Management of delayed-onset skin flap complications after pediatric cochlear implantation

An Approach to Managing Recurrent Cochlear Implant Wound Infection and Skin Breakdown

We report the case of a cochlear implant patient who developed multiple infections with device extrusion necessitating explanation and reimplantation twice. An approach using a vancomycin washout followed by a temporalis muscle rotation and scalp rotation flap was utilized to salvage the device.

Brazilian Society of Otology task force - cochlear implant ‒ recommendations based on strength of evidence

OBJECTIVE

To make evidence-based recommendations for the indications and complications of Cochlear Implant (CI) surgery in adults and children.

METHODS

Task force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on cochlear implantation were eligible for inclusion. The American College of Physicians' guideline grading system and the American Thyroid Association's guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions.

RESULTS

The topics were divided into 2 parts: (1) Evaluation of candidate patients and indications for CI surgery; (2) CI surgery - techniques and complications.

CONCLUSIONS

CI is a safe device for auditory rehabilitation of patients with severe-to-profound hearing loss. In recent years, indications for unilateral hearing loss and vestibular schwannoma have been expanded, with encouraging results. However, for a successful surgery, commitment of family members and patients in the hearing rehabilitation process is essential.

Transmuscular pocket: a modified technique to overcome thick musculocutaneous flap in cochlear implant surgery

OBJECTIVE

To describe and evaluate a modified cochlear implant surgical procedure for patients with a thick musculocutaneous flap.

MATERIALS AND METHODS

A prospective study for cochlear implant surgery in selected patients with a musculocutaneous flap thicker than 7 mm.

RESULTS

Fourteen patients with a thick scalp flap underwent cochlear implantation between July 2019 and December 2020. The patient age ranged between 17 and 53 years. The flap thickness was between 7 mm and 14 mm. The mean follow uptime post operatively was 16.5 months. The cochlear implant receiver coil was successfully implanted using the transmuscular technique without complications and with normal audiological function.

CONCLUSION

The transmuscular pocket modified technique is a safe and effective method to overcome a thick musculocutaneous flap in cochlear implant surgery.

Cochlear reimplantation outcomes over 20 years: Expertise in reimplantation surgery and auditory-speech rehabilitation

OBJECTIVES

The aim of this study was to present an institution's experience with cochlear reimplantation (CRI), to assess surgical challenges and post-operative outcomes and to increase the success rate of CRI.

STUDY DESIGN

Retrospective single-institution study.

SETTING

Tertiary medical center.

METHODS

We retrospectively evaluated data from 76 reimplantation cases treated in a tertiary center between 2001 and 2022. Clinical features including etiology of hearing loss, type of failure, surgical issues, and auditory speech performance were analyzed. Categorical Auditory Performance (CAP) and Speech Intelligibility Rating (SIR) scores were used to evaluate pre- and post-CRI outcomes.

RESULTS

The CRI population comprises of 7 patients from our institute,69 referred patients from other centers. Device failure was the most common reason (68/76, 89.5 %) for CRI; in addition, there were 7 medical failures and 1 had both soft device failure. Medical failures included flap rupture and device extrusion, magnet migration, auditory neuropathy, leukoencephalopathy, foreign-body residue and meningitis. In 21/76 patients, the electrode technology was upgraded. The mean time to failure was 0.58-13 years, with a mean of 4.97 years. The mean (± SD) CAP and SIR scores before and after CRI were 5.2 ± 1.2 versus 5.5 ± 1.1 and 3.4 ± 1.1 versus 3.5 ± 1.1, respectively. Performance was poor in six patients with severe cochlear malformation, auditory nerve dysplasia, leukoencephalopathy, and epilepsy.

CONCLUSION

CRI surgery is a challenging but relatively safe procedure, and most reimplanted patients experience favorable postoperative outcomes. Medical complications and intracochlear damage are the main causes of poor postoperative results. Therefore, adequate preoperative preparation and atraumatic CRI should be carried out for optimal results.

Complications of cochlear implantation: a decade's experience

PURPOSE

Surgery for cochlear implantation is becoming increasingly common. It is a precise surgery and carries with it a number of very specific complications. Although uncommon, they can profoundly affect the recipients' quality of life. We report on our patients' population and compare with different series.

METHODS

This is a retrospective analysis of patients who underwent cochlear implant surgery in our center or who were referred for management of complications between November 2012 and November 2022.

RESULTS

There were 2126 patients aged 9 months-68 years [mean 3.2 yrs] with 147 adults > 18 yrs. The male: female ratio was nearly 1. We are reporting on late complications excluding device failures. There were 186 complications [8.7%], 124 minor complications [66% of the complications, 5.8% of the total population; and 62 major complications [ 33% of the complications and 2.9% of the total]. The commonest minor complication was surgical site infection [16%] and the commonest major complication was flap necrosis and device extrusion [26%].

CONCLUSION

Complications in our series were comparable to other series from different locations. But there seems to be a difference in the frequency of each complication depending on many factors which must be addressed. Standardization of reporting should be also more homogenized.

Temporal Swelling Following Cochlear Implantation: Frequency, Treatment, and Outcomes

OBJECTIVE

To investigate the frequency, treatment, and outcomes of postoperative delayed-onset swelling around cochlear implants.

STUDY DESIGN

Retrospective, observational, nonrandomized group study.

SETTING

Academic medical center.

PATIENTS/INTERVENTIONS

Among 354 patients (516 ears) who underwent cochlear implantation (CI) at our hospital between May 2009 and October 2022, 329 (472 ears: 138 children [246 ears] and 191 adults [226 ears]) with a follow-up period of >3 months were included.

