Device fixation in cochlear implantation: is bone anchoring necessary?

OBJECTIVES/HYPOTHESIS To compare complication rates between patients whose cochlear implants were secured by a bony tie-down technique versus those secured by a periosteal tie-down technique. STUDY DESIGN A retrospective review of 302 consecutive patients undergoing cochlear implantation (327 implants), including both adults and children, at a single institution by a single surgeon. METHODS Cochlear implantation was performed in the standard fashion with bony securement of the device in the first subset of patients. The surgical technique was then modified to exclude the bony tie-down step in favor of a periosteally placed suture tie-down in the next subset of patients. The patient's medical records were then reviewed to determine complications, which were then compared between groups using chi(2) testing. RESULTS The overall complication rate for the periosteally secured cochlear implant subset was 9.5%, with no significant difference noted when compared to the 12.2% overall complication rate seen with the bone-secured implants. Minor complication rates were 9.5% versus 8.1%, respectively, with major complications occurring in 0% versus 4.1% of periosteally secured versus bone-secured devices. There were no statistical differences between groups for major, minor, or any specific complications. There were no cases of device migration. CONCLUSIONS Cochlear implant devices may be secured in place with periosteally anchored sutures in lieu of bone-anchored sutures without any significant increases in perioperative complications.