The prevalence and clinical course of facial nerve paresis following cochlear implant surgery

Abstract

Objectives/Hypothesis:To describe the prevalence, clinical course, and outcomes of facial nerve paresis following cochlear implantation and to identify variables associated with poor definitive facial nerve function.Study Design:Retrospective cohort study with systematic literature review.Methods:All patients who underwent cochlear implantation between January 1990 and December 2010 at a single tertiary academic referral center were reviewed. Data including clinical presentation, intraoperative findings, onset, severity, management, and outcomes of all patients who experienced facial nerve paresis following cochlear implantation were recorded.Results:Eight hundred eighty‐eight cochlear implants (282 pediatric, 606 adult) were performed in 768 patients. Eleven patients with postoperative facial nerve paresis were identified. Ten patients (1.1%) developed delayed‐onset paresis and had complete recovery within 6 months of surgery, whereas a single patient (0.1%) demonstrated immediate onset paresis and experienced incomplete return of facial nerve function. Seventeen additional cases were identified in the literature and were summarized.Conclusions:Facial nerve paresis following cochlear implantation is rare. Most cases demonstrate a delayed onset and have complete recovery within months of surgery. Delayed onset facial nerve paresis following cochlear implantation heralds an excellent prognosis, whereas immediate onset facial paresis prognosticates a poorer outcome. In the absence of medical contraindications, corticosteroid therapy should be considered in facial paresis following cochlear implant surgery.

Facial palsy following cochlear implantation

“…a b c Fig. 1 12,16,17]. Most of the studies reported 0.7 % incidence of FN palsy after CI [9,11,18], which is in the range of the present study ( Table 2).…”

“…Treatment of FN palsy following otologic surgery includes observation, corticosteroids, antiviral therapy, and surgical decompression [12]. Corticosteroids, compared to placebo, have been shown to significantly improve FN outcomes [32,33].…”

“…All other patients were included and the following information was gathered from their charts: Onset of FN palsy was classified as either immediate (primary) or delayed (secondary). Delayed FN palsy was all FN palsy that occurred more than 1 h of CI surgery [12].…”

“…Transmastoid posterior tympanotomy (facial recess) is the most commonly used surgical approach for CI [12]. The boundaries of this triangular space are the facial nerve postero-medially, the chorda tympani nerve antero-laterally and the fossa incudis superiorly [7].…”

Endoscopic-Assisted Cochlear Implantation: A Case Series

“…Hence, Kronenberg et al [7] presented a suprameatal approach to avoid facial nerve injury. The ratio of facial paralysis following cochlear implantation has been reported as 0.07-1.1% in the literature, and most of these reported cases were delayed onset paralysis [8][9][10] . In our previous cochlear implantation case series, we did not observe early or immediate facial paralysis after cochlear implantation.…”