Delayed Complications After Cochlear Implantation

作者：Terry Bradford; Kelt Rachel E; Jeyakumar Anita^*

来源：JAMA Otolaryngology-Head & Neck Surgery, 2015, 141(11): 1012-1017.

DOI：10.1001/jamaoto.2015.2154

IMPORTANCE Surgeons should understand the potential long-term complications in patients who undergo cochlear implantation (CI) and should be able to facilitate counseling.
OBJECTIVES To review the delayed complications after CI and some of the management plans used to treat these complications.
EVIDENCE ACQUISITION The PubMed and OVID databases were searched for articles published from January 1, 2003, through December 31, 2013, using the search terms cochlear implant and complications. Seven hundred sixty-six articles were identified and searched for reports of delayed complications (>3 days after surgery). Exclusion criteria consisted of a language other than English, no long-term follow-up or report of delayed complications, small case series with fewer than 10 patients, and CI in patients with cochlear malformations. Additional articles were identified with specific search criteria consisting of cochlear implant combined with mastoiditis, meningitis complication, otitis media, hematoma, cholesteatoma, and facial nerve injury. Data were collected from January 1 through April 1, 2014, and analyzed from April 30 to May 1, 2014.
FINDINGS A total of 88 individual articles were analyzed for this study. These articles included a total of 22 842 patients. Of 8519 patients with data in regard to sex, 4319 (50.7%) were male. The patients' ages ranged from 0.2 to 94.9 years, with a mean age of 19.0 years. The duration of follow-up ranged from 1 month to 17 years. The total number of delayed complications was 1302 (5.7%), with vestibular complications (181 of 4655 patients [3.9%]) being the most common; device failure (507 of 14 704 patients [3.4%]), the second most common; and taste problems (22 of 776 patients [2.8%]), the third most common. Less common complications included cholesteatoma (40 of 8579 patients [0.5%]) and facial nerve palsy (31 of 4785 patients [0.6%]).
CONCLUSIONS AND RELEVANCE Cochlear implantation continues to be a reliable and safe procedure, with a low percentage of severe complications when performed by experienced surgeons. The patients should receive lifetime follow-up. These patients need lifetime follow-up to monitor for potential complications and to facilitate their care if complications occur.

• 出版日期2015-11