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The Incidence and Clinical Course of Facial Nerve Paresis following Contemporary Cochlear Implant Surgery

Objective: In contemporary otologic surgery, iatrogenic facial nerve paresis is an uncommon but distressing complication. This study will describe our institutional experience with facial nerve injury following cochlear implantation. We report the incidence, clinical presentation, course, and possible mechanisms of facial nerve paresis following implantation surgery and review the relevant literature. Method: A retrospective chart review at a tertiary otologic referral center (teaching hospital) including all patients who underwent cochlear implant surgery between 2000 and 2010. Patients experiencing postoperative facial nerve weakness were identified, and data were gathered with respect to intraoperative findings, onset, severity, management strategy, and level of recovery. Results: In the past decade, 815 implant surgeries were performed at our institution. All patients underwent a limited mastoidectomy with posterior tympanotomy (facial recess) approach, and intraoperative electromyographic facial nerve monitoring was routinely employed. No patients experienced immediate paresis while 5 implantees (0.6%) developed delayed onset weakness. All 5 patients were treated with steroid therapy, and all but one recovered to a House-Brackmann grade 1 (of 6) facial nerve function within 6 months of surgery. Conclusion: The incidence of temporary facial nerve paresis following cochlear implantation at a tertiary teaching hospital was 0.49% while the incidence of permanent incomplete paralysis was 0.12%. Thermal injury and/or reactivation of latent virus with progressive neuroedema and subsequent delayed weakness are the most likely mechanisms of injury.