Surgical and medical complications in paediatric cochlear implantation: a review of 300 cases

The aim of the study was to investigate an incidence of surgical and medical complications in different age groups of cochlear implant children. A retrospective study design was used. Patients' medical records were reviewed for age at the time of implantation, cause of deafness and complications. The incidence of complications was compared between the young (aged up to 2 years, n = 61) and older children (aged 216 years, n = 239). Some 300 paediatric cochlear implantations were performed in our department between January 1993 and March 2005. Major complications, such as facial nerve paralysis, electrode misplacement, foreign body reaction, flap breakdown, protrusion of the positioner and cholesteatoma were rare (3%). Disequilibrium was found to be the most common complication, followed by wound problems and mastoiditis without significant differences between the two groups. However, magnet or receiver-stimulator displacement were more common in the young children (p = 0.028). Most surgical and medical complications could be treated successfully, and only 2% required explantation of the device. Generally, operating on a child aged under 2 years was not particularly different from operating on an older child.     

Surgical and medical complications following cochlear implantation: comparison of two surgical approaches

Our study was designed to evaluate the complication rate of cochlear implantation (CI) and to compare two different surgical approaches that are currently being used for implantations in our department. This retrospective study was conducted on the patients who underwent CI in our center between 1989 and 2003 and who were followed-up for at least 18 months. The patients were divided into two groups according to the surgical technique that had been used for the implantation: the mastoidectomy with posterior tympanotomy approach and the suprameatal approach (without mastoidectomy). The incidence of complications following CI was compared between the two groups and between children and adults. Facial nerve paralysis, electrode misplacement, injury to the chorda tympani nerve and mastoiditis occurred only in the mastoidectomy with posterior tympanotomy approach group. Acute middle ear infection with or without mastoiditis emerged as the most common complication in both groups, followed by vestibular and wound problems. Disequilibrium was significantly more common among the adults than among the children (p < 0.0001). The suprameatal approach was demonstrated as being a good alternative technique to the classical surgery for CI.     

Contemporary surgical issues in paediatric cochlear implantation

Abstract

Objective: To review the contemporary surgical issues in paediatric cochlear implantation (CI) based on published evidence. Design: Narrative literature review. Results: Surgical challenges in paediatric CI are discussed, with respect to post meningitic labyrinthitis ossificans; cochlear malformation; cochlear implantation in infants; auditory neuropathy and cochlear nerve deficiency; bilateral cochlear implantation; hearing preservation; otitis media; and device failure. Conclusion: Early CI is recommended if bacterial meningitis causes profound sensorineural hearing loss (SNHL). CI in cochleovestibular malformation requires pre-operative imaging to plan surgical technique, choice of electrode, and to anticipate complication. Children with congenital severe to profound SNHL should undergo early bilateral simultaneous implantation, preferably before 12 months of age, except those with auditory neuropathy spectrum disorder who should be implanted after one year. Soft surgical technique should be deployed in an attempt to preserve any residual hearing. Otitis media with effusion is not a contraindication to cochlear implantation, but active or recurrent acute otitis media requires resolution of infection with grommet insertion pre-operatively. Device failure in CI recipients requires a stepwise audiological, medical, radiological, and device integrity assessment to determine the need for reimplantation.     

Developing surgical techniques in cochlear implantation

Since Djourno and Eyries described their first experience of electrical stimulation of the auditory nerve in 1957, the journey to an easily insertable, reliable and effective cochlear implant has been one of the most exciting in the history of medicine. The hallmark of the venture has been global collaboration between basic scientists in many fields - bioengineering, microcircuitry, signal processing, cognitive science and linguistics - as well as surgeons and educationalists. Many ingenious devices have been developed and equally ingenious operations have been proposed in order to maximize their effectiveness and minimize their potential damage to the inner ear. Complicated extracochlear devices eventually gave way to intracochlear multi-channel implants, and surgical challenges such as paediatric implantation, ossification, CSOM and dysplasia were addressed and solutions found. The journey is not yet over, however, and progress continues to be made to develop a fully implantable cochlear implant, which should be a reality within five years.     

Long-term complications after cochlear implantation

Objective

Cochlear implantation has become an effective treatment for many profoundly deaf patients. As with any surgical procedure, a proportion of patients suffer postoperative complications. The aim of this study was to analyze long-term postoperative complications in patients with cochlear implants with a view to improve clinical interventions and propose a consensus for reporting complications.

Methods

A total of 406 cases received cochlear implants between December 1985 and April 2007 at Tokyo Medical University (TMU) Hospital. We retrospectively reviewed case notes from 366 patients who had undergone cochlear implantation (215 adults and 151 children) after excluding 40 patients of re-implantation including 13 cases implanted initially at other hospitals. Life-threatening, major and minor complications were examined retrospectively.

