Cochlear implant complications in a low-income area of Brazil

Castro, Gabriel Reis; Santiago, Hágada Cristine Coelho; Aguiar, Rosauro Rodrigues de; Almeida, Ana Beatriz Gouveia de; Oliveira, Leonardo Santana Ramos; Gurgel, Ricardo Queiroz

doi:10.1590/1806-9282.20210924

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Revista da Associação Médica Brasileira

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Original Article • Rev. Assoc. Med. Bras. 68 (5) • May 2022 • https://doi.org/10.1590/1806-9282.20210924 copy

Cochlear implant complications in a low-income area of Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

SUMMARY

OBJECTIVE:

The primary objective was to analyze and report on the complications that occurred in the cochlear implant surgeries performed at a large philanthropic teaching hospital located in a low-income area of Brazil.

METHODS:

A historical cohort study that analyzed surgical records of 432 patients of all age groups and both genders who received unilateral cochlear implant in a tertiary referral center that serves only Brazil's Public Health Care System patients, from February 2009 to December 2017.

RESULTS:

A total of 67 (15.5%) complications occurred in the cochlear implant surgeries, with 21 (5.4%) major complications. Minor complications occurred in 50 (12%) cases. The most frequent major complication was receiver-stimulator displacement (four cases). There were three cases of hardware failure. Only one case of meningitis and one case of facial nerve paralysis (grade VI in House-Brackmann scale) were found. Six patients needed to be explanted due to a major complication. The relative risk of major complications in the population aged 60 years and older was 4.41 (1.53–12.72; 95% confidence interval [CI]).

CONCLUSIONS:

Elderly patients suffered more complications than younger patients. receiver-stimulator displacement and dizziness were the most frequent complications (major and minor, respectively). The overall complication rates were comparable to those in the literature. Age as an isolated risk factor for complications in cochlear implant surgery is a path to be explored in future observations.

KEYWORDS:
Otolaryngology; Cochlear implants; Postoperative complications

			n	%
Age
	Age group, year
		<2	20	4.6
		2–5	132	30.6
		5–18	109	25.2
		18–59	145	33.6
		>59	26	6.0
	Gender
		Female	224	51.9
		Male	208	48.1
	Implant brand
		Advanced bionics (USA)	196	45.4
		Med-el (Austria)	211	48.8
		Cochlear (Australia)	18	4.2
		Oticon (Denmark)	7	1.6
	Complication
		Yes	67	15.5
		No	365	84.5
	MAJOR complication
		Yes	21	5.4
		No	365	94.6
	MINOR complication
		Yes	50	12.0
		No	365	88.0
	Time elapsed from surgery to complication
		<30 days	17	25.4
		1–3 months	5	7.5
		3–12 months	15	22.4
		1–5 years	27	40.3
		>5 years	3	4.5

Age (year)	Major complication	Time from surgery to complication	Treatment	Outcome
3	Cholesteatoma	Over 5 years	Mastoidectomy	Complication resolved
57	Cholesteatoma	Over 5 years	On schedule for re-operation	In progress
12	Electrode array extrusion	9 months	Re-operation	Complication resolved
73	Electrode migration	26 months	Patient lost follow up	Patient lost follow-up
7	Electrode migration	7 months	Re-operation	Complication resolved
80	Electrode misplacement	4 months	Re-operation	Complication resolved
3	Electrode misplacement	15 months	Re-operation	Complication resolved
60	External ear canal erosion and tympanic membrane perforation	11 months	Tympanoplasty	Complication resolved
67	Facial paralysis	Immediate	Re-operation	Facial paralysis HB VI
6	Hardware failure	36 months	Internal component replacement	Complication resolved
4	Hardware failure after head injury	6 months	Internal component replacement	Complication resolved
3	Hardware failure after head injury and poor adaptation	30 months	Explant	Explant
16	Headache	<30 days	Explant	Explant
2	Receiver-stimulator extrusion	16 months	Explant and contralateral implant	Explant
65	Receiver-stimulator displacement	48 months	On schedule for re-operation	In progress
42	Receiver-stimulator displacement	22 months	On schedule for re-operation	In progress
3	Receiver-stimulator displacement	24 months	On schedule for re-operation	In progress
33	Receiver-stimulator displacement	27 months	Re-operation	Complication resolved
5	Meningitis	51 months	Explant	Explant
30	Poor outcome	25 months	Explant	Explant
3	Skin infection after insect sting	27 months	Explant and contralateral implant	Explant

Major complications		Yes	No	p-value	RR (95%CI)	p-value
Age,Median (IQR)		12.2 (3.9–58.7)	7 (3.8–32.3)	0.166 ^W
Age group, year, n (%)
	<2	0 (0) ^a a,b Different subgroups at the 5% level for the Z-test for proportions with Bonferroni correction. RR: relative risk. 95%CI:95% confidence interval. ,^b a,b Different subgroups at the 5% level for the Z-test for proportions with Bonferroni correction. RR: relative risk. 95%CI:95% confidence interval.	18 (100)	0.012 ^C
	2–5	7 (5.6)^b a,b Different subgroups at the 5% level for the Z-test for proportions with Bonferroni correction. RR: relative risk. 95%CI:95% confidence interval.	117 (94.4)		1
	5–18	5 (5)^a a,b Different subgroups at the 5% level for the Z-test for proportions with Bonferroni correction. RR: relative risk. 95%CI:95% confidence interval. ,^b a,b Different subgroups at the 5% level for the Z-test for proportions with Bonferroni correction. RR: relative risk. 95%CI:95% confidence interval.	96 (95)		1.00 (0.33–3.07)	0.994
	18–59	4 (3.3)^b a,b Different subgroups at the 5% level for the Z-test for proportions with Bonferroni correction. RR: relative risk. 95%CI:95% confidence interval.	116 (96.7)		0.68 (0.20–2.25)	0.524
	>59	5 (21.7)^a a,b Different subgroups at the 5% level for the Z-test for proportions with Bonferroni correction. RR: relative risk. 95%CI:95% confidence interval.	18 (78.3)		4.41 (1.53–12.72)	0.006
Gender, n (%)
	Female	12 (6)	187 (94)	0.658 ^F
	Male	9 (4.8)	178 (95.2)

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[1] *Corresponding author: gabrielreiscastro@gmail.com