Minimal access and standard cochlear implantation: a comparative study

[Frankfurt concept of early inpatient rehabilitation after cochlear implant treatment : Feasibility for aftercare. German version]

BACKGROUND

The Association of the Scientific Medical Societies in Germany (AWMF) clinical practice guideline on cochlear implant (CI) treatment, which was updated in 2020, defined the entire process of CI care for the first time. In the present study, the feasibility and results of very early rehabilitation were examined.

MATERIALS AND METHODS

The intervention group (IG) comprised 54 patients in whom rehabilitation was initiated within 14 (maximally 28) days after implantation. Patients with a significantly longer waiting time were included in the control group (CG, n = 21). In addition to the start and duration of rehabilitation, the speech intelligibility achieved with CI was recorded at different timepoints within a 12-month period. In addition, questionnaires were used to assess the effort of fitting the CI processor and the patients' satisfaction with the outcome as well as the timing of the start of rehabilitation.

RESULTS

Median waiting time between implantation and start of rehabilitation was 14 days in the IG and 106 days in the CG; 92.6% of IG patients were able to start rehabilitation within 14 days. The effect of rehabilitation in the IG was 35 and in the CG 25 percentage points (Freiburg monosyllabic test). After 6 and 12 months of CI use, both groups showed comparable results in the test condition in quiet (IG/CG 6 months: 70%/70%; 12 months: 70%/60%, Freiburg monosyllabic test) and in noise (IG/CG 6 months: -1.1-0.85 dB SNR; 12 months: -0.65 dB SNR/0.3 dB SNR, Oldenburg sentence test). Hearing quality assessment scores collected by SSQ (Speech, Spatial and Qualities of Hearing Scale) questionnaire showed better scores in the IG at 6 months, which converged to CG scores at 12 months. The IG was significantly more satisfied with the timing of the start of rehab than the CG. All other data obtained from questionnaires showed no differences between the two groups.

CONCLUSION

A very early start of inpatient rehabilitation after cochlear implantation was successfully implemented. The rehabilitation was completed within 7 weeks of CI surgery. Comparison of speech recognition test results before and after rehabilitation showed a significant improvement. A clear rehabilitation effect can therefore be demonstrated. Inclusion of CI rehabilitation in the German catalog of follow-up treatments is thus scientifically justified and therefore strongly recommended.

Improved Postoperative Speech Recognition and Processor Use With Early Cochlear Implant Activation

OBJECTIVE

To report speech recognition outcomes and processor use based on timing of cochlear implant (CI) activation.

STUDY DESIGN

Retrospective cohort.

SETTING

Tertiary referral center.

PATIENTS

A total of 604 adult CI recipients from October 2011 to March 2022, stratified by timing of CI activation (group 1: ≤10 d, n = 47; group 2: >10 d, n = 557).

MAIN OUTCOME MEASURES

Average daily processor use; Consonant-Nucleus-Consonant (CNC) and Arizona Biomedical (AzBio) in quiet at 1-, 3-, 6-, and 12-month visits; time to peak performance.

RESULTS

The groups did not differ in sex ( p = 0.887), age at CI ( p = 0.109), preoperative CNC ( p = 0.070), or preoperative AzBio in quiet ( p = 0.113). Group 1 had higher median daily processor use than group 2 at the 1-month visit (12.3 versus 10.7 h/d, p = 0.017), with no significant differences at 3, 6, and 12 months. The early activation group had superior median CNC performance at 3 months (56% versus 46%, p = 0.007) and 12 months (60% versus 52%, p = 0.044). Similarly, the early activation group had superior median AzBio in quiet performance at 3 months (72% versus 59%, p = 0.008) and 12 months (75% versus 68%, p = 0.049). Both groups were equivalent in time to peak performance for CNC and AzBio. Earlier CI activation was significantly correlated with higher average daily processor use at all follow-up intervals.

CONCLUSION

CI activation within 10 days of surgery is associated with increased early device usage and superior speech recognition at both early and late follow-up visits. Timing of activation and device usage are modifiable factors that can help optimize postoperative outcomes in the CI population.

