Incidence and management of gusher in cochlear implantation.

Objective: To present a report on the incidence and management protocol of cerebrospinal fluid gusher in cochlear implantation in the national institute of respiratory diseases.

Method: We conducted a clinical, longitudinal, retrospective investigation of all the medical charts from implanted patients between October 1999 and December 2016 in the national institute of respiratory diseases to evaluate the incidence of gusher, management protocol and evolution after surgery. Statistical analysis was conducted using Fishers test to find out if there was a relationship between the number of inner ear malformations and gusher severity and between the surgical access to the inner ear (cochleostomy or round window) and gusher severity.

Results: 276 patients were evaluated, 12 (4.3%) presented gusher during cochlear implantation. Seven had minimal gusher that stopped completely with a fascia seal, three had moderate gusher that required fascia and cartilage and two had severe gusher that required middle ear packing and obliteration of the eustachian tube. There was no statistically significant relationship between the number of inner ear malformations or the surgical access to the inner ear with gusher severity.

Conclusions: A thorough evaluation of the imaging study should always be conducted, it should include specific measurements and an individualized management in accordance with gusher severity should always be performed.