Device fixation and small incision access for pediatric cochlear implants.

OBJECTIVE Small incision cochlear implant surgery has been advocated to improve cosmesis and reduce post-operative morbidity. However, with standard small incision techniques, it is not possible to securely fix the device in place. This risks displacement of the device, particularly in active children. This paper describes the development of a technique which combines secure ligature tie-down of the device with a small incision. METHODS A 25 mm skin incision is positioned close to the hair line behind the pinna. Specially modified instruments are used to drill a well for the receiver-stimulator pedestal down to dura. In younger children, ligature tie-down holes are drilled through the calvarium. Alternative methods for older children are described. Outcome data are reviewed. RESULTS One hundred children have been implanted with the small incision technique. No complications have occurred related to the current technique (maximum follow up 22 months). In five cases, during early development of the technique, the receiver-stimulator device was only secured by a tight periosteal pocket. In one of these cases, the device became dislodged from its well. CONCLUSIONS Secure fixation of the receiver-stimulator unit of a cochlear implant is particularly important in children because of the risk of displacement with trauma. The conventional means of securing the device with a ligature has been combined with modified small incision techniques to meet this requirement successfully.