Early fitting in cochlear implant surgery: preliminary results

PURPOSE

Cochlear implants are usually activated 3-5 weeks after surgery; to date, no universal protocol exists regarding switch on and fitting of these devices. The aim of the study was to assess safety and functional results of activation and fitting of cochlear implant within 24 h following surgery.

METHODS

In this retrospective case-control study, 15 adult patients who underwent cochlear implant surgery, for a total of 20 cochlear implant procedures were analyzed. In particular, clinical safety and feasibility were investigated by examinating patients at activation and at each follow-up. Values of electrodes' impedance and most comfortable loudness (MCL) were analyzed from the time of surgery to 12 months after activation. Free-field pure tone average (PTA) was also recorded.

RESULTS

No major or minor complications were reported and all patients could perform the early fitting. Activation modality influenced impedance values only in the short term but the differences were not statistically significant (p > 0.05). Mean MCL values in the early fitting group were lower than MCL of the late fitting in all follow-up sessions, and the difference was statistically significant (p < 0.05). The mean PTA was lower in the early fitting group but the difference was not statistically significant (p < 0.05).

CONCLUSIONS

Early fitting of cochlear implants is safe, allows for an early rehabilitation and can have possible beneficial effects on stimulation levels and dynamic range.

Early activation of cochlear implants: a systematic review and narrative synthesis

BACKGROUND

Device activation typically occurs four weeks post cochlear implant surgery. Emerging evidence suggests earlier activation is feasible and beneficial, giving patients quicker access to sound and rehabilitation.

OBJECTIVES

Assess current literature for effects of early cochlear implant activation.

METHODS

Electronic searches of Medline/PubMed, AMED, EMBASE, CINAHL and the Cochrane Library following PRISMA guidelines. Studies investigating any aspect of early activation were included for review.

RESULTS

From 15 studies, 625 patients received early activation, compared with 243 patients in the control groups. Early activation was considered as within 7 days post-operatively with 12 studies reporting within 1 day post-operatively, compared with standard activation of 9-46 days post-operatively in the control group. Some studies indicated earlier low levels of impedance in the early activation group. Magnet strength adjustment or off-ear processor wear was often recommended within the early activation cohort. Complication rates were low in both groups. Early activation improved patient satisfaction and anxiety levels without detriment to speech recognition or rehabilitation.

CONCLUSION

Early cochlear implant activation is feasible and allows patients with no contraindications, earlier access to auditory perception and rehabilitation and reduces anxiety linked to delay in activation. Further evidence is required to monitor long-term effects of early activation.

Simultaneous Bilateral Cochlear Implantation in Adults

The objective of this study is to review our experience with simultaneous bilateral cochlear implantation (BiCI) in adults, and assess its feasibility. This could shorten the time required to regain binaural hearing, prevent social isolation, and potentially eliminate the need for hearing aids, as seen with sequential BiCI. A retrospective study was conducted involving adult patients who received simultaneous BiCI at our center between 2010 and 2023. The feasibility of simultaneous BiCI was assessed through postoperative clinical evaluations, outpatient visits, discharge status, and the acceptance of device fitting. Twenty-seven patients underwent simultaneous BiCIs. Their mean age was 37 years, comprising 59.3% males and 40.7% females. Out of the included patients, 51.9% had childhood-onset hearing loss, while 29.6% developed hearing loss later in life. Causes of hearing loss included meningitis 7.4%, trauma 11.1%, non-specific high-grade fever 11.1%, and Brucellosis infection 3.7%. Labyrinthine ossificans (LO) was present in 7.4%, and retrofenestral otospongiosis in 3.7%. The post-operative period and initial outpatient visit were uneventful for 88.8% and 81.5% of patients, respectively. Intraoperative complications were absent in 96.2% of cases. Simultaneous BiCI is feasible in adults without major intraoperative complications or troublesome recovery periods, offering potential benefits by reducing the number of surgeries and hospital admissions compared to the sequential method.

