title: Rescuing the imperiled cochlear implant: a report of four cases.
abstract: OBJECTIVE
  To report experience with exposed cochlear implants in patients with risk factors that may contribute to flap failure.
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  University-based tertiary referral center.
  
  
  METHODS
  Four patients with exposed cochlear implants who presented with various risk factors that compromise healing.
  
  
  METHODS
  After beginning antibiotic therapy, we took steps to correct the thyroid levels and blood glucose levels when indicated. We administered hyperbaric oxygen therapy in one case. At surgery, we debrided all devitalized and infected tissue. In one case, it was necessary to obliterate the mastoid bowl and relocate the device to a different site around the ear. In all four cases, we covered the implant with well-vascularized rotation flaps.
  
  
  METHODS
  Wound healing, resolution of infection, and preservation of implant function.
  
  
  RESULTS
  In each case, the infection cleared and the implant covered. Nevertheless, one of the patients suffered implant failure 6 months after salvage surgery, and another suffered implant failure 3 years after salvage.
  
  
  CONCLUSIONS
  All exposed or infected implants need not be removed. By using sound wound handling technique and by optimizing the patient's medical status, many exposed implants can be salvaged.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical School, Dallas, Texas 75390-9035, USA. jleach@mednet.swmed.edu
authors.forename: Joseph
authors.initials: J
authors.lastname: Leach
authors.forename: Pamela
authors.initials: P
authors.lastname: Kruger
authors.forename: Peter
authors.initials: P
authors.lastname: Roland
mesh_terms: D000368:Aged; D019929:Cochlear Implantation / Q000379:methods; D003054:Cochlear Implants; D003638:Deafness / Q000601:surgery*; D003646:Debridement; D020878:Device Removal; D004567:Electrodes, Implanted; D005260:Female; D006801:Humans; D006931:Hyperbaric Oxygenation; D007223:Infant; D008297:Male; D008416:Mastoid / Q000601:surgery; D008875:Middle Aged; D009336:Necrosis; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery*; D011475:Prosthesis Failure; D012086:Reoperation; D012307:Risk Factors; D016879:Salvage Therapy / Q000379:methods; D013203:Staphylococcal Infections / Q000601:surgery; D013524:Surgical Flaps / Q000098:blood supply; D013530:Surgical Wound Infection / Q000209:etiology / Q000601:surgery*; D014945:Wound Healing / Q000502:physiology