title: 228 cases of cochlear implant receiver-stimulator placement in a tight subperiosteal pocket without fixation.
abstract: OBJECTIVE
  (1) To investigate the outcomes of cochlear implant receiver-stimulator (RS) placement using a tight subperiosteal pocket technique without device fixation and (2) to compare the efficiency of this approach with the traditional bony well and trough technique.
  
  
  METHODS
  Case series with planned chart review.
  
  
  METHODS
  Single tertiary academic referral center.
  
  
  METHODS
  All cochlear implant surgeries utilizing a tight subperiosteal pocket without additional fixation or use of a bone well were identified retrospectively. Revision cases were only included if the tight subperiosteal pocket technique was used during the initial surgery. Patients with less than 6 months of postoperative follow-up were excluded. Primary outcome measures included RS migration, flap complications, device failure, and percentage reduction in operative time.
  
  
  RESULTS
  Two hundred twenty-eight cases (average age 45.3 years) met inclusion criterion and were analyzed. At a mean follow-up of 18.1 months, no patient experienced RS migration. One patient experienced a postoperative hematoma that was managed with observation. One patient developed a surgical site infection that resolved following exploration and intravenous antibiotics. The subperiosteal pocket technique resulted in an 18.9% reduction in total operative time compared to a more conventional RS placement method (P < .01).
  
  
  CONCLUSIONS
  The tight subperiosteal pocket without fixation is a safe, durable, and time-saving technique for RS placement during cochlear implantation. Notably, device migration and flap complications are very uncommon.
authors.affiliation: The Otology Group, Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
authors.forename: Alex D
authors.initials: AD
authors.lastname: Sweeney
authors.affiliation: The Otology Group, Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Carlson
authors.affiliation: The Otology Group, Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
authors.forename: Carla V
authors.initials: CV
authors.lastname: Valenzuela
authors.affiliation: The Otology Group, Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
authors.forename: George B
authors.initials: GB
authors.lastname: Wanna
authors.affiliation: The Otology Group, Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Rivas
authors.affiliation: The Otology Group, Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
authors.forename: Marc L
authors.initials: ML
authors.lastname: Bennett
authors.affiliation: The Otology Group, Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA david.haynes@vanderbilt.edu.
authors.forename: David S
authors.initials: DS
authors.lastname: Haynes
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D019929:Cochlear Implantation / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005548:Foreign-Body Migration / Q000453:epidemiology; D006319:Hearing Loss, Sensorineural / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D013524:Surgical Flaps; D016896:Treatment Outcome; D055815:Young Adult
keywords: cochlear implant; sensorineural hearing loss; subperiosteal pocket; surgical technique; tight pocket