Problems in cochlear implant surgery

In cochlear implant surgery, major complications, requiring revision procedures, do not exceed 5% of cases reported. Less frequent are problems that call for specific technical solutions. In 44 multichannel implantations (out of 54 cases) adverse conditions occurred and were successfully resolved in 6 patients: 1) delayed wound breakdown (one case); 2) chronic otitis media (three cases); 3) cochlear obliteration (two cases). Problem 1 was managed with the excision of an ellipse of skin including the devitalized areas under local anesthesia. The electronic package was left untouched, and the freshly cutaneous edges were mobilized and layer-sutured. Problem 2 was solved through a two-stage procedure. The chronic ear was dealt with as usual (myringoplasty, tympanoplasty, revision of a radical mastoidectomy). In the second stage the cochleotomy and device implantation were carried out. Problem 3 is a major issue for the surgeon. Following the Lehnhardt technique we drilled along the basal cochlear turn using the sharp line between the yellowish otic bone and the white newly formed bone as a landmark, until a patent s.tympani was found at the ascending part of the 1st or at the beginning of the 2nd turn.