Revision Cochlear Implant Surgery: Rates and an Expanded Approach for Classification

Doron Sagiv ^1,2 Yifat Yaar Soffer ^3,4 Ziva Yakir ³ Michael Wolf ^1,2 Yael Henkin ^3,4 Yisgav Shapira ^1,2

¹The Department of Otolaryngology-Head and Neck Surgery, Sheba Medical Center, Tel Hashomer
²Sackler Faculty of Medicine, Tel Aviv University
³Hearing, Speech, and Language Center, Sheba Medical Center, Tel Hashomer
⁴Department of Communication Disorders, Sackler Faculty of Medicine, Tel Aviv University

Background: Revision cochlear implant (RCI) surgery has become a major load in many large cochlear implant (CI) programs. The traditional categories for RCI are not precise enough to distinguish between the different indications.

Objective: The goals of the current study were to quantify RCI rates and to examine RCI indications using a new approach for classification.

Method: We reviewed the medical records of all patients that underwent RCIs since the initiation of the Sheba CI program in 1989 through 2016. Data extracted included background variables, surgical reports, medical follow-up, and audiological evaluations.

Results: During the study period, 1,299 CI surgeries in 890 patients were performed (65% children, 35% adults). Of these, 153 surgeries (11.8%) in 134 patients (78% children, 22% adults) were RCI. The indications for RCI were classified into the four traditional categories – device failure (41% soft, 24% hard), medical (7%), and surgical (6.5%), with the addition of two new categories – pain (11%) and trauma (9%). RCI surgery was accomplished in 98% of cases.

Conclusion: The Sheba RCI rate is similar to previously reported rates. As pain and trauma amounted to 20% of RCI, we suggest an expanded classification approach including these two distinct categories.