The effect of cochlear implant bed preparation and fixation technique on the revision cochlear implantation rate

Pamuk, Ahmet Erim; Pamuk, Gözde; Jafarov, Shamkhal; Bajin, Münir Demir; Saraç, Sarp; Sennaroḡlu, Levent

doi:10.1017/s0022215118000609

Cited by 18 publications

(11 citation statements)

References 15 publications

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“…showed that the bone recess with suture receiver/stimulator fixation technique was associated with a lower revision rate than the subperiosteal pocket technique. 11 Based on our experience, modified minimal access surgery, as described by Sennaroglu et al ., 12 allows the surgeon to perform the time-consuming work of drilling holes for tie-down sutures using a smaller post-auricular incision than is possible with other surgical methods. The present findings seem to support Shelton and Warren's theory 13 that micro-movement of the fantail can lead to wire fatigue and fantail damage.…”

Section: Discussionmentioning

confidence: 99%

Twenty years of experience in revision cochlear implant surgery: signs that indicate the need for revision surgery to audiologists

et al. 2019

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ObjectiveTo report device failures, audiological signs and other reasons for revision cochlear implant surgery, and discuss indications for revision surgery.MethodsRevision procedures between November 1997 and August 2017 were retrospectively analysed. Over 20 years, 2181 cochlear implant operations were performed, and 114 patients underwent 127 revision operations.ResultsThe revision rate was 4.67 per cent. The full insertion rate for revision cochlear implant surgery was 88.2 per cent. The most frequent reasons for revision surgery were: device failure (59 per cent), wound breakdown (9.4 per cent) and electrode malposition (8.7 per cent). The device failure rate was: 2.78 per cent for Advanced Bionics, 1.82 per cent for Cochlear and 5.25 per cent for Med-El systems. The number of active electrodes was significantly increased only for Med-El devices after revision surgery. The most common complaints among 61 patients were: gradually decreased auditory performance, sudden internal device shutdown and headaches.ConclusionThe most common reason for revision surgery was device failure. Patients should be evaluated for device failure in cases of: no hearing despite appropriate follow up, side effects such as facial nerve stimulation, and rejection of speech processor use in paediatrics. After revision surgery, most patients have successful outcomes.

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Section: Discussionmentioning

confidence: 99%

Twenty years of experience in revision cochlear implant surgery: signs that indicate the need for revision surgery to audiologists

et al. 2019

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“…One study from this review reported advantages of the traditional technique in a sample of over 1,500 CI cases. (5) This study describes similar wound complication rates between the two techniques but found higher revision rates in the subperiosteal pocket technique due to IRS migration (5). Although our meta-analysis did not report a significant difference in the risk of wound complication between the two IRS fixation methods, the overall data, including unpaired samples, showed a trend toward higher rates of wound complications in the standard fixation method.…”

Section: Discussionmentioning

confidence: 61%

“…Five of these studies compared cochlear implantation with suture fixation of the IRS to cochlear implantation with a subperiosteal pocket fixation of the IRS using a paired-sample design and, thus, a meta-analysis was conducted with these studies (Fig. 3) (5,16,(23)(24)(25). While well-drilling was common among the suture fixation studies, not all studies commented on whether a well was drilled or not.…”

Section: Implant Placement/fixationmentioning

confidence: 99%

“…Wound complications, such as infections, skip flap breakdown, wound dehiscence, hematoma, and seroma, can compromise the health of the patient and function of the implant. Postoperative wound complication rates range from 0.03 to 13.9%, with incidence of major wound complications (those requiring additional hospitalization and/or surgery) reaching as high as 2% (2)(3)(4)(5)(6). In a small number of cases, major wound complications may necessitate explantation of the device (6,7,8).…”

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confidence: 99%

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Surgical Factors Influencing Wound Complication After Cochlear Implantation: A Systematic Review and Meta-Analysis

