title: Low pediatric cochlear implant failure rate: contributing factors in large-volume practice.
abstract: OBJECTIVE
  To evaluate the rate of cochlear implant (CI) failure and CI reimplantation (CIri) in our population of children receiving implants by means of a technique that includes device fixation with suture to cortical bone.
  
  
  METHODS
  Retrospective analysis from January 1990 to June 2010.
  
  
  METHODS
  Tertiary pediatric hospital.
  
  
  METHODS
  A total of 971 devices were provided to 738 children (5575 implant-years).
  
  
  METHODS
  Cochlear implant explants and CIri.
  
  
  METHODS
  Surgical findings at CIri were assessed by device model. The Pediatric Ranked Order Speech Perception score and the Phonetically Balanced Kindergarten score were used to make comparisons of hearing ability before and after CIri.
  
  
  RESULTS
  Thirty-four patients have undergone CIri in our pediatric center during the past 20 years. Excluding 7 of these patients who received their initial implant at other centers, our rate of CIri was 2.9%. Mean (SD) time to device failure was 61 (43) months. A disproportionately high number of patients (7 of 35 [20%]) requiring CIri had meningitis before implantation. After CIri, children maintained or improved their best speech performance measured before device failure, with only 2 children showing a significant reduction in speech perception after CIri.
  
  
  CONCLUSIONS
  A very low rate of failure occurs in children who receive CI devices, and several factors may account for this low rate. Children who develop meningitis before CI appear to be at an increased risk of device failure.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Toronto, 190 Elizabeth St, Toronto, Ontario, Canada. antoine.eskander@utoronto.ca
authors.forename: Antoine
authors.initials: A
authors.lastname: Eskander
authors.forename: Karen A
authors.initials: KA
authors.lastname: Gordon
authors.forename: Latif
authors.initials: L
authors.lastname: Kadhim
authors.forename: Vicky
authors.initials: V
authors.lastname: Papaioannou
authors.forename: Sharon L
authors.initials: SL
authors.lastname: Cushing
authors.forename: Adrian L
authors.initials: AL
authors.lastname: James
authors.forename: Blake C
authors.initials: BC
authors.lastname: Papsin
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003054:Cochlear Implants / Q000706:statistics & numerical data*; D003638:Deafness / Q000151:congenital / Q000534:rehabilitation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D008297:Male; D009864:Ontario; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012092:Replantation; D012189:Retrospective Studies; D012307:Risk Factors; D013069:Speech Reception Threshold Test; D055815:Young Adult