Revision Cochlear Implant Surgery in Children: The Johns Hopkins Experience

Objective: To assess the efficacy of revision cochlear implantation (RCI) and to identify clinical and device-related factors predictive of RCI outcome. Study Design: Retrospective case series with attempted correlation to ex vivo device analysis. Setting: Academic tertiary referral center. Patients: Children (<18 yr) who underwent RCI in a tertiary-care center. Intervention: Revision cochlear implantation with multichannel cochlear implant. Main Outcome Measures: Open-set speech perception testing and subjective report by child, family, teacher, or therapist; patient report of symptom resolution. Results: During the 15-year period, 13% of pediatric CI surgeries were revised (at an average of 3.4 yr after initial operation). Hard failures (42%), suspected device failure (29%), and extracochlear electrodes (16%) were the most common indications for RCI. Most hard and suspected device failure cases (n = 37; 84%) reported a return to previous peak performance within 18 months of RCI. Previous peak performance was more likely to be achieved or exceeded in younger than in older children. A decline in speech perception was a stronger predictor of successful outcome (100%) than chronic under-performance (57%) among children with suspected device failure. Preoperative integrity testing was only moderately predictive of functional results or findings at ex vivo device analysis. Conclusion: Revision cochlear implantation should be considered when longitudinal clinical assessment reveals an unfavorable trajectory in the development of receptive communication skills. Device testing provides important, but not definitive, supporting data. Revision cochlear implantation as guided by device and patient factors can exert a positive impact on access to verbal language and therefore its development. A delay to act can have lasting negative consequences because benefits seem to diminish with age.