COCHLEAR IMPLANTATION COMPLICATIONS: SUB-PERIOSTEAL TECHNIQUE VERSUS WELL-DRILLING TECHNIQUE; A BETTER MODALITY IN PEDIATRIC PATIENTS

Abstract

Objective

To evaluate the safety, complications, stability, cosmetic outcomes, and long-term results of pediatric cochlear implantation, focusing on implant bed techniques.

Place and duration of study: ENT Department of a tertiary care hospital in Rawalpindi from June 2024 to November 2024

Methodology
Pediatric patients severe to profound congenital sensorineural hearing loss (≥90 dB on PTA or ASSR) were included. All patients had failed prior hearing aid trials and had normal middle ear anatomy. Intraoperative variables and postoperative outcomes were assessed through clinical, radiological, and functional follow-up.

Results
A total of 70 patients underwent cochlear implantation, with 36 in the subperiosteal pocket technique (SPT) group and 34 in the well-drilling technique (WD) group. Intraoperative complications were low, including dural exposure (5.6% SPT, 2.9% WD, P = 0.532) and CSF leaks (P = 1.000). Postoperative complications included wound dehiscence (5.6% SPT, 2.9% WD, P = 0.533), infections (8.3% SPT 2.9% WD, P = 0.256), and devices migration (2.9% WD, P = 0.317). Cosmetic outcomes were excellent in 72.2% (SPT) and 70.6% (WD, P = 0.758). For long-term outcomes, the mean hearing threshold was 29 ± 7 dB (SPT) and 31 ± 9 dB (WD, P = 0.471), with significant speech improvement and high patient satisfaction (91.7% SPT, 94.1% WD, P = 0.745).

Conclusion
Pediatric cochlear implantation is a safe and effective procedure with low complication rates, excellent implant stability, favorable cosmetic outcomes, and significant improvements in auditory and speech performance.