A clinical profile of revision cochlear implant surgery: MERF experience

Rayamajhi, Pabina; Kurkure, Rahul; Castellino, Ashish; Kumar, Santhosh; Ha, Manjunath; Nandhan, Raghu; Kameswaran, Mohan

doi:10.1080/14670100.2020.1823128

Cited by 12 publications

(9 citation statements)

References 17 publications

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“…The most common indication for CIR in this study was device failure (73%), in which 54 and 19% were for hard and soft failure, respectively. This is consistent with the literature on CIR in which other large case series have consistently found that device failure accounts for the majority of CIR cases (8,19,56). In this study, pediatric patients were found to have a higher device failure rate.…”

Section: Indications For Revisionsupporting

confidence: 92%

Cochlear Implant Revisions Over Three Decades of Experience

Andresen¹,

Shneyderman

Bowditch³

et al. 2023

Otol Neurotol

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Importance: The indications, technology, and surgical technique for cochlear implantation have evolved over the last three decades. Understanding the risk of cochlear implant revision (CIR) is important for patient counseling. Objective: The objective of this study was to analyze the rates, indications, and audiologic outcomes for CIR over three decades of experience at a single academic medical center. Design: A retrospective chart review was performed at a single academic medical center for individuals who underwent cochlear implantation between 1985 and 2022. Setting: Single academic medical center. Participants: Three thousand twenty-five individuals who underwent 3,934 cochlear implant operations from 1985 to 2022. Exposure: Cochlear implantation. Main Outcomes and Measures: Rates, indications, risk factors, and audiologic outcomes for CIR. Results: There were 276 cases of CIR after primary implantation and an overall revision rate of 7.6% (95% confidence interval, 6.8-8.5%) over 37 years of follow-up with many cases of CIR secondary to Advanced Bionics vendor B and field action failure groups. CIR rates increased sharply through the early and mid-2000s and have since remained stable. Hard or soft device failure was the most common indication for CIR, accounting for 73% of cases. Pediatric patient status and previous CIR were associated with an increased risk of CIR. Audiologic outcomes after CIR were similar to those before device failure. Conclusions and Relevance: CIR remains a common procedure most often performed for device failure. Pediatric patients and those who have undergone previous CIR are at the highest risk for future CIR. Audiologic outcomes remain stable after CIR, and these data will help providers counsel patients at the risk of future CIR and understand the risk factors associated with CIR.

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Section: Indications For Revisionsupporting

confidence: 92%

Cochlear Implant Revisions Over Three Decades of Experience

Andresen¹,

Shneyderman

Bowditch³

et al. 2023

Otol Neurotol

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“…Another critical question was whether the auditory and speech performance of patients who underwent cochlear reimplantation were similar with that when they underwent the initial CI, which was assessed in <50% of studies. In some large cohort studies, effect evaluation or analysis was not performed ( Rayamajhi et al 2020 ; Aldhafeeri et al 2021 ; Layfield et al 2021 ). Because the follow-up data were not systematic and complete in large cohort studies, the analysis was limited ( Hermann et al 2020 ).…”

Section: Discussionmentioning

confidence: 99%

Cochlear Reimplantation Rate and Cause: a 22-Year, Single-Center Experience, and a Meta-Analysis and Systematic Review

