title: Surgical outcomes with subperiosteal pocket technique for cochlear implantation in very young children.
abstract: OBJECTIVE
  As data continue to emerge demonstrating improved hearing outcomes associated with younger age at time of cochlear implantation, more children aged 12 months or younger are undergoing this procedure. Drilling a well to house the cochlear implant receiver/stimulator (R/S) may carry an increased risk in this group of patients as the calvarium is thin and drilling an adequate well may require exposure of the underlying dura. Our group has employed a technique in this age group which involves securing the R/S in a subperiosteal pocket without creating a bony well. We report our experience with six infants 12 months of age or younger undergoing cochlear implantation with the subperiosteal pocket technique.
  
  
  METHODS
  Cases were identified by searching an IRB approved research registry. Charts were reviewed for demographics, surgical technique, and clinical outcomes. Descriptive statistics were calculated.
  
  
  RESULTS
  Six patients 12 months of age or younger underwent cochlear implantation over a one year period. Simultaneous bilateral implantation was performed in all cases, for a total of 12 implanted ears. The average age at time of implantation was 9.8 months (SD 2.1 months). There were no postoperative wound complications. No evidence of device migration was noted in any patient as of the most recent follow-up appointment. There was one device hard failure at 32 months. Average length of follow-up was 28.4 months (SD 13.8 months).
  
  
  CONCLUSIONS
  No wound complications or device migrations occurred in 12 cochlear implantations in six children aged 12 months or younger. Advantages of this technique include no risk to the dura in this location, smaller incisions, and shorter surgical time. A potential disadvantage is the increased device profile from the lack of a well. New thinner implant designs may minimize this concern. Further prospective study is justified to confirm our initial experience in this small group.
authors: Department of Otology and Laryngology, Harvard Medical School, United States. Electronic address: michael_cohen@meei.harvard.edu.
authors: Michael S
authors: MS
authors: Cohen
authors: The Warren Alpert Medical School, Brown University, United States.
authors: Austin Y
authors: AY
authors: Ha
authors: Department of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of UPMC, United States.
authors: Dennis J
authors: DJ
authors: Kitsko
authors: Department of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of UPMC, United States.
authors: David H
authors: DH
authors: Chi
mesh_terms: D019929:Cochlear Implantation / Q000009:adverse effects / Q000379:methods*; D003054:Cochlear Implants; D003638:Deafness / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D011183:Postoperative Complications
keywords: Cochlear implants; Hearing loss; Pediatrics