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Helbig S, Thiemann N, Hattingen E, Loth A, Stöver T, Leinung M. Prospective study on magnetic resonance imaging in cochlear implant patients. Eur Arch Otorhinolaryngol 2024; 281:1231-1242. [PMID: 37707616 PMCID: PMC10858110 DOI: 10.1007/s00405-023-08224-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 09/01/2023] [Indexed: 09/15/2023]
Abstract
PURPOSE Monocentric, prospective study to investigate whether concomitant support of cochlear implant (CI) patients by CI-trained otolaryngologists and application of a standardized head bandage can minimize potential complications during magnetic resonance imaging (MRI). METHODS Thirty-seven patients with 46 CIs underwent MRI with a prophylactic head bandage. All participants and the otolaryngologist at the CI center completed pre- and post-MRI questionnaires documenting body region scanned, duration of MRI and bandage wear, field strength during the scan, and any complications. If pain was experienced, it was assessed using a visual analog scale (1-10). RESULTS MRI was performed without adverse events in 37.8% of cases. Magnet dislocation requiring surgical revision occurred in 2% of cases. Pain was reported in 86% of cases, often due to the tightness of the dressing. Patients with rotating, MRI-compatible magnets reported significantly less pain than participants with older-generation implants. In 11% of cases, the MRI was discontinued. CONCLUSION Serious complications during MRI in cochlear implant patients are rare. Pain is the most common adverse event, probably mainly due to the tight bandage required by most implant types. With newer generations of magnets, these patients experience less pain, no dislocation of the magnets, and no need for bandaging. Although magnet dislocation cannot be completely prevented in older generations of implants, it appears to be reduced by good patient management, which recommends examination under the guidance of physicians trained in the use of hearing implants.
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Affiliation(s)
- Silke Helbig
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
| | - Neele Thiemann
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Elke Hattingen
- Department of Neuroradiology, University Hospital, Goethe University Frankfurt, Frankfurt, Germany
| | - Andreas Loth
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Timo Stöver
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Martin Leinung
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
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Rupp R, Balk M, Allner M, Sievert M, Mueller SK, Hoppe U, Hornung J, Iro H, Gostian AO. Surgical Versus Noninvasive Manual Repositioning After Cochlear Implant Partial Magnet Dislocation. EAR, NOSE & THROAT JOURNAL 2023:1455613231206297. [PMID: 37864335 DOI: 10.1177/01455613231206297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2023] Open
Abstract
Objectives: To compare surgical magnet repositioning (SMR) and noninvasive manual magnet repositioning (MMR) as treatments for partial magnet dislocation (PMD) of the internal magnet in a cochlear implant (CI) caused by magnetic resonance imaging (MRI). The primary objective was the success rate, while the secondary objectives were total postinterventional CI downtime and complications. Methods: This single-center retrospective study was conducted at a tertiary referral medical center. Patients with CI treated for PMD between January 1, 2007 and September 30, 2022 were included. SMR served as primary treatment until June 2019 and as secondary treatment after the introduction of MMR. Results: A total of 51 cases of PMD were observed in 42 patients and 43 devices (18 ♀; 24 ♂; 12 with bilateral CI). MMR was performed successfully in 19 out of 20 cases (95%), while 32 cases were managed successfully by SMR. The median age at first magnet repositioning was 53.8 years (minimum 19 years, maximum 93 years). When MMR was performed, the mean time from diagnosis to treatment (0.5 ± 1.5 days vs 9.8 ± 7.6 days; P < .01), the mean time from repositioning to CI reactivation (1.4 ± 4.3 days vs 13.1 ± 6.7 days; P < .01), and the mean total CI downtime (1.9 ± 4.8 days vs 22.9 ± 11.9 days; P < .01) were significantly shorter compared to SMR. Significantly fewer complications were experienced with MMR [n = 0 (0%) vs n = 8 (25%); P = .04]. Conclusion: In case of PMD caused by MRI, noninvasive MMR shows a high success rate with a shorter total CI downtime as well as a lower complication rate compared to SMR. Therefore, MMR should be considered as first line treatment with SMR as a second option in case of failure.
