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Transcript
P1-8-15
Evaluation of internal receiver migration in cochlear implantation using subperiosteal pocket technique
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Orhan K.S. , Aydemir L. , Polat B. , Enver N. , Güldiken Y.
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Istanbul University Faculty of Medicine, Istanbul, Turkey
Objective: Stabilization of the internal receiver stimulator (IRS) is crucial for data transmission between the
headpiece and the IRS in cochlear implantation. In the standard technique of cochlear implantation, the internal
receiver-stimulator (IRS) is embedded into a socket drilled on the calvarial bone in order to prevent migration.
Sutures have also been used for this purpose. Improper stabilization of the IRS may lead to migration and
extrusion from the skin. In the subperiosteal technique, IRS is fixed under the subperiosteal plane, and drilling is
redundant. Therefore, operation time can be reduced up to 30% with this technique and there is no risk of
intracranial complication. The aim of the study to evaluate migration of the IRS in cochlear implantation using
subperiosteal pocket technique.
Materials and methods: This is a prospective clinical study. Between December 2012 and January 2014, 32
pediatric patients (age between 12 months and 8 years (96 months), mean±SD 27.8± 19.5 months) who
underwent cochlear implantation included the study. All the implantations were performed by two experienced
surgeons (YG, KSO) using subperiosteal pocket technique. At the planning phase of the study, the application of
cranial x-ray scanning for the evaluation of migration was considered. However, this plan was discontinued due
to concerns about children being unduly exposed to x-ray radiation. Therefore, a migration was evaluated by the
measurements between external receiver and reference points that were lateral cantus, tragus and mastoid tip.
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We measured all the distances during surgery and at 6 months of postoperative period. We accepted as
implant migration if difference between intraoperative and postoperative values in 2 or 3 different measurements
was more than 1cm. Intraoperative and postoperative values were compared by statistical analysis.
Results: Thirty-two pediatric patients were included in the study. Of these patients, 17 were female and 15 male.
There was no major or minor complication during or after the surgery. Intraoperative mean implant- lateral cantus
distance±SD was 13±1.3 in cm, mean implant- tragus ditance±SD was 8.5±0.9 in cm and mean implant-mastoid
tip distance was 8.4±1.1 in cm. At the 6th month of postoperative period, mean implant- lateral cantus
distance±SD was 13,3±0.5 in cm, mean implant- tragus ditance±SD was 8.6±0.5 in cm and mean implantmastoid tip distance was 9±0.6 in cm. There were no statistically significant differences between intraoperative
and postoperative measurements. We observed posterior implant migration of 1.5 cm in 2 cases, but they have
used the implants without any problem. There was no anterior implant migration.
Conclusion: Some authors claim that implant migration is an important drawback in subperiosteal pocket
technique. Although we have observed minimal migration in two patients (6%) in our study, no troublesome
complications were found in these patients.
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