Complication profile in a cochlear implantation- surgical audit in a large study population of low socio-economic status in a developing country

Abstract

Objectives

To audit surgical complications and their management in cochlear implant (CI) recipients in a tertiary care referral otorhinolaryngology center in South India.

Materials and methods

Hospital data on 1,250 CI surgeries performed from June 2013 to December 2020 was reviewed. This is an analytical study with data collected from medical records. The demographic details, complications, management protocols and relevant literature were reviewed. Patients were divided into the following five age groups: 0–3 years, 3–6 years, 6–13 years, 13–18 years and above 18 years. Complications were divided into major and minor and complication occurrence was divided into peri-operative, early post-operative, and late post-operative, and the results were analyzed.

Results

The overall major complication rate was 9.04% (including 6.0% due to device failure). If the device failure rate was excluded, the major complication rate was 3.04%. The minor complication rate was 6%.

Discussion

CI is the gold standard in the management of patients with severe to profound hearing loss with minimal benefit from conventional hearing aids. Experienced tertiary care CI referral and teaching centers manage complicated implantation cases. Such centers typically audit their surgical complications, providing important reference data for young implant surgeons and newer centers.

Conclusion

Although not bereft of complications, the list of complications and its prevalence is sufficiently low to warrant the advocacy of CI worldwide, including developing countries with low socio-economic status.

Keywords:

• Cochlear implantation
• Complication
• Major
• Minor
• Management
• Surgical audit

Acknowledgements

We thank all the implanted patients and their families who trusted and stood with the implant team during times of complications and their management.

Disclaimer statements

Contributors: None.

Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Conflict of interests: None.

Ethics approval: Ethics approval was received from Institute's ethics committee.

Additional information

Notes on contributors

Sunil Mathews

Dr Sunil Mathews did his fellowship in implantation Otology and Neurotology at Madras ENT Research Foundation, Chennai, Tamil Nadu, India. He is presently appointed as Associate Professor at Institute of Naval Medicine, INHS Asvini, Colaba, Mumbai, India. He has completed his MS and DNB in ENT from the Armed Forces Medical College, Pune, India and was awarded the Lt Col D N Mehta Memorial Silver Medal for the best graduating student in the specialty. His interests are in the fields of otology, implantation otology, neurotolgy, endoscopic sinus surgery, facial plastics and microlaryngeal surgeries. He was a member of teaching faculty for undergraduate and post-graduate teaching at the Armed Forces Medical College, Pune India and was part of the team of instructors for hands-on training on temporal bone dissection and head and neck cadaveric dissection courses. He has won first prizes for paper and poster presentations in various National ENT conferences and has published papers in national and international journals.

K. Karthikeyan

Dr K. Karthikeyan is an Assistant professor at PSG Institute of Medical Sciences and Research, Coimbatore. He completed his Diploma in ENT from Madras Medical College, Chennai. He completed his DNB in 2008 from Madras ENT Research Foundation as the All India Gold Medalist and was awarded the Dr. S. Kameswaran Gold Medal. He is a life member of many learned associations. His fields of interest are Endoscopic Skull Base Surgery, Endoscopic Sinus Surgery and Microscopic Ear Surgeries. He has attended various national and state conferences and presented papers in scientific sessions. He has published papers in reputed journals.

Senthil Vadivu Arumugam

Dr Senthil Vadivu Arumugam is a Consultant ENT surgeon at Madras ENT Research Foundation (MERF) and she is in-charge of the Cochlear Implant clinic at MERF and is also the Cochlear Implant coordinator for Tamil Nadu Chief Minister's Comprehensive Health Insurance Scheme. She has completed her DNB in 2008. She is a life member of many learned associations and has published papers in reputed international journals. She has an active interest in research and statistical analysis. She is also part of an ongoing clinical study on genetic association in children with congenital hearing loss. She has attended various national and international conferences and presented papers in scientific sessions and won awards. She was a Joint Secretary for the first National Conference on Snoring and Sleep Apnoea, Chennai, February 2013 and Joint Treasurer for the First National Convention of the Indian Academy of Otorhinolaryngology and Head and Neck Surgery. She was invited as a guest speaker in the 4th International Conference on Clinical & Experimental Cardiology (Cardiology-2014), San Antonio, USA in April 2014. She has many publications in national and international reputed journals.

