Management of Cochlear Implant Electrode Migration

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Abstract

Objective:

The present study reviewed a cochlear implant (CI) patient population after surgery, which received a free-fitting electrode carrier designed for hearing preservation. The aim was to determine the rate of electrode migration of the CI electrodes and present clinical and surgical implications.

Study Design:

Retrospective patient review.

Setting:

Tertiary referral university hospital.

Patients:

Two hundred seventy-eight patients implanted uni- or bilaterally with lateral wall electrodes designed for hearing preservation (358 implants). The control group was 323 patients implanted uni- or bilaterally with preformed perimodiolar electrodes (468 implants).

Interventions:

Determination of CI electrode migration was conducted according to a clinical test protocol. Revision surgery was offered in confirmed patients of electrode migration. A bone groove was considered to improve the fixation of the electrode.

Main Outcome Measures:

Audiological testing including speech audiometry, subjective sound quality rating, and bilateral pitch comparison in bilateral patients, as well as radiological examinations, were conducted.

Results:

Electrode migration was observed solely in patients implanted with lateral wall electrodes; 10 of 358 patients with free-fitting electrodes (2.8%) had electrode migration, which was successfully confirmed by the proposed clinical test protocol. Nine of the 10 confirmed patients underwent reinsertion surgery. Mean perception score decreased from 75.0% to 62.1% after electrode migration and recovered completely after reinsertion surgery. A flowchart to detect electrode migration was designed for clinical practice.

Conclusion:

Although electrode migration is a rare complication in CI surgery, long-term follow-up diagnostics should include a test protocol to detect electrode shifts of lateral wall electrode arrays. A reinsertion surgery should be conducted in confirmed patients to recover speech perception.

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