Cochlear Implantation in a Residency Training Program: The Kaiser Permanente Oakland Experience

Abstract

Objectives: Assess the complications of cochlear implantation and determine whether resident physicians can perform this procedure safely. Methods: Retrospective chart review of consecutive cochlear implant recipients who underwent primary cochlear implantation performed with extensive resident surgeon involvement between January 1, 2005 and April 30, 2012. Setting: Tertiary care teaching hospital. One hundred and fifty-nine adults and children collectively underwent a total of 194 primary cochlear implant operations (n = 194). Complications after cochlear implantation were classified into major and minor categories. Minor complications included those that either settled spontaneously or with conservative management. Major complications were defined as those requiring further surgery or hospitalization. Spontaneous failures of internal devices were reported separately. Results: The overall complication rate was 11.3% (22 of 194 cochlear implant cases). Minor complications occurred in 14 cases (7.2%). These included wound infection or dehiscence, hematoma formation, delayed facial paresis, and non-auditory stimulation. Major complications were present in 8 cases (4.1%). These involved implant malposition or migration, incorrect device implantation, flap-related problems, chronic infection with cholesteatoma, and severe vertigo requiring hospitalization. One of the 8 patients experiencing a major complication required device explantation. There were no post-operative deaths, cases of meningitis, or persistent facial nerve palsies in this series. Device failures occurred in 4 cases (2.1%). Conclusions: The rate of complications is comparable to those published by other institutions. Residents can safely and successfully perform cochlear implant surgery. With close supervision, satisfactory results can be achieved.