Surgical safety issues relating to the use of diathermy in patients with cochlear implants: the patient's perspective.

OBJECTIVES: The number of cochlear implant recipients throughout the world is set to increase markedly. Surgical diathermy used inappropriately in the head and neck region can be damaging to implant electronics and may irreversibly damage the remaining auditory neural pathways. Safety guidelines have been published but many non-implant surgeons are unaware of their existence. We aimed to examine this issue from the patient's perspective. METHODS: A questionnaire was supplied to 50 adults and the parents of 50 implanted children registered at the South of England Cochlear Implant Centre. RESULTS: Adults Forty-six percent felt that non-implant surgeons would be aware of the diathermy restrictions. Only one patient had undergone subsequent surgery. Eighty-six percent still possess their implant identification (ID) card, and 71% carry it with them. Seventy-seven percent felt that if they required surgery they would show their implant ID card and raise the diathermy issue. Parents Although 76% of parents believed that surgeons would be unaware of the diathermy restrictions, none of the 12% of parents whose children underwent subsequent surgery had highlighted the issue to their surgeon. Eighty-four percent of the parents/children possessed their ID card. While only 8% of parents ensured that their child carried it at all times, a further 12% reported in free text that they carry the card on behalf of their children. CONCLUSION: Diathermy use in cochlear implant recipients is a significant patient safety issue. There is a role for further education of patients and surgeons, for better utilization of the ID card, and for increased clarity on manufacturers' websites.

MRI during cochlear implant assessment: Should we image the whole brain?

OBJECTIVES: Magnetic resonance imaging (MRI) is a standard part of a cochlear implant assessment in most centres. While there is ample literature on the temporal bone-specific imaging that is required, the role of whole brain imaging has not been as fully studied. We present the first report of the incidence of associated brain abnormalities in the whole cochlear implant population, including adults and consider their significance. METHODS: We retrospectively reviewed 51 (12 adults and 39 children) sequential cases since we added whole brain MRI sequences to our cochlear implant assessment protocol. We reviewed the scans for abnormalities of the cochlea and cochlear nerve and a neuroradiologist reviewed the images of the whole brain sequences for further abnormalities. RESULTS: We identified abnormalities on the whole brain sequences in 21 (41%) of these patients, 5 of 12 adults (42%) and 16 of 39 children (41%). Thirty-six (71%) patients subsequently had at least one implant inserted, 13 with abnormalities on whole brain MRI (36%) and 23 without. Of the 15 patients who did not undergo subsequent implantation, 8 had positive findings on their whole brain MRI sequence (53%). There was no statistical difference in the probability of finding an abnormality on the whole brain MRI between those who did and those who did not go on to have an implant (P = 0.35). There were abnormalities within the inner ear in five patients. DISCUSSION: The abnormalities detected on the whole brain images are heterogenous and of wide ranging clinical significance ranging from truly incidental findings to abnormalities that are so severe that they may predict a very poor prognosis such that an implant may contribute little.

Malignant peripheral nerve sheath tumors of the head and neck: two cases and a review of the literature.

Malignant peripheral nerve sheath tumors are uncommon lesions that occasionally affect the head and neck. We describe 2 new cases of head and neck pathology. One tumor involved the parotid gland and resulted in erosion of the temporal bone, and the other affected the lower lip. A rapid diagnosis has significant implications for management because of the tumor's potential for aggressive behavior and its high rate of recurrence. To the best of our knowledge, lip involvement is rare and temporal bone involvement has not been previously described.