Skip to main content
SpringerLink
Log in

Cochlear implant magnet dislocation after MRI: surgical management and outcome

  • Otology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Purpose

An increasing number of cochlear implant (CI) users is examined by magnetic resonance imaging which may cause the displacement of the implant magnet. This complication prevents the usage of the external processor and has to be treated surgically in most cases. The purpose of this study is to analyze the results of the surgical intervention and the consequences for the CI recipients.

Methods

The retrospective study was conducted at a tertiary referral center. From the patient care records between October 2014 and July 2018, 9 cases were reviewed that had undergone MRI after cochlear implantation and had experienced magnet displacement.

Results

Nine patients from 9 to 74 years of age were identified with MRI-induced magnet displacement. Implants of different manufacturers were affected (8 × Cochlear®, 1 Advanced Bionics®) but did not include the latest 3 T MR conditional product generation. The patients reported pain, swelling, redness above the implant and/or a noticeably dislocated magnet. One-third of the MRI examination were conducted in external radiological sites without any precautions such as a compression bandage. Surgical magnet repositioning was successful in all but one case with postoperative implant infection and consecutive explantation. In total, the patient was unable to use his CI for 420 days (1.2 years) after the MRI examination. The remaining eight patients averaged 29 days between MRI-related magnet dislocation and CI re-activation.

Conclusions

The present study shows that in the majority of cases a surgical magnet reposition is possible without complications, and thus the time of nonuse of the CI is usually low. Nevertheless, there is a risk that in individual cases significant medical, functional, social and economic consequences for patients may occur. The presented data demonstrate that the indication to perform MRI scans in CI users needs to be further critically considered. An attentive, critical assessment of an MRI indication by both the initiating physician (usually not an ENT specialist) and the performing radiologist is mandatory.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. von Ilberg CA, Baumann U, Kiefer J, Tillein J, Adunka OF (2011) Electric-acoustic stimulation of the auditory system: a review of the first decade. Audiol Neurotol 16(Suppl 2):1–30. https://doi.org/10.1159/000327765

    Article  Google Scholar 

  2. Holden LK, Finley CC, Firszt JB, Holden TA, Brenner C, Potts LG, Gotter BD, Vanderhoof SS, Mispagel K, Heydebrand G, Skinner MW (2013) Factors affecting open-set word recognition in adults with cochlear implants. Ear Heart 34(3):342–360. https://doi.org/10.1097/AUD.0b013e3182741aa7

    Article  Google Scholar 

  3. Mudery JA, Francis R, McCrary H, Jacob A (2017) Older individuals meeting medicare cochlear implant candidacy criteria in noise but not in quiet: are these patients improved by surgery? Otol Neurotol 38(2):187–191. https://doi.org/10.1097/MAO.0000000000001271

    Article  PubMed  Google Scholar 

  4. Kraaijenga VJC, Ramakers GGJ, Smulders YE, van Zon A, Stegeman I, Smit AL, Stokroos RJ, Hendrice N, Free RH, Maat B, Frijns JHM, Briaire JJ, Mylanus EAM, Huinck WJ, Van Zanten GA, Grolman W (2017) Objective and subjective measures of simultaneous vs sequential bilateral cochlear implants in adults: a randomized clinical trial. JAMA Otolaryngol Head Neck Surg 143(9):881–890. https://doi.org/10.1001/jamaoto.2017.0745

    Article  PubMed  PubMed Central  Google Scholar 

  5. Goupell MJ, Kan A, Litovsky RY (2016) Spatial attention in bilateral cochlear-implant users. J Acoust Soc Am 140(3):1652

    Article  Google Scholar 

  6. Dorman MF, Natale SC, Butts AM, Zeitler DM, Carlson ML (2017) The sound quality of Cochlear implants: studies with single-sided deaf patients. Otol Neurotol 38(8):e268–e273. https://doi.org/10.1097/MAO.0000000000001449

    Article  PubMed  PubMed Central  Google Scholar 

  7. Mosnier I, Bebear JP, Marx M, Fraysse B, Truy E, Lina-Granade G, Mondain M, Sterkers-Artières F, Bordure P, Robier A, Godey B, Meyer B, Frachet B, Poncet-Wallet C, Bouccara D, Sterkers O (2015) Improvement of cognitive function after cochlear implantation in elderly patients. JAMA Otolaryngol Head Neck Surg 141(5):442–450. https://doi.org/10.1001/jamaoto.2015.129

