Cochlear implantation has become a safe procedure-and, as result of refinements in devices and surgical techniques, complications are atypical. The major complication to be feared is meningitis, which is rare but potentially fatal. Other complications include device breakdown, flap breakdown, and local reactions at the site of implant, and these are manageable, agreed experts interviewed for this article. Although not all otolaryngologists perform cochlear implant surgery, it is important that all otolaryngologists be aware of the possible complications from this type of surgery.
Explore This IssueAugust 2007
Most surgeons think it is advisable to refer a patient who presents with a complication in the implanted ear to the original treating surgeon. Otolaryngologists are the gatekeepers of ear care. When faced with a problem from a cochlear implant, an otolaryngologist should not hesitate for one minute to call upon the surgeon who did the implant. Cochlear implant surgeons have a lifelong commitment to their patients, and the surgeon who did the procedure will be aware of unique issues related to that patient, stated Cliff Megerian, MD, Professor of Otolaryngology and Medical Director of the Cochlear Implant Program at University Hospitals of Cleveland and Case Western Reserve University School of Medicine in Cleveland, OH.
For any surgical complication, the patient should be referred back to the surgeon. Each surgeon differs a bit in technique, and the surgeon is the only person who is aware of unique patient factors, agreed Gerard J. Gianoli, MD, a neurotologist in private practice in Baton Rouge, LA, and Clinical Associate Professor of Otolaryngology and Pediatrics at Tulane University in New Orleans, LA.
Although it would be preferable, it is not always geographically feasible to refer patients back to the original surgeon, however, noted Samuel Levine, MD, Professor of Otolaryngology at the University of Minnesota in Minneapolis. He said that there are instances when patients have moved far away from the institution where they received a cochlear implant, and it is possible for the next surgeon to manage complications.
Complications Rare-But Meningitis Can Be Lethal
Dr. Megerian said that the lion’s share of cochlear implants are performed by a handful of about 100 otolaryngologists in the United States. In his experience, complications are extremely rare. Dr. Gianoli said that although he performs only a few of these procedures each year, he has not seen any serious complications.
Meningitis, although rare, is an important exception. Although meningitis has been shown to occur in fewer than one of every 1000 patients who receive the implant, it can be life-threatening. Meningitis related to the implant can occur anywhere from one day to many years after surgery, Dr. Megerian said.