1. Revision Cochlear Implant Dr Y Hui, Dr D Au Advances in Deafness Management Conference and Workshops 9 Oct 2005 Hong Kong

2. Experience from QMH 1989 – 2005 18 patients required surgery for revision Children (<12) - 9 Teenager (13-19) - 4 Adult (>20) - 5 Time interval: 5m to 7yrs (mean 4 yrs)

3. Reason (n=18) Primary Device failure 15 Electrode extrusion 1 Infection 1 Trauma 1

4. Presentation Sudden deterioration in hearing Often preceded by periods of malfunction Audiologist called for immediate assessment.

5. ENT assessment Otoscopy Implant site Plain XR

6. Confirm the Dx Audiologist from the manufacturer to confirm the diagnosis

7. What are the issues 1. Financial cost (currently a 10 year warranty) 2. The need for another surgery (approach Avoidance conflict) 3. Intervening period of deafness – affect work/school 4. Will the new implant fail soon?

8. Approach Diagnosis convey to patient Revision Surgery ASAP or at a time convenient to patient.

9. Surgery Audiologist from manufacturer Old incision New bone over the electrode &/or the receiver No new bone over the posterior tympanotomy No post-op complication

11. Infection with Staph Epidermidis

15. Revision as a result of trauma

30. Post-op mapping Easier to perform Prior experience with mapping Eager to make to sure the new implant is functioning well If this is an upgraded model, they want to find out the difference.

31. Discussion We tell the patient of such possibility before the operation Some patients anticipate this as an inevitable event in the future. See this as an opportunity to upgrade

32. Discussion Revision surgery may become more common Primary failure may reduce Voluntary decision to replace old model with a more advance one.

33. Results

34. Speech Perception (9 Adult) WordVowelConsonantSentenceTone Initial (%)66.974.382.186.360.1 Post Revision (%) 63.478.678.784.264.3

35. Speech Perception (7 Children) No significant difference in Ling ’ s 7 Sounds, vowel, consonant and sentences tests

36. Thank You