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Objectives: Cochlear implantation in patients with a history of CSOM raises many concerns. Risk of infection, meningitis, device extrusion and the presence of residual or recurrent disease, including cholesteatoma are all to be avoided. In those with pre-existing canal wall down mastoid cavities, efforts have been made to 'bury' the electrode lead by obliterating the cavity with various materials. Unwanted 'resurfacing' and electrode extrusion as these tissues settle is an added risk. We describe a two-staged technique using a silastic block placed in the mastoid cavity as a space-saving obturator after radical first stage surgery. This includes a revision tympanomastoidectomy with eradication of all remaining disease and a blind sac closure using a robust "tragal swing", cartilage-reinforced technique. The second stage at 3-6 months involves removal of the silastic spacer, assessment for residual disease, irrigation, debridement and implant insertion. Method: We present a series of patients who have undergone this two-staged surgery. Results: Our first case had a previous cochlear implant in the presence of a mastoid cavity that was partially obliterated. She subsequently had a device failure associated with settling of the obliterated cavity which began to drain. Our second and third cases involved cochlear implantation in patients with pre-existing canal wall down cavities and poor middle ear ventilation. All underwent first stage revision with blind sac closure and a space-saving obturator. Conclusion: This two-staged technique has simplified our approach to these challenging cases. The obturator removes the need for primary mastoid obliteration and allows a swift second-stage surgical approach as all the preparatory work has been done. Cosmesis is good, healing quick and aftercare minimal as there is no risk of the electrode reappearing from beneath obliterated tissues and no mastoid cavity to care for. [ABSTRACT FROM AUTHOR]

Objectives: Intracochlear schwannoma is a rare entity. Tumours arise either primarily in the labyrinth or invade from the internal auditory canal. Our case follows a patient with Neurofibromatosis Type 2 and bilateral severe to profound hearing loss. She received a unilateral cochlear implant on the side where here tumour had been stable previously untouched by surgery but where there was MRI suspicion of intracochlear extension from the internal auditory canal. There is very little in the literature regarding hearing rehabilitation in these patients with cochlear implantation. Method: This is a case presentation with an indepth review of her clinical pathway, the decisional conflicts encountered, her radiological and audiological assessments with long term follow-up over 7 years. Results: Preoperative suspicion of cochlear invasion was confirmed at surgery. Schwannoma was confirmed histologically after piecemeal removal at cochleostomy and successful electrode insertion was achieved. Factors influencing the device chosen and modifications made to the surgical technique are outlined. Conclusions: The case highlights that cochlear implantation can achieve success with careful removalof an intracochlear schwannoma in a patient with NF2. Our patient went on to full-time implant use with enhanced communication abilities. Challenges arising from her NF2 are ongoing. [ABSTRACT FROM AUTHOR]