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  1. Introduction • they happen! • almost always preventable • attention to detail • early identification and management are key

  2. Soft Tissue Complications

  3. Soft Tissue Complications (<1yr)

  4. Soft Tissue Complications • “antecedent trauma” • device movement • IV antibiotics • emergent debridement and resiting

  5. Device Failure • 971 devices in 738 children (5575 implant-yrs) • 971 devices in 738 children (5575 implant-yrs) (3.6%)

  6. Post-Replant Performance

  7. Mastoiditis After CI • increased risk • device contamination • chronic infection • meningitis

  8. Discussion • recent mastoidectomy may facilitate post-auricular abscess formation • IV antibiotics • early operative drainage • rapid resolution • preservation of CI

  9. Otitis Media - Atelectasis • 2.5 yr old • 18 months post implant

  10. Tympanic Membrane Perforation • repair • cartilage graft

  11. Post Implantation Cholesteatoma • >2 years post-operatively • avoid breaching annulus • betadine in the canal at OR

  12. Management of Cholesteatoma in Implanted Patients • explant and implant other side • combined approach mastoidectomies

  13. Magnet Out

  14. Magnet Site Infection • common • remove magnet for a week • reapply when skin healthy with reduction in magnet force • moleskin on antenna

  15. Facial Nerve Injury • use a monitor • damage most likely during the cochleostomy • cool if shaft touches posterior wall • decompress if injury suspected

  16. Intracranial Bleed • rare • extradural vessel • pulsatile pain • photophobia • excessive nausea • shift of the midline?

  17. Summary • commonest complication is device failure • most complications are easily managed • early identification is the key to successful management