Cervicofacial surgery and implantable hearing device extrusion: management of challenging cases

OBJECTIVE

To describe our management of implantable hearing device extrusion in cases of previous cervicofacial surgery.

METHODS

A review was conducted of a retrospectively acquired database of surgical procedures for implantable hearing devices performed at our department between January 2011 and December 2019. Cases of device extrusion and previous cervicofacial surgery are included. Medical and surgical management is discussed.

RESULTS

Four cases of implant extrusion following cervicofacial surgery were identified: one involving a Bonebridge system and three involving cochlear implants. In all cases, antibiotic treatment was administered and surgical debridement performed. The same Bonebridge system was implanted in the middle fossa. The three cochlear implants were removed, and new devices were implanted in a more posterior region.

CONCLUSION

Previous cervicofacial surgery is a risk factor for hearing implant extrusion. The middle fossa approach is the best option for the Bonebridge system. Regarding the cochlear implant, it is always suitable to place it in a more posterior area. An inferiorly based fascio-muscular flap may be a good option to reduce the risk of extrusion.

Hyperbaric oxygen therapy as a therapeutic option in cochlear implants extrusion treatment in infected wounds

Background: Cochlear implant extrusion as a result of infection is an uncommon, but serious complication, which can lead to implant removal as the ultimate solution.Objectives: (1) to identify the incidence of cochlear implant extrusion and its causes, (2) to report our management of patients presenting skin complications after cochlear implant surgery (3) to propose new therapeutical options with hyperbaric oxygen therapy (HBOT).Materials and methods: A retrospective analysis of medical documentation of 1250 patients who were operated on with cochlear implants in our department between 1993 and 2015. The medical charts of 25 patients were selected due to reported skin flap complications resulting in CI extrusion. Five of those patients were subsequently removed from the study because of no infection signs.Results: Non-traumatic cochlear implant extrusion occurred in 1.6% of implanted patients, and secondary treatment was effective in 90% of all cases (18 of 20 patients). HBOT as additional treatment was applied in 9 patients.Conclusions: Hyperbaric oxygen therapy can be considered as safe adjuvant treatment option in individual cases of proceeding with cochlear implant extrusion with signs of wound infection.Significance: HBOT may contribute to reducing the need for cochlear implant explantation due to infectious skin flap complication.

Bone-anchored hearing aid and skin graft removal with subsequent cochlear implantation

We describe a novel technique of scalp flap rearrangement for cochlear implant (CI) candidates who have previously undergone ipsilateral bone-anchored hearing aid (BAHA) placement. One patient with single-sided deafness (SSD) underwent removal of a BAHA with subsequent scalp rearrangement for coverage of the implant site. After adequate healing of the scalp rotational flap, he underwent uncomplicated cochlear implantation without soft tissue complications. With increasing utilization of CIs in SSD, there will be more patients undergoing cochlear implantation who have previously had a BAHA. We present a novel method for accomplishing this goal while minimizing the risk of soft tissue complications. Laryngoscope, 126:2601-2604, 2016.

Skin Flap Necrosis by Bone Marking with Methylene Blue in Cochlear Implantation

One of surgical complications in cochlear implantation is the necrosis of the skin flap above the receiver-stimulator coil. We present a case of 55-year-old woman who underwent cochlear implantation and developed a bluish skin necrosis due to bone marking. The planned position for the receiver-stimulator was marked using methylene blue through skin to bone. She did not undergo skin flap thinning and underwent successful implantation with complete electrode insertion. Few weeks postoperatively, the patient developed bluish discoloration with progressive thick, blue eschar formation and skin flap necrosis. She subsequently underwent wound debridement and skin flap closure. Cochlear explantation was not necessary. Timely diagnosis and management about this complication is necessary to prevent further skin breakdown and subsequent device extrusion. This report identifies the marking using methylene blue as another possible source of skin flap necrosis in cochlear implantation, and surgeons should be aware of this potential complication.