Cochlear reimplantation: Surgical techniques and functional results

Objectives/Hypothesis. The most common indication for cochlear reimplantati on. is device failure. Other, less frequent indications consist of "upgrade s" (e.g., single to multichannel), infection, and flap breakdown. Although the percentage of failures has decreased over time, an occasional patient r equires reimplantation because of device malfunction. The varying designs o f internal receiver/stimulators and electrode arrays mandate an examination of the nature and effects of reimplantation for the individual designs. Th e purpose of the current study was to investigate the reimplantation of sev eral implant designs and to determine whether differences in surgical techn ique, anatomical findings, and postoperative performance exist. Study Desig n: Retrospective chart review. Methods. The subjects were 33 of 618 severel y to profoundly deaf adults and children who had implantation at the New Yo rk University Medical Center (New York, NY) between February 1984 and Decem ber 2000. The subjects had previously had implantation with either a single -channel 3M/House (House Ear Institute, Los Angeles, CA) or 3M/Vienna (Tech nical University of Vienna, Vienna, Austria) device or with one of the mult ichannel Clarion (Advanced Bionics, Sylmar, CA), Ineraid (Smith & Nephew Ri chards, TN), or Nucleus (including the Contour) devices (Cochlear Corp., En glewood, CO) before reimplantation. Results: Length of use before reimplant ation ranged from I month to 13 years and included traumatic and atraumatic (electronic) failures, as well as device extrusion or infection. Results i ndicated that postoperative performance was either equal to or better than scores before failure. None of the devices explanted caused damage that pre cluded the implantation of the same or an upgraded device. These findings s upport the efficacy and safety of internal implant designs as related to th e maintenance of a functional cochlea for the purpose of reimplantation. Co nclusions. Cochlear reimplantation can be performed safely and without decr ement to performance. The number of implanted electrodes at reinsertion wer e either the same or greater in all cases.