Revision cochlear implant surgery in children: the Johns Hopkins experience.

OBJECTIVE: To assess the efficacy of revision cochlear implantation (RCI) and to identify clinical and device-related factors predictive of RCI outcome. STUDY DESIGN: Retrospective case series with attempted correlation to ex vivo device analysis. SETTING: Academic tertiary referral center. PATIENTS: Children (<18 yr) who underwent RCI in a tertiary-care center. INTERVENTION: Revision cochlear implantation with multichannel cochlear implant. MAIN OUTCOME MEASURES: Open-set speech perception testing and subjective report by child, family, teacher, or therapist; patient report of symptom resolution. RESULTS: During the 15-year period, 13% of pediatric CI surgeries were revised (at an average of 3.4 yr after initial operation). Hard failures (42%), suspected device failure (29%), and extracochlear electrodes (16%) were the most common indications for RCI. Most hard and suspected device failure cases (n = 37; 84%) reported a return to previous peak performance within 18 months of RCI. Previous peak performance was more likely to be achieved or exceeded in younger than in older children. A decline in speech perception was a stronger predictor of successful outcome (100%) than chronic underperformance (57%) among children with suspected device failure. Preoperative integrity testing was only moderately predictive of functional results or findings at ex vivo device analysis. CONCLUSION: Revision cochlear implantation should be considered when longitudinal clinical assessment reveals an unfavorable trajectory in the development of receptive communication skills. Device testing provides important, but not definitive, supporting data. Revision cochlear implantation as guided by device and patient factors can exert a positive impact on access to verbal language and therefore its development. A delay to act can have lasting negative consequences because benefits seem to diminish with age.

Revision cochlear implantation surgery in adults: indications and results.

OBJECTIVE: To assess the efficacy, risks, and indications of revision cochlear implantation (RCI) and to identify the clinical, audiologic, and device-related characteristics that predict outcome. STUDY DESIGN: Retrospective case series. SETTING: Academic tertiary referral center. PATIENTS: Adults (> or = 18 yr) who underwent RCI at Johns Hopkins University. INTERVENTION: Revision cochlear implant surgery. MAIN OUTCOME MEASURES: Speech perception by open-set testing and patient report and patient report of symptom resolution. RESULTS: During the 16-year period of this study, 4.8% of all adults implanted at our center have required 1 or more RCI surgeries. A total of 48 RCIs have been performed. The indications for RCI included infection (12%), electrode extrusion (15%), hard failure (23%), suspected device failure (42%), and isolated facial nerve stimulation (8%). Overall, successful resolution of the implant-related or medical condition was achieved with RCI in 83% of cases. Speech perception was lower in only 1 (2.1%) of 48 cases. Satisfactory preoperative speech recognition was preserved or surpassed in 5 of 6 infection cases and 8 cases with progressive symptoms of tinnitus and facial nerve stimulation. All cases of hard failure regained or surpassed previous peak performance. Improved speech recognition was experienced by 75% of cases with suspected device failure. Of cases in which RCI failed to restore previous functional benefit, there was a significant association with advanced age (> 70 yr). Whereas an abnormal integrity test was predictive of favorable outcome after RCI, a negative test was not predictive of outcome. A similar pattern of results was observed with respect to ex vivo device analysis. CONCLUSION: Revision cochlear implantation can be safely performed to restore lost benefit in appropriately selected cases. When properly performed after medical and audiologic options have been exhausted, RCI rarely compromises previous function and, in most cases, can resolve functional complaints and distracting symptoms. When positive, integrity testing is a useful screen for the presence of a device defect. In cases in which device integrity is uncertain, clinical judgment guided by longitudinal assessment can help determine whether RCI is likely to be beneficial.