title: Cochlear implant positioning in children: a survey of patient satisfaction.
abstract: BACKGROUND
  The past decade has been witness to significant diminution in incision size and placement for pediatric cochlear implantation at our institution. Furthermore, the orientation of the long axis of the implant relative to the skull base plane has generally evolved from a retro-verted to ante-verted direction to accommodate the ear level receiver stimulator and the new minimal access technique.
  
  
  OBJECTIVE
  To characterize the cosmetic, functional and clinical implications of this evolution in cochlear implant positioning by means of a patient satisfaction survey.
  
  
  METHODS
  A survey of patient satisfaction was administered to 100 cochlear implant recipients or their parents. The survey elicits the patient's level of satisfaction with respect to implant position and functional limitations. In addition, the angle formed by the long axis of the implant and the skull base plane (implant angle) was determined from lateral skull radiographs to detect the temporal evolution in implant positioning.
  
  
  RESULTS
  Analysis of the radiographs revealed an implant angle of 65.4-125 degrees in patients implanted prior to 1997, an implant angle of 56.3-87.5 degrees in patients implanted from 1997 to 2001, and an implant angle of 35.1-78.1 degrees after 2002. In spite of this evolution in positioning, the patient satisfaction survey did not reveal any change in incidence of cosmetic, functional or clinical problems.
  
  
  CONCLUSIONS
  The significant changes in incision and implant positioning represent a technical evolution in pediatric cochlear implant surgery. The fact that patients have been consistently satisfied over time suggests that the cosmetic, functional and clinical implications are minimal.
authors.affiliation: The Cochlear Implant Program, The Hospital for Sick Children, University of Toronto, 555 University Avenue, 6th Floor, Elm Wing, Ontario, Canada M5G 1X8. ps.campisi@utoronto.ca
authors.forename: P
authors.initials: P
authors.lastname: Campisi
authors.forename: A
authors.initials: A
authors.lastname: James
authors.forename: L
authors.initials: L
authors.lastname: Hayward
authors.forename: S
authors.initials: S
authors.lastname: Blaser
authors.forename: B
authors.initials: B
authors.lastname: Papsin
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D019929:Cochlear Implantation / Q000009:adverse effects / Q000379:methods* / Q000523:psychology / Q000592:standards; D005260:Female; D034381:Hearing Loss / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011859:Radiography; D012189:Retrospective Studies; D012886:Skull / Q000000981:diagnostic imaging; D011795:Surveys and Questionnaires