Abstract
Owing to its anatomical location, the facial nerve (FN) is at risk of damage during cochlear implantation, especially during posterior tympanotomy. The aim of this study was, therefore, to evaluate the risk of FN palsy following cochlear implantation surgery via mastoidectomy and posterior tympanotomy approach (facial recess). This is a retrospective study. The data bank of patients who received a cochlear implant between 2000 and 2012 was analyzed. 3403 surgeries were done during this period. Records of the patients who had suffered from FN palsy were evaluated and the type of FN palsy, the severity, time of onset, and need for revision surgery were recorded. 0.76 % (26/3403) of the patients had FN palsy and were, therefore, included in the study. 76.9 % (20/26) subjects were 18 years or older. 0.15 % (5 subjects) suffered from immediate FN palsy and 0.62 % (21 subjects) from delayed FN palsy. Intraoperative FN injury was documented in only three subjects of the immediate FN palsy group. In two subjects with immediate FN palsy, the FN was intraoperatively exposed but not injured, despite these individuals’ experiencing FN palsy. In 100 % of the immediate onset FN palsy group a part of the FN was exposed during surgery, whereas it was exposed only in 9.5 % of the delay onset FN palsy group. Although the FN was bone protected in 19 subjects, they had FN palsy. Most of the subjects presented House-Brackmann grade III or IV (69.2 %). All of the subjects were treated initially with a conservative therapy, only 42.3 % (11 subjects) underwent revision surgery. The recovery rate was 80.8 % (in immediate onset palsy 40 %, in delayed onset palsy 90.5 %). Cochlear implantation entails only a minimal risk of FN palsy and that FN palsy is chiefly a transient problem.
Similar content being viewed by others
References
Teschner M, Polite C, Lenarz T, Lustig L (2013) Cochlear implantation in different health-care systems: disparities between Germany and the United States. Otol Neurotol 34(1):66–74
Song JJ, Park JH, Jang JJ et al (2012) Facial nerve aberrations encountered during cochlear implantation. Acta Otolaryngol 132(7):788–794
Lisi CV, Landrum T, Sataloff RT (2013) Facial nerve sheath hematoma and paralysis after cochlear implant surgery. Ear Nose Throat J 92(1):E26–E27
Kempf HG, Tempel S, Johann K, Lenarz T (1999) Complications of cochlear implant surgery in children and adults. Laryngorhinootologie 78(10):529–537
Ciorba A, Bovo R, Trevisi P et al (2012) Postoperative complications in cochlear implants: a retrospective analysis of 438 consecutive cases. Eur Arch Otorhinolaryngol 269(6):1599–1603
Migirov L, Dagan E, Kronenberg J (2009) Surgical and medical complications in different cochlear implant devices. Acta Otolaryngol 129:741–744
Alzhrani F, Lenarz T, Teschner M (2013) Taste sensation following cochlear implantation surgery. Cochlear Implants Int 14(4):200–206
Kempf HG, Johann K, Lenarz T (1999) Complications in pediatric cochlear implant surgery. Eur Arch Otorhinolaryngol 256(3):128–132
Fayad JN, Wanna GB, Micheletto JN, Parisier SC (2003) Facial nerve paralysis following cochlear implant surgery. Laryngoscope 113(8):1344–1346
Hehar SS, Nikolopoulos TP, Gibbin KP, O’Donoghue GM (2002) Surgery and functional outcomes in deaf children receiving cochlear implants before age 2 years. Arch Otolaryngol Head Neck Surg 128(1):11–14
Migirov L, Muchnik C, Kaplan-Neeman R, Kronenberg J (2006) Surgical and medical complications in paediatric cochlear implantation: a review of 300 cases. Cochlear Implants Int 7(4):194–201
Thom JJ, Carlson ML, Olson MD et al (2013) The prevalence and clinical course of facial nerve paresis following cochlear implant surgery. Laryngoscope 123(4):1000–1004
