Minimal access cochlear implant fixation: Temporalis pocket with a plate

OBJECTIVE: Minimal access approaches for cochlear implants have recently gained popularity, offering a smaller incision and minimal hair shave. The current generation of thinner internal receiver stimulators is adaptable for these approaches. However, conventional bony fixation of the internal receiver stimulator is difficult through this limited exposure, and some minimal access techniques rely on soft tissue fixation only. Inadequate fixation can result in device migration, extrusion, and electrode migration. We compare wound complications and electrode migration for a group undergoing conventional exposure and device fixation using a bone well and sutures with a group undergoing minimal access with plate fixation. STUDY DESIGN: Retrospective case review. SETTING: Tertiary referral center. PATIENTS: Adults and children undergoing primary cochlear implant surgery using either technique. INTERVENTION(S): Therapeutic. MAIN OUTCOME MEASURE(S): Wound complications including device exposure or extrusion, electrode migration, wound breakdown, abscess, or cellulitis. RESULTS: There were 193 implants in the conventional group and 103 in the minimal access with plate group. The conventional group experienced an overall complication rate of 3.6%, and the minimal access with plate group experienced an overall complication rate of 2%. Major complications occurred in 1% of patients in either group. There were no incidents of device migration, extrusion, or electrode migration in either group. CONCLUSION: Cochlear implant surgery using the minimal access with plate fixation results in a similar wound complication rate as the conventional approach.