(318) Monopolar Electrosurgery with Cochlear Implants: Working Toward a Position Statement

Introduction: Due to the potential for device or tissue damage, cochlear implant (CIs) manufacturers generally recommend against use of monopolar electrosurgery in CI recipients. Despite this, reports exist of exposure to monopolar electrosurgery without negative effect. As the number of CI recipients approaches 1 million, and as certain surgical procedures preferentially use monopolar electrosurgery, surgeons will inevitably encounter this dilemma frequently. In light of this, the current study aims to comprehensively review the prevalence of detected monopolar electrosurgery-related complications among CI recipients.

Methods: To provide a comprehensive overview, this study utilized a multifaceted approach: i retrospective review of data from a tertiary medical center; ii systematic review of current literature; iii and review of industry data from 3 FDA approved CI manufacturers encompassing all devices implanted in the United States to date.

Results: Review of all data demonstrated 2 incidents where CI damage could be linked to cautery exposure out of over 600,000 CIs; only 1 in a live subject. Specifically, data from implant manufacturers showed a single report of damage that could be linked to monopolar electrosurgery, out of roughly 600,000 CIs at time of query. Systematic review identified 9 studies, with a total 185 episodes of cautery exposure. From these, a single implant showed evidence of damage after exposure to a dental cautery in a cadaveric study. Review of institutional records failed to identify any definitive episode of CI damage from monopolar electrosurgery.

Conclusions: This report estimates the risk of device damage, or injury of adjacent tissue to be extraordinarily low. In fact, reported rates of general hardware failure far exceed the number of CIs with damage linked to electrosurgery. Short of operating in immediate proximity, these data indicate that monopolar electrosurgery can be used in the torso or extremities and also head and neck of CI recipients with minimal risk. These data may guide clinical decision making in cases optimally or preferably performed with monopolar electrosurgery.