Pain After Cochlear Implantation Without Signs of Inflammation: A Systematic Review

Abstract

Objectives: This review summarizes current evidence on causes and management strategies for delayed pain post-cochlear implantation (CI) surgery, without clinical evidence of inflammation or infection. Methods: The systematic review was undertaken in line with Preferred Reporting Items for Systematic review and Meta-Analysis Protocols 2015 guidelines. A literature search was undertaken, with inclusion of patients who underwent CI and presented with delayed pain (>3 months post-operatively) around their device site without an identifiable cause. Analysis was undertaken using MATLAB (MathWorks, Natick, MA) and the R-software package (www.r-project.org). Results: 4 articles (48 patients), all retrospective case series, met inclusion criteria. The mean onset of pain post-CI was 60 months and mean follow-up was 15.8 months, there was no difference in the prevalence of pain between device brands (p=0.13). The majority (90%) did not have any hearing deterioration, and investigations did not reveal a cause for the pain in any of the patients. In terms of management, medical therapies, including oral therapy (analgesia, non-steroidal anti-inflammatories, antibiotics) and local treatments (topical, injections) resolved pain in 41% and 63%, respectively. Surgical intervention (explantation, magnet replacement, tympanic neurectomy), where undertaken, resolved pain in 100%. A minority had an identifiable infective microorganism cultured from intra-operative soft tissue or biofilm samples. Conclusions: Evidence for the causes and management of delayed pain post-CI without clinical evidence of inflammation is scarce. A stepwise approach is deemed best, with decisions being made on an individual basis, evaluating each patient's specific circumstances and priorities. Further evaluation of explanted devices would allow for better understanding of the causes and treatment of this group of patients.

Multimodal Analysis of the Tissue Response to a Bone-Anchored Hearing Implant: Presentation of a Two-Year Case Report of a Patient With Recurrent Pain, Inflammation, and Infection, Including a Systematic Literature Review

“…In reviewing the literature on causes and management strategies for delayed pain post cochlear implantation (CI) surgery, without clinical evidence of inflammation or infection, it was found that oral therapy (analgesia, nonsteroidal anti-inflammatories, antibiotics) and local treatments (topical, injections) resolved pain in 41% and 63% of patients, respectively. A total of 33% of patients in this review required explantation of the device, with complete resolution of pain in all of these patients (Sethi et al, 2020). Additionally, for the patient described in the present case report, the pain diminished at the first follow-up visit after implant removal.…”

Rates of Delayed Postcochlear Implant Pain in the Pediatric Population—Role of Proactive Approach

“…For this purpose, the authors set checkpoints for up to 5 years after surgery. Considering the work by Sethi et al (9), which showed that the mean time from CI to the onset of pain was 5 years, it is possible that our rates may reflect an underestimation of general DPCIP. The study has two additional main limitations: First, as in other studies on children, the pain evaluation is based on the parental reports regarding their children's pain, rather than direct reports from the children, which may have altered the true prevalence.…”

“…They suggested that pain, unrelated to stimulation or usage, should be considered a major complication, given that half of their cases became temporary non-users, and some underwent reimplantation. In a recent meta-analysis conducted by Sethi et al (9), it was found that the mean time from CI to the onset of pain was 60 months (both adults and children). In all patients, physical examination was documented as unremarkable, and mostly without hearing deterioration.…”

Pain at the Cochlear Implant Site Requiring Device Removal in Pediatric Patients

“…22,23 A recent review and meta-analysis showed that conservative treatment using medical therapy was successful in treating pain in 41% of patients. 24 However, device replacement was effective in 100% of patients. In the current study, we focused on individuals who underwent explantation with the goal of determining an underlying cause of pain.…”

“…A recent review and meta‐analysis showed that conservative treatment using medical therapy was successful in treating pain in 41% of patients 24 . However, device replacement was effective in 100% of patients.…”