    Article  PubMed  Google Scholar 

  8. Dietz A, Wüstefeld M, Niskanen M, Löppönen H (2016) cochlear implant surgery in the elderly: the feasibility of a modified suprameatal approach under local anesthesia. Otol Neurotol 37(5):487–491. https://doi.org/10.1097/MAO.0000000000001025

    Article  PubMed  Google Scholar 

  9. European Association of Cochlear Implant Users (2017) What is the cochlear implant? https://eurociu.eu/what-is-the-ci-. Accessed 5 Jan 2020

  10. Rinck P (2018) Magnet Resonance in Medicine. A Critical Introduction. 12th edn. www.rinckside.org

  11. Statistisches Bundesamt (2018) Fallpauschalenbezogene Krankenhausstatistik (DRG-Statistik), Diagnosen und Prozeduren der vollstationären Patientinnen und Patienten in Krankenhäusern Accessed 5 July 2018

  12. Kim B, Kim J, Park J, Kim S, Kim H, Choi J (2015) Adverse events and discomfort during magnet resonance imaging in Cochlear implant recipients. Jama Otolaryngol Head Neck Surg 141(1):45–52. https://doi.org/10.1001/jamaoto.2014.2926

    Article  PubMed  Google Scholar 

  13. Carlson ML, Neff BA, Link MJ, Lane JI, Watson RE, McGee KP, Bernstein MA, Driscoll CL (2015) Magnet resonance imaging with cochlear implant magnet in place: safety and imaging quality. Otol Neurotol 36(6):965–971. https://doi.org/10.1097/MAO.0000000000000666

    Article  PubMed  Google Scholar 

  14. Azadarmaki R, Tubbs R, Chen DA, Shellock FG (2013) MRI Information for commonly used otologic implants. Otolaryngol Head Neck Surg 150(4):512–519. https://doi.org/10.1177/0194599813518306

    Article  Google Scholar 

  15. Posner D, Scott A, Polite C, Lustig LR (2010) External magnet displacement in cochlear implants: causes and management. Otol Neurotol 31(1):88–93. https://doi.org/10.1097/MAO.0b013e3181c2a0c4

    Article  PubMed  Google Scholar 

  16. Majdani O, Leinung M, Rau T, Akbarian A, Zimmerling M, Lenarz M, Lenarz T, Labadie R (2008) Demagnetization of cochlear implants and temperature changes in 3.0T MRI environment. Otolaryngol Head Neck Surg 139(6):833–839. https://doi.org/10.1016/j.otohns.2008.07.026

    Article  PubMed  Google Scholar 

  17. Shew M, Wichova H, Lin J, Ledbetter LN, Staecker H (2018) Magnet resonance imaging with cochlear implants and auditory brainstem implants: are we truly practicing MRI safety? Laryngoscope 129(2):482–489. https://doi.org/10.1002/lary.27516 (Epub 2018 Nov 9)

    Article  PubMed  Google Scholar 

  18. Young NM, Rojas C, Deng J, Burrowes D, Ryan M (2016) Magnetic resonance imaging of cochlear implant recipients. Otol Neurotol 37(6):665–671. https://doi.org/10.1097/MAO.0000000000001053

    Article  PubMed  Google Scholar 

  19. Hassepass F, Stabenau V, Maier W, Arndt S, Laszig R, Beck R, Aschendorff A (2014) Revision surgery due to magnet dislocation in cochlear implant patients: an emerging complication. Otol Neurotol 35(1):29–34. https://doi.org/10.1097/MAO.0b013e3182a5d2c5

    Article  PubMed  Google Scholar 

  20. Leong W, Yuen H (2018) Dislocation of cochlear implant magnet during 1.5 Tesla magnet resonance imaging despite head bandaging, and its repositioning using an endoscopic approach. J Laryngol Otol 132(10):943–945. https://doi.org/10.1017/S0022215118001421 (Epub 2018 Aug 28)

    Article  CAS  PubMed  Google Scholar 

  21. Shew M, Bertsch J, Camarata P, Staecker H (2017) Magnet resonance imaging in a neurofibromatosis type 2 patient with a novel MRI-compatible auditory brainstem implant. J Neurol Surg Rep 78(1):e12–e14. https://doi.org/10.1055/s-0036-1597588

