Monopolar Electrosurgery With Cochlear Implants

Abstract

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.

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

“…Review of the extant literature identified 9 human clinical studies, with a total of 84 devices and 199 discrete episodes of monopolar electrosurgery exposure 1,5,7‐10,15‐17 . Details of the involved studies are noted in Table 2.…”

“…After review by title and abstract, 15 articles underwent full-text review, resulting in 9 articles deemed appropriate (Figure 1). 1,5,[7][8][9][10][16][17][18] Articles were reviewed to ensure no overlapping populations. Disagreement was mediated by the senior author.…”

“…of monopolar electrosurgery exposure. 1,5,[7][8][9][10][15][16][17] Details of the involved studies are noted in Table 2. Of these, 6 reported on patient records and 3 involved cadaveric specimens.…”

“…Despite this recommendation, to the best of the authors' knowledge, the existing literature has not produced any clinical evidence supporting the theoretical concern surrounding risks associated with monopolar electrosurgery exposure among CI recipients 1,5,6 . In addition to cadaveric studies, a number of CI recipients have been exposed to monopolar cautery 5,7‐9 . Exposure is often incidental, but intentional exposure has been reported, where anatomy or need for hemostasis required the use of monopolar electrosurgery over alternatives such as a bipolar device 10 …”

“…1,5,6 In addition to cadaveric studies, a number of CI recipients have been exposed to monopolar cautery. 5,[7][8][9] Exposure is often incidental, but intentional exposure has been reported, where anatomy or need for hemostasis required the use of monopolar electrosurgery over alternatives such as a bipolar device. 10 As CI recipients approaches 1 million worldwide, 11 and as some procedures preferentially rely on monopolar electrosurgery, 12 surgeons may find themselves increasingly facing the dilemma of using monopolar electrosurgery in CI recipients, balancing concern for implant damage with providing safe, efficient surgical care.…”