This document discusses complications that can occur with various implantable devices used for hearing loss, including cochlear implants, bone anchored hearing aids, middle ear implants, and auditory brainstem implants. Early complications include facial nerve injury, infection, dizziness, and wound issues. Late complications include device migration, failure, skin issues, and meningitis. Managing complications involves careful surgery and follow-up care.

2. Complications of Implantable
Devices
SAFDAR ALI
Consultant Audiologist
Bahawal Victoria Hospital
Bahawalpur, Punjab, Pakistan

3.  Cochlear Implant
 BAHA
 Middle Ear Implant
 Auditory Brainstem Implant
Implanted Devices

4.  Early Complications
 Facial Nerve Injury
 Infection
 Dizziness
 Wound Dehiscence/Flap Necrosis
 Early Device Failure
 CSF Leakage
Complications of Cochlear Implants

5. Facial Nerve Injury:
 Rare
 But devastating condition
It can be
 Temporary Paresis
 Facial Nerve Damage/Paralysis
Electromyogenic monitoring of
facial during surgery can be helpful
and reduces the chances of paralysis
CI Complications

6. Wound Dehiscence/Flap
Necrosis
 Occurs due to aggressive
thinning of flap.
 Most serious
complication.
 Require device removal.
 Wound breakdown over
internal receiver with
early extrusion of device.
CI Complications

7. CSF Leak
 Occurs frequently at time of
drilling tie down holes
 Can also occur after opening of
scala tympani in case of common
cavity
CI Complications

8.  Controlled by packing common cavity.
 If not controlled ear is closed by plugging
Eustachian tube, filling the middle ear and
mastoid with fat and over sewing the EAC.
CI Complications

9. LATE:
 Extrusion/exposure of device
 Device migration
 Late device failure
 Otitis media
 Meningitis
CI Complications

10. Meningitis:
 CI Children are at high risk for developing Meningitis.
 That’s why pneumococcal vaccination is mandatory
while candidacy profile is making of CI child.
 Rare but potential to be serious
 CSF may leak.
CI Complications

11. Device Migration:
 Rare
 When implant package is not secure ,may
create shear forces that can break
electrode.
Device Failure:
 Manufacturing defect
 Trauma
CI Complications

12. Facial Nerve Stimulation:
 Occurs when stimulation to electrode is
conducted through the bone also stimulate the
facial nerve.
 Can be fix by reprogramming of device.
CI Complications

13. Why BAHA?
Some conditions where conventional air conduction hearing aids
fail to provide desired results like.
 CSOM
 Congenital Atresia
 Microtia
 Cholesteatoma
 Middle ear dysfunction/disease.
Complications of BAHA

14.  Skin overgrowth over the abutment
 To prevent overgrowth use longest implant possible
 Obtain adequate removal of surrounding soft tissue
 Loss of skin graft
 Have thin, immobile & hairless skin around the abutment
 Ensure skin graft is firmly attached to underlying periosteum
 Ensure fixture & abutment are f firmly secured
 Infections/Inflammation
 Loose Fixture
 Bone exposure
Complications of BAHA

15. A middle ear implant (MEI)
makes the structures in the
middle ear vibrate in much
the same way as normal
sounds move the bones
in the middle ear by
converting sounds into
vibrations.
Middle Ear Implant (MEI)

16.  Risk of facial
paralysis
 Impairment of Taste
 Ear pain
 Device malfunction
Complications of MEI
 Wound
complication/Infection
 Middle ear effusion
 Tympanic membrane
perforation
 Ossicular Discontinuity

17.  Neuroprosthetic device that
provides hearing sensations to
deaf patients who are ineligible
for the cochlear implant (CI)
due to anatomic constraints.
 It bypasses the cochlear nerve
to electrically stimulate second
order neurons in the cochlear
nucleus (CN) using a
multichannel surface array in
patients with cochlear and
retrocochlear pathologies.
Auditory Brainstem Implant (ABI)

18.  CSF Leak
 Facial Nerve Palsies (loss of Facial
movement)
 Wound infection
 Meningitis
 Implant Failure
Complications of ABI