Microvascular free tissue transfer and cochlear implants: A case series and literature review

Cochlear Implantation After Head and Neck Radiation: A Case Series, Systematic Review, and Meta-analysis

OBJECTIVE

To determine if cochlear implant (CI) is safe and effective in patients with radiation therapy (XRT)-induced sensorineural hearing loss and to discuss considerations in this population through a retrospective cohort review, systematic review, and meta-analysis.

DATABASES REVIEWED

PubMed, Cochrane Library, and Embase.

METHODS

We retrospectively reviewed all CI cases after head and neck (HN) XRT at our institution, noting intraoperative findings, postoperative complications, and hearing outcomes. Change in speech discrimination scores (SDSs) was the primary outcome measure. Systematic review was performed to identify all cases of CI after HNXRT. A meta-analysis was performed to assess SDS change.

RESULTS

The retrospective cohort review identified 12 patients who underwent CI after HNXRT. One patient with HN cancer (HNC) and one with central nervous system pathology (CNSP) received bilateral implants. Six had HNC, three had CNSP, and one had Langerhans cell histiocytosis. Eleven had abnormal findings during CI. There were no postoperative complications. Twenty articles with an additional 97 patients were suitable for systematic review inclusion. Of the 109 patients, 67 (61.5%) had HNC and 18 (16.5%) had CNSP. Abnormal intraoperative findings were common (30.3%), most frequently in the mastoid (66.7%). Postoperative complications, including wound dehiscence and infection with some requiring explantation, occurred in 10.1% of patients. Sixty-six patients were included in the meta-analysis. All demonstrated SDS improvement (mean increase, 56.2%).

CONCLUSION

Patients with prior HNXRT benefit from CI. Paying careful attention to surgical planning and technique, postoperative care, and patient expectations is imperative, as complications are not uncommon.

Autologous fat grafting as a minimally invasive technique to avoid cochlear implant extrusion

OBJECTIVES

Infection of the skin-muscle flap is one of the most severe risks of cochlear implantation. The aim of this paper is to describe a novel and minimally invasive procedure to avoid cochlear implant (CI) extrusion.

METHODS

A 79-year-old woman with severe comorbidities developed a pressure injury of the skin-muscle flap overlying the CI receiver/stimulator (R/S) nine years after surgery. Skin thinning and failure of conventional pressure injury management led the patient to a high risk of CI extrusion. Therefore, she underwent a single procedure of autologous fat grafting under local anesthesia to increase scalp thickness and vascularization over the CI R/S.

RESULTS

Within one month, complete healing of the pressure injury was observed, and the patient was able to safely use her CI. No further signs of infection and skin deterioration were detected at the 15-months follow-up.

DISCUSSION

Fat grafting has been proven to promote neoangiogenesis and tissue regeneration. To the best of our knowledge, this is the first report of fat grafting utilized in the skin-muscle flap area to avoid incipient CI R/S extrusion.

CONCLUSION

The described case demonstrates the efficacy of this salvage procedure to avoid major surgery and the additional costs related to CI reimplantation.

Salvaging Exposed Cochlear Implants

The cochlear implant (CI) procedure is one of the most efficient surgical options for the management of patients suffering from severe bilateral sensorineural hearing loss. Notably, CI exposure is one of the most commonly reported complications. Herein, we report our experience in the management of three patients with CIs complicated by implant exposure.