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Surgical outcomes of paediatric cochlear implantation: the Hospital for Sick Children's experience
A L de Jong1, J Nedzelski, B C Papsin
1Department of Otolaryngology, Hospital for Sick Children, Toronto, Ontario.
Insights
Cochlear implantation in children is a safe procedure with a low complication rate. Surgical innovations improve device stability and fixation, enhancing outcomes for pediatric hearing loss.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Audiology
Background:
- Cochlear implantation in children presents unique surgical challenges due to anatomical differences and growth.
- Analyzing surgical factors is crucial as pediatric cochlear implant programs expand.
Purpose of the Study:
- To evaluate the safety and outcomes of cochlear implantation in children.
- To analyze surgical factors and complications in pediatric cochlear implant recipients.
Main Methods:
- Retrospective study of 52 children who received cochlear implants between 1990 and 1997.
- Examination of surgical procedures, complications, and outcomes.
- Inclusion of two novel surgical techniques: periosteal flap design and NED's knot for electrode fixation.
Main Results:
- The average age at implantation was 7.0 years; 90% of cases had congenital hearing loss.
- An overall complication rate of 7.6% was observed, with two minor and two major complications.
- No device or electrode migration occurred; surgical innovations aimed to reduce device mobility and improve fixation.
Conclusions:
- The Hospital for Sick Children (HSC) series is the largest pediatric cochlear implant cohort in Canada.
- Cochlear implantation in children is a safe surgical procedure with infrequent morbidity.
- Surgical innovations contribute to improved safety and outcomes in pediatric cochlear implantation.
Objective:
Cochlear implantation in children represents a special challenge for the otologist because of such factors as skull dimensions and postimplantation temporal bone growth. As implant programs accrue increasing numbers of children, surgical factors relating to outcomes can be analyzed.
Method:
A retrospective study was performed of all children receiving a cochlear implant from January 1990 through May 1997 at The Hospital for Sick Children (HSC). The surgical procedure as well as the complications encountered were examined. Fifty two children, 28 females (54%) and 24 males (46%) were implanted.
Results:
Overall, the average age at time of implantation was 7.0 years (range, 1.9-17.3 yr). The presumed cause of deafness was acquired in five children (10%) and congenital in the remaining 47 patients (90%). A recognized syndrome was associated with the hearing loss in only three patients. There were two minor complications (3.8%) and two major complications (3.8%) with an overall complication rate of 7.6%. There were no episodes of device or electrode migration. Two surgical innovations are also discussed: 1) a new periosteal flap design which decreases device mobility, and 2) a new technique for electrode fixation (NED's knot).
Conclusion:
The HSC experience represents the largest paediatric cochlear implant series in Canada. The findings indicate that the procedure is safe and is associated with infrequent morbidity.