Joseph ST, Vishwakarma R, Ramani MK, Aurora R (2009) Cochlear implant and delayed facial palsy. Cochlear Implants Int 10(4):229–236
Coker NJ, Jenkins HA, Fisch U (1986) Obliteration of the middle ear and mastoid cleft in subtotal petrosectomy: indications, technique, and results. Ann Otol Rhinol Laryngol 95(1 Pt 1):5–11
Kim EJ, Lee J, Lee JW, Lee JH, Park CJ, Kim YD, Lee HJ (2015) Peripheral facial nerve palsy after therapeutic endoscopy. Clin Endosc 48(2):171–173
Tarkan Ö, Tuncer Ü, Özdemir S et al (2013) Surgical and medical management for complications in 475 consecutive pediatric cochlear implantations. Int J Pediatr Otorhinolaryngol 77(4):473–479
Thom J, Neff BA, Beatty CW, Driscoll CL, Carlson M (2011) The incidence and clinical course of facial nerve paresis following contemporary cochlear implant surgery. Otolaryngol Head Neck Surg 145(2 suppl):P102–P103
Hoffman RA, Cohen NL (1995) Complications of cochlear implant surgery. Ann Otol Rhinol Laryngol Suppl 104:420–422
Vrabec JT (1999) Delayed facial palsy after tympanomastoid surgery. Am J Otol 20(1):26–30
Shea JJ Jr, Ge X (2001) Delayed facial palsy after stapedectomy. Otol Neurotol 22(4):465–470
Stowe RP, Mehta SK, Ferrando AA, Feeback DL, Pierson DL (2004) Immune responses and latent herpesvirus reactivation in spaceflight. J Med Virol 72(1):174–179
Prasad SC, Prasad KC, Kumar A, Thada ND, Rao P, Chalasani S (2014) Osteomyelitis of the temporal bone: terminology, diagnosis, and management. J NeurolSurg B Skull Base 75(5):324–331
Choi JW, Park YH (2015) Facial nerve paralysis in patients with chronic ear infections: surgical outcomes and radiologic analysis. Clin Exp Otorhinolaryngol 8(3):218–223
d’Andréa C, Méliet JL, Staikowski F (2008) Peripheral facial palsy secondary to middle-ear overpressure. Presse Med 37(4 Pt 2):643–647
Esaki S, Yamano K, Katsumi S, Minakata T, Murakami S (2015) Facial nerve palsy after reactivation of herpes simplex virus type 1 in diabetic mice. Laryngoscope 125(4):E143–E148
Greco A, Gallo A, Fusconi M, Marinelli C, Macri GF, de Vincentiis M (2012) Bell’s palsy and autoimmunity. Autoimmun Rev 12(2):323–328
Ting CH, Wang CW, Lee JT, Peng GS, Yang FC (2015) Bilateral facial nerve palsy as the sole initial symptom of syphilis: a case report. CJEM 17(5):576–581
Lee JH, Kim KW, Myong NH, Jung JY (2013) Wegener’s granulomatosis presenting as bilateral otalgia with facial palsy: a case report. Korean J Audiol 17(1):35–37
Lalwani AK, Butt FY, Jackler RK, Pitts LH, Yingling CD (1995) Delayed onset of facial nerve dysfunction following acoustic neuroma surgery. Am J Otol 16(6):758–764
Hoffman RA, Downey LL, Waltzman SB, Cohen NL (1997) Cochlear implantation in children with cochlear malformations. Am J Otol 18(2):184–187
Marquet J (1981) Congenital malformations and middle ear surgery. J R Soc Med 74(2):119–128
Sullivan FM, Swan IR, Donnan PT et al (2007) Early treatment with prednisolone or acyclovir in Bell’s palsy. N Engl J Med 357:1598–1607
Engstörm M, Berg T, Stjernquist-Desatnik A et al (2008) Prednisolone and valacyclovir in Bell’s palsy: a randomized double-blind, placebo-controlled, multicentre trial. Lancet Neurol 7(11):993–1000
Murakami S, Honda N, Mizobuchi M, Nakashiro Y, Hato N, Gyo K (1998) Rapid diagnosis of varicella zoster virus infection in acute facial palsy. Neurology 51(4):1202–1205
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
Authors declare that they have no conflict of interest.
Financial disclosure
There are no funders to report for this submission.
Rights and permissions
About this article
Cite this article
Alzhrani, F., Lenarz, T. & Teschner, M. Facial palsy following cochlear implantation. Eur Arch Otorhinolaryngol 273, 4199–4207 (2016). https://doi.org/10.1007/s00405-016-4124-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00405-016-4124-0