massachusetts Eye and Ear Infirmary

Department of Otolaryngology, Harvard Medical School, Boston

Department of Otolaryngology, UMass Medical Center

§University of Massachusetts Medical School, Worcester, Massachusetts

Address correspondence and reprint requests to Elliott D. Kozin, M.D., Aaron K Remenschneider, M.D., M.P.H., Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114; E-mail:;

Grant Support: NIDCD (NIH) Grant # 2R01-DC000152.

The authors disclose no conflicts of interest.

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