Cochlear reimplantation in the same ear: Findings, peculiarities of the surgical technique and complications
Reimplantación coclear en el mismo oído: hallazgos, peculiaridades de la técnica quirúrgica y complicaciones
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The surgical cochlear reimplantation technique is not substantially different from the initial implantation but does have some peculiarities. These distinctive features are analysed in this paper not only from the point of view of surgical technique but also with respect to the complications involved and the functional auditory outcome obtained.</p> <span class="elsevierStyleSectionTitle">Objectives</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">An accurate description of the surgical findings, peculiarities of the surgical technique and complications found during the process of cochlear reimplantation. An evaluation of the audiometric functional outcome of the reimplantation.</p> <span class="elsevierStyleSectionTitle">Materials and method</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A descriptive retrospective review of 34 reimplantations in the same ear, carried out at our department during the period between 1993 and 2008, in 27 patients in a tertiary hospital by the same team of senior surgeons. The cochlear implants replaced were 2 Ineraid<span class="elsevierStyleSup">®</span> (Smith & Nephew Richards, TN), 23 Laura<span class="elsevierStyleSup">®</span> (Philips Hearing Implants), 8 nucleus 24K<span class="elsevierStyleSup">®</span> (Cochlear Corp., Englewood, CO) and 1 Clarion<span class="elsevierStyleSup">®</span> (Advanced Bionics, Sylmar, CA).</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The rate of reimplantation in the same ear was 18.5% per patient. The most frequent reason in our series was internal failure of the device (14 cases). Other causes were substitution for a technological update (7 cases), misplacement of electrodes (8 cases), necrosis/infection of the skin flap with exposure of the implant (3 cases) and external injuries (2 cases). The most important surgical findings were partial mastoidectomy reossification, absence of ossification in the posterior tympanostomy and the permeability of the basal turn of the cochlea when it housed the electrodes. Complete reintroduction of the electrodes was achieved in 25 patients and partial reintroduction in 2 patients. The rate of complications generated was similar in reimplantation and in virgin ear implantation, except for when the original implant was an Ineraid<span class="elsevierStyleSup">®</span> device.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The surgical technique for reimplantation and multireimplantation has characteristic peculiarities at each step. However, in general terms, its complexity is similar to that of implantation in virgin ears and the rate of complications is also similar. The introduction of the new electrodes is simple and complete in the immense majority of cases, given that the cochlea remains permeable, as long as it houses the electrodes; otherwise it tends to become reossified. The functional auditory outcome of the new implant is in relation with its capacities. If these are equal to those of the initial implant, then the auditory outcome will be similar; if they are better, then so will the outcome be. One exception is ears with long periods of auditory deprivation.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Introducción</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Los implantes cocleares son, por diversos motivos, dispositivos electrónicos perecederos y, en ocasiones, han de reemplazarse. La técnica quirúrgica de reimplantación coclear, si bien no difiere substancialmente de la implantación virgen, sí tiene unas peculiaridades características. En este artículo se analizan estas peculiaridades, no sólo desde el punto de vista técnico, sino también respecto a las complicaciones que genera y el rendimiento funcional auditivo que consigue.</p> <span class="elsevierStyleSectionTitle">Objetivos</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Descripción detallada de los hallazgos operatorios, las peculiaridades de la técnica quirúrgica y las complicaciones generadas en el proceso de reimplantación coclear. Evaluación del rendimiento auditivo funcional del paciente reimplantado.</p> <span class="elsevierStyleSectionTitle">Material y método</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Revisión descriptiva retrospectiva de 34 reimplantaciones en el mismo oído, realizadas en nuestro servicio durante el periodo entre 1993 y 2008 en 27 pacientes en un hospital terciario por el mismo equipo de cirujanos. Los implantes reemplazados fueron 2 Ineraid<span class="elsevierStyleSup">®</span> (Smith & Nephew Richards), 23 Laura<span class="elsevierStyleSup">®</span> (Philips Hearing Implants), 8 Nucleus 24K<span class="elsevierStyleSup">®</span> (Cochlear Corp.) y un Clarion<span class="elsevierStyleSup">®</span> (Advanced Bionics).