人工内耳再植込み術：後ろ向きコホート研究
Mélyssa Fortin1, Richard Bussières1, Mathieu Côté1
1Departments of Otolaryngology-Head and Neck Surgery.
Objectives:
To describe the reasons leading to cochlear reimplantation and discuss implications related to technological failures and manufacturer recalls.
Study Design:
Retrospective cohort study over a 40-year period.
Setting:
Tertiary academic referral center.
Patients:
Children and adults who underwent cochlear reimplantation between May 1, 1984, and May 1, 2024. Patients were evaluated, treated, and followed at our center.
Intervention:
Cochlear reimplantation.
Main Outcome Measures:
Incidence of cochlear reimplantation, reasons for explantation, and delay between implantation and reimplantation, stratified by age and device manufacturer.
Results:
A total of 3885 cochlear devices were implanted (66% adults). We report 257 reimplantations, including 86 (33%) pediatric cases at a mean age of 9.6 years. Patients were affected by 4 industry-issued recalls. The overall reimplantation rate was 6.6%, with comparable rates in children (6.5%) and adults (6.7%). Manufacturer-specific reimplantation rates were 12.6% for Advanced Bionics, 3.4% for Cochlear, 8.9% for Oticon, and 1.8% for MED-EL. Recalls and hard failures equally accounted for 70.8% of reimplantations. On average, reimplantations occurred 6.5 years after implantation, and 5.8 years in pediatric cases. Reimplantation delays were significantly reduced for recalls compared with hard failures (-3.7 y; P <0.01) and other causes (-4.7 y; P <0.01). About half (50.4%) of reimplantations occurred within 5 years, and 80.2% within 10 years.
Conclusions:
This study highlights the complexity of cochlear reimplantation from both technological and human perspectives in a large population. Given the multifaceted burdens of cochlear reimplantation, future efforts should focus on improving device reliability and care pathways to reduce the need for reimplantation.
