title: Cochlear implant failures and revision.
abstract: OBJECTIVE
  To review cases involving implant failure and revision surgery in a large cochlear implant program.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  Cochlear implant program in an academic medical center.
  
  
  METHODS
  Adults and children who underwent revision cochlear implantation (n = 58).
  
  
  METHODS
  Diagnosis and explantation of failed cochlear implants, with subsequent reimplantation. Assessment of implant function and speech perception.
  
  
  METHODS
  Device type, time from implantation to revision, cause of failure, performance with original implant versus revision, number of electrodes placed, and surgical challenges related to reimplantation.
  
  
  RESULTS
  Forty-five patients initially implanted at this program and 13 patients implanted elsewhere underwent revision surgery. The institutional device failure rate was 3.7% and the overall revision rate was 5.1%. Reasons for implant revision included documented internal device failure (46%), scalp flap complications (17%), optimization of electrode placement (13%), unexplained deterioration of performance (12%), technology upgrade (10%), and intratemporal pathology (3%). Revision surgery typically involved only minor anatomic challenges, but five patients required circumodiolar drillout procedures to improve electrode position. Electrode insertion was equal or deeper in 53 of 58 cases. Speech perception ability decreased in only three patients.
  
  
  CONCLUSIONS
  Management of implant failures and performance of revision surgery are becoming increasingly important in cochlear implant programs. Outcomes are generally excellent. Revision implantation is a safe and appropriate procedure that should be pursued in a timely fashion when patients experience cochlear implant failure.
authors: Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical Center, Ann Arbor, Michigan 48109, USA. aadon@umich.edu
authors: Amy-Anne Donatelli
authors: AA
authors: Lassig
authors: Teresa A
authors: TA
authors: Zwolan
authors: Steven A
authors: SA
authors: Telian
mesh_terms: D000328:Adult; D002648:Child; D002675:Child, Preschool; D003054:Cochlear Implants; D005260:Female; D034381:Hearing Loss / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D011475:Prosthesis Failure; D012086:Reoperation; D012189:Retrospective Studies; D013067:Speech Perception