Long-term Incidence of Revision Surgery Caused by Electrode Migration in a Large Cochlear Implant Cohort Using a Titanium Fixation Clip Applied by a Novel Reverse Application Technique

OBJECTIVE: To determine the effect on the frequency of revision surgery caused by electrode migration (EM) in cochlear implantation by use of an electrode fixation clip combined with a novel surgical technique. STUDY DESIGN: Retrospective chart review. SETTING: Tertiary referral center. PATIENTS: The investigated institutional cohort included 1052 cases of cochlear implantation with straight electrode arrays from a single manufacturer between 2011 and 2023. Until 2016, the fixation clip was not used, whereas since 2017, the fixation clip and the described novel surgical technique have been applied as an institutional standard in nearly all cases. INTERVENTION: The titanium electrode fixation clip was first introduced and described in 1998 and was CE marked in Europe in 2014. In modification of the original description, a "Reverse Fixation Clip Technique" was applied to optimize the surgical handling and fixation stability. A similar approach has been described recently. MAIN OUTCOME MEASURE: Cumulative incidence of revision surgery caused by EM. RESULTS: The cumulative incidence of revision surgery caused by EM at 3, 5, and 7 years was 0.5%, 1.0%, and 1.9% in the group without the fixation clip (n=461; 43.4%) and 0.0% at all time points in the group with the fixation clip using the "Reverse Fixation Clip Technique" (n=591; 56.6%) (log-rank test P=0.054). No fixation clip-related complications were noted. CONCLUSION: The application of the fixation clip using the "Reverse Fixation Clip Technique" prevents revision surgery caused by EM in cochlear implantation.