</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">La tasa de reimplantación por paciente en el mismo oído fue del 18,5%. La causa más frecuente de reimplantación en nuestra serie fue el fallo interno del implante (14 casos). Otras causas fueron la substitución por actualización tecnológica (7 casos), malposición del haz de electrodos (8 casos), necrosis/infección del colgajo cutáneo con exposición del implante (3 casos) y por último traumatismos externos (2 casos). Los hallazgos operatorios más significativos fueron la reosificación parcial de la mastoidectomía, la ausencia de osificación de la timpanotomía posterior y la permeabilidad de la espira basal de la cóclea cuando esta alojaba el haz de electrodos. En 25 pacientes, se consiguió una reintroducción completa del haz de electrodos y en 2 pacientes una introducción parcial. La tasa de complicaciones generadas fueron, tanto cuantitativamente como cualitativamente, comparables a la tasa de implantación en el oído virgen, salvo cuando el implante original fue del tipo Ineraid<span class="elsevierStyleSup">®</span>.</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">La técnica quirúrgica de reimplantación y de multirreimplantación tiene peculiaridades específicas en cada uno de sus pasos, pero, en términos generales, tiene una complejidad parecida a la implantación de oídos vírgenes y se asocia a una tasa de complicaciones similar. La introducción del nuevo haz de electrodos es sencilla y completa en la inmensa mayoría de los casos, dado que la cóclea permanece permeable, siempre y cuando aloje al haz de electrodos; en caso contrario, tiene tendencia a reosificarse. El rendimiento auditivo esperable del nuevo implante está en consonancia con sus prestaciones. Si son iguales a las del implante substituido, el rendimiento auditivo del implantado es similar, y si son mejores, también lo es su rendimiento, excepto en oídos con grandes periodos de deprivación auditiva.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:23 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Analysis of the cochlear implant as a treatment technique for profound hearing loss in pre- and postlocutive patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. Manrique" 1 => "C. Morera" 2 => "M.J. Lavilla" 3 => "F.J. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 October | 0 | 19 | 19 |
| 2024 September | 0 | 12 | 12 |
| 2024 August | 0 | 7 | 7 |
| 2024 July | 0 | 4 | 4 |
| 2024 June | 0 | 8 | 8 |
| 2024 May | 0 | 1 | 1 |
| 2024 April | 0 | 11 | 11 |
| 2024 March | 0 | 13 | 13 |
| 2024 February | 0 | 1 | 1 |
| 2024 January | 0 | 3 | 3 |
| 2023 December | 0 | 6 | 6 |
| 2023 November | 0 | 15 | 15 |
| 2023 October | 0 | 6 | 6 |
| 2023 September | 0 | 14 | 14 |
| 2023 August | 0 | 7 | 7 |
| 2023 July | 0 | 9 | 9 |
| 2023 June | 0 | 8 | 8 |
| 2023 May | 0 | 8 | 8 |
| 2023 April | 0 | 12 | 12 |
| 2023 March | 1 | 15 | 16 |
| 2023 February | 0 | 7 | 7 |
| 2023 January | 0 | 8 | 8 |
| 2022 December | 0 | 8 | 8 |
| 2022 November | 0 | 14 | 14 |
| 2022 October | 0 | 11 | 11 |
| 2022 September | 0 | 12 | 12 |
| 2022 August | 0 | 3 | 3 |
| 2022 July | 0 | 2 | 2 |
| 2022 June | 0 | 9 | 9 |
| 2022 May | 0 | 3 | 3 |
| 2022 April | 0 | 4 | 4 |
| 2022 March | 0 | 18 | 18 |
| 2022 February | 0 | 7 | 7 |
| 2022 January | 0 | 10 | 10 |
| 2021 December | 0 | 13 | 13 |
| 2021 November | 0 | 17 | 17 |
| 2021 October | 0 | 12 | 12 |
| 2021 September | 0 | 6 | 6 |
| 2021 August | 0 | 3 | 3 |
| 2021 July | 0 | 4 | 4 |
| 2021 June | 0 | 1 | 1 |
| 2021 May | 0 | 3 | 3 |
| 2021 April | 0 | 1 | 1 |
| 2021 March | 0 | 1 | 1 |
| 2021 February | 0 | 4 | 4 |
| 2021 January | 0 | 1 | 1 |
| 2020 December | 0 | 2 | 2 |
| 2020 November | 0 | 1 | 1 |
| 2020 August | 0 | 1 | 1 |
| 2020 June | 0 | 3 | 3 |
| 2020 May | 0 | 4 | 4 |
| 2020 April | 0 | 1 | 1 |
| 2020 March | 2 | 2 | 4 |
| 2020 February | 3 | 13 | 16 |
| 2020 January | 2 | 11 | 13 |
| 2019 December | 7 | 8 | 15 |
| 2019 November | 6 | 11 | 17 |
| 2019 October | 3 | 6 | 9 |
| 2019 September | 1 | 2 | 3 |
| 2019 August | 2 | 5 | 7 |
| 2019 July | 17 | 32 | 49 |
| 2019 June | 16 | 30 | 46 |
| 2019 May | 95 | 78 | 173 |
| 2019 April | 24 | 38 | 62 |
| 2019 March | 1 | 2 | 3 |
| 2019 February | 3 | 16 | 19 |
| 2019 January | 1 | 5 | 6 |
| 2018 December | 0 | 17 | 17 |
| 2018 November | 4 | 3 | 7 |
| 2018 October | 9 | 13 | 22 |
| 2018 July | 0 | 1 | 1 |
| 2018 April | 0 | 8 | 8 |
| 2018 February | 4 | 4 | 8 |
| 2018 January | 0 | 1 | 1 |
| 2017 December | 0 | 1 | 1 |
| 2017 November | 1 | 2 | 3 |
| 2017 October | 6 | 3 | 9 |
| 2017 September | 5 | 6 | 11 |
| 2017 August | 4 | 8 | 12 |
| 2017 July | 6 | 0 | 6 |
| 2017 June | 3 | 1 | 4 |
| 2017 May | 7 | 5 | 12 |
| 2017 April | 5 | 32 | 37 |
| 2017 March | 9 | 7 | 16 |
| 2017 February | 4 | 0 | 4 |
| 2017 January | 2 | 0 | 2 |
| 2016 December | 3 | 2 | 5 |
| 2016 November | 13 | 2 | 15 |
| 2016 October | 3 | 0 | 3 |
| 2016 September | 4 | 1 | 5 |
| 2016 August | 5 | 0 | 5 |
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