Laureano

Ekman

Balasuriya

et al. 2021

Otology &Amp; Neurotology

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perioperative practices with wound complications. The objective of this systematic review and meta-analysis is to identify the surgical factors and quantify the association of different techniques with wound complication rates following cochlear implantation. METHODS Search StrategyThis study was exempt from Institutional Review Board approval, as it is a systematic review of the literature. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis checklist was used to guide our review (11) (Fig. 1). Our primary question was composed with the following PICOTS (population, intervention, comparisons, outcomes, time, study design) elements: 1) adults and/or children with hearing loss, who 2) underwent unilateral or bilateral cochlear implantation, with 3) description of surgical technique or perioperative management approach, with 4) reporting of a postoperative wound complication, 5) at any time following surgery, and 6) were reported in either retrospective or prospective research. Inclusion criteria were as follows: 1) Studies reporting wound complications following cochlear implantation, 2) studies reporting wound complications with a description of the surgical technique and/ or perioperative management (incision type, fixation method, antibiotic use), and 3) original research in the form of prospective or retrospective observational studies or as a case series. We defined wound complication as any process that disrupts the normal healing of the surgical site (wound infection, wound dehiscence, necrosis, abscess, cellulitis, seroma, hematoma, and skin flap breakdown). Exclusion criteria included: 1) case reports or nonoriginal research, 2) language other than English, 3) studies not reporting postoperative wound complications. Although we included studies without control/comparison groups in the systematic review for qualitative data analysis and synthesis, only studies with paired samples were included in the meta-analysis.The search was developed using the National Library of Medicine's medical subject headings (MeSH), allowing an inclusive search that encapsulated studies reporting wound complications following cochlear implantation. The search was conducted on 02/10/2020 in PubMED. No publication date restrictions were placed on the search. The search string is found in Appendix 1, http://links.lww.com/MAO/B320. After the initial search, Web of Science and Cochrane Database were searched using the same string. Duplicates between the three databases were removed. Finally, the bibliographies of included studies were searched to identify additional articles. Study SelectionThe studies retrieved from the search were reviewed by four authors. Titles and abstracts were initially reviewed with respect to the inclusion and exclusion criteria. Titles/abstracts in question were reviewed and discussed by all four authors. Three authors conducted a full text review of the studies that passed abstract review, with all articles being reviewed by at least two authors. There were no disagreements between the ...

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“…As such, these failures did not appear to cause a decline in performance, however devices with more than three electrode failures were at high risk for future device performance deterioration leading to explantation (26,30). The causes for these failures included loss of hermetic seal, fatigue fractures due to micro-movements in the electrode lead exit or the electrode lead itself (31)(32)(33)(34), or external trauma, where the latter was reportedly more common in children (32,35). In a recent revision case of robotic cochlear implantation, Morrel et al observed wire fractures at the acute turn from the mastoid surface into the drilled tunnel (36), and have suggested smoothing the edges of the tunnel at the surface of the mastoid.…”

Section: Cochlear Implantation Complicationsmentioning

confidence: 99%

Robotic Milling of Electrode Lead Channels During Cochlear Implantation in an ex-vivo Model

et al. 2021

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Objective: Robotic cochlear implantation is an emerging surgical technique for patients with sensorineural hearing loss. Access to the middle and inner ear is provided through a small-diameter hole created by a robotic drilling process without a mastoidectomy. Using the same image-guided robotic system, we propose an electrode lead management technique using robotic milling that replaces the standard process of stowing excess electrode lead in the mastoidectomy cavity. Before accessing the middle ear, an electrode channel is milled robotically based on intraoperative planning. The goal is to further standardize cochlear implantation, minimize the risk of iatrogenic intracochlear damage, and to create optimal conditions for a long implant life through protection from external trauma and immobilization in a slight press fit to prevent mechanical fatigue and electrode migrations.Methods: The proposed workflow was executed on 12 ex-vivo temporal bones and evaluated for safety and efficacy. For safety, the difference between planned and resulting channels were measured postoperatively in micro-computed tomography, and the length outside the planned safety margin of 1.0 mm was determined. For efficacy, the channel width and depth were measured to assess the press fit immobilization and the protection from external trauma, respectively.Results: All 12 cases were completed with successful electrode fixations after cochlear insertions. The milled channels stayed within the planned safety margins and the probability of their violation was lower than one in 10,000 patients. Maximal deviations in lateral and depth directions of 0.35 and 0.29 mm were measured, respectively. The channels could be milled with a width that immobilized the electrode leads. The average channel depth was 2.20 mm, while the planned channel depth was 2.30 mm. The shallowest channel depth was 1.82 mm, still deep enough to contain the full 1.30 mm diameter of the electrode used for the experiments.Conclusion: This study proposes a robotic electrode lead management and fixation technique and verified its safety and efficacy in an ex-vivo study. The method of image-guided robotic bone removal presented here with average errors of 0.2 mm and maximal errors below 0.5 mm could be used for a variety of other otologic surgical procedures.

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The effect of cochlear implant bed preparation and fixation technique on the revision cochlear implantation rate

Cited by 18 publications

References 15 publications

Twenty years of experience in revision cochlear implant surgery: signs that indicate the need for revision surgery to audiologists

Twenty years of experience in revision cochlear implant surgery: signs that indicate the need for revision surgery to audiologists

Surgical Factors Influencing Wound Complication After Cochlear Implantation: A Systematic Review and Meta-Analysis

Robotic Milling of Electrode Lead Channels During Cochlear Implantation in an ex-vivo Model

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