Ultrasound in Diagnosis of Magnet Dislocation of Cochlear Implants: A Retrospective Study in Patients With Surgical Magnet Repositioning and Preinterventional Ultrasound Examination

Rupp, Robin; Hornung, Joachim; Balk, Matthias; Hoppe, Ulrich; Iro, Heinrich; Gostian, Antoniu‐Oreste

doi:10.1097/mao.0000000000002752

Cited by 7 publications

(12 citation statements)

References 23 publications

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“…28 Recently, the diagnostic ultrasound has been utilized as one of the diagnostic tools for identifying magnet dislocation. 29 Once the diagnosis of magnet dislocation has been proven, most cases would require surgical repositioning or replacement of the magnet. A literature search revealed that the procedure can be conducted under general anesthesia or local anesthesia.…”

Section: Discussionmentioning

confidence: 99%

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Magnet and receiver-stimulator displacement after cochlear implantation

Alahmadi

Alenzi

Alsheikh

et al. 2021

SMJ

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To systematically review the occurrence of magnet or receiver/stimulator displacement following cochlear implant (CI) placement complication and evaluate the existing literature on this topic. Methods: A systematic literature search was conducted using PubMed, Scopus, Web of Science, Virtual Health Library (VHL), and Cochrane Library. Original studies reporting cases of magnet or receiver-stimulator migration occurring as a complication after CI placement were included. The quality of the included studies was evaluated using the National Institutes of Health Quality Assessment Tool for observational studies and CARE checklist for case studies. Systematic ReviewResults: A total of 36 studies, including 6469 patients, were included. Magnet migration was reported in 82 (1.3%) patients, while receiver/stimulator was reported in 4 (0.1%) cases. The cause of magnet migration was identified in 78 cases; MRI-induced movement was the most frequently reported cause (n=43, 55.1%), followed by head trauma (n=25, 32.1%). A total of 20 studies involving 35 patients with magnet migration performed skull radiography to diagnose magnet migration. Revision/exploratory surgery with surgical repositioning or replacement was the most frequent management procedure (n=46).Conclusions: Further research on magnet pocket design and standard protocols for MRI in CI users is needed. Early diagnosis of magnet migration and instant referral to specialized CI centers is necessary for proper management and prevention of major complications.

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Section: Discussionmentioning

confidence: 99%

“… 28 Recently, the diagnostic ultrasound has been utilized as one of the diagnostic tools for identifying magnet dislocation. 29 …”

Section: Discussionmentioning

confidence: 99%

Magnet and receiver-stimulator displacement after cochlear implantation

Alahmadi

Alenzi

Alsheikh

et al. 2021

SMJ

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“…Even in the latest CIs that are MRI-compatible, the magnet of the RS and the implant itself produce an artifact that impedes the proper assessment of the implant area [27]. In this regard, transcutaneous ultrasound is a valuable imaging modality that avoids radiation exposure and has been described for the diagnostic workup of haematoma around the CI and for detecting magnet dislocation [16][17][18]. However, the literature on the feasibility and reliability of ultrasound in other CI complications has so far been limited to a few case reports [13,19,20].…”

Section: Discussionmentioning

confidence: 99%

“…This imaging modality has been described in the diagnosis of Robin Rupp and Vivian Thimsen contributed equally to the study. haematoma around the CI and dislocation of the internal CI magnet [16][17][18]. However, data on the use of ultrasound in other complications are rare and consist of case reports only [13,19,20].…”

Section: Introductionmentioning

confidence: 99%

Diagnosing complications following cochlear implantation using transcutaneous ultrasound