Results

Major complications occurred following cochlear implantation in 32 patients (8.7%) who had received their initial implant at TMU Hospital. Revision surgery was required for 30 patients. The mean age at implantation was 33 years 6 months (range, 1 year 9 months to 83 years; median, 37 years). The main etiology of deafness was unknown or progressive (113, 52.6%) in adults and congenital (132, 87.4%) in children. The cause of deafness was meningitis in 41 cases (11.2%), and 26 cases (7.1%) were diagnosed with idiopathic sudden deafness.Flap-related problems (including middle ear infection and/or flap necrosis) developed in 13 cases (3.6%), with 12 cases (7 adults, 5 children) requiring re-implantation. Electrode slip-out occurred in 8 patients (7 adults, 1 child). All adult cases in whom electrodes slipped out underwent implantation before 1994, while the child (1 pediatric case) was operated in 2003. All cases required re-implantation and most cochlear implantations were performed using the modified split-bridge technique after 1997. Six patients (4 adults, 2 children) experienced device failure. Four patients experienced electrode problems. Non-surgical major complications included 1 patient with permanent facial nerve paralysis as a result of thermal injury in 1995.The total number of minor medical and surgical complications was 27, representing 7.4% of all operations.

Conclusion

Many cases of major complications, including electrode problems and facial paralysis, excluding traumatic device failure were considered avoidable by strict operative and postoperative procedures. Some cases of flap infection and traumatic device failure may not be able to be avoided completely, and every possible care should be taken by implant patients and others involved.     

Surgical and nonsurgical complications associated with cochlear prosthesis implantation

Relatively few complications have been reported for cochlear implant surgery in spite of a recent report detailing a complication rate of 11.8 percent. This report highlights both the surgical and nonsurgical complications we have encountered that have resulted in either replacement of the implanted prosthesis or compromise of the sound processing strategy employed by the external unit. These complications make a strong argument for the use of preoperative, intraoperative, and postoperative radiologic examinations. Since the complications reported herein have not been attributed to the implant device proper, we feel cochlear implantation remains a safe and effective procedure for those patients who are untreatable by traditional methods.     

Surgical complications in 550 consecutive cochlear implantation

Cochlear implantation is a safe and reliable method for auditory restoration in patients with severe to profound hearing loss.ObjectiveTo describe the surgical complications of cochlear implantation.Materials and MethodsInformation from 591 consecutive multichannel cochlear implant surgeries were retrospectively analyzed. All patients were followed-up for at least one year. Forty-one patients were excluded because of missing data, follow-up loss or middle fossa approach.ResultsOf 550 cochlear implantation analyzed, 341 were performed in children or adolescents, and 209 in adults. The mean hearing loss time was 6.3 ± 6.7 years for prelingual loss and 12.1 ± 11.6 years for postlingual. Mean follow-up was 3.9 ± 2.8 years. Major complications occurred in 8.9% and minor in 7.8%. Problems during electrode insertion (3.8%) were the most frequent major complication followed by flap dehiscence (1.4%). Temporary facial palsy (2.2%), canal-wall lesion (2.2%) and tympanic membrane lesion (1.8%) were the more frequent minor complications. No death occurred.ConclusionThere was a low rate of surgical complications, most of them been successfully managed. These results confirm that cochlear implant is a safe surgery and most surgical complications can be managed with conservative measures or minimal intervention.     

儿童人工耳蜗手术的并发症与处理

通过复习国内外文献、内部交流及根据我院临床病例经验，回顾、总结儿童人工耳蜗手术常见并发症的发病率、临床表现、诊断和处理方法，其中包括国内外有关手术并发症的最新进展。本文着重讨论的是临床经常遇到而且较难处理的并发症，包括皮瓣感染及坏死，植入体硅橡胶过敏，面神经损伤，面神经刺激和开机后无听性反应等。认真做好术前诊断，完善手术细节，提高手术经验，手术并发症是可以避免和减少的。     

Suprameatal approach: new surgical approach for cochlear implantation

The conventional technique for cochlear implantation is via a mastoidectomy and posterior tympanotomy. An alternative approach for cochlear implantation is hereto described. The middle ear is entered through a suprameatal approach (SMA) bypassing the mastoid cavity. This surgical approach shortens the duration of the procedure to approximately one hour. The introduction of the cochlear implant electrode array involves drilling in the suprameatal region and the osseous portion of the external auditory canal at a safe distance from the anatomical position of the facial nerve. This prevents possible injury by direct trauma or drill overheating of the chorda tympani or facial nerves. We report 15 consecutive patients who were operated on using the SMA technique. No complications were encountered as a result of this surgical technique but further experience may be necessary.     

