title: Fixation methods in pediatric cochlear implants: retrospective review of an evolution of 3 techniques.
abstract: OBJECTIVE
  To review 3 techniques of cochlear implant (CI) fixation used by a single surgeon for the fixation of 320 consecutive CIs in a pediatric population and associated complications.
  
  
  METHODS
  Case series with chart review.
  
  
  METHODS
  Tertiary referral children's hospital.
  
  
  METHODS
  Patients receiving CIs between July 1995 and July 2009 were reviewed. Clinical information obtained included age at implant, implant type, duration of follow-up, method of implant fixation (intraosseous suture ligature, prolene mesh with titanium screws, and a small periosteal pocket with periosteal sutures), and postoperative complications of fixation (migration or extrusion).
  
  
  RESULTS
  Three hundred twenty consecutive CIs were reviewed: 64 of which were bilateral (42 staged, 22 concurrent). The median age at implantation was 3.6 years (range, 8 months to 20 years). Manufacturers included Cochlear (223) and Advanced Bionics Corporation (97). Median follow-up was 26 months (range, 1 month to 12.7 years). The intraosseous suture ligation method of fixation was used for 182 CIs. Ninety-eight CIs were fixed using a small piece of polypropylene mesh and titanium screws. Forty implants were secured by using a tight periosteal pocket and placing the suture through the periosteum and soft tissue to collar the receiver in a modified well. No complications of device migration or extrusion were noted, nor were there any intracranial complications. Device failure occurred in 13 (4%) patients requiring explantation and reimplantation, but these were unrelated to surgical technique or fixation.
  
  
  CONCLUSIONS
  This study illustrates that with an evolution toward less invasive and less complex methods of fixation, there has not been an associated increase in fixation-related complications.
authors.affiliation: Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Alabama, USA.
authors.forename: Nathan S
authors.initials: NS
authors.lastname: Alexander
authors.forename: Eric
authors.initials: E
authors.lastname: Caron
authors.forename: Audie L
authors.initials: AL
authors.lastname: Woolley
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D019929:Cochlear Implantation / Q000379:methods*; D006801:Humans; D007223:Infant; D012189:Retrospective Studies; D053441:Suture Anchors; D055815:Young Adult