A monocenter, patient-blinded, randomized, parallel-group, non-inferiority study to compare cochlear implant receiver/stimulator device fixation techniques (COMFIT) with and without drilling in adults eligible for primary cochlear implantation

BACKGROUND

During the cochlear implantation procedure, the receiver/stimulator (R/S) part of the implant is fixated to prevent postoperative device migration, which could have an adverse effect on the position of the electrode array in the cochlea. We aim to compare the migration rates of two fixation techniques, the bony recess versus the subperiosteal tight pocket without bony sutures.

METHODS AND ANALYSIS

This single-blind randomized controlled trial will recruit a total of 112 primary cochlear implantation adult patients, eligible for implantation according to the current standard of practice. Randomization will be performed by an electronic data capture system Castor EDC, with participants block randomized to either bony recess or standard subperiosteal tight pocket in a 1:1 ratio, stratified by age. The primary outcome of this study is the R/S device migration rate; secondary outcomes include patient-experienced burden using the validated COMPASS questionnaire, electrode migration rate, electrode impedance values, speech perception scores, correlation between R/S migration, electrode array migration and patient complaints, assessment of complication rates, and validation of an implant position measurement method. Data will be collected at baseline, 1 week, 4 weeks, 8 weeks, 3 months, and 12 months after surgery. All data analyses will be conducted according to the intention-to-treat principle.

DISCUSSION

Cochlear implantation by means of creating a tight subperiosteal pocket without drilling a bony seat is a minimally invasive fixation technique with many advantages. However, the safety of this technique has not yet been proven with certainty. This is the first randomized controlled trial that directly compares the minimally invasive technique with the conventional method of drilling a bony seat.

TRIAL REGISTRATION

Netherlands Trial Register NL9698. Registered on 31 August 2021.

Residual low-frequency hearing after early device activation in cochlear implantation

PURPOSE

The cochlear implant (CI) is a standard treatment for patients with severe to profound hearing loss. In recent years, early device activation of the sound processor after 2-3 days following surgery has been established. The aim of this study is to evaluate the residual hearing of CI patients with substantial preoperative low-frequency hearing after early device activation over a period of 12 months.

METHODS

Results were compared between an early fitted group (EF) with device activation to less than 15 days after CI surgery and a control group (CG) with device activation after 3-6 weeks. In total, 57 patients were divided into EF group (n = 32), and CG (n = 25). Low-frequency residual hearing and speech recognition in quiet and in noise were compared over an observation period of 12 months.

RESULTS

No significant difference (p > 0.05) in the residual low-frequency hearing PTAlow between EF and CG was found, neither preoperatively (EF 33.2 dB HL/CG 35.0 dB HL), nor postoperatively (EF 46.8 dB HL/CG 46.2 dB HL). In both groups, postoperative residual hearing decreased compared to preoperative and remained stable within the first year after CI surgery. Furthermore, both groups showed no significant differences (p > 0.05) in speech recognition in quiet and in noise within the first year.

CONCLUSION

Early device activation is feasible in CI patients with preoperative low-frequency residual hearing, without an additional effect on postoperative hearing preservation.

Comparison of Cochlear Implantation Complications with Subperiosteal Pocket Technique Versus Well-Drilling Technique in Pediatric Patients: A Retrospective Study

Aims: Cochlear implantation is becoming the standard treatment for rehabilitating patients with sensorineural hearing (SNH) impairment. Various techniques can be used to achieve this goal. In the current study, we compared the subperiosteal technique (SPT) with the development of a subperiosteal pocket without fixation to the well-drilling method (WD) by constructing an incision into the scalp with suture fixation. Materials and methods: Our study weighted the efficiency of children who underwent WD or SPT from 2017 to 2021 at King Abdulaziz University Hospital. In this retrospective records review, we compared 63 SPT cases with 104 WD cases during a 5-year period who were followed for 1 month or more. Results: There were 88 females (50.9%) and 79 male (45.7%) with a mean age of 4.49 ± 3.06 years at the time of surgery. The mean WD duration was 2.47 ± 1.05 h, and 2.91 ± 1.05 h for SPT (P = 0.01). Moreover, there was a significant relationship between comorbidities and electrode complications (P = 0.022). There was no significant correlation between the surgical method and intraoperative complications (P = 0.714), electrode array issues (P = 0.88), or serious postoperative complications including device failure and migration skin problems (P = 0.207). Conclusion: Overall, the WD technique was faster. However, both methods can be used safely and effectively, as no significant intraoperative or postoperative complications were observed. Further long-term studies are required to validate our findings.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12070-023-03735-z.

