Revision Cochlear Implantation

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Indications for revision or reimplantation

Device failure is the most common cause for revision cochlear implant surgery. Reimplantation is performed expeditiously, as usually the patient is rendered deaf by the device failure. This situation is usually very stressful for the patient. A common symptom of a hard failure is a lack of communication between the internal and external hardware, with no sound perception when the device is activated. Additional symptoms include abnormal sounds, painful sensations, and frequent or increased need

Surgical considerations

Reoperation for a failed or failing cochlear implant requires thoughtful planning and consideration of several issues. Most of the time, the same incision used for the first operation is opened and similar flaps are developed. It is important to avoid monopolar cautery to prevent current spread through the device to the delicate neural elements of the cochlea. Although this type of complication has never been documented, it could render an ear unsuitable for cochlear implantation. Additionally,

Outcomes

The first reports of cochlear reimplantation were published in the 1980s. In 1985, Hochmair-Desoyer and Burian [10] described two subjects who underwent reimplantation for gradual device failure. Scar tissue and new bone formation were encountered during the surgery, but new electrodes were inserted without difficulty, and thresholds and speech performance were stable postreimplantation. Jackler and colleagues [11] published a cat model of a large series of subjects implanted with different

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      Similar to revision surgery to work under Magnification and usage of bipolar cautery or plasma knife is also advisable. If a staged reimplantation needed electrode array should be cut and left in situ [12]. If reimplantation is not staged the surgeon should kept the array inside the cochlea until the new device fixed and its array is brought into the field.

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      The electrode lead might be encased in soft tissue and the use of a 12-blade scalpel has been proven useful to cut the adhesions and follow the wire down to the facial recess at which point the array is cut. The intracochlear electrode is left in place until the new electrode, of similar or smaller size and diameter, is ready for reinsertion.75 The removal of the electrode array should be done under direct visualization just before insertion of a new lead through the same intracochlear tract.68,78

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      For this reason, some implant centers discourage participation in contact sports among recipients. Fortunately, studies report excellent outcomes for reimplantation surgery, with equal or improved performance in most cases [38]. After cochlear implant surgery, most centers will wait approximately 2–4 weeks before activating the device to allow time for healing.

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