Cochlear implantation safety and reliability in paediatric cases

Abstract

The objectives were to assess device failure cases, as well as the early postoperative, late postoperative and medical complications occurring after paediatric cochlear implantation, and to discuss the causes and treatments associated with cochlear implant reliability and management. A retrospective study of 272 consecutive cochlear implantations and 21 cochlear re-implantations was carried out in a tertiary referral centre. All children, implanted between 1989 and September 2005, were studied and all complications and their associated treatments were systematically reviewed with a maximum follow-up of 16 years. The risk of complication was compared to age at time of implantation. Numbers of re-implantations were calculated relative to follow-up times to determine the cochlear implant survival rate. Finally, percentage of electrode deactivation was evaluated according to the implant length. The overall rate of complications was 16.91% (46/272). The rate of cochlear re-implantation was 7.72% (21/272), the risk of device failure or performance decrement was 7.36% (20/272) and the risk of severe infection (eventually requiring explantation of the internal device) was 1.10% (3/272). Revision surgery without cochlear re-implantation was performed in 2.94% of the cases. Fifty per cent of re-implantations took place before three years of implant use and 80% of the re-implantations occurred before the fourth year of implant use. The percentage of electrode deactivations increased after the sixth year following implantation. Complication rates were similar regardless of age at implantation. Cochlear implantation remains a safe surgical technique with device failure representing the most common complication. Pain, facial stimulation and head traumas are more frequently noticed in children than adults. Conversely, vertigo and tinnitus are less frequent in children than adults. Long-term follow-up of cochlear implant patient populations allows detection of device failures and electrode deactivations.