European Archives of Oto-Rhino-Laryngology

, Volume 274, Issue 11, pp 3883–3892 | Cite as

Prevention and management of vascular complications in middle ear and cochlear implant surgery

  • Filippo Di LellaEmail author
  • Maurizio Falcioni
  • Silvia Piccinini
  • Ilaria Iaccarino
  • Andrea Bacciu
  • Enrico Pasanisi
  • Davide Cerasti
  • Vincenzo Vincenti


The objective of this study is to illustrate prevention strategies and management of vascular complications from the jugular bulb (JB) and internal carotid artery (ICA) during middle ear surgery or cochlear implantation. The study design is retrospective case series. The setting is tertiary referral university hospital. Patients were included if presented pre- or intraoperative evidence of high-risk anatomical anomalies of ICA or JB during middle ear or cochlear implant surgery, intraoperative vascular injury, or revision surgery after the previous iatrogenic vascular lesions. The main outcome measures are surgical outcomes and complications rate. Ten subjects were identified: three underwent cochlear implant surgery and seven underwent middle ear surgery. Among the cochlear implant patients, two presented with anomalies of the JB impeding access to the cochlear lumen and one underwent revision surgery for incorrect positioning of the array in the carotid canal. Subtotal petrosectomy was performed in all cases. Anomalies of the JB were preoperatively identified in two patients with attic and external auditory canal cholesteatoma, respectively. In a patient, a high and dehiscent JB was found during myringoplasty, while another underwent revision surgery after iatrogenic injury of the JB. A dehiscent ICA complicated middle ear effusion in one case, while in another case, a carotid aneurysm determined a cholesterol granuloma. Rupture of a pseudoaneurysm of the ICA occurred in a child during second-stage surgery and required permanent balloon occlusion without neurological complications. Knowledge of normal anatomy and its variants and preoperative imaging are the basis for prevention of vascular complications during middle ear or cochlear implant surgery.


Cochlear implant Middle ear surgery Complications Vascular Jugular bulb Internal carotid artery 


Compliance with ethical standards


No funding sources were used for this study.

Conflict of interest

The authors (F. Di Lella, M. Falcioni, I. Iaccarino, S. Piccinini, A. Bacciu, E. Pasanisi, D. Cerasti, and V. Vincenti) declare no conflict of interest.

Ethical statement

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  1. 1.Otolaryngology and Otoneurosurgery DepartmentAzienda Ospedaliero-Universitaria di ParmaParmaItaly
  2. 2.The Neuroradiology DepartmentAzienda Ospedaliero-Universitaria di ParmaParmaItaly

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