Factors Influencing Aberrant Facial Nerve Stimulation Following Cochlear Implantation: A Systematic Review and Meta-analysis

Abstract

Objective: The purpose of this study was to systematically evaluate the literature to evaluate the rate of and associated factors with aberrant facial nerve stimulation (AFNS) following cochlear implantation. Additionally, management strategies for AFNS were assessed. Data Sources: A systematic search was performed in PubMed, Cochrane Database of Systematic Reviews, and Web of Science to identify peer reviewed research. Study Selection: Eligible studies were those containing peer-reviewed research in English addressing AFNS following cochlear implantation. Studies with paired data were included in the meta-analysis. Data Extraction: Three investigators independently reviewed all articles and extracted data. Bias was assessed using the National Institutes of Health Study Quality Assessment Tool. Data Synthesis: Thirty-seven articles were included, representing 5,694 patients. The overall reported AFNS rate was 5.6% (range, 0.68–43%). Array type demonstrated a significant association with AFNS with lateral wall electrodes having a higher odds ratio than perimodiolar electrodes (odds ratio [OR] = 3.92, 95% confidence interval [CI] 1.46–10.47, p = 0.01). CI recipients with otosclerosis were also more likely to experience AFNS compared with non-otosclerosis pathology (OR = 13.73, 95% CI 3.57–52.78, p < 0.01). Patients with cochlear malformations had an overall AFNS rate of 28% (range, 5.3–43%) and those with otosclerosis had an overall rate of 26% (range, 6.25–75%). Reprogramming with or without electrode deactivation was successful for AFNS elimination. Four patients of 3,015 required explantation. Conclusion: Array type and underlying cochlear pathology are associated with AFNS and implant reprogramming is an overall successful management strategy. Further research is needed to elucidate mechanism of AFNS and develop management strategies that limit impact on hearing outcomes.

Multi‐mode grounding and monophasic passive discharge stimulation avoid aberrant facial nerve stimulation following cochlear implantation

“…Its prevalence was estimated at 5.6% (range: 0.68–43%) in a recent systematic review assessing over 5000 patients. 1 The underlying pathological correlate for this postoperative complication is cochlea‐facial nerve dehiscence (CFD), which was first described in two patients in 2014. 2 In the majority of cases, reimplantation can be avoided and further use of the device safeguarded by appropriate programming of the device; however, hearing benefit is variable and limited.…”

Management of Severe Facial Nerve Cross Stimulation by Cochlear Implant Replacement to Change Pulse Shape and Grounding Configuration: A Case-series

“…Cochlear implants (CIs) provide sound perception using a series of electric pulses to stimulate the auditory nerve (AN). However, 5.7% of patients (range, 0.7-43%) will also experience unwanted facial nerve stimulation (FNS) (1)(2)(3). FNS can begin at CI activation, or may take >10 years to manifest (4).…”

Risk Factors for Facial Nerve and Other Nonauditory Side Effects Following Cochlear Implantation

“…Effect of array type did not yield any significance in the current study. While some studies report similar findings (22), others have reported a higher incidence of NASx with straight arrays (23,24).…”