Bilateral simultaneous cochlear implantation is a safe method of hearing rehabilitation in adults

Abstract

Purpose: Bilateral cochlear implantation is an effective treatment for patients with bilateral profound hearing loss. In contrast to children, adults mostly choose a sequential surgery. This study addresses whether simultaneous bilateral CI is associated with higher rates of complications compared to sequential implantation.

Methods: 169 bilateral CI surgeries were analyzed retrospectively. 34 of the patients were implanted simultaneously (group 1), whereas 135 patients were implanted sequentially (group 2). The duration of surgery, the incidence of minor and major complications and the duration of hospitalization of both groups were compared.

Results: In group 1, the total operating room time was significantly shorter. The incidences of minor and major surgical complications showed no statistically significant differences. A fatal non-surgical complication in group 1 was particularly extensively reappraised without evidence of a causal relationship to the chosen mode of care. The duration of hospitalization was 0.7 days longer than in unilateral implantation but 2.8 days shorter than the combined two hospital stays in group 2.

Conclusion: In the synopsis of all considered complications and complication-relevant factors, equivalence of simultaneous and sequential cochlear implantation in adults in terms of safety was found. However, potential side effects related to longer surgical time in simultaneous surgery must be considered individually. Careful patient selection with special consideration to existing comorbidities and preoperative anesthesiologic evaluation is essential.

Keywords: Adults; Bilateral cochlear implant; Complication; Sequential; Simultaneous; Total operating room time.

Fig. 1

Duration of surgery in simultaneous (group 1) and sequential (group 2) bilateral cochlear implantation. The patients in group 2 are differentiated according to the two consecutive procedures on both sides (seq₁ and seq₂) and as an overall view (seq₁₊₂). The mean value ± standard deviation of the surgical time, the setup time and the total operative room time (TORT) are shown. Statistically significant differences are marked with * (p < 0.05) and ** (p < 0.01) (ø = no difference)

Fig. 2

Incidences of minor (1–6) and major complications (A–C) in both groups. Arrow marks on the right margin indicate comparative values for the total complication rate from the literature. The differences between the two groups are not statistically significant

Fig. 3

Cumulative incidence of minor and major complications over the course of the first 5 postoperative years of follow-up. 6% of major complications occured after the fifth year of follow-up

Fig. 4

Duration of hospitalization. Mean ± standard deviation of the number of postoperative days of both groups. Statistically significant differences are marked with * (p < 0.05) and ** (p < 0.01) (ø = no difference)

Fig. 5

Comparison of the TORT of the present work (black marker: mean ± standard deviation) with the results of other authors (white markers: mean values) for the forms of care unilateral/sequential (circles, ⓵ = seq1, ⓶ = seq2), cumulative sequential bilateral (triangle) or simultaneous bilateral (diamond)