Ossified versus patent cochlea: objective and subjective results of partial drill-out of the basal turn

Objective: To compare the objective benefits and subjective impact of surgery on the quality of life (QOL) of implanted patients with a totally ossified or patent cochlea. Design: Prospective, observational, pre- versus postsurgery study. Setting: Academic otolaryngology department. Patients: Five consecutive patients (3 women and 2 men with a mean age of 43.6 years; range 15-62 years) with a totally ossified cochlea treated with Cohen's partial drill-out technique were selected from a series of 78 patients who underwent cochlear implantation. Five implanted patients (three women and two men with a mean age of 43.8; range 26-60 years) with a patent cochlea were used as a control group. The mean age, gender distribution, and causes of deafness were the same in the two groups. Main Outcome Measures: Recognition test of open and closed sets of two-syllable words; sentence test; subjective QOL test for auditory, social, and emotional impairment. Results: The patients with an ossified cochlea showed a gradual improvement in all objective speech modalities during the 24-month follow-up period, whereas those with a patent cochlea reached their best score at the first follow-up evaluation. At the subjective QOL test, auditory impairment in the patients with an ossified cochlea was 91% before and 34% after surgery; the social impairment scores at the same times were, respectively, 52% and 18%. The presurgery emotional impairment score of 56% decreased over the following months, but this trend was more striking in the earlier postoperative period. Conclusions: The benefits of cochlear implants should be considered not only in terms of objective evaluation by means of traditional clinical tests but also in terms of the patients' subjective evaluation of auditory and communicative performances. Together with the improvement in auditory and communicative skills, a better QOL (psychological and social comfort) is undoubtedly one of the more appreciated aspects for implanted patients.