A musculoperiosteal flap cochlear implant device fixation technique: Our experience in one hundred and seventy nine patients

Meta-analysis of subjective complaints of vertigo and vestibular tests after cochlear implantation

OBJECTIVE

Postoperative vertigo is a common complaint after cochlear implantation, but published incidence rates differ vastly. The aim of the present study was to investigate both subjective complaints of vertigo before and after cochlear implantation and related vestibular diagnostic tests on cochlear implant candidates.

DATA SOURCES

We performed a systematic literature search according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement in PubMed, Cochrane Register, and EMBASE.

REVIEW METHODS

We presented 116 eligible studies investigating subjective complaints of vertigo after cochlear implantation and/or related vestibular diagnostic tests. We conducted three meta-analyses of 46 eligible studies with matched pre- and postoperative data to calculate the odds ratio of new vertigo onset, as well as the impairment of vestibular receptors measured by nystagmography and cervical vestibular evoked myogenic potentials (cVEMP). Postoperative vertigo was calculated from 95 studies and further subdivided by mean age with pooled data.

RESULTS

We observed a significant increase in postoperative vertigo and significant impairment of nystagmography and cVEMP detection. Vertigo after cochlear implantation was reported in 9.3% of the patients with a continuous increase in patient age at surgery. In a subgroup of studies, new onset of vertigo was found in 17.4% of the patients. In addition, 7.2% of the patients had persisting vertigo complaints, whereas 11.6% described an altered vertigo quality and 7.7% had their preoperative complaints resolved. A comparison of round window approach and cochleostomy revealed significantly increased vertigo after cochleostomy. Both insertion methods showed similar effects in nystagmography and cVEMP testing.

CONCLUSION

Cochlear implantation has a significant impact on subjective vertigo and vestibular receptor function. This is affected by the patient's age at the time of surgery. The surgical technique (round window or cochleostomy) may influence the outcome, but this requires further investigation. Younger patients may compensate better following vestibular dysfunction. Perioperative testing is required to correlate vestibular impairment and subjective complaints. Laryngoscope, 2018 Laryngoscope, 128:2110-2123, 2018.

Salvaging the Exposed Cochlear Implant

Cochlear implant exposure is an uncommon occurrence that may imperil the fate of the implant. Insertion of this costly device is a delicate procedure, and reimplantation with another implant after removal is expensive and emotionally stressful for patients. Salvage of the original implant can be quite successful with a fully vascularized scalp-nape of the neck rotation flap. The authors review the literature and report their experience in salvaging exposed implants in 2 patients, who had risk factors that compromised healing.

Safety and feasibility of initial frequency mapping within 24 hours after cochlear implantation

CONCLUSION

Switch-on within 24 h after cochlear implantation can be safely and practically performed. The minimally invasive approach presented here also brought about benefits such as nonstop rehabilitation programs and shorter duration of uncertainty/worry for patients and their families about surgical outcomes. Those were important factors for international patients. Our research invites further studies to show whether instant commencement of electrical stimulation helps to expedite long-term hearing/speech performance in cochlear implantees.

OBJECTIVES

Initial switch-on generally could not launch until weeks after cochlear implantation due to factors associated with wound conditions. Commencement of electrical stimulation within 24 h after the surgery has long been performed in our department on a routine basis. The idea issued from the need to sew-and-go for international patients. This study presents the safety and feasibility of the procedure.

METHODS

Charts of 79 subjects with profound hearing impairment were studied. A minimally invasive approach was used for cochlear implantation, with an intention to control wound condition and tissue swelling. Hearing threshold was measured preoperatively and postoperatively.

RESULTS

Initial switch-on within 24 h was done in all patients. Good hearing gain was obtained. No major complication occurred. There was no significant difference in hearing postoperatively that was attributable to the early switch-on.

Cochlear implant fixation using a subperiosteal tight pocket without either suture or bone-recess technique

OBJECTIVES/HYPOTHESIS

To assess the complication and migration rates associated with the fixation of cochlear implant receiver-stimulators using a subperiosteal tight pocket without either suture fixation or bone recession.

STUDY DESIGN

Dual-institution retrospective case review.

METHODS

A retrospective case review was conducted at two tertiary referral centers. All patients who underwent cochlear implantation with device fixation using a subperiosteal tight pocket without suturing over the device or recessing of the receiver stimulator in bone were identified. There was a minimum follow-up period of 6 months. Outcome measures included intraoperative and postoperative complications, including evidence of device migration associated with interference with external device use or the need for revision surgery. Other outcome measures included soft tissue flap complications.

RESULTS

Sixty-two patients were identified with a mean age of 39 years, (range 1.5-5 years). The average follow-up period was 32.6 months (range 6-120 months). Device manufacturers included Cochlear Corporation (Denver, CO) (n=44), MED-EL (Durham, NC) (n=12), and Advanced Bionics (Valencia, CA) (n=6). There were no associated intraoperative complications related to subperiosteal pocket fixation of the receiver stimulator, and no cases of migration were identified.

CONCLUSION

Fixation of the cochlear implant receiver stimulator using a subperiosteal tight pocket without either suture fixation or bone recession has been demonstrated to be feasible across a range of patient demographics and cochlear implant devices. This method of fixation appears to allow for an efficient and minimally invasive approach without compromising patient safety or device performance.

LEVEL OF EVIDENCE

4.