Purpose: Present surgical techniques for converting percutaneous (PC) to transcutaneous (TC) BCD devices and for electrode placement in revision CI cases.

Methods: We reviewed 16 patients converting PC to a TC BCD and 18 revision CI cases in our single implant center October1, 2023-July 30, 2026.

Results: Reasons for converting to TC BCD included extruded the abutment/fixture from persistent granulation tissue with superficial infection, skin breakdown, chronic recurring granulation tissue around the abutment and elective change to a TC device. The CI group included revisions for device malfunction, delayed infection, basal turn ossification, and unexpected cochlear duct soft tissue obstruction. Scalp flap revision and management of internal device components are reviewed in video and pictorial formats. In the CI cases, the use of SMART-Nav intraoperatively was used to verify electrode placement after revision. Wound complications, facial nerve stimulation, balance issues, and comparison to prior performance will be presented. Pedicled scalp rotation flap design, antibiotic utilization and implanted fixture assessment will be discussed.

Conclusion: Common principles for managing the soft tissue of the scalp when revising BCD and CI will be presented in an interactive format. Managing implanted fixtures and CI electrodes will be addressed separately with emphasis on optimizing postop healing and auditory performance.

Abstract:

Purpose: In revisions and in patients with unusual cochlear duct anatomy, optimal CI electrode insertion is the goal to secure patient performance. Verification of placement should be done at surgery.

Methods: Retrospective review of all CI cases in our center between January 1, 2023 and October 15, 2025. Of 131 cases, 6 were revisions for device malfunction, 3 for delayed infection, 3 for intracochlear schwannoma, 4 for basal turn ossification, and two for unexpected cochlear duct soft tissue obstruction. Depth of insertion, wound complications, facial nerve stimulation, balance issues, and comparison to prior performance was analyzed.

Results: 18 (13.7%) patients met criteria for 22-month study period. 5/6 re-implants for device failure achieved full insertion. 1 was inserted to 16/22 electrodes. Removal of the receiver stimulator while leaving the electrode, 6 weeks of culture specific antibiotics, and re-implantation was successfully achieved in 3/3 cases of delayed implant site infection. 2/3 with intracochlear schwannomas had full insertion. 1 had partial insertion. 3/4 with basal turn ossification had full insertion with a drill-through technique. 1 case had a partial insertion. 2/2 patients with unexpected soft tissue obstruction of the basal turn obtained full insertion, 1 was concurrently treated for a round window gusher. All 21 patients in this cohort are full time CI users with average follow-up of 15 months.

Conclusions: Electrode selection and verification of placement are essential components to optimize patient performance in this challenging population. SmartNav estimates both electrode position without a radiograph and provides starting programming parameters in this population.