228 cases of cochlear implant receiver-stimulator placement in a tight subperiosteal pocket without fixation

Otolaryngol Head Neck Surg. 2015 Apr;152(4):712-7. doi: 10.1177/0194599814567111. Epub 2015 Jan 20.


Objectives: (1) To investigate the outcomes of cochlear implant receiver-stimulator (RS) placement using a tight subperiosteal pocket technique without device fixation and (2) to compare the efficiency of this approach with the traditional bony well and trough technique.

Study design: Case series with planned chart review.

Setting: Single tertiary academic referral center.

Subjects and methods: All cochlear implant surgeries utilizing a tight subperiosteal pocket without additional fixation or use of a bone well were identified retrospectively. Revision cases were only included if the tight subperiosteal pocket technique was used during the initial surgery. Patients with less than 6 months of postoperative follow-up were excluded. Primary outcome measures included RS migration, flap complications, device failure, and percentage reduction in operative time.

Results: Two hundred twenty-eight cases (average age 45.3 years) met inclusion criterion and were analyzed. At a mean follow-up of 18.1 months, no patient experienced RS migration. One patient experienced a postoperative hematoma that was managed with observation. One patient developed a surgical site infection that resolved following exploration and intravenous antibiotics. The subperiosteal pocket technique resulted in an 18.9% reduction in total operative time compared to a more conventional RS placement method (P < .01).

Conclusions: The tight subperiosteal pocket without fixation is a safe, durable, and time-saving technique for RS placement during cochlear implantation. Notably, device migration and flap complications are very uncommon.

Keywords: cochlear implant; sensorineural hearing loss; subperiosteal pocket; surgical technique; tight pocket.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Child
  • Child, Preschool
  • Cochlear Implantation / instrumentation
  • Cochlear Implantation / methods*
  • Female
  • Foreign-Body Migration / epidemiology
  • Hearing Loss, Sensorineural / surgery*
  • Humans
  • Infant
  • Male
  • Middle Aged
  • Operative Time
  • Surgical Flaps
  • Treatment Outcome
  • Young Adult