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Author Spotlight: Advancements in Impedance Monitoring for Cochlear Implant Surgery
Published on: August 4, 2023
Outcomes after cochlear reimplantation in children
Françoise Sterkers1, Fanny Merklen1, Jean Pierre Piron1
1Cochlear Implant Center Montpellier-Palavas, University Hospital of Montpellier, 34295 Montpellier Cedex 5, France.
Insights
Cochlear reimplantation in children with prelingual deafness due to device failure or medical reasons does not negatively impact auditory outcomes. Speech perception scores often remain stable or improve post-reimplantation.
Area of Science:
- Otolaryngology
- Audiology
- Neurosurgery
Background:
- Cochlear implantation is a standard procedure for prelingual deafness.
- Reimplantation has become more frequent due to device malfunctions and medical/surgical complications.
- Assessing auditory outcomes after reimplantation is crucial for patient management.
Purpose of the Study:
- To investigate the indications for cochlear reimplantation in prelingually deafened children.
- To evaluate the auditory and speech perception outcomes following reimplantation surgery.
Main Methods:
- Retrospective analysis of 45 prelingually deafened children who underwent cochlear reimplantation between 1990 and 2013.
- Recorded causes for reimplantation, device types, insertion angles, and surgical findings.
- Assessed speech perception using phonetically balanced kindergarten words, open-set sentence testing, and speech tracking scores at 1, 2, and 3 years post-reimplantation, comparing them to pre-failure scores.
Main Results:
- Device malfunction (77.7%) was the primary reason for reimplantation, followed by medical reasons (22.2%).
- Postoperative speech perception outcomes showed no significant difference compared to pre-failure scores.
- While 43.2% of children showed over 10% improvement in performance, 16.2% experienced a decline, sometimes linked to partial electrode insertion.
Conclusions:
- Cochlear reimplantation does not adversely affect auditory outcomes in prelingually deafened children.
- Auditory performance generally remains stable or improves after reimplantation.
- A small percentage may experience decreased performance, necessitating tailored rehabilitation strategies.
Objectives:
With cochlear implantation now a routine procedure, reimplantation is becoming more commonplace for medical/surgical complications or device malfunctions. This study investigated the indications for reimplantation and the auditory outcomes following reimplantation surgery in prelingually-deafened children.
Methods:
Of the 539 prelingually deafened children implanted between 1990 and 2013, 45 were reimplanted (8.3% of implantations). Causes of reimplantation, type of device and angle of insertion at initial implantation were recorded, as well as type of implant reinserted, number of electrodes inserted and angle of insertion (calculated on cone beam computed tomography) on reimplantation, and finally any surgical findings. Speech perception test scores (phonetically balanced kindergarten (PBK) words, open-set sentence testing in quiet and in noise (S/N+ 10 dB SNR), and speech tracking scores) were obtained 1, 2 and 3 years after reimplantation, and compared against the best speech recognition score obtained with the first implant before failure.
Results:
Medical reasons for reimplantation were found in 10 cases (22.2%). A malfunctioning device had occurred in 35 cases (77.7%) including hard failure in 24 and soft failure in 11. Complete insertion was achieved in the scala tympani in 42 cases and in the scala vestibuli in one case; partial insertion occurred in the remaining two cases. In two cases, one or two electrode rings snatched off from the electrode array during removal. The mean insertion angle was 330.5° before surgery and 311.8° after reimplantation (no statistical difference p=0.48). The postoperative speech perception outcome measures showed no significant difference to the best score before reimplantation. Angle of insertion, type of device and etiology of deafness did not influence the results. The PBK performance improved over 10% in 43.2% of children, was similar in 40.5%, and showed a more than 10% decrease in 16.2% of children after reimplantation. The latter decline in performance was explained for some children by a partial insertion.
Conclusions:
Reimplantation has no negative effect on auditory outcome. In rare cases, speech perception outcome may not improve, requiring a specific rehabilitation program.
