(Figure 1)
We decided to salvage the implant, and our surgical plan included:
  1. Local wide excision of swelling. (Figure 2)
  2. Exposure of cochlear implant.
  3. Dipping the implant body in 6% hydrogen peroxide for 1 hour while the magnet was removed from the pocket and treated separately, both in hydrogen peroxide and Polyhexanide solution.
  4. Dipping the implant body in Polyhexanide and Betaine surfactant for half an hour.
  5. Filling the mastoid cavity with polyhexanide and betaine solution taking care that the electrodes doesn’t come out of cochlea while lifting the implant body.
  6. Debridement of biofilm (visually seen as gelatinous mass in the wound), drilling new bed and tunnel.
  7. Preparing double layered vascularized soft tissue flap.
  8. Changing the packing at the cochleostomy site after placing the implant body in its position and replacing the same magnet.
  9. Before closure, an anti-biofilm solution was filled in the mastoid cavity and polyhexanide gel was applied on the bed and flap cover.
  10. Neural response telemetry (NRT) was done to normal functioning of the implant.
Post operatively- Injection Augmentin (50-60mg/kg/day), Injection Piperacillin + Tazobactam (200-300mg/kg/day) were given for 10 days followed by oral antibiotics for a week and oral Rifampicin (10 mg/kg/day) for 6 months. Patients were discharged on the 10th day of surgery. A histopathological examination of the biofilm showed chronic inflammation. One year after the surgery, there were no signs of infection and patients are in follow up (Figure 3). One patient presented a recurrent infection for three weeks and we decided to take out the implant, leaving the array in the cochlea in order to avoid fibrosis and cochlear ossification. In the first month of the follow up, one patient presented some swelling and discharge from the flap which was infected with Pseudomonas aeruginosa. We explanted the patient without undergoing any further salvage surgeries. After a follow up period of one year, none of the patients on examination presented any sign of implant infection and are still in follow up. (Table 1)