Implante coclear en hipoacusia neurosensorial postraumática: reporte de caso, revisión de la literatura y propuesta de algoritmo de manejo

Abstract

Objective. To describe a case of bilateral post-traumatic sensorineural hearing loss (SNHL) with delayed sudden hearing loss and to propose a practical algorithm for cochlear-implant indication and timing.

Study design. Case report with narrative review.

Materials and methods. A 35-year-old woman sustained a second-story fall in 2019, resulting in bilateral SNHL and vestibular dysfunction; three years later she developed right-sided sudden hearing loss without vertigo. Clinical otoneurological evaluation, computed tomography (CT) and magnetic resonance imaging (MRI) were performed to assess cochlear patency and auditory-nerve integrity. In parallel, a focused narrative review of recent literature on cochlear implantation after temporal bone fracture (observational studies and case reports) addressed auditory outcomes, complications, ossification risk, and timing considerations.

Results. A right cochlear implant was placed with full insertion and functional contacts; functional improvement with daily device use and favorable rehabilitation was reported at three months postoperatively. Based on this case and the literature review, we propose a three-step algorithm: (1) anatomic and neural confirmation (CT/MRI with or without promontory stimulation); (2) timing according to ossification risk: high (otic-capsule violation or hemorrhage or labyrinthitis) weeks-wide window; lower (capsule respected and MRI without inflammatory activity) months-wide window with serial imaging; (3) side selection based on greater patency and better neural pathway, with an alternative plan if basal-turn ossification is present.

Conclusions. In post-traumatic SNHL, the temporal window depends on anatomic risk and should be defined with high-resolution imaging and, when in doubt, promontory testing. Available evidence is limited and non-comparative; the proposed algorithm helps standardize decision-making while higher-quality studies are generated.

Keywords (MeSH): Temporal Bone; Skull Fractures; Cochlear Implants; Hearing Loss, Sensorineural.