(A857) Rate of Skin Breakdown and Retention Complications in Off-The-Ear Cochlear Implant Processors

Introduction: With the evolution of cochlear implant (CI) device design, there has been increasing use of off-the-ear (OTE) CI processors as an alternative to behind-the-ear (BTE) devices. The present study examines the frequency of local skin site complications and device retention issues in CI users with OTE processors.

Methods: Retrospective single institution review of CI recipients who utilized OTE processors between 2017 and 2024.

Results: In total, 253 implants (202 patients) were identified with OTE processors. Within this cohort, 32% (82/253) had some form of skin complication. The majority of skin complications were minor, including 64% (53/82) of patients experiencing pain at their device, without any evidence of gross skin breakdown on examination, and 33% (27/82) with evidence of erythema and superficial skin irritation. Only two patients were found to have ulceration over their device requiring topical or systemic treatments in addition to breaks with device usage. Treatments for minor skin complications commonly included decreasing magnet strength (84%, 69/82), addition of device padding (9%, 7/82), with two patients electing to switch to a BTE processor due to persistent pain despite magnet alteration. Difficulties with device retention occurred in 19% (49/253) of implants. Most of the retention complications resolved with increasing magnet strength (63%, 31/49), though seven patients eventually switched to a BTE processor due to recalcitrant device retention difficulties.

Conclusions: The present study demonstrates that OTE CI processors are generally well tolerated. While minor skin complications occurred in approximately one third of individuals, and one fifth of implants experienced difficulties with retention, both concerns were typically resolved with conservative measures.