1. Introduction they happen! almost always preventable attention to detail early identification and management are key

2. Soft Tissue Complications Author – Date PatientsNumber of Patients Minor Complications Major Complications Total Complications De Jong ‘98<18 yr523.8 7.6 Bhatia ’04<18 yr300162.318.3 Venail ‘08<18 yr5005.61.47 Ovensen ‘08All ages31311.24.515.7 Loundon ‘10<16 yr4341.13.44.5 Davids ‘09<18 yr4620.41.51.9

3. Soft Tissue Complications (<1yr) Author – Date PatientsNumber of Patients Minor Complications Major Complications Total Complications Bhatia ‘04<5 yr300162.318.3 Ovensen ‘08All ages31311.24.515.7 Rolland ’09<1 yr5010616 Das ’10<1 yr80/1122.5/1.81.3/0.93.8/2.7

4. Soft Tissue Complications “antecedent trauma” device movement IV antibiotics emergent debridement and resiting

5. Device Failure 971 devices in 738 children (5575 implant-yrs) N= (%) or Median (Range) CIs requiring re-implantation35 Original Implant at another center7 (20%) Time in months between initial and re-implant46 (12-154) Model difference between first and second device 20 (57%) 971 devices in 738 children (5575 implant-yrs) (3.6%)

6. Post-Replant Performance

7. Mastoiditis After CI increased risk device contamination chronic infection meningitis

8. recent mastoidectomy may facilitate post-auricular abscess formation IV antibiotics early operative drainage rapid resolution preservation of CI Discussion

9. Otitis Media - Atelectasis 2.5 yr old 18 months post implant

10. Tympanic Membrane Perforation repair cartilage graft

11. Post Implantation Cholesteatoma >2 years post- operatively avoid breaching annulus betadine in the canal at OR

12. Management of Cholesteatoma in Implanted Patients explant and implant other side combined approach mastoidectomies

13. Magnet Out

14. Magnet Site Infection common remove magnet for a week reapply when skin healthy with reduction in magnet force moleskin on antenna

15. Facial Nerve Injury use a monitor damage most likely during the cochleostomy cool if shaft touches posterior wall decompress if injury suspected

16. Intracranial Bleed rare extradural vessel pulsatile pain photophobia excessive nausea shift of the midline?

17. Summary commonest complication is device failure most complications are easily managed early identification is the key to successful management