Presentation Sudden deterioration in hearing Often preceded by periods of malfunction Audiologist called for immediate assessment.
ENT assessment Otoscopy Implant site Plain XR
Confirm the Dx Audiologist from the manufacturer to confirm the diagnosis
What are the issues 1. Financial cost (currently a 10 year warranty) 2. The need for another surgery (approach Avoidance conflict) 3. Intervening period of deafness – affect work/school 4. Will the new implant fail soon?
Approach Diagnosis convey to patient Revision Surgery ASAP or at a time convenient to patient.
Surgery Audiologist from manufacturer Old incision New bone over the electrode &/or the receiver No new bone over the posterior tympanotomy No post-op complication
Infection with Staph Epidermidis
Revision as a result of trauma
Post-op mapping Easier to perform Prior experience with mapping Eager to make to sure the new implant is functioning well If this is an upgraded model, they want to find out the difference.
Discussion We tell the patient of such possibility before the operation Some patients anticipate this as an inevitable event in the future. See this as an opportunity to upgrade
Discussion Revision surgery may become more common Primary failure may reduce Voluntary decision to replace old model with a more advance one.