MAIN OUTCOME MEASURES

Physical examination and computed tomography of the head were performed.

RESULTS

In total, 5.5% (26/472 ears) had a history of delayed-onset swelling around the implant. This complication occurred in 9.8% (24/246 ears) of children and 0.9% (2/226 ears) of adults. The mean time to onset of swelling was 50 (range, 5.5-147) months following CI. In 60% (21/35) of the cases, the cause was unknown, whereas in 25.7% (9/35) and 11.5% (4/35) of cases, it was head trauma and acute inflammation, respectively. Conservative treatment (observation, antibiotics, and/or strong magnetic compression) was adapted in 91.4% (32/35) of cases. After conservative treatment, revision CI surgery was performed in one ear. Additionally, recurrent swelling was observed in 23.1% (6/26 ears) of swelling cases.

CONCLUSIONS

The results suggest that delayed-onset swelling around implants occurs more frequently in children than in adults because of the higher incidence rates of head trauma and acute otitis media in children. In most cases, conservative treatment was adequate; however, careful follow-up is necessary. Our findings can serve as a reference for optimizing care and intervention options after CI.

Intraoperative Difficulties and Postoperative Complications Associated With Cochlear Implantations: A Study From Erbil City

Background and objective Cochlear implants are highly effective for the treatment of severe to profound hearing loss. Cochlear implant surgery is a safe surgical procedure; however, due to many modifications over the years, it has been associated with certain minor and major complications. This study aimed to examine the intraoperative difficulties and postoperative complications in patients who received cochlear implants in Erbil City. Methods We conducted a retrospective descriptive study regarding complications of cochlear implants involving patients who received unilateral or bilateral cochlear Implants at the Rizgary Teaching Hospital and a private hospital in Erbil City from January 2013 to July 2022. Their medical records were analyzed, and data on demographics, intraoperative difficulties, and postoperative complications were gathered. Results A total of 160 patients with cochlear implants (87 male, 54.4%; 73 female, 45.6%) were included in the study. The mean age of the patients at the time of operation was 6.76 ± 8.02 years (range: 1-53 years); 150 of these patients were children and 10 were adults (18 years and above). Intraoperative difficulties occurred in five patients (3.1%). The overall rate of complication was 10%, 7.5% of which was minor (the most common being wound infection) and 2.5% major (the most frequent being device extrusion). Conclusions Cochlear implant surgery is a safe procedure performed to treat profoundly deaf patients. It is associated with a low rate of complications, most of which can be successfully managed with conservative measures or minimal intervention.

Comparison of Adult and Pediatric Cochlear Implant Wound Complications: A Meta-Analysis

OBJECTIVE

To compare age-related differences in wound complications following cochlear implantation (CI).

METHODS

We performed a systematic review of PubMed, Cochrane Database, and Web of Science databases to identify original research evaluating the patient-level factors (demographics and medical history) associated with wound complications following CI. Outcomes were expressed as relative risk (RR) with 95% confidence intervals using the inverse variance method. Studies without comparison groups were described qualitatively.

RESULTS

Thirty-eight studies representing 21,838 cochlear implantations were included. The rate of wound complications ranges from 0% to 22%. Patient age (adult versus pediatric) was the only factor with comparison groups appropriate for meta-analysis. The 10 studies (n = 9547 CI's) included in the meta-analysis demonstrated that adults had a higher incidence of overall wound complications (2.94%) than in children (2.44%) (RR 1.31, 95% CI 1.01-1.69). Adults had a higher incidence of general/unclassified wound complications (2.07%) than in children (1.34%) (RR 1.68, 95% CI 1.12-2.52). There was no difference between adults and children for specific complications such as hematoma, infection, or seroma. Elderly patients (over age 75) have wound complication rates that range from 1% to 4%. No studies contained comparison groups regarding other patient-level factors and CI wound complications.

CONCLUSION

CI wound complication rates reported in the literature are low; however, adults have a higher risk of these complications than pediatric patients. The reported complication rate in elderly adults is low. There is a gap in CI research in consistently reporting wound complications and rigorous research investigating the impact of patient-level factors and wound complications.

LEVEL OF EVIDENCE

NA Laryngoscope, 133:218-226, 2023.

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.

Cochlear implantations in Jordan: Retrospective analysis of post-operative complications

AIMS

This study aims to carry out a retrospective analysis of demographic information and post-operative complications with special emphasis on complications related to the soft tissue over the implanted device in patients who underwent cochlear implantation.

SETTINGS AND DESIGN

Retrospective study.

PATIENTS AND METHODS

We conducted a retrospective review of 840 patients who had cochlear implants at our centre during the period between March 2010 and November 2020. The patients' demographic details and complications related to the soft tissue over the implanted device were analysed.

STATISTICAL ANALYSIS USED

SPSS software version 12.

RESULTS

In total, 380 (45.2%) patients were male and 460 (54.8%) were female. The age of patients at the time of surgery ranged between 7 months and 68 years and the mean age was 4.64 ± 2.91 years. The majority of patients underwent unilateral cochlear implantation (837 patients), with only three patients receiving a bilateral implant. There were a total of 19 implanted patients who developed complications related to the soft tissue around the implanted device, with an incidence rate of 2.3%. Haematoma was the most commonly encountered complication and other complications were: seroma, wound infection, abscess formation and flap necrosis.

CONCLUSIONS

Cochlear implantation is considered to be a reliable and safe surgical procedure for the rehabilitation of deaf patients. Complications can be avoided by proper patient preparation, appropriate incision and flap design, rigorous surgical techniques and periodic post-operative follow-up to detect and manage any complications early.