Revision cochlear implant surgery in children

OBJECTIVE: To determine the incidence of revision cochlear implant (CI) surgery in children and the indications for revision surgery and to examine the pattern of events that lead to revision CI surgery. STUDY DESIGN: Retrospective case review. SETTING: Two tertiary pediatric CI centers. PATIENTS: Pediatric CI patients who underwent revision surgery related to their CI. MAIN OUTCOME MEASURES: Reasons for revision, surgical outcomes, complications, performance, and device analyses were sought. RESULTS: Nine hundred fifty-two pediatric CI operations were performed between 1991 and 2005. Ninety-three patients underwent 107 (11.2%) revision operations. Hard device failure occurred in 46% (n = 49); soft failure occurred in 15% (n = 16); medical/surgical causes were responsible for 37% (n = 40); and magnet dislodgement requiring revision surgery occurred in 2% (n = 2). Head trauma was associated with 41% of the hard failure cases (n = 20). Device analyses revealed identifiable abnormalities in most of both hard and soft failure cases. In most patients, auditory performance equaled or surpassed the best preoperative performance by 6 to 12 months after revision. CONCLUSION: Revision CI surgery is common among pediatric CI recipients. Hard failure is the most common reason for undertaking revision surgery, and this mode of failure is frequently associated with preceding head trauma. Patients and parents should be counseled that performance is expected to equal or surpass the child's best level of performance before revision surgery, although this may take some time, and exceptions do exist.