Changes in Revision Cochlear Implantation and Device Failure Profiles
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Objectives. As cochlear implantation (CI) experiences rapid innovations and its indications expand, the characteristics ofrevision CI (RCI) are evolving. This study investigated changes in the RCI profile and explored their clinical implica-tions. Methods. A retrospective chart review was conducted of all CIs performed at a tertiary medical institution between Octo-ber 2001 and January 2023. The rates of and reasons for RCI were evaluated in relation to the manufacturer and de-vice model. Kaplan-Meier analysis was employed to examine cumulative and device survival curves. Cumulative anddevice survival rates were additionally analyzed based on age group, period of primary CI, and manufacturer. A Coxproportional hazards model was employed to evaluate the association between RCI and the device manufacturer. Results. Among 1,430 CIs, 73 (5.1%) required RCI. The predominant reason for RCI was device failure (40 of 73 RCIs[54.8%]), with an overall device failure rate of 2.8%. This was followed by flap-associated problems and migration(nine of 73 RCIs each [12.3%]). Flap retention issues emerged as a new cause in three cases (two involving the CI632 and one involving the SYNCHRONY 2 implant), and six instances of electrode tip fold-over arose (four for theCI 600 series and two for the CI 500 series). The overall 10-year cumulative and device survival rates were 93.4%and 95.8%, respectively. After excluding models with recall issues, significant differences in cumulative (P =0.010)and device (P =0.001) survival rates were observed across manufacturers. Conclusion. While the overall CI survival rate is stable, device failure persists as the predominant reason for RCI. Moreover,the types of complications leading to revision (including issues with flap retention and electrode tip fold-over) haveshifted, particularly for newer implant models. Given the clinical importance of device failure and subsequent reop-eration, clinicians should remain informed about and responsive to these trends.
Abstract
Objectives. As cochlear implantation (CI) experiences rapid innovations and its indications expand, the characteristics ofrevision CI (RCI) are evolving. This study investigated changes in the RCI profile and explored their clinical implica-tions. Methods. A retrospective chart review was conducted of all CIs performed at a tertiary medical institution between Octo-ber 2001 and January 2023. The rates of and reasons for RCI were evaluated in relation to the manufacturer and de-vice model. Kaplan-Meier analysis was employed to examine cumulative and device survival curves. Cumulative anddevice survival rates were additionally analyzed based on age group, period of primary CI, and manufacturer. A Coxproportional hazards model was employed to evaluate the association between RCI and the device manufacturer. Results. Among 1,430 CIs, 73 (5.1%) required RCI. The predominant reason for RCI was device failure (40 of 73 RCIs[54.8%]), with an overall device failure rate of 2.8%. This was followed by flap-associated problems and migration(nine of 73 RCIs each [12.3%]). Flap retention issues emerged as a new cause in three cases (two involving the CI632 and one involving the SYNCHRONY 2 implant), and six instances of electrode tip fold-over arose (four for theCI 600 series and two for the CI 500 series). The overall 10-year cumulative and device survival rates were 93.4%and 95.8%, respectively. After excluding models with recall issues, significant differences in cumulative (P =0.010)and device (P =0.001) survival rates were observed across manufacturers. Conclusion. While the overall CI survival rate is stable, device failure persists as the predominant reason for RCI. Moreover,the types of complications leading to revision (including issues with flap retention and electrode tip fold-over) haveshifted, particularly for newer implant models. Given the clinical importance of device failure and subsequent reop-eration, clinicians should remain informed about and responsive to these trends.
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