Early activation after cochlear implantation: a systematic review

PURPOSE

To systematically review the outcomes of early activation following cochlear implantation (CI) based on the findings from different studies in the literature.

METHODS

A comprehensive search strategy was conducted through different databases to identify relevant articles. Our outcomes included impedance levels, rates of complications, hearing and speech perception performance, and patients' satisfaction levels.

RESULTS

The total number of included studies in this systematic review is 19, which recruited 1157 patients, including 857 who underwent early activation following CI. Seventeen studies investigated impedance levels or feasibility rates of early activation approaches. Most of these studies (n = 10) reported that mean impedance levels remarkably decreased within the first day-to-month (first measurement) post-activation. In addition, all 17 studies showed that impedance levels finally normalize and become comparable with intraoperative levels or the conventional activation group. Seventeen studies reported the occurrence of complications in their population. Ten of these studies indicated that none of their patients developed any post-operative complications after early activation. Seven studies reported the development of some minor complications, including pain 9.2% (28/304), infection 4.7% (13/275), swelling 8.2% (25/304), vertigo 15.1% (8/53), skin hyperemia 2.2% (5/228), and others 16.4% (9/55). Hearing and speech perception was assessed in six studies, which showed a remarkable improvement in their patients. Three studies investigated patients' satisfaction and showed high satisfaction levels. Only one report investigated the economic advantages of early activation.

CONCLUSION

Early activation is safe and feasible and does not impact the hearing and speech outcomes of the patients undergoing CI procedures.

Delayed-onset swelling around the implant after cochlear implantation: a series of 26 patients

PURPOSE

We aimed to clarify the clinical features of delayed-onset swelling around cochlear implants (CI), and to present our experience on how to avoid and address this problem.

METHODS

We performed a retrospective review of all CI cases at our institution between June 2001 and June 2020. Information on postoperative complications of swelling in the receiver area > 3 months after implantation were analyzed, and clinical data sheets were drawn.

RESULTS

Twenty-six of 1425 patients (1.82%) with an age at implantation ranging from 1 to 9 years experienced delayed-onset swelling around the implant. Swelling episodes occurred as early as 4 months, and as late as 178 months after implantation (median, 79.7 months). The predisposing factor in 12 cases was unclear, 7 cases were caused by trauma at the implantation site, 5 cases were without predisposing factors, and 2 cases were related to infection. We found the frequency of delayed-onset swelling after cochlear implantation with different incision was statistically insignificant (P = 0.423). Nineteen patients (73.1%) were cured after one treatment, and five patients (19.2%) relapsed. Follow-up examinations at least 18 months after surgery revealed that all patients experienced a complete recovery.

CONCLUSIONS

Delayed-onset swelling at the receiver site is a long term but not exactly uncommon complication after cochlear surgery and long-term follow-up is eagerly required. It can recur more than once, causing more complex treatment strategies in clinical practice. Conservative treatment first recommended, while needle aspiration should initially be considered in recurrent cases also when the effusion swelling is > 3 ml.

Surgical Factors Influencing Wound Complication After Cochlear Implantation: A Systematic Review and Meta-Analysis

OBJECTIVE

To identify perioperative surgical factors associated with wound complications following cochlear implantation (CI).

DATA SOURCES

PubMed, Web of Science, and Cochrane databases.

