title: Safety of Cochlear Implants in Electrosurgery: A Systematic Review of the Literature.
abstract: BACKGROUND
  The implications of electrosurgical instrument use in patients with cochlear implants (CIs) are becoming increasingly relevant for dermatologic surgeons as the number of implanted CI devices continues to grow. The literature, however, fails to provide clear recommendations for appropriate treatment of these patients.
  
  
  OBJECTIVE
  To systematically consolidate and critique the current literature regarding electrosurgical instrument use in patients with CI, to determine implications of various electrosurgical devices and settings on CI function and health of cochlear tissues, and to devise recommendations for appropriate use.
  
  
  METHODS
  The manuscript was created based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. A broad search of PubMed, Access Medicine, Clinical Key, Ovid, Scopus, the Cochrane Library, and Web of Science was performed using key words such as CI, electrosurgery, and/or electrosurgical device. Criteria for inclusion included being written in English language and institutional access to manuscript. All years were included. Additional references were obtained from personal communication with CI manufacturers. Study biases were assessed through evaluation of funding and/or sponsoring agencies for included studies.
  
  
  RESULTS
  The authors' search yielded a total of 8 studies, 5 of which were a level of evidence 5, 2 of which were level of evidence 4, and 1 of which was a level of evidence 3. The remaining study was relegated only to device testing. These studies were complicated by inaccurate terminology and inconsistent recommendations.
  
  
  CONCLUSIONS
  The body of evidence evaluating electrosurgical instrument use in patients with CI is severely limited in number and quality. Thus, vague and inconsistent recommendations have emerged that place patients at risk of serious and costly adverse effects. In light of this, the authors suggest use of the most conservative recommendations available for electrosurgical instrument use in patients with CI.
authors.affiliation: *Department of Dermatology, Keck Medicine of USC, Los Angeles, California; †Department of Dermatology, Tina and Rick Caruso Department of Otolaryngology-Head and Neck Surgery, Keck Medicine of USC, Los Angeles, California.
authors.forename: James
authors.initials: J
authors.lastname: Behan
authors.forename: Shauna
authors.initials: S
authors.lastname: Higgins
authors.forename: Ashley
authors.initials: A
authors.lastname: Wysong
mesh_terms: D003054:Cochlear Implants / Q000009:adverse effects; D004598:Electrosurgery / Q000295:instrumentation*; D006801:Humans; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D017410:Practice Guidelines as Topic; D012449:Safety