Rescuing the imperiled cochlear implant: a report of four cases.
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.
Leach
Joseph
J
Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical School, Dallas, Texas 75390-9035, USA. jleach@mednet.swmed.edu
Kruger
Pamela
P
Roland
Peter
P
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