Is Hard Failure Still a Common Indication for Revision Surgery in Adult Cochlear Implant Recipients?. Issue 3 (March 2019)

• Record Type: Journal Article
• Authors: Stevens, Shawn M.; Dougherty, Hayden; Wenstrup, Lisa; Hammer, Theresa; Cole, Tyler; Redmann, Andrew; Pensak, Myles L.; Samy, Ravi N.
• Is Part Of: Otology & neurotology. Volume 40:Issue 3(2019)
• Publication Date: 2019-03
• Subjects: Adult -- Cochlear implant -- Complication -- Hard failure -- Revision -- Soft failure; Otology -- Periodicals; Ear -- Diseases -- Periodicals; Skull base -- Surgery -- Periodicals; 617.8005
• DOI: 10.1097/MAO.0000000000002118
• Languages: English
• ISSNs: 1531-7129

Abstract

Abstract : Outcome Objectives: Review a 15-year, single institution experience with adult-cochlear implant (CI) revision surgery. Describe chronologic changes in the incidence of hard failure (HF), soft failure (SF), wound complications (WC), and magnet/device migration (MM). Study Design: Retrospective chart review. Setting: Single tertiary care center, 2001 to 2016. Patients: Adult CI recipients were assessed. Inclusion required ≥1 revision surgeries, operative note(s), and postrevision follow-up of 6 months. Interventions: Therapeutic/rehabilitative. Main Outcomes Measures: Indications for revision (HF, SF, WC, and MM) were tabulated. The incidence of each was compared between cohorts implanted before/after 2011. Additional outcomes included implant usage, explantation rates, and postrevision speech scores. Results: Four hundred thirty-two patients received 512 CIs. Of these, 30 patients required 38 revisions. Median time to revision was 24.5 months. Frequency by indication was HF (n = 14), SF (n = 12), WC (n = 8), and MM (n = 4). The overall revision rate was 7.4%. There was a significant decline in overall revisions for patients implanted before/after 2011 (10.4 versus3.5%; p = 0.009). No patients implanted after 2011 experienced a HF ( p = 0.002). Patients with WC/MM had significantly shorter time to revision compared with patients with HF/SF ( p = 0.04). The overall median follow-up was 24 months. Twenty-three of 30 patients are still using their revised CI. Patients revised for HF and MM achieved the best outcomes. Conclusion: 7.4% of adult CI recipients required revision surgery. Explantation/immediate reimplantation was an effective management strategy. While HF was the most common indication overall, no patients implanted after 2011 have suffered this complication. The overall revision rate has significantly declined since 2011.