Cochlear implant failure, revision, and reimplantation

Area of Science:

• Otolaryngology
• Biomedical Engineering
• Neurosurgery

Background:

• Cochlear implantation (CI) is a common treatment for severe to profound hearing loss.
• Revision surgery, including cochlear implant reimplantation (CIR), may be necessary due to device failure or complications.
• Long-term outcomes following CI revision surgery are not well-documented.

Purpose of the Study:

• To evaluate long-term adverse outcomes of cochlear implant (CI) surgery.
• To determine the incidence and causes of revision surgeries, including CI reimplantation (CIR).
• To compare revision rates and outcomes between pediatric and adult CI patients.

Main Methods:

• Retrospective review of pediatric and adult patients undergoing revision surgery after CI placement.
• Analysis of device type, follow-up duration, failure time and cause, audiometric performance (pre- and post-CIR), surgical complications, and operative findings.
• Comparison of CIR rates between pediatric and adult populations.

Main Results:

• A total of 317 patients with 439 CIs were analyzed; the overall revision surgery rate was 4.1%, with a CIR rate of 3.0%.
• Pediatric patients had a significantly higher CIR rate (5.0%) compared to adults (1.3%).
• Device failure occurred in 8 patients, predominantly with the CI24R (CS) device (75%); 0.9% of revisions were for fixation failure or extrusion.

Conclusions:

• Reimplanted patients generally achieved good audiometric outcomes, except for those with soft failures.
• Adherence to manufacturer's recommended surgical techniques, including bony recess drilling and suture fixation, resulted in low revision rates.
• Pediatric patients experienced higher complication rates requiring CIR, with all hard failures occurring in this group with a single device model.