Cochlear Implant Fixation Techniques: A Systematic Review of the Literature

Abstract

Objective: Given the lack of consensus on fixation techniques of the cochlear implant, this review aims to create an up-to-date overview of intra-and postoperative complications, focusing on migration of the internal receiver/stimulator (R/S) device and the electrode array. Data Sources: On June 29, 2020 we conducted a search in PubMed, Embase, Cochrane, Web of Science, and CINAHL. Keywords were ''Cochlear implant,'' ''complication,'' ''migration,'' and synonyms. Study Selection: Studies were considered if: 1) the adult study population consisted of ! 10 patients, 2) the R/S device was fixated using the bony well or tight subperiostal pocket technique without bone-anchoring sutures or screws on the implant, and 3) migration of the R/S device or displacement of the electrode array were described as outcomes. Data Extraction: Study characteristics, interventions, followup, and outcomes were extracted. For critical appraisal, an adapted version of the Newcastle-Ottawa quality assessment scale for cohort studies was used. Data Synthesis: Seven studies were included (n ¼ 430 patients). Migration of the R/S device was reported by three studies. Two studies applying the tight pocket technique reported migration rates ranging from 9.0 to 69.2%. One study using the bony bed technique reported migration of 100%, with an average of 2.5 mm. All studies lacked the required standard for comparability, assessment of outcome, and follow-up. Conclusions and Relevance: There is currently no evidence of a difference between the bony bed-and tight pocket fixation technique, regarding migration of the R/S device or the electrode array, in adult patients.

A monocenter, patient-blinded, randomized, parallel-group, non-inferiority study to compare cochlear implant receiver/stimulator device fixation techniques (COMFIT) with and without drilling in adults eligible for primary cochlear implantation

“…This sample size calculation was based on the primary outcome, R/S migration after 12 months. Due to limited quality evidence on the migration rate for both techniques, an estimation of the migration rates cannot be based on literature; therefore, we base our assumptions on clinical expertise [ 34 , 42 , 43 ]. We consider a migration under 1.0 mm or 1° to be clinically irrelevant.…”

“…However, since the R/S device is not fixated in a bony recess or by sutures, migration of the device is a point of concern due to the complications that can occur. To evaluate the difference in migration rates between the fixation technique currently used in our center (the bony recess technique), and the intervention technique (subperiosteal tight pocket technique), we conducted a literature review [ 34 ]. The results were inconclusive due to a lack of high-quality studies from a methodological point of view.…”

Cochlear implant positioning: development and validation of an automatic method using computed tomography image analysis

“…Implantation of the internal component of the CI consists of insertion of the electrode array in the cochlea, and fixation of the receiver/stimulator (R/S) device on the skull. Although there is extensive literature available for the different surgical techniques of electrode array implantation, definitive evidence regarding optimal fixation techniques of the R/S device is lacking ( 3 ). However, migration of the device could lead to surgical complications such as headache, speech processor problems, hematoma, or device failure which can lead to revision surgery ( 4 – 9 ).…”

The Cochlear Implant “Seatbelt” Technique for Receiver/Stimulator Fixation

“…Device migration remains one of the more common complications of cochlear implantation, and a variety of surgical techniques have been developed to fix cochlear implants (CIs) in place. 1 Improvements in device design and surgical techniques have resulted in a reduction in surgical cochlear implant revision rates (2.9% from 6%) in the past two decades. 1,2 Broadly, fixation methods can be divided into the bony-bed technique, in which a bone well is drilled into the calvarium to accommodate device placement, and the tight periosteal pocket technique, which fixes the device under blunt-elevated pericranium.…”

“…1 Improvements in device design and surgical techniques have resulted in a reduction in surgical cochlear implant revision rates (2.9% from 6%) in the past two decades. 1,2 Broadly, fixation methods can be divided into the bony-bed technique, in which a bone well is drilled into the calvarium to accommodate device placement, and the tight periosteal pocket technique, which fixes the device under blunt-elevated pericranium. Either technique can be modified with suture tie-downs, historically either in drilled channels in the cranial cortex, or directly to the periosteum.…”