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Updated: Apr 26, 2026
Robotic Cochlear Implantation for Direct Cochlear Access
Published on: June 16, 2022
Surgical outcomes with subperiosteal pocket technique for cochlear implantation in very young children
Michael S Cohen1, Austin Y Ha2, Dennis J Kitsko3
1Department of Otology and Laryngology, Harvard Medical School, United States.
Insights
Cochlear implantation in infants under 12 months using a subperiosteal pocket technique showed no wound complications or device migration. This method avoids dural risk and reduces surgical time for pediatric hearing restoration.
Area of Science:
- Pediatric Otolaryngology
- Cochlear Implant Surgery
- Auditory Rehabilitation
Background:
- Increasing cochlear implantation in infants younger than 12 months due to improved hearing outcomes.
- Traditional bony well creation for receiver/stimulator (R/S) poses risks (dural exposure) in infants with thin calvaria.
- Need for alternative surgical techniques for safe cochlear implantation in young children.
Purpose of the Study:
- To evaluate the safety and efficacy of a subperiosteal pocket technique for cochlear implantation in infants aged 12 months or younger.
- To report surgical outcomes and device performance in this pediatric population.
Main Methods:
- Retrospective review of six infants (≤12 months) who underwent cochlear implantation using the subperiosteal pocket technique.
- Simultaneous bilateral implantation was performed in all cases.
- Data collected included demographics, surgical approach, and clinical outcomes; descriptive statistics were calculated.
Main Results:
- Twelve cochlear implantations were performed in six infants with an average age of 9.8 months.
- No postoperative wound complications or device migrations were observed.
- One device hard failure occurred at 32 months; average follow-up was 28.4 months.
Conclusions:
- The subperiosteal pocket technique is a safe and effective method for cochlear implantation in infants aged 12 months or younger.
- Advantages include avoidance of dural risk, smaller incisions, and shorter surgical duration.
- Further research with thinner implant designs is warranted to address potential increased device profile.
Objectives:
As data continue to emerge demonstrating improved hearing outcomes associated with younger age at time of cochlear implantation, more children aged 12 months or younger are undergoing this procedure. Drilling a well to house the cochlear implant receiver/stimulator (R/S) may carry an increased risk in this group of patients as the calvarium is thin and drilling an adequate well may require exposure of the underlying dura. Our group has employed a technique in this age group which involves securing the R/S in a subperiosteal pocket without creating a bony well. We report our experience with six infants 12 months of age or younger undergoing cochlear implantation with the subperiosteal pocket technique.
Methods:
Cases were identified by searching an IRB approved research registry. Charts were reviewed for demographics, surgical technique, and clinical outcomes. Descriptive statistics were calculated.
Results:
Six patients 12 months of age or younger underwent cochlear implantation over a one year period. Simultaneous bilateral implantation was performed in all cases, for a total of 12 implanted ears. The average age at time of implantation was 9.8 months (SD 2.1 months). There were no postoperative wound complications. No evidence of device migration was noted in any patient as of the most recent follow-up appointment. There was one device hard failure at 32 months. Average length of follow-up was 28.4 months (SD 13.8 months).
Conclusions:
No wound complications or device migrations occurred in 12 cochlear implantations in six children aged 12 months or younger. Advantages of this technique include no risk to the dura in this location, smaller incisions, and shorter surgical time. A potential disadvantage is the increased device profile from the lack of a well. New thinner implant designs may minimize this concern. Further prospective study is justified to confirm our initial experience in this small group.
