Monopolar Cautery and Adverse Affects on Cochlear Implants&lt;alt-title&gt;Monopolar Cautery &amp;amp; Adverse Affects on Cochlear Implants&lt;/alt-title&gt;

Jeyakumar, Anita; Wilson, Meghan N.; Sorrel, Jonathan E.; McIntire, J. Benjamin; Jones, Dara D.; Brickman, Todd M.; Arriaga, Moisés A.

doi:10.1001/jamaoto.2013.3297

Cited by 12 publications

(24 citation statements)

References 5 publications

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“…MES applied to the adenoid of implanted cadaveric pigs at a setting of 50 (double the normal intensity) for 15 min failed to produce any damages upon manufacturer testing of the CI 4 . Similarly, no adverse effects were noted in CI devices on manufacturer testing after MES was applied at up to 50 W for up to 30 min to the abdomen and tongue of two fresh human cadavers 6 . Even with application of MES at up to 100 W for 1 min to a location as close as the ipsilateral temporalis muscle immediately overlying a CI in a fresh human cadaver, manufacturer testing noted no damage to the implant 5 .…”

Section: Discussionmentioning

confidence: 85%

“…4 Similarly, no adverse effects were noted in CI devices on manufacturer testing after MES was applied at up to 50 W for up to 30 min to the abdomen and tongue of two fresh human cadavers. 6 Even with application of MES at up to 100 W for 1 min to a location as close as the ipsilateral temporalis muscle immediately overlying a CI in a fresh human cadaver, manufacturer testing noted no damage to the implant. 5 However, in the dental study noted previously, the combination of maximum electrosurgical unit device energy output and the use of a mode applying unidirectional electrical current resulted in "irrevocable damage" to the CI.…”

Section: Discussionmentioning

confidence: 98%

“…Partial rectification is a specific type of blended mode in which a portion of the sine wave is blocked with a negative polarity, converting the alternating current into a unidirectional current; it is uncommonly used except in dentistry and dermatology. 3 Subsequent animal 4 and human 5,6 cadaveric studies applying very high energies of 50-100 W via "cut" and "coagulation" modes to regions near the CI (including nasopharynx, tongue, and ipsilateral temporalis muscle) have failed to replicate the damage seen in the dental study. Two retrospective reports of three patients undergoing surgery after implantation (one open heart surgery, two adenotonsillectomies) demonstrated no adverse effects on the implant or patient.…”

Section: Introductionmentioning

confidence: 99%

“…Subsequent animal 4 and human 5,6 cadaveric studies applying very high energies of 50–100 W via “cut” and “coagulation” modes to regions near the CI (including nasopharynx, tongue, and ipsilateral temporalis muscle) have failed to replicate the damage seen in the dental study. Two retrospective reports of three patients undergoing surgery after implantation (one open heart surgery, two adenotonsillectomies) demonstrated no adverse effects on the implant or patient 7,8 .…”

Section: Introductionmentioning

confidence: 99%

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Monopolar Electrosurgery With Cochlear Implants

et al. 2022

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Objective: To evaluate safety of monopolar electrosurgery (MES) in patients with cochlear implants (CIs) by reporting outcomes of a series of patients who underwent MES after CI.Study Design: Retrospective case series.Setting: Tertiary referral center.Patients: Patients with indwelling CI subsequently undergoing surgery with operative note specifically detailing MES use.Main Outcome Measures: Adverse outcomes in post-operative audiology/otolaryngology documentation; speech recognition scores.Results: Thirty-five patients (10 with bilateral CI) experienced 63 unique MES exposure events, 85.7% below and 14.3% above the clavicle. No adverse events or decreased performance due to MES use were reported for any patient. Pre-and immediate postoperative speech recognition scores were not significantly different for patients using either consonant-nucleusconsonant (CNC; n = 23, 68%-66%, p = 0.80) or AzBio (n = 15, 82%-88%, p = 0.60). For individual CNC performance, 21 (91%) patients demonstrated stability, 1 improved >15%, and 1 declined >15%, although this patient had become a nonuser due to magnet issues and, after resolution of these issues, exceeded baseline pre-operative score. For individual AzBio performance, 12 (80%) patients demonstrated stability, 3 improved >15%, and none declined >15%.Conclusions: No adverse events resulted from MES use in CI patients. Given the increased prevalence and expansion of indications for CIs, and widespread utility of MES, we suggest clarification and improved guidance from device manufacturers regarding safety and use of MES for patients with these devices. We hope that data regarding electrosurgery exposure events will better inform clinician decision-making with regards to relative benefits and risks for MES use for CI patients.