Surgical complications of cochlear implantation in a tertiary university hospital

Introduction: Cochlear implantation remains a popular and effective therapy for patients with sensorineural hearing loss that not get benefit from conventional hearing aids

Objective: To analyze the surgical complications obtained in patients that underwent cochlear implantation in a tertiary university hospital.

Materials and methods: Retrospective analysis of the medical files of cochlear implant patients who underwent surgery at our institution between October 2014 and July 2016. This population comprised 163 patients (52.7% males and 47.3% females). Complications were classified in to ‘major’ and ‘minor’ complications depending on degree of management.

Results: Overall, the mean age at the time of implantation was 7.44 years. The cause of deafness was congenital in 81.6% of patients and acquired in 18.4% of patients. The overall complication rate was 10.43%, 3.68% being major and 6.75% being minor complications. The most common minor complication in our series was wound complications, and the most common major complication was device failure. Excluding device failures, the major complication rate was 1.84%.

Conclusion: Cochlear implantation is a safe surgical technique for rehabilitation of patients with severe to profound hearing loss, associated with a low surgical complications rate. The majority of surgical complications can be managed with conservative measures or minimal intervention.     

经外耳道后上径路人工耳蜗植入的手术入路和相关解剖关系研究

目的：探讨一种新的通过外耳道后上径路（SMA）植入电极的人工耳蜗植入方法。方法：对8例（16侧）尸头模拟SMA的人工耳蜗植入法，对该手术径路进行了相关解剖数据的测量，并且在术前、术后进行HRCT扫描及重建加以对照和证实。结果：SMA的人工耳蜗植入术电极通过颢骨区隧道、外耳道骨槽，从鼓索神经下方、锤骨柄和砧骨长脚之间植入耳蜗底周，隧道与颢线向前延伸假想水平线平均角度成人为（28．0±1．3）°儿童为29．0°±1．7°，电极植入耳蜗入口的定位为成人距圆窗龛（1．31±0．13）mm，儿童为（1．19±0．12）mm。结论：SMA的人工耳蜗植入术是一种简便，安全的方法，可以达到人工耳蜗植入术的预期要求，并且距离面神经和鼓索神经足够的安全距离，临床上应根据患者的年龄、术前情况、相关病史选择不同的手术入路。     

Preservation of residual hearing following cochlear implantation: comparison between three surgical techniques

The preservation of residual hearing is becoming a high priority in cochlear implant surgery. It allows better speech understanding and ensures long-lasting and stable performance; it also allows the possibility, in selected cases, of combining electro-acoustic stimulation in the same ear. We present the results of a retrospective study of the conservation of residual hearing in three different groups of patients who had undergone cochlear implantation using three different cochlear implant electrode arrays, combined with three different surgical techniques for the cochleostomy. The study aimed to evaluate which approach allowed greater preservation of residual hearing. The best residual hearing preservation results (i.e. preservation in 81.8 per cent of patients) were achieved with the Contour Advance electrode array, using the Advance Off-Stylet technique and performing a modified anterior inferior cochleostomy; this combination enabled reduced trauma to the lateral wall of the cochlea during electrode insertion.     

Complications of paediatric cochlear implantation: experience in Izmir

Surgery for cochlear implantation (CI) bears the risks of complication associated with all major surgery, in addition to the particular risks associated with implanting a foreign body into the peripheral auditory system. Here we present a retrospective study involving 227 cochlear implant operations in 205 children to evaluate the rate of intra- and post-operative complications. Complications were defined as major complications, requiring explantation of the device or further operation, causing a significant medical problem, or leading to any degree of facial paralysis or requiring additional hospitalization for treatment; or defined as minor complications, namely those that settled spontaneously, with conservative treatment, with local care and/or with medication alone. In our study there were 15 (6.6 per cent) minor and 28 (12.33 per cent) major complications. The most frequent minor complication was dizziness and vomiting (3.08 per cent), followed by transient hemifacial oedema (1.76 per cent), head pain (1.32 per cent) and mild ataxia (0.4 per cent). The most frequent major complication was trauma to the device (9.69 per cent), followed by cerebrospinal fluid (CSF) gusher (2.2 per cent) and facial paresis (0.4 per cent). All of the device trauma cases were re-implanted. There were neither any life-threatening complications nor any facial nerve paralysis in our implanted children. This study confirms that CI is relatively safe and that major complications are few and within acceptable limits.