I could not remain silent after reading the article in the Archives by Hulka et al.1 The subject of their report was a 31-year-old black woman who was deaf, apparently in the right ear, and had a 25-dB speech reception threshold with 80% speech discrimination in the left ear. Magnetic resonance imaging demonstrated intracanalicular tumors, 8 mm on the right and 6 mm on the left.
First, I believe the retromastoid approach was inadvisable and not the surgical procedure of choice for an intracanalicular tumor. Second, and more importantly, to risk deafness in an only-hearing ear with 80% speech discrimination was a poor choice. The lateral end of the internal auditory canal cannot be evaluated through a retromastoid approach. I believe it would have been far wiser to have not operated on this only-hearing ear or perhaps to have decompressed the internal auditory canal through a middle fossa approach.
Luetje CM. Cochlear Implantation in a Patient After Removal of an Acoustic Neuroma. Arch Otolaryngol Head Neck Surg. 1996;122(2):205. doi:10.1001/archotol.1996.01890140089019
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