Cochlear implant device failure in the postoperative period: An institutional analysis

Introduction: As the cochlear implant (CI) surgeries are on rise, there is a compelling need to understand its long-term complications and revision surgery protocols. Our experience in the management of CI devices failure is shared in this paper. Aim: To review the experience in patients who underwent CI device manipulation/explanation in terms of failure rate, etiology, surgical considerations, and preoperative and postoperative auditory and speech outcome. Study Design: This was a retrospective study. Materials and Methods: A retrospective study of 250 patients (201 children and 49 adults) with normal cochlea at a tertiary care center from June 2004 to June 2014 was done. All cases were implanted multichannel devices via Veria technique of CI surgery. Preoperative assessment, surgical considerations, and postoperative auditory and speech outcomes were analyzed. Preoperative and postoperative auditory/speech outcomes were analyzed using Category of Auditory Perception (CAP) and Speech Intelligibility Rating (SIR) scores. Results: Reimplantation rate was 4%. The causes of revision CI surgery were hard device failure (n = 3), surgical site infection (n = 3), magnet displacement (n = 2), and electrode extrusion (n = 2). In one patient, recurrent cutaneous infection on the implanted site ultimately resulted in reimplantation in the opposite ear after multiple surgical interventions on the same side. The preoperative and postoperative CAP and SIR scores showed improvement in the postoperative period with P < 0.05 as compared with the paired t- test. Conclusions: Preoperative counseling for device failure should always be emphasized. The success rate is high in revision surgery with good performance in the postoperative audiological outcome. There is a compelling need for an agreed international definition of CI failure and the adoption of uniform reporting protocols.

Key-words:

Category of Auditory Perception score - cochlear implant device failure - reimplantation protocol - Speech Intelligibility Rating score - surgical considerations