May 12-15, 2011 Divani Apollon Palace « Athens, Greece Celebrating 50 years af Cochlear ImplantationSurgical issues in cochlear implantation — our experience Necula V, Sirb M, Tiple C, Bumbag C, Necula SE, Cosgarea M ENT Deparment of University af Medicine and Pharmacy ClajeNapoca, Romania ‘Summary: Aims: Cochlear implantation is a safe surgical procedure in severe-to-profound heanng unpaired patents The nck of cochlear implantation i smal thore of classic mastoid surgery with a low rate of severe complications. ‘Material, Method: We evalusted the complication in a renospective stay, on 67 patients, who underwent cochlear implantation in our department since 2003 to 2010 Results: Intraoperative, gusher syndrome occured in one patient, facial nerve sualigaon ut one patent, Ueeding Gum mastoid emlsay vein m two cases and chorda tympani nerve injury in 3 cases. Early postoperative complications occur in the first 7-10 days and include minor flap complications in 5 patients. Late complications included otitis media and devices failure. Conclusions: Careful operation technique and a well-trained surgeon can avoid severe intraoperative and early postoperative complications. Late-onset complications like otitis media or device falwe could occur im some cases and needs surgical treatment. Key words: cochlear implant, surgery. complications Introduction: Cochlear implant is the best option for patients with severe or profound sensori- neural hearing loss when hearing prosthesis does not bring significant benefits. ‘As in any medical act, the more as it is a surgical act, occurs a number of incidents and accidents either during the surgery or in the postoperative period. Complications of cochlear implantation can be divided into complications related to the surgical procedure and device-related complications [1]. Device related com- ‘various components. it the surgical procedure into minor and major Although there isto clear demarcation (2011 by MEDIMOND s1. wer 105106 10th European Symposium on Paediatric Cochlear Implantation pain that can be cropped by deactivating electrodes. Material, methods: Since November 2003 to March 2010, in Cluj-Napoca’s ENT Clinic 67 patients underwent cochlear implant surgery. Patients operated were both children (62) and adults (5), 27 (40.3%) female and 40 (59.7%) male. Implanted patients’ aze ranged between 12 months and 43 years, 35 (52.2%) children being infants under 60 months GS years) at time of surgery and 32 patients (47.8%) older than 5 years, 5 of them adults (over 18). We used Medel, Combi 40 ~ type electode in 3 cases and Pulsar Gil00 im other cases. Data were studied retrospectively, analyzing the patients’ case report forms. We identified 14 patients (20.89%) who bad various problems intra or postoperatively. Complications were divided as inyaoperative incident: and postoperative compli- cations occurred early, within 7 days after surgery, or late, if occured after 7 days from surgery. Results: Of all patients only three patients had is ve incidents but that did not have consequences in the postoperative period. A 4 years and 3 months old patient, with Pendred after an al perilimfatic leak but filling it with bone pate. We had only one patient with a facial nerve malformation ‘but it was operated without nerve injury (Figure 1). Postoperative complications were reported in 15 patients (21.0%) of all 67. (Table b Five patients (7.5%) had early minor complications such haematomalseroma or wound dehiscence. Only one adult patient (1.5%) presented subcutaneous emphysemaAthens, Greece, 12-15 May. 2017 107 ‘Faure 1. Facil nerve maiiormaton Table 1 Pastoperatve comalcations ana teainent madaaty Etolozy Number of patients Percentaze T. Unknown causes 8 a4 2 Genetic causes 15 3. Treatment sth obotosae 12 4. Meningiti: 5. Peematurity 6. Barth suffering 7 Fetal CMV infection Otascterosis Hea ini Total in the first days after surgery. In the late minor complications category, one patient (1.5%) bad acute otitis media 3 months postoperatively, which was recolved with anibiotherapy and adenoidectomy 2 months after resolving of acute episode. Five patients (7.5%) required revision surgery at different intervals after the imitial cochlear implant. Four (6.0%) of them presented cochlear implant failure, with more than four non-functional electrodes which required explantation and reimplantation of another