Device fixation in cochlear implantation: Is bone anchoring necessary?

Abstract

Cochlear implant devices may be secured in place with periosteally anchored sutures in lieu of bone-anchored sutures without any significant increases in perioperative complications.

Electrode Migration in Patients with Perimodiolar Cochlear Implant Electrodes

“…Proper fixation of the receiver/stimulator is one of the most important surgical steps [Adunka and Buchman, 2007;Balkany et al, 2009;Davis et al, 2004;Jethanamest et al, 2014;Lee and Driver, 2005;Molony et al, 2010]. Furthermore, a titanium clip or split bridge can be used as a stable fixation point for the electrode array at the incus buttress [Muller et al, 1998;Roland et al, 1998].…”

“…Additional screws and special tips at the receiver/stimulator have been established to avoid movement of the device [Davis et al, 2004;Lee and Driver, 2005;Schnabl et al, 2014]. Whether foreign bodies are really necessary to achieve proper fixation of the implant has been widely discussed in the literature [Adunka and Buchman, 2007;Boscolo-Rizzo et al, 2011;Molony et al, 2010]. Additional fixation of the electrode in the facial recess can be achieved using titanium clips [Muller et al, 1998;Roland et al, 1998].…”

Surgical Technique for Implantation of the MED-EL SONATATI¹⁰⁰

“…Although the need of an implant bed and the fixation of the implant device are controversial we recommend both, to drill an implant bed as well as to fix the SONATATI 100 implant with sutures as a bony bed for the titanium housing increases stability, lowers the profile and decreases the risk of trauma [3] . Although multiple studies exist describing different surgical techniques focusing on incision, implant bed and fixation of the device, none has so far used the SONATATI 100 implant [6][7][8][12][13][14] . In a retrospective, anonymized, cross-sectional survey, Yoshikawa et al [13] report on the current common practices and techniques used to fix and stabilize internal receivers.…”

“…Adunka and Buchman [17] describe a technique for implant device fixation that uses a seat for the device and suture fixation through the native cranial periosteum without complication in 160 pediatric cochlear implant recipients. Also, Molony et al [7] favor a perio steal tie-down technique. Cuda [18] reports on a small incision technique drilling a bony bed for MED-EL's PULSARCI 100 device.…”

“…Consequently, a tendency towards smaller incisions, no drilling of the implant bed and no additional fixation with sutures, and away from these principles has evolved to minimize anesthetic time, for example, and to benefit from the further development of implant device technology, such as the steadily decreasing size and width of the devices [6][7][8] . However, despite the positive aspects of these surgical changes, several general principles seem to remain crucial for a safe implantation -even in the smaller and thinner implant devices currently on the market or in development [8] .…”