Six months after cochlear implantation, a patient has recurrent post-auricular infection, exposed receiver-stimulator and a draining biofilm-associated wound despite culture-directed antibiotics. The electrode still provides benefit. What is the most defensible management?
Established device exposure and chronic biofilm make durable salvage unlikely; explantation, preservation of cochlear patency where appropriate, microbiology and staged or selected immediate reimplantation require an implant-centre plan.
A. Attempt vascularised scalp-flap coverage while retaining all exposed hardware: Selected early threatened exposures may be salvaged, but recurrent draining biofilm after antibiotics makes retention unreliable.
B. Exploration with removal of infected hardware, infection control and planned reimplantation: Established device exposure and chronic biofilm make durable salvage unlikely; explantation, preservation of cochlear patency where appropriate, microbiology and staged or selected immediate reimplantation require an implant-centre plan.
C. Exchange only the receiver-stimulator and leave contaminated soft tissue: Hardware exchange without radical debridement and infection control leaves the infected bed untreated.
D. Continue culture-directed suppressive antibiotics until electrical failure: Ongoing device benefit does not justify indefinite biofilm suppression with an exposed implant.
E. Remove the receiver package but abandon the intracochlear electrode permanently: An electrode may sometimes be retained temporarily to preserve cochlear patency, with reimplantation planned by the implant centre.
If there were superficial erythema without wound breakdown, collection or device exposure, early culture-directed medical treatment and close implant-team review might salvage the device.
Independent Clinora educational material; not official JCIE content, an accredited programme, clinical advice, or a substitute for local policy and specialist judgement.
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