implant, One patient (1.5%) had ehronie otitis media with cholesteatoma, 2 years after implantation, developing a retraction pocket thorough posterior timpanotomy, with electrode exposure. The mastoid was reopened: the retraction pocket was removed entirely till the cochleostoms, Posterior tympanotomy was filled with connective tissue and a tympanoplasty was performed with conchal cartilage (Figure 2) Postoperative evolution was favowable with the preservation of the hearing threshold and a good percentage of words recornition in open set. This complication oceumred due to a bad collaboration; the patient missed some follow-up visits after the first year10s 10th European Symposium on Paediatric Cochlear Implantation Figure 2. Choesteatoma: (1) betoe the surgery: (2 inaoperative tage; (3} one year atisr surgery Discussions: Cochlear implant surgery is relatively safe surgery, especially for a surgical team. ‘properly prepared, well trained in ear surgery. Postoperative complication: have a relatively lew incidence. If in 1995, on 2 group of 4969 patients, adults and children, Hofmann and Cohen [6] reported a 12.2% com- plication rate, Amoldner and Baumgartner [7], on 2 group of 342 patients described 4.97% (adults) rate or 15.20% (children) when taking into account the complications related to implant requiring reimplantation and 2 study of Kim et al [8] on a group of 430 patients indicates a rate of 9.8%. In the studied group. postoperative compli- cations had an 16.41% incidence, of which 5.97% are reimplantation cases, values relatively close to those of literature Minor complications (7.3%) were mostly related to the flap, being more frequent in the early years. Over the time modifying the incision, reducing the flap and im- ‘proving the local care, the incidence of these complications decreased, nowadays ‘being extremely rare. “Major complications were mostly related to the implanted device, 6.0% of patients requiring cochlear reimplantation. Amoldner and Baumgartner [7] have compared im their study the incidence of implant-related malfunctions from different studies, ‘values ranging between 1.76% and 13.92%, without making reference to the implant manufacturer, the percentage obtained in our study ranging inte these values. From 67 cases only one (1.5%) had cholesteatoma, 24 months after implantation. Arnoldner and Baumgarmer on 2 342 patients’ lot reported two cases of cholesteatoma, one in. am adult patient and one in 2 child Tull now we have not had severe complications such as meningitis or other kind of infections or related to the facial nerve. There was no electrode malposition, elec- trodes were fully inserted into the cochlea. Conclusions: Cochlear implant remains 2 safe surgical procedure for a well trained texm in. ear surgery, with 2 relatively low rate of severe complications. Expentence acquired over time, the improvement of technology and surgical techniques have reduced the minor complications whose incidence was higher in the frst years after the procedure imation.Athens, Greece, 12-15 May. 2011 109 Our experience is still reduced and requires consideration of several parameters describing the postoperative evolution of patients and their longer follow-up to draw ralisble conclusions. L COHEN N, ROLAND T. Complications of cochlesr implant surgery. In: Waltzman $B, Roland T Jr editors. Cochlear implants. New York, Thieme. 2007 COHEN NL, HOFFMAN R. Complications of cochlear implant surgery in adults and children Ann Otol Rhinol Laryneo! ;100:708-11,1991 KURO T, MATSUURA 5, TWAKIT. Complications of cochlesr implant surgery. Operative Techniques in Orolaryagology. 16-154-158,2005 European consensus statement om cochlear implant feilures and explantstions. Orel NYeu- rorwl. 26(6):1097-1099,2005 ‘BHATIA K, GIBEIN EP, NIKOLOPOULOS TP, O'DONOGHUE GM. Surgical complica- ‘bons and their manazement in a series of 300 consecutive pediatric cochlesr implantations. Otol Neurotal. 25(5):730-739,2004; HOFFMAN RA, COHEN NL. Complications of cochlear implant surgery. Ann Otol Rhinol Laryngol 104:430-2,1995; ARNOLDNER C, BAUMGARTNER WD, GSTOETINER W, HAMZAVI J. Surgical consideration in cochlesr implantation in children and adults: a review of 342 cases m ‘Vieuma. Acta Otolaryagol. 125(3)-228-34,2005, KIM C-S, CHANG SO, OH S-H. LEE HJ. Complications in cochlear implantation. In- temational Conzress Series 1273 145-148, 2004;