Revision Cochlear Implant Dr Y Hui, Dr D Au Advances in Deafness Management Conference and Workshops...
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Transcript of Revision Cochlear Implant Dr Y Hui, Dr D Au Advances in Deafness Management Conference and Workshops...
Revision Cochlear Implant
Dr Y Hui, Dr D Au
Advances in Deafness ManagementConference and Workshops
9 Oct 2005Hong Kong
Experience from QMH 1989 – 2005 18 patients required surgery for
revision Children (<12) - 9 Teenager (13-19) - 4 Adult (>20) - 5
Time interval: 5m to 7yrs (mean 4 yrs)
Reason (n=18) Primary Device failure 15 Electrode extrusion 1 Infection 1 Trauma 1
Presentation Sudden deterioration in hearing Often preceded by periods of
malfunction
Audiologist called for immediate assessment.
ENT assessment Otoscopy Implant site Plain XR
Confirm the Dx Audiologist from the manufacturer
to confirm the diagnosis
What are the issues
1. Financial cost (currently a 10 year warranty)
2. The need for another surgery (approach Avoidance conflict)
3. Intervening period of deafness – affect work/school
4. Will the new implant fail soon?
Approach Diagnosis convey to patient Revision Surgery ASAP or at a time
convenient to patient.
Surgery Audiologist from manufacturer
Old incision New bone over the electrode &/or
the receiver No new bone over the posterior
tympanotomy No post-op complication
Infection with Staph Epidermidis
Revision as a result of trauma
Revision as a result of trauma
Post-op mapping Easier to perform Prior experience with mapping Eager to make to sure the new
implant is functioning well If this is an upgraded model, they
want to find out the difference.
Discussion We tell the patient of such
possibility before the operation Some patients anticipate this as an
inevitable event in the future. See this as an opportunity to
upgrade
Discussion Revision surgery may become
more common Primary failure may reduce Voluntary decision to replace old
model with a more advance one.
Results1015202530354045505560657075808590
250 500 1000 2000 4000 Hz
So
un
d P
ress
ure
Le
vel
Initial After revision
Speech Perception (9 Adult)
Word Vowel
Consonant
Sentence
Tone
Initial (%)
66.9 74.3 82.1 86.3 60.1
Post Revision (%)
63.4 78.6 78.7 84.2 64.3
Speech Perception (7 Children) No significant difference in Ling’s 7
Sounds, vowel, consonant and sentences tests
Thank You