Mediterr J Otol 2005:1(2):94-103.

Early pediatric implantation: Cochlear implant surgery at the crossroads?

Black B., Black J., Wallwork B.
Dept. Otolaryngology, Royal Children's Hospital, Brisbane, Australia.  bruceblackmd@bigpond@com.au

OBJECTIVES: Universal neonatal screening for deafness now identifies many profoundly deaf infants at birth. Hearing aids should be fitted and in case there is no substantial progress, cochlear implantation should be considered as early as possible. This study describes a minimalist (small incision) surgical technique used in early implantation and presents the results of this application in children as early as six months old.

PATIENTS AND METHODS: Closed/minimalist surgery was undertaken via a small C-incision (pinna C-incision) on the posterior surface of the pinna, using a pericranial pocket to retain the implant body, without implant retention beds, stay sutures, head shaves and large wounds. From 1997 to 2004, 56 children were implanted, with ages from 6 months to 5 years (42 under the age of 14 months). The mean follow-up of these cases was four years and three months.

RESULTS: The minimum implantation age declined progressively from two years to the current six months. Surgical times were substantially reduced (30-40 minutes). Implant performance outcomes were normal. Minor implant body migration occurred in 4%, but without functional impact. There were no other major complications.

CONCLUSION: Implantation of the very small infant is best achieved by minimalist, atraumatic surgery. The surgery is also applicable and recommended for the older patient. The results suggest that some surgical complications may be due in part to the larger incision methods that are currently widely used. Modified implant designs and skilled associated services are also desirable.