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Affiliation(s)
- Robin Rupp
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Matthias Balk
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Moritz Allner
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Matti Sievert
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Sarina K Mueller
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Ulrich Hoppe
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Joachim Hornung
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Heinrich Iro
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Antoniu-Oreste Gostian
- Department of Otorhinolaryngology, Head and Neck Surgery, Merciful Brothers Hospital St. Elisabeth, Straubing, Germany
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Rupp R, Thimsen V, Balk M, Mueller SK, Sievert M, Mantsopoulos K, Hoppe U, Hornung J, Iro H, Gostian AO. Diagnosing complications following cochlear implantation using transcutaneous ultrasound. Eur Arch Otorhinolaryngol 2021; 279:3867-3873. [PMID: 34704135 PMCID: PMC9444831 DOI: 10.1007/s00405-021-07128-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 10/05/2021] [Indexed: 11/25/2022]
Abstract
Purpose The aim of this study was to investigate the feasibility and reliability of transcutaneous ultrasound for the detection of complications after cochlear implantation. Methods In a single center retrospective cohort study, 115 consecutive cases of suspected complications after cochlear implantation (intervention group) were examined. The rate of pathologic ultrasound findings for specific leading symptoms and diagnoses was compared to a control group comprising twenty consecutive cochlear implants in symptom-free patients. Results Diagnostic ultrasound showed distinctly more pathologic findings in the intervention group (n = 67; 58.3%; p < 0.001) compared to the control group (n = 1; 5%). Ultrasound revealed significantly more pathologic findings in haematoma or seroma around the implant (n = 17; 100%; p < 0.001; ϕ = 0.94) and magnet dislocation (n = 44; 97.7%; p < 0.001; ϕ = 0.92) confirmed by a strong effect. Ultrasound examination showed a medium to high effect size in patients presenting with local infections (n = 3; 21.4%; p = 0.283; ϕ = 0.25) and skin flap oedema (n = 2; 50%; p = 0.061; ϕ = 0.51). In contrast, ultrasound examinations displayed a low effect size in undefined cephalgia (0%; p = 0.444; ϕ = 0.17) and device malfunction or failure (0%; p > 0.999; ϕ = 0.13). Conclusion Transcutaneous ultrasound can be advocated as a feasible and effective method in the diagnostic work-up of magnet dislocation and haematoma or seroma around the implant following cochlear implantation. Contrary, ultrasound findings can be expected to be inconspicuous in patients presenting with undefined cephalgia and device malfunction or failure.
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Affiliation(s)
- Robin Rupp
- Medical Faculty, Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Waldstraße 1, 91054, Erlangen, Germany.
| | - Vivian Thimsen
- Medical Faculty, Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Waldstraße 1, 91054, Erlangen, Germany
| | - Matthias Balk
- Medical Faculty, Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Waldstraße 1, 91054, Erlangen, Germany
| | - Sarina K Mueller
- Medical Faculty, Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Waldstraße 1, 91054, Erlangen, Germany
| | - Matti Sievert
- Medical Faculty, Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Waldstraße 1, 91054, Erlangen, Germany
| | - Konstantinos Mantsopoulos
- Medical Faculty, Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Waldstraße 1, 91054, Erlangen, Germany
| | - Ulrich Hoppe
- Medical Faculty, Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Waldstraße 1, 91054, Erlangen, Germany
| | - Joachim Hornung
- Medical Faculty, Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Waldstraße 1, 91054, Erlangen, Germany
| | - Heinrich Iro
- Medical Faculty, Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Waldstraße 1, 91054, Erlangen, Germany
| | - Antoniu-Oreste Gostian
- Medical Faculty, Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Waldstraße 1, 91054, Erlangen, Germany
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Rupp R, Hornung J, Balk M, Traxdorf M, Sievert M, Hoppe U, Iro H, Gostian AO. Ultrasound-Controlled Manual Magnet Repositioning in Magnet Dislocation of Cochlear Implants. Otol Neurotol 2021; 42:e536-e542. [PMID: 33534388 DOI: 10.1097/mao.0000000000003019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate whether ultrasound is a helpful and reliable diagnostic tool to survey the status of the magnet previous and after manual repositioning in patients with partially dislocated cochlear implant (CI) magnets and to assess the success rate of a manual repositioning maneuver. DESIGN A prospective cohort study. SETTING A tertiary referral medical center. PATIENTS Patients with a cochlear implant who presented with magnet dislocation after magnetic resonance imaging (MRI) between June 1, 2019 and July 15, 2020. INTERVENTIONS Manual repositioning of the partially dislocated CI magnet surveyed by pre- and post-interventional ultrasound. MAIN OUTCOME MEASURES Rate of successfully diagnosed and manually repositioned magnets; complication rate and recurrence rate after initial manual repositioning maneuver. RESULTS Nine patients presented with a partial magnet dislocation diagnosed by pre-interventional ultrasound following MRI (n = 9 magnets; three ♀; eight right-sided implants; 65.4 ± 21.7 yr). All magnets were repositioned manually. The magnets were successfully repositioned at the first attempt in six out of eight patients. Two patients required a second and one patient a third attempt of manual repositioning. Post-interventional ultrasound confirmed the entirely restored magnet position in all cases. During the mean follow-up period of 7.3 months (±5.4 mo) no patient experienced any complication or recurrent dislocation of the respective magnet. CONCLUSION Manual magnet repositioning is a feasible and reliable method with a high success rate for partially dislocated CI magnets. The pre-interventional diagnosis as well as the post-interventional confirmation of the magnet status can be effectively determined by ultrasound. Thus, manual magnet repositioning and ultrasound investigation can be advocated as first-line therapeutic and diagnostic instruments when dealing with partial magnet dislocation.
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Affiliation(s)
- Robin Rupp
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
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