Rupp

Thimsen

Balk

et al. 2021

Eur Arch Otorhinolaryngol

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Purpose The aim of this study was to investigate the feasibility and reliability of transcutaneous ultrasound for the detection of complications after cochlear implantation. Methods In a single center retrospective cohort study, 115 consecutive cases of suspected complications after cochlear implantation (intervention group) were examined. The rate of pathologic ultrasound findings for specific leading symptoms and diagnoses was compared to a control group comprising twenty consecutive cochlear implants in symptom-free patients. Results Diagnostic ultrasound showed distinctly more pathologic findings in the intervention group (n = 67; 58.3%; p < 0.001) compared to the control group (n = 1; 5%). Ultrasound revealed significantly more pathologic findings in haematoma or seroma around the implant (n = 17; 100%; p < 0.001; ϕ = 0.94) and magnet dislocation (n = 44; 97.7%; p < 0.001; ϕ = 0.92) confirmed by a strong effect. Ultrasound examination showed a medium to high effect size in patients presenting with local infections (n = 3; 21.4%; p = 0.283; ϕ = 0.25) and skin flap oedema (n = 2; 50%; p = 0.061; ϕ = 0.51). In contrast, ultrasound examinations displayed a low effect size in undefined cephalgia (0%; p = 0.444; ϕ = 0.17) and device malfunction or failure (0%; p > 0.999; ϕ = 0.13). Conclusion Transcutaneous ultrasound can be advocated as a feasible and effective method in the diagnostic work-up of magnet dislocation and haematoma or seroma around the implant following cochlear implantation. Contrary, ultrasound findings can be expected to be inconspicuous in patients presenting with undefined cephalgia and device malfunction or failure.

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“…However, for people with thick scalps, or in cases of suspected mild displacement, an oblique plain film x-ray, or use of ultrasound may be used to clarify magnet seating (Fig. 3) (8,11). It is worth noting that some devices with removeable magnets are subject to silicone magnet housing fatigue and small tears that may occur during past magnet removal, which heightens risk of future magnet displacement.…”

Section: Methodsmentioning

confidence: 99%

Magnetic Resonance Imaging in Patients with Cochlear Implants without Magnet Removal: A Radiology-Administered Protocol to Enhance Operational Efficiency and Improve Workflow

Johnson,

Macielak,

Watson

et al. 2023

Otol Neurotol

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Objective To describe the development, implementation, and validation of a radiology-administered protocol to obtain magnetic resonance imaging (MRI) in patients with cochlear implants and auditory brainstem implants without magnet removal. Study Design Retrospective review and description of novel care pathway. Methods A radiology-administered protocol was designed based on careful input from the radiology safety committee and neurotology. Radiology technologist training modules, consent instructions, patient educational material, clinical audits, and other safeguards were implemented, with samples provided in this report. The primary outcomes measured included instances of magnet displacement during MRI and premature termination of MRI studies secondary to pain. Results Between June 19, 2018, and October 12, 2021, 301 implanted ears underwent MRI without magnet removal, including 153 devices housing diametric MRI-conditional magnets, and 148 implants with conventional axial (i.e., nondiametric) magnets. Among cases with diametric MRI-conditional magnets, all studies were completed without magnet dislodgement or need to terminate imaging early due to pain. Among cases with conventional axial (nondiametric) magnets, 29 (19.6%) MRI studies were stopped prematurely secondary to pain or discomfort; the overall rate of this event was 9.6% (29 of 301) among the entire study cohort. In addition, 6.1% (9 of 148) experienced confirmed magnet displacement despite headwrap placement; the overall rate among all cases was 3.0% (9 of 301). Eight of these patients received successful external magnet reseating through manual pressure on the external scalp without surgery, and one required surgical replacement of the magnet in the operating room. There were no documented instances of hematoma, infection, device or magnet extrusion, internal device movement (i.e., gross receiver-stimulator migration), or device malfunction in this cohort related to MRI. Conclusions We present the successful implementation of a radiology-administered protocol designed to streamline care for cochlear implant and auditory brainstem implant recipients who require MRI and ease clinical demands for otolaryngology providers. Examples of resources developed, including a process map, radiology training modules, consent instructions, patient educational materials, clinical audit, and other procedural safety measures are provided so interested groups may consider adapting and implementing related measures according to need.

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Ultrasound in Diagnosis of Magnet Dislocation of Cochlear Implants: A Retrospective Study in Patients With Surgical Magnet Repositioning and Preinterventional Ultrasound Examination

Cited by 7 publications

References 23 publications

Magnet and receiver-stimulator displacement after cochlear implantation

Magnet and receiver-stimulator displacement after cochlear implantation

Diagnosing complications following cochlear implantation using transcutaneous ultrasound

Magnetic Resonance Imaging in Patients with Cochlear Implants without Magnet Removal: A Radiology-Administered Protocol to Enhance Operational Efficiency and Improve Workflow

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