title: Cochlear implant fixation using a subperiosteal tight pocket without either suture or bone-recess technique.
abstract: OBJECTIVE
  To assess the complication and migration rates associated with the fixation of cochlear implant receiver-stimulators using a subperiosteal tight pocket without either suture fixation or bone recession.
  
  
  METHODS
  Dual-institution retrospective case review.
  
  
  METHODS
  A retrospective case review was conducted at two tertiary referral centers. All patients who underwent cochlear implantation with device fixation using a subperiosteal tight pocket without suturing over the device or recessing of the receiver stimulator in bone were identified. There was a minimum follow-up period of 6 months. Outcome measures included intraoperative and postoperative complications, including evidence of device migration associated with interference with external device use or the need for revision surgery. Other outcome measures included soft tissue flap complications.
  
  
  RESULTS
  Sixty-two patients were identified with a mean age of 39 years, (range 1.5-5 years). The average follow-up period was 32.6 months (range 6-120 months). Device manufacturers included Cochlear Corporation (Denver, CO) (n=44), MED-EL (Durham, NC) (n=12), and Advanced Bionics (Valencia, CA) (n=6). There were no associated intraoperative complications related to subperiosteal pocket fixation of the receiver stimulator, and no cases of migration were identified.
  
  
  CONCLUSIONS
  Fixation of the cochlear implant receiver stimulator using a subperiosteal tight pocket without either suture fixation or bone recession has been demonstrated to be feasible across a range of patient demographics and cochlear implant devices. This method of fixation appears to allow for an efficient and minimally invasive approach without compromising patient safety or device performance.
  
  
  METHODS
  4.
authors.affiliation: Department of Otolaryngology, University of Miami Miller School of Medicine (D.J., G.A.C., F.F.T.), Miami, Florida.
authors.forename: Daniel
authors.initials: D
authors.lastname: Jethanamest
authors.forename: Guyan A
authors.initials: GA
authors.lastname: Channer
authors.forename: William J
authors.initials: WJ
authors.lastname: Moss
authors.forename: Lawrence R
authors.initials: LR
authors.lastname: Lustig
authors.forename: Fred F
authors.initials: FF
authors.lastname: Telischi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003054:Cochlear Implants; D003638:Deafness / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D010521:Periosteum / Q000601:surgery*; D012189:Retrospective Studies; D013536:Suture Techniques / Q000295:instrumentation*; D013537:Sutures; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Cochlear implant; fixation; minimal access; subperiosteal; surgical technique; temporalis pocket