STUDY SELECTION

Eligible studies included peer-reviewed research in English evaluating wound complications (wound infection, skin flap breakdown/dehiscence, seroma/hematoma) following CI. Studies with paired samples were included in the meta-analysis.

DATA EXTRACTION

Surgical factors (techniques and perioperative management) in CI and reported wound complications were examined. Level of evidence was assessed using the Oxford Centre for Evidence-based Medicine guidelines and bias was assessed using the NIH Quality Assessment Tool.

DATA SYNTHESIS

Twenty-six studies representing 10,214 cochlear implantations were included. The overall wound complications rate was 3.1% (range 0.03-13.9%). Eleven studies contained paired data and were used for meta-analysis regarding three different surgical factors: incision length, implant placement method, and antibiotic usage. Longer incision lengths (≥7 cm) demonstrated a higher risk of wound complications (risk ratio 2.27, p = 0.02, CI 1.16-4.43). Different implant placement techniques (suture fixation versus periosteal pocket) (p = 0.08, CI 0.92-3.69) and postoperative antibiotic regimens (postoperative use versus none) (p = 0.68, CI = 0.28-7.18) were not associated with differences in wound complication rates following CI.

CONCLUSIONS

Overall rate of wound complications following CI is low. Shorter incision length is associated with lower risk of wound complications. Differences in perioperative techniques and practices regarding implant placement and antibiotic use were not associated with differences in wound complication rates. Considering the low number and quality of studies, there is a need for research in CI outcomes using paired sample prospective designs and standardized reporting.

Comparison of Cochlear Implant Device Fixation-Well Drilling Versus Subperiosteal Pocket. A Cost Effectiveness, Case-Control Study

OBJECTIVE

To compare surgical characteristics and complications between well drilling (WD) and subperiosteal pocket techniques (SPT) for receiver/stimulator (R/S) fixation of cochlear implant (CI), and conduct cost-effectiveness analysis.

STUDY DESIGN

Retrospective clinical study, decision-analysis model.

SETTING

Tertiary referral center.

PATIENTS

Three-hundred and eighty-eight CI recipients with a minimum of 6-months follow-up.

INTERVENTIONS

CI surgery using either WD or SPT for R/S fixation. A decision-analysis model was designed using data from a systematic literature review.

MAIN OUTCOME MEASURES

Surgical operation time, rates of major and minor long-term complications were compared. Incremental cost-effectiveness was also estimated, comparing the two methods of fixation.

RESULTS

We compared 179 WD with 209 SPT. Surgery time was significantly shorter in SPT (148 versus 169 min, p = 0.001) and remained significant after adjustment for possible confounders. Higher rates of major complications requiring surgical intervention were found with SPT (10.5% versus 4.5%, p = 0.042), however, the difference was not significant after adjusting for follow-up time (47.8 versus 32.5 months for SPT, WD respectively; p < 0.001). The incremental cost-effectiveness ratio for WD (compared with SPT) was $48,795 per major complication avoided, which was higher than the willingness-to-pay threshold of $47,700 (average cost of 2 h revision surgery).

CONCLUSIONS

SPT was found to be faster but potentially risks more complications, particularly relating to device failure. Further long-term studies are required to validate these differences. Based on data from the current literature, neither of the methods is compellingly cost-effective over the other, and surgeons can base their choice on personal preference, comfort, and previous training.

Association of the Duration of Antibiotic Therapy With Major Surgical Site Infection in Cochlear Implantation

Importance

Infection after cochlear implantation is a rare but serious event that can lead to meningitis. There is no consensus on prevention of infection in these patients, and each center applies its own strategy.

Objective

To describe the rates of major surgical site infection for patients undergoing cochlear implantation who receive prolonged antibiotic treatment compared with those who receive a single perioperative dose of antibiotic prophylaxis.

Design, Setting, and Participants

Retrospective cohort study of patients who underwent cochlear implantation between January 1, 2011, and July 8, 2015, with a postoperative follow-up of 1 to 3 years. In this multicenter study at 8 French university centers, 1180 patients (509 children and 671 adults) who underwent cochlear implantation during this period were included.