et al. 2022

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Objectives: In terms of cochlear reimplantation, there is no consensus on the definition, range, or calculation formulation for the reimplantation rate. This study aims to put forward a relatively standardized and more explicit definition based on a literature review, calculate the rate of cochlear reimplantation, and examine the classification and distribution of the reimplantation causes. Design: A systematic review and retrospective study. A relatively clearer definition was used in this study: cochlear reimplantation is the implantation of new electrodes to reconstruct the auditory path, necessitated by the failure or abandonment of the initial implant. Seven English and Chinese databases were systematically searched for studies published before July 23, 2021 regarding patients who accepted cochlear reimplantation. Two researchers independently applied the inclusion and exclusion criteria to select studies and complete data extraction. As the effect size, the reimplantation rate was extracted and synthesized using a random-effects model, and subgroup and sensitivity analyses were performed to reduce heterogeneity. In addition, a retrospective study analyzed data on cochlear reimplantation in a tertiary hospital from April 1999 to August 2021. Kaplan-Meier survival analysis and the log-rank test were adopted to analyze the survival times of cochlear implants and compare them among different subgroups. Results: A total of 144 articles were included, with 85,851 initial cochlear implantations and 4276 cochlear reimplantations. The pooled rate of cochlear reimplantation was 4.7% [95% CI (4.2% to 5.1%)] in 1989 to 2021, 6.8% [95% CI (4.5% to 9.2%)] before 2000, and 3.2% [95% CI (2.7% to 3.7%)] after 2000 (P=0.003). Device failures accounted for the largest proportion of reimplantation (67.6% [95% CI (64.0% to 71.3%)], followed by medical reasons (28.9% [95% CI (25.7% to 32.0%)]). From April 1999 to August 2021, 1775 cochlear implants were performed in West China Hospital (1718 initial implantations and 57 reimplantations; reimplantation rate 3.3%). In total, 45 reimplantations (78.9%) were caused by device failure, 10 (17.5%) due to medical reasons, and 2 (3.5%) from unknown reasons. There was no difference in the survival time of implants between adults and children (P = 0.558), while there existed a significant difference between patients receiving implants from different manufacturers (P < 0.001). Conclusions: The cochlear reimplantation rate was relatively high, and more attention should be paid to formulating a standard definition, calculation formula, and effect assessment of cochlear reimplantation. It is necessary to establish a sound mechanism for long-term follow-up and rigorously conduct longitudinal cohort studies.

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“…Both of these findings might be more related to surgical technique than the distinction between straight and perimodiolar array ( 43 ). Revision surgery caused by electrode migration is rare at around 0.2–2.5% ( 23 , 42 – 48 ) per cochlear implant surgery in clinics, but electrode migration itself could have a much higher incidence. With various imaging modalities, electrode migration rates (at least one electrode out of the cochlea, or displacements >1 mm) have been reported anywhere from 0.4% in a direct postoperative scan ( 49 ), 7.4% 1 month after activation only in cases with an impedance increase ( 41 ), 13.4% at least 1 month after surgery ( 50 ), 29% after a mean follow-up time of 24 months ( 39 ), to 61% after a mean follow-up time of 34 months ( 51 ).…”

Section: Background Of Cochlear Implantationmentioning

confidence: 99%

Robotic Milling of Electrode Lead Channels During Cochlear Implantation in an ex-vivo Model

et al. 2021

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Objective: Robotic cochlear implantation is an emerging surgical technique for patients with sensorineural hearing loss. Access to the middle and inner ear is provided through a small-diameter hole created by a robotic drilling process without a mastoidectomy. Using the same image-guided robotic system, we propose an electrode lead management technique using robotic milling that replaces the standard process of stowing excess electrode lead in the mastoidectomy cavity. Before accessing the middle ear, an electrode channel is milled robotically based on intraoperative planning. The goal is to further standardize cochlear implantation, minimize the risk of iatrogenic intracochlear damage, and to create optimal conditions for a long implant life through protection from external trauma and immobilization in a slight press fit to prevent mechanical fatigue and electrode migrations.Methods: The proposed workflow was executed on 12 ex-vivo temporal bones and evaluated for safety and efficacy. For safety, the difference between planned and resulting channels were measured postoperatively in micro-computed tomography, and the length outside the planned safety margin of 1.0 mm was determined. For efficacy, the channel width and depth were measured to assess the press fit immobilization and the protection from external trauma, respectively.Results: All 12 cases were completed with successful electrode fixations after cochlear insertions. The milled channels stayed within the planned safety margins and the probability of their violation was lower than one in 10,000 patients. Maximal deviations in lateral and depth directions of 0.35 and 0.29 mm were measured, respectively. The channels could be milled with a width that immobilized the electrode leads. The average channel depth was 2.20 mm, while the planned channel depth was 2.30 mm. The shallowest channel depth was 1.82 mm, still deep enough to contain the full 1.30 mm diameter of the electrode used for the experiments.Conclusion: This study proposes a robotic electrode lead management and fixation technique and verified its safety and efficacy in an ex-vivo study. The method of image-guided robotic bone removal presented here with average errors of 0.2 mm and maximal errors below 0.5 mm could be used for a variety of other otologic surgical procedures.

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A clinical profile of revision cochlear implant surgery: MERF experience

Cited by 12 publications

References 17 publications

Cochlear Implant Revisions Over Three Decades of Experience

Cochlear Implant Revisions Over Three Decades of Experience

Cochlear Reimplantation Rate and Cause: a 22-Year, Single-Center Experience, and a Meta-Analysis and Systematic Review

Robotic Milling of Electrode Lead Channels During Cochlear Implantation in an ex-vivo Model

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