International Journal of Pediatric Otorhinolaryngology
Magnet dislodgement in cochlear implantation: Correction utilizing a lasso technique
Introduction
Advancements in cochlear implantation continue to increase success in reversing hearing impairment in patients with bilateral, profound sensorineural hearing loss (SNHL). To date, over 120,000 individuals have been granted access to sound through placement of cochlear implants (Industry data, 2007).
Despite advances in cochlear implantation, surgical complications remain a reality. Complications have been labeled as major or minor depending on the degree of intervention required for their treatment. Specific complications are seen more frequently in the pediatric population. A child's naivety and curiosity promotes regular, uninhibited exploration of their surroundings. Poor motor control places young children at risk of frequent episodes of inadvertent trauma [1]. Accidental head trauma has been identified as a profound influence on the performance of cochlear implants in the pediatric population. Migration of the implant's internal magnet represents but one complication associated with head trauma [2].
Magnet migration has only recently been described as a complication of cochlear implantation [2]. The surgical solution to this problem remains a challenge. The purpose of this paper is to describe a case in which an internal implant magnet became displaced on two separate occasions. The management of these complications is discussed and a new technique for securing implant magnets is described. This new “lasso” technique represents an efficient, cost-effective less invasive and safer surgical option which poses minimal risk to patients.
Section snippets
Case presentation
An 18-month old male with Waardenburg syndrome was implanted with a Nucleus contour 24R device in January 2002 because of bilateral SNHL. Three and a half months post-implantation, the patient suffered inadvertent, minor head trauma. This resulted in migration of his implant magnet out of its housing within the internal receiver-stimulator (IRS). The magnet was palpable antero-inferiorly relative to the internal prosthesis. Findings on physical examination were confirmed with plain radiographs
Discussion
Cohen and Hoffman [3] classified complications of cochlear implantation into major and minor categories. “Major” complications are those requiring surgery and/or hospitalization for treatment. “Minor” complications exhibit either spontaneous resolution or improvement without operative intervention or hospital admission. Complications can be further subdivided into early and delayed categories. Early complications occur from the immediate post-operative period up until 3 months after surgery.
Conflict of interest
None.
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Cited by (12)
Head trauma and Cochlear implant displacement – A systematic review
2022, American Journal of Otolaryngology - Head and Neck Medicine and SurgeryCitation Excerpt :The 8 other case reports/series addressed RS/magnet migration. Six of these studies indicated that patients' CI magnets were dislodged from the silicone holding pockets and inappropriately located near or on top of the RS titanium housing, confirmed with plain radiographs of the head [4,11–15]. Table 1 shows the mechanisms of injury resulting in displacement for each case.
Complications and clinical analysis of 416 consecutive cochlear implantations
2011, International Journal of Pediatric OtorhinolaryngologyCitation Excerpt :Revision surgery was necessary to replace and secure the magnet. Mickelson and Kozak [10] utilized a “lasso” technique to correct magnet displacement. And the new technique was regarded as a simple, safe, efficient and cost-effective surgical option with minimal morbidity.
Anaesthesia for cochlear implant surgery
2011, Trends in Anaesthesia and Critical CareCitation Excerpt :Displacement of magnet from the receiver pocket possibly by the use of magnetic toys has been reported even three years after the surgery.29 The magnets, once displaced need to be replaced under general anaesthesia exposing the children to further risk and morbidity.30 Silicone allergy has been proposed as a rare cause of cochlear implant extrusion.
A case of magnet displacement in a cochlear implant detected after MRI corrected by a non-invasive approach
2017, Practica Oto-Rhino-Laryngologica