Soft Tissue Complications After Small Incision Pediatric Cochlear Implantation

Objectives/Hypothesis: To report and analyze the soft tissue complications of 462 consecutive cochlear implants using a minimal access approach at a single institution. Study Design: A retrospective case series analysis was performed. Methods: A database of all patients implanted at our institution between January 2002 and December 2007 was searched, and 385 consecutive patients were identified. Posteochlear implantation notes and case records were searched for soft tissue complications. Soft tissue complications were divided into minor and major complications. All devices were implanted using a minimal access technique with device fixation in all but five patients. Results: There were 385 consecutive children implanted with 462 cochlear implants. Of these, 322 were primary single-sided implants, 124 bilateral implants, and 16 reimplants for device failure. Median follow up was 2.9 years. There were two minor complications: one minor seroma and one postoperative hematoma, both were managed conservatively. There were five major complications: two soft tissue infections, one extrusion, and two major seromas leading to device migration. Four of the five major complications involved loss of device fixation. Three out of the five major complications required device explantation; the decision not to reimplant was made in two cases. Conclusions: An overall soft tissue complication rate of 1.51% (7/462) at our institution supports the use of a small incision technique combined with device fixation as a safe method of cochlear implantation. We believe that good fixation is especially important in pediatric implantation, because of the thinner soft tissue envelope and increased frequency of minor head trauma.