Download 13th International Conference on Cochlear Implants and Other

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Transcript
S3-19
CI re-implantation
Chen K.C.
1
1
Cheng Hsin General Hospital / Natioanl Yang Ming University, Otolaryngology, Taipei, Taiwan, Republic of China
Introduction: Previously, the common belief is that once a cochlear implant is implanted, it is implanted forever.
However, contrary to beliefs, re-implants are inevitable. Markets only require the reliability of cochlear implants to
be 98.5% in order to be put on sale. Even if manufacturers proclaim their products to be 99% reliable (or more),
in a pool of 1000 patients, there will still be a few “hard failure” exceptions. Furthermore, head trauma and
hermetic problems would potentially increase the number of hard failures. Apart from hard failures, other causes
for re-implants include cholesteatomas, wound infections and flap problems. Recently, even with no technical
problems with their cochlear implants, patients have requested to replace their old CI models for newer models
with updated technology.
Method: In cases of re-implants, doctors have often encountered fibrosis and new bone formation. These would
surround the electrodes messily, causing the removal of the electrodes to be difficult. The standard method of
removing electrodes is to cut the electrodes in half, and extracting them separately. However, the separate
halves cause electrode troubleshooting to be hard. To reduce such problems, we do not drill the cortical bone,
but harvest a piece of cortical bone with a chisel. Before the closure of the wound, we cap the bone piece back
to its original place.
Result: This would prevent random bone growth and fibrosis growth into the mastoid cavity. During re-implants,
we discovered that this method causes a significant decrease of fibrotic tissue in the mastoid cavity.
Discussion: This allows the cable to be more visible, allowing the surgeon to extract the cable as a whole.
Because the cable can be explanted harmlessly, not only that multiple re-implantations are made possible, but
also that residual hearing can still be well-preserved after the re-implant. Statistics show that there is only a 5 dB
loss of residual hearing 30 days after the operation.
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