Objective: The purpose of this study is to retrospectively review the complications of patients who underwent cochlear implantation at 51 hospitals in mainland China over a decade. Methods: A retrospective analysis of 1,237 patients who underwent cochlear implantation from February 1998 to December 2008. The patients were reviewed for demographic information, type of hearing loss, abnormal findings on temporal CT scans, cochlear implant device, procedure time, and complications that included meningitis, hematoma (intracranial and extracranial), wound infection and implant extrusion, cerebrospinal fluid leak and facial palsy. Results: A total of 1,237 patient records were identified, and pertinent clinical information was reviewed. Of the patients, 59.6% were male, and 98.9% were prelingually deaf. The most common etiologies of hearing loss were: ototoxicity (28.1%), non-syndromic congenital hearing loss (14.8%), and inner ear malformation (18.5%). Inner ear malformations included: enlarged vestibular aqueduct (9.4%), Mondini defect (5.4%), common cavity (2.8%), cochlear ossification (3.9%), round window dysplasia (0.4%), and narrow internal auditory meatus (1.2%). The most common intraoperative complications were: gusher (5%) and electrode kinking (2.3%). The most common postoperative complications were hematoma (1.7%), wound infection and implant extrusion (0.5%), and device failure (0.9%). No CSF leakage or permanent facial palsy occurred. Conclusions: Cochlear implantation is a safe and reliable otosurgical procedure in China, and the rate of complications is similar to developed countries. Carefully preoperative preparation and standardization of the procedure are important for the development of cochlear implant programs in developing countries.
The facial recess approach was used in 3 patients with CC malformation with an incomplete basal turn, and the transmastoid single-slit labyrinthotomy approach in 18 patients with classic CC malformation. After follow-up for 36 months, the average free-field hearing threshold was higher, and the scores for the CAP, SIR, IT-MAIS, and closed-set/open-set auditory speech perception tests were lower than in the control group (p < 0.05).
Among the 39 cases, the narrowest distance between the facial nerve and the chorda tympani nerve was less than 1.0 mm. All patients successfully underwent cochlear implantation surgery. No injuries of the facial nerve, chorda tympani nerve, or the posterior wall of the auditory canal were reported in any of the patients. There were significant differences in the injuries of the facial nerve, chorda tympani nerve, and posterior wall of the auditory canal in these cases compared with previous approaches to this operation.
Among the 422 cases, 134 (30%) suffered from the complication of CSF gusher during the operation. They were all found to have a bony defect in the fundus of the internal acoustic meatus on the CT scans.
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