Interventions

Prolonged antibiotic treatment vs single-dose antibiotic prophylaxis.

Main Outcomes and Measures

Major infection and explantation.

Results

Among 1180 patients (509 children [51.7% female] with a mean [SD] age of 4.6 [3.8] years and 671 adults [54.9% female] with a mean [SD] age of 54.8 [17.0] years), 12 patients (1.0%) developed a major infection, with 4 infections occurring in the prolonged antibiotic treatment group and 8 infections occurring in the antibiotic prophylaxis group (odds ratio, 2.45; 95% CI, 0.73-8.17). Children (9 of 509 [1.8%]) were more likely to develop infection than adults (3 of 671 [0.4%]). Among children, 4 infections occurred in the prolonged antibiotic group (n = 344), and 5 infections occurred in the antibiotic prophylaxis group (n = 158) (odds ratio, 2.78; 95% CI, 0.74-10.49). Among adults, 3 infections occurred in the antibiotic prophylaxis group (n = 365), whereas no infections occurred in the prolonged antibiotic treatment group (n = 290).

Conclusions and Relevance

After cochlear implantation, infection was rare, was less common among those who received prolonged antibiotic treatment, and was less likely to occur in adults than in children.

Cochlear implant symmetry via template

Current trends in bilateral cochlear implantation (CI) favor a minimally invasive subperiosteal pocket technique. Symmetric receiver-stimulator (R/S) placement is an important goal for bilateral CI, especially with regard to patient satisfaction. In this article, we describe a method easily adopted to achieve optimal symmetry. Upon reviewing the Senior Author's 11 bilateral CI cases using the direct subperiosteal pocket technique with the proposed "mirror template," we found improved symmetry, which translated into high patient and family satisfaction regarding the aesthetics of the symmetric R/S placement.

Preliminary experience using a cochlear implant with a novel linear pedestal design

OBJECTIVE

To assess the safety and efficiency of cochlear implantation using a novel device with a linear silastic pedestal (2 mm wide, 2 mm deep, 10 mm long) on the flat undersurface.

METHODS

Operative times required to drill a linear groove (LG) for the new linear pedestal design were prospectively accrued for 46 implantations in 30 children (median age 3). Intra-operative safety was assessed during each case. Instances of dural exposure in the base of the LG were noted. Length of stay was also recorded as a secondary measure of efficiency.

RESULTS

Across all surgeons, the mean time needed to create the LG was 1.9 ± 1.5 min (±SD) with a median time of 1.5 min (95% Cl: 1-2 min). The range in time was 1-10 min. No intraoperative complications occurred. Intended device positioning was confirmed with on-table post-operative x-rays in all cases. 43% of patients were discharged on the day of surgery.

CONCLUSIONS

The novel linear pedestal design allows for deliberate device placement while adding little additional operative time and complexity, an improvement on our current standard of care.

Local anaesthesia and conscious sedation for cochlear implantation: experience with 20 patients

Objective:

Cochlear implantation is mostly performed under general anaesthesia. This study aimed to evaluate cochlear implantation performed under local anaesthesia and sedation.

Method:

Twenty patients had a cochlear implant fitted under combined local anaesthesia (local anaesthesia group) and 41 patients had one fitted under general anaesthesia (general anaesthesia group) for bilateral profound hearing loss, from 2011 to 2014. Surgical duration, period of post-operative hospitalisation and early post-operative symptoms were compared. In the local anaesthesia group, operative symptoms reported during the surgery and by questionnaire were analysed.

Results:

Mean surgical duration was significantly shorter in the local anaesthesia group: 87 versus 122 minutes (p< 0.001). No significant difference was observed between the local anaesthesia and general anaesthesia groups regarding mean post-operative hospitalisation and early post-operative symptoms. Under local anaesthesia, patients had no particular symptoms in 60 per cent of cases. The remaining patients in this group experienced vertigo (10 per cent), pain (20 per cent) and pain-related movement (10 per cent) during the intervention. These symptoms can be controlled with symptomatic treatment.