Rahul Kurkure

Dr Rahul Kurkure is an ENT Surgeon with qualification such as MBBS and MS(ENT) from the prestigious Armed Forces Medical College, Pune in 2013 and also did his DNB(ENT) in 2014 from NBE. He finished his Fellowship of 2 years in Neurotology from Madras ENT Research Foundation, Chennai under the guidance and mentorship of Prof Mohan Kameswaran from 2017 to 2019. Presently he is working as an Assistant Professor in the Army College of Medical Sciences and Base Hospital Delhi Cantt, New Delhi. He is a member of various professional bodies like AOI, IAOHNS, CIGI and ISO. He also has various publications in national and international journals.

Vijaya Krishnan Paramasivan

Dr Vijaya Krishnan Pramasivan is a Consultant ENT surgeon at Madras ENT Research Foundation and part of the teaching faculty in MERF Institute of Speech and Hearing. He completed his DNB in 2007. His interest is in the field of Sleep Disorders and Obstructive Sleep Apnoea and had training at Euro Sleep Clinic, Bergen, Norway. He is the only Indian member of the International Scientific Committee of the World Congress on Sleep Medicine. He is the Founding Secretary of IASSA, IAOHNS and ISFARO. He conducted the sixty-third Annual National Conference of Otolaryngologists of India, First National Conference on Snoring and Sleep Disorders, and First National Convention of the Indian Academy of Otorhinolaryngology and Head and Neck Surgery. He has conducted instructional courses on Sleep Apnoea at the International Federation of Otorhinolaryngology IFOS2013, Korea and in the 5th International World Sleep Congress at Valencia, Spain. He was an instructor for hands on training and cadaver dissection course for OSA at Singapore General Hospital. He has been an invited faculty member in panel discussions and delivered guest lectures in various national and international conferences. He is the reviewer for international journals like the International Journal of Pediatric Otorhinolaryngology and is an Editorial Board member of Austin's International Journal of Sleep Disorders.

Mohan Kameswaran

Professor Mohan Kameswaran is the Senior Consultant of Madras ENT Research Foundation and Honorary Senior Lecturer, Edge Hill University, Ormskirk, Lancashire, UK. He was awarded Padma Shri (2006) and Dr B.C. Roy Award (2008) by the Presidents of India. He was awarded ‘Indo-Australian Award’ by the Indo-Australian Association, ‘Award for Excellence of Service’ (2006) for pioneering Cochlear Implant Program in Sri Lanka. He is the only Indian elected as a Member of the Governing Body-Asia-Pacific Cochlear Implant Board, in 2007. He has been elected as a Member, Executive Board, IFOS, Brazil and has been elected Board Member of the Politzer Society (London, 2009). He was the President of APSCI. He is the first Indian Otologist to be appointed as a Visiting Professor in Otology (2015) by JLO and the Royal Society of Medicine, UK. He is one of the pioneers of Cochlear Implant Surgery in India and has Mentored Cochlear Implant surgery in 32 centers in India, and in 7 centers overseas. He is the first surgeon in South and South East Asia to have performed ABI and the first Paediatric ABI in Asia, in 2009. He is also the first surgeon in Asia Pacific region to have performed the Totally Implantable Hearing Device surgery. He is a Fellow of the Royal College of Surgeons (Edinburgh) and Fellow of the International College of Surgeons. He is also a designated overseas Clinical Tutor of the Royal College of Surgeons (Edinburgh). He is also the Founding President of the Cochlear Implant Group of India.