Risk factors and management strategies of inadvertent facial nerve stimulation in cochlear implant recipients: A systematic review

Abstract

ObjectivesTo systematically review the prevalence and risk factors of inadvertent facial nerve stimulation (FNS) after cochlear implant (CI) surgery. And to report the different management strategies used for reducing and resolving FNS.Data SourceWeb of Science, Scopus, PubMed, Cochrane Library, and Virtual Health Library (VHL) of the World Health Organization (WHO).Review MethodsA systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analysis (PRISMA) on studies that reported FNS as a complication after CI. A comprehensive electronic search strategy was used to identify the relevant articles. We extracted the data on the prevalence of FNS after CI activation, the reported grades, and the management strategies. The number of associated electrodes; cause of deafness; co‐anomalies; and duration of hearing loss and their relationships with FNS were also studied.ResultsTwenty‐one relevant articles were included in this review. The prevalence of FNS among the CI populations was 5.29% (175/3306 patients). Among those whose ages were reported, 58.3% (95/163) were adults, and 41.7% (68/163) were pediatrics. Modifying the different fitting parameters was the most used strategy, as it successfully resolved FNS in 85.5% of the patients (142/166). The second commonly used management strategy was surgical intervention (reimplantation or explantation), which was reported in seven studies for 23 patients.ConclusionFNS after CI activation could be controlled and resolved with many advances that range from readjusting the fitting parameters to surgical intervention. However, further studies are required to validate the efficacy of each management strategy and its impact on patients' performance. Our findings demonstrate that CI recipients with FNS could still benefit from the CI devices and their FNS could be controlled.

Cochlear implant electrode design for safe and effective treatment

“…All these reports reveal that FNS can occur with any electrode type, although its incidence is relatively lower with the perimodiolar electrode type. A recent systematic review by Alahmadi et al ( 67 ) reports that modifying different fitting parameters successfully resolved FNS in 85.5% of the patients. Tri-phasic pulse stimulation in the MED-EL system ( 68 ) and pseudo-monophasic stimulation ( 69 ) in the Oticon system are typical examples of new fitting parameters that can minimize FNS.…”