Low pediatric cochlear implant failure rate: contributing factors in large-volume practice.

OBJECTIVE: To evaluate the rate of cochlear implant (CI) failure and CI reimplantation (CIri) in our population of children receiving implants by means of a technique that includes device fixation with suture to cortical bone. DESIGN: Retrospective analysis from January 1990 to June 2010. SETTING: Tertiary pediatric hospital. PATIENTS: A total of 971 devices were provided to 738 children (5575 implant-years). INTERVENTIONS: Cochlear implant explants and CIri. MAIN OUTCOME MEASURES: Surgical findings at CIri were assessed by device model. The Pediatric Ranked Order Speech Perception score and the Phonetically Balanced Kindergarten score were used to make comparisons of hearing ability before and after CIri. RESULTS: Thirty-four patients have undergone CIri in our pediatric center during the past 20 years. Excluding 7 of these patients who received their initial implant at other centers, our rate of CIri was 2.9%. Mean (SD) time to device failure was 61 (43) months. A disproportionately high number of patients (7 of 35 [20%]) requiring CIri had meningitis before implantation. After CIri, children maintained or improved their best speech performance measured before device failure, with only 2 children showing a significant reduction in speech perception after CIri. CONCLUSIONS: A very low rate of failure occurs in children who receive CI devices, and several factors may account for this low rate. Children who develop meningitis before CI appear to be at an increased risk of device failure.