Classification of cochlear implant complications using a modified Clavien-Dindo classification

Abstract

Objectives:

Cochlear implantation (CI) surgery is a highly effective procedure for severe to profound hearing loss, with a low complication rate. There are currently multiple grading systems for CI surgery complications, making comparison of outcomes difficult. We propose a modification to the Clavien-Dindo classification of complications, and use this modified classification to analyse our complications.

Methods:

Complications were classified as: I – Self-limiting complications requiring no treatment or simple pharmacological therapies; II – Complications requiring pharmacological interventions other than those permitted under the criteria for Grade I, or non-invasive radiological imaging; IIIa – Complications necessitating surgical, radiological or endoscopic intervention, but excluding implant explantation and/or reimplantation. IIIb – Complications necessitating implant explantation and/or reimplantation.

Results:

1053 patients were recorded as having had at least one cochlear implant inserted with 114 complications reported in 90 patients. The 114 complications were classified into the proposed classification with 18 (15.7%) as Grade I, 36 (31.5%) as Grade II, 17 (14.9%) as Grade IIIa and 43 (34.2%) as Grade IIIb.

Discussion:

We found a low complication rate, and were able to use the modified Clavien-Dindo classification system to analyse our data. We would strongly advocate for a uniform reporting system and propose this modification of a widely used system.

Keywords:

• Cochlear implant
• Complications
• Clavien-Dindo
• Surgery
• Hearing loss

Acknowledgements

We acknowledge the support received from the Southern Cochlear Implant Programme in allowing us access to their database as part of our data collection.

Disclaimer statements

Contributors None.

Conflict of interest None.

Ethics approval None.

Additional information

Funding

None.

Notes on contributors

Lara Angele Benoiton

Lara Angele Benoiton graduated from the University of Otago Medical School. She is currently a Otolaryngology Head and Neck Surgery SET Trainee with the Royal Australasian College of Surgeons and is currently based in Christchurch, New Zealand.

Alice Lilly MacLachlan

Alice Lilly MacLachlan graduated from the University of Otago Medical School in 2008 and is currently working as a resident medical officer at the Canterbury District Health Board. Her varied research interests have included the prevention of chronic postoperative pain; comparative health systems economics; cancer tissue biobanking and complications following cochlear implants.

Jill Mustard

Jill Mustard is a Speech Language Therapist and LSLS Auditory Verbal Therapist. She is the Clinical Manager at the Southern Cochlear Implant Programme in Christchurch, New Zealand.

Janitha Jayawardana

Janitha Jayawardana graduated from the University of Western Australia in 2009 and obtained a Fellowship of the Australian College of Surgeons in 2019. He obtained further fellowship training in Otology and Neurotology at the Otolaryngology Head and Neck Surgery Department in Christchurch from 2021 to 2022.

Philip Bird

Phil Bird is an Otologist, Neurotologist and Lateral Skull Base Surgeon based in Christchurch. He is a Clinical Associate Professor at the University of Otago, Christchurch and a Consultant surgeon in the Department of Otolaryngology, Head and Neck Surgery at Christchurch Hospital. His fellowship training was at the University of Miami. His current research interests include Cochlear Implantation, the inner ear effects of middle ear surgery and drug delivery to the inner ear.