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Monopolar Electrosurgery With Cochlear Implants

et al. 2022

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“…This can cause damage to the device or to the auditory neurons where the electrode inserts. 17 In a cadaver study, Jeyakumar et al found that cochlear implants had no electrical damage from electrocautery tested up to levels of 100 W, well above usages in orthopaedic surgery which typically do not exceed 50 W. 18,19 Manufacturer's safety guidelines for surgical procedures warn that monopolar is safe to use on the trunk and limbs but should not be used on the head and neck. Bipolar instruments may be used in this area, though should not be used within 2 cm of the electrodes.…”

Section: Nonorthopaedic Devicesmentioning

confidence: 99%

Perioperative Management of Nonorthopaedic Devices in the Pediatric Neuromuscular Patient Population

Tetreault

Illingworth

Oetgen

et al. 2023

J Am Acad Orthop Surg

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Pediatric patients with neuromuscular conditions often have nonorthopaedic implants that can pose a challenge for MRI acquisition and surgical planning. Treating physicians often find themselves in the position of navigating between seemingly overly risk-averse manufacturer's guidelines and an individual patient's benefits of an MRI or surgery. Most nonorthopaedic implants are compatible with MRI under specific conditions, though often require reprogramming or interrogation before and/or after the scan. For surgical procedures, the use of electrosurgical instrumentation poses a risk of electromagnetic interference and implants are thus often programmed or turned off for the procedures. Special considerations are needed for these patients to prevent device damage or malfunction, which can pose additional risk to the patient. Additional planning before surgery is necessary to ensure appropriate equipment, and staff are available to ensure patient safety. Patients with neuromuscular disorders often require surgical treatment to improve function, manage contractures, and correct deformity. Owing to underlying diagnoses or associated medical conditions, these patients may have medical implants to help manage muscle tone, control seizures, treat cardiac conditions, improve hearing, etc. Managing nonorthopaedic implants can cause delays and confusion when planning for advanced imaging studies and/or surgical intervention. Identifying these devices before MRI acquisition or surgical procedures is important to ensure the appropriate equipment, or support staff are available to maintain patient safety and device integrity.There is little guidance regarding the management of these implants, and manufacturer's recommendations may differ from practical application. Manufacturers' guidelines often make conservative recommendations accounting for rare worst case scenarios, but strict compliance to these guidelines may be impractical and could prevent medically necessary imaging or surgery for a patient. Treating physicians must navigate the conflict of risk-averse guidelines and patient's medical needs. Often, we rely on expert

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Risk of Monopolar Electrosurgery in Cochlear Implant Recipients is Nominal: Evidence to Guide Clinical Practice

Dornhoffer,

Haller,

Lohse

et al. 2023

Otolaryngol.--head neck surg.

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ObjectiveComprehensively assess the prevalence of monopolar electrosurgery‐related device complications among cochlear implant (CI) recipients.Study DesignMultifaceted retrospective review and survey.SettingTertiary medical center.MethodsMultifaceted approach including: (i) review of the current literature; (ii) historical review of institutional data from an academic, tertiary CI center; (iii) review of industry data provided by 3 Food and Drug Administration‐approved CI manufacturers; and (iv) survey of high‐volume CI centers.ResultsLiterature review identified 9 human studies, detailing 84 devices with 199 episodes of device‐cautery exposure. From studies reporting on patients records, no implant showed evidence of damage after exposure. One cadaveric study using dental cautery reported 1 episode of device damage. Review of institutional records did not identify any CI damage in 84 instances of exposure. Data from the 3 major implant manufacturers showed a single report of damage that could be reasonably linked to monopolar electrosurgery, out of a possible 689,426 CIs. Last, a survey of 8 high‐volume CI centers did not identify any adverse events associated with monopolar cautery.ConclusionThese data estimate the risk of adverse device‐related events or tissue injury to be extraordinarily low. Short of operating in immediate proximity to the CI (ie, the ipsilateral temporoparietal scalp), these data indicate that monopolar electrosurgery can be used in the body and the head‐and‐neck of CI recipients with nominal risk. These findings may guide decision‐making in cases that are optimally or preferably performed with monopolar electrocautery and can be used to counsel CI patients following inadvertent exposures.

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Monopolar Cautery and Adverse Affects on Cochlear Implants<alt-title>Monopolar Cautery & Adverse Affects on Cochlear Implants</alt-title>

Abstract: Monopolar cautery did not produce detectible damage to any of the cochlear implant devices or produce detectible temperature change in the cochlea at low or high levels of cautery in the oral cavity in this experimental model.

Cited by 12 publications

References 5 publications

Monopolar Electrosurgery With Cochlear Implants

Monopolar Electrosurgery With Cochlear Implants

Perioperative Management of Nonorthopaedic Devices in the Pediatric Neuromuscular Patient Population

Risk of Monopolar Electrosurgery in Cochlear Implant Recipients is Nominal: Evidence to Guide Clinical Practice

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