ABSTRACT
INTRODUCTION: Due to the increasing number of cochlear implant (CI) recipients, growing indications, and the aging population, the reimplantation of CI recipients has become a focus of attention. The aim of this study is to examine the causes, timing, and postoperative speech understanding in a large cohort over the past 30 years. METHODS: A retrospective data analysis was conducted on over 4000 CI recipients and 214 reimplanted children and adults from 1993 to 2020. This involved collecting and comparing data on causes, manufacturer information, and demographic data. In addition, a comparison of speech understanding in Freiburg monosyllables and numbers before and after reimplantation was carried out. RESULTS: Children did not exhibit elevated rates of reimplantation. The overall reimplantation rate in the entire cohort was 5%. The CI overall survival rate after 10 years in the entire cohort was 95.2%. Device failure was the most common reason for reimplantation, with 48% occurring within the first 5 years after implantation. The second most common reason was medical complications, with the risk of reimplantation decreasing as more time passed since the initial implantation. There were no significant differences in Freiburg numbers and monosyllable comprehension before and after reimplantation, both in the overall cohort and in the subcohorts based on indications. Even a technical upgrade did not result in a significant improvement in speech understanding. DISCUSSION: There was no significant difference in the frequency of reimplantation based on patient age, especially when comparing children and adults. Device failure is by far the most common indication for reimplantation, with no significant difference in implant survival between manufacturers. Patients most often choose the same manufacturer for reimplantation. The likelihood of reimplantation decreases with increasing time since the initial implantation. The indication for reimplantation should be carefully considered, as on average, no improved speech understanding is achieved, regardless of the cause, even with a technical upgrade.
ABSTRACT
OBJECTIVE: Due to increasing indication for cochlear implantation (CI), reimplantation and technical upgrades their consequences are a special focus in CI surgery research. The aim of this study is to examine the indication and influences on both morphological position of the electrode array and audiological outcome following reimplantation. DESIGN: This is a retrospective analysis of adult CI patients reimplanted between 2004 and 2019. We evaluated the scalar position in pre- and postoperative cone beam computed tomography (CBCT) after CI and reimplantation and examined the indication for and the audiological outcome following reimplantation. RESULTS: The reimplanted patients showed stable and comparable audiological results for monosyllables and numbers for best fitted situation before and following reimplantation. Technical upgrades did not result in a significant improvement of speech perception. CBCT scans of reimplanted ears did not show significant increased rates of scalar dislocation or partial insertion. CONCLUSION: Even with a technical upgrade, reimplantation does not improve speech perception outcome in CI patients. Therefore, the indication to reimplant should be approved critically. Reimplantation does not lead to a significantly increased risk for partial insertion, scalar dislocation or diminished electrode array insertion angle.