Conclusion:

Combined local anaesthesia for cochlear implantation is a good alternative to general anaesthesia for co-operating patients.

Cochlear Implantation in Pediatric Patients: Comparison of Limited-Incision and Standard Cochlear Implantation

Today, cochlear implantation has become the standard procedure for rehabilitation of people with impaired sensory neural hearing. This procedure can be done through different techniques. The present study aimed to compare the standard technique (ST) with creation of "C" incision into the scalp with suture fixation and limited-incision technique (LIT) with creation of subperiosteal pocket without any fixation. The outcomes included operative time and complications. This retrospective study was conducted on 343 consecutive cochlear implantations. The patients received cochlear implants at our institution between 2004 and 2011. The complications were identified as "minor" or "major". All the complications and operation times were assessed for the two surgical techniques. The overall rates of complications were 4.4 % (11 out of 252) and 2.2 % (2 out of 91) for ST and LIT, respectively. The results revealed no significant difference between the two fixation techniques regarding the complications. The mean operation time was 150 ± 23.7 and 133 ± 23.12 min in ST and LIT, respectively, and the difference was statistically significant. Both ST and LIT are safe techniques with a relatively low complication rate. However, ST can be effectively replaced by LIT because of its shorter operative time.

Surgical outcomes with subperiosteal pocket technique for cochlear implantation in very young children

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.

Surgical duration of cochlear implantation in an academic university-based practice

OBJECTIVE

Establish the time to safely and efficiently perform cochlear implantation (CI) in a university-based academic center.

STUDY DESIGN

Case series with chart review.

SETTING

Academic neurotologic referral center.

PATIENTS

424 patients who underwent CI surgery between 2002 and 2010.

INTERVENTION

Unilateral, bilateral or revision CI using commercially available devices approved for use in the United States.

MAIN OUTCOME MEASURES

mean surgical duration (SD) and mean total operative room time (TORT).

RESULTS

Overall mean SD for all 424 patients was 83 ± 30 min (min) whereas the mean TORT was 135 ± 56 min. The mean SD for unilateral CI was 84 ± 18 min for the first implant and 82 ± 22 min for the second implant (p=0.55). The SD for primary and revision CI was 83 ± 18 min and 85 ± 36 min, respectively (p=0.51). The mean SD for pediatric and adult CI was 83 ± 21 min and 83 ± 18 min, respectively (p=0.92). The mean SD without resident assistance was 74 ± 14 min whereas with the assistance of a resident the mean SD was 84 ± 20 min (p=0.02). When ossification was encountered the mean SD was 90 ± 32 min compared to 82 ± 19 min when absent (p<0.001). An association was found between TORT or SD, and the year of surgery, presence of ossification and the involvement of an assistant.

CONCLUSION

In a university-based academic center, CI surgery can be safely and efficiently performed, supporting future cost-effectiveness analysis of its current practice.

Evaluation of the Digisonic® SP cochlear implant: patient outcomes and fixation system with titanium screws

Cochlear implants have revolutionized the way patients affected by severe hearing loss experience the world. Neurelec developed a fixation system with two titanium screws that requires no skull bone drilling.

Objective

To describe the outcomes and procedure-related details of a series of patients implanted with the Digisonic® SP cochlear implant.

Method

This retrospective study analyzed patients submitted to cochlear implant placement within a period of 18 months. All patients had postlingual hearing impairment. Data was collected from patient charts and standard questionnaires answered by the surgeons in charge of carrying out the procedures.

Results

The six patients offered the Digisonic® SP cochlear implants were operated by experienced surgeons. The procedures took 95 to 203 minutes (mean = 135') to be completed, which is less time than what has been described for other fixation approaches. No complications were recorded and hearing improvement was satisfactory.

Conclusion

The Digisonic® SP cochlear implant developed by Neurelec offered good audiological results for adult patients, shorter surgery time, and no surgical or postoperative complications.