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September 24, 2005

Ear surgery study: Smaller cut is better

From: San Antonio Express, TX - Sep 24, 2005

Cindy Tumiel
Express-News Staff Writer

For years, surgeons installed cochlear implants — a device that restores a degree of hearing to some deaf people — by cutting a large triangular incision into the skin covering the skull, a technique that caused considerable pain and swelling.

A few years ago, a British doctor developed a method using a much smaller incision to implant the receiver and electrodes that carry sound waves to the brain.

A study of that technique by San Antonio surgeons, begun four years ago, suggests the newer method has advantages over the traditional surgery and carries no additional risk of complications.

Patients had less pain and swelling, and faster healing that allowed their devices to become operational sooner, said Dr. Charles A. Syms III, a specialist in otology and neurotology who is a clinical professor at the University of Texas Health Science Center.

"We also showed in this study that there is no difference in the complication rate compared to the traditional surgery," Syms said.

The surgical team, which includes Dr. Susan Marenda King, Dr. Brian P. Perry and Dr. Elias D. Stratigouleas, will present its results this weekend at the American Academy of Otolaryngology scientific conference in Los Angeles.

Cochlear implants consist of both internal electrodes implanted beneath the skull and an external microphone, processor and transmitter on the surface of the skin.

The bionic ear, as it sometimes is called, processes sounds and sends electronic signals to the brain. The device does not restore auditory sound, but many people are able to learn to interpret the electronic stimulations and communicate fully with others.

Still, the devices are recommended only for people who have severe or total hearing loss.

According to the Food and Drug Administration about 13,000 American adults and 10,000 children have had cochlear implants since the devices were licensed in the 1980s.

"The bigger the (surgical) flap, the more pain and the more swelling you are going to see," Syms said. Doctors found the surgical wounds healed faster and they were able to activate the hearing devices within days of the surgery, rather than the weeks needed for traditional techniques.

In their study, the San Antonio doctors evaluated 167 children and adults, ages 1 to 85, all of whom had undergone less invasive cochlear implant surgery. They compared the rate of complications from this group with about 400 patients from an earlier study who had undergone the more invasive procedure.

There were seven major complications in the San Antonio group, three of which involved failure of the cochlear device rather than medical problems related to the surgery, the doctors said. Less serious complications included one patient with a minor infection of the surgical incision.

Among patients who had traditional surgery, nine had serious wound infections that resulted in significant skin death around the triangular incision, the study found.

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