Rescuing the imperiled cochlear implant: A report of four cases

Objective: To report experience with exposed cochlear implants in patients with risk factors that may contribute to flap failure. Study Design: Retrospective review. Setting: University-based tertiary referral center. Patients: Four patients with exposed cochlear implants who presented with various risk factors that compromise healing. Intervention: After beginning antibiotic therapy, we took steps to correct the thyroid levels and blood glucose levels when indicated. We administered hyperbaric oxygen therapy in one case. At surgery, we debrided all devitalized and infected tissue. In one case, it was necessary to obliterate the mastoid bowl and relocate the device to a different site around the ear. In all four cases, we covered the implant with well-vascularized rotation flaps. Main Outcome Measures: Wound healing, resolution of infection, and preservation of implant function. Results: In each case, the infection cleared and the implant covered. Nevertheless, one of the patients suffered implant failure 6 months after salvage surgery, and another suffered implant failure 3 years after salvage. Conclusion: All exposed or infected implants need not be removed. By using sound wound handling technique and by optimizing the patient's medical status, many exposed implants can be salvaged.