    Article  PubMed  PubMed Central  Google Scholar 

  22. Todt I, Tittel A, Ernst A, Mittmann P, Mutze S (2017) Pain free 3 T MRI scans in Cochlear implantees. Otol Neurotol 38(10):e401–e404

    Article  Google Scholar 

  23. Nospes S, Brockmann MA, Läßig A (2019) MRI in patients with auditory implants equipped with implanted magnets-an update: Overview and procedural management. Radiologe. 59(1):48–56. https://doi.org/10.1007/s00117-018-0462-9

    Article  CAS  PubMed  Google Scholar 

  24. Erhardt JB, Fuhrer E, Gruschke OG, Leupold J, Wapler MC, Hennig J, Stieglitz T, Korvink JG (2018) Should patients with brain implants undergo MRI? J Neural Eng 15(4):041002. https://doi.org/10.1088/1741-2552/aab4e4

    Article  PubMed  Google Scholar 

  25. Gubbels SP, McMenomey SO (2006) Safety Study of the Cochlear Nucleus® 24 Device with Internal Magnet in the 1.5 Tesla magnet resonance imaging scanner. Laryngoscope 116(6):865–871. https://doi.org/10.1097/01.MLG.0000216807.03225.CE

    Article  PubMed  Google Scholar 

  26. Broomfield SJ, Da Cruz M, Gibson WP (2013) Cochlear implants and magnetic resonance scans: a case report and review. Cochlear Implants Int 14(1):51–55. https://doi.org/10.1179/1754762811Y.0000000027

    Article  PubMed  Google Scholar 

  27. Cuda D, Murri A, Italica SG (2013) Focused tight dressing does not prevent cochlear implant magnet migration under 1.5 Tesla MRI. Acta Otorhinolaryngol Ital 33(2):133–136

    CAS  PubMed  PubMed Central  Google Scholar 

  28. Deneuve S, Loundon N, Leboulanger N, Rouillon I, Garabedian EN (2008) Cochlear implant magnet displacement during magnet resonance imaging. Otol Neurotol 29(6):789–190. https://doi.org/10.1097/MAO.0b013e3181825695

    Article  PubMed  Google Scholar 

  29. Advanced Bionics (2020) MRI Safety Information. https://advancedbionics.com/de/de/home/professionals/mri-safety-information.html. Accessed 5 Jan 2020

  30. Cochlear Ltd. (2020) Cochlear™ Nucleus® Implantate und ihre MRT-Kompatibilität. https://www.cochlear.com/de/startseite/unsere-produkte/cochlea-implantate/portfolio-der-nucleus-implantate/mrt-kompatibilitaet. Accessed 5 Jan 2020

  31. MED-EL (2019) MED-EL Hörimplantate. MRT-Sicherheitsstatus im Überblick. https://www.medel.com/docs/default-source/isi-important-safety-information/languages/de-german/mri-safety-status-overview/aw36744_40_mri-safety-status-overview-(de-german).pdf?sfvrsn=7f126942_2. Accessed 5 Jan 2020

  32. Oticon Medical (2020) MRT und Cochlea-Implantate. https://wdh01.azureedge.net/de/-/media/medical/main/files/for-professionals/ci/surgical/mri/en/210437uk_qg_mri-checklist_version_a_2019-07_low.pdf?la=en&rev=7D8E&hash=2FABD0D66C26CF4D05602040333F0CCA. Accessed 5 Jan 2020

  33. Nospes S, Mann W, Keilmann A (2013) Magnetic resonance imaging in patients with magnetic hearing implants: overview and procedural management. Radiologe. 53(11):1026–1032. https://doi.org/10.1007/s00117-013-2570-x

    Article  CAS  PubMed  Google Scholar 

  34. Hassepass F, Stabenau V, Arndt S, Beck R, Bulla S, Grauvogel T, Aschendorff A (2014) Magnet dislocation: an increasing and serious complication following MRI in patients with cochlear implants. Rofo. 186(7):680–685. https://doi.org/10.1055/s-0033-1356238 (Epub 2014 Feb 4)

    Article  CAS  PubMed  Google Scholar 

  35. Grupe G, Wagner J, Hofmann S, Stratmann A, Mittmann P, Ernst A, Todt I (2017) Prevalence and complications of MRI scans of cochlear implant patients: english version. HNO 65(Suppl 1):35–40. https://doi.org/10.1007/s00106-016-0129-7

    Article  CAS  PubMed  Google Scholar 

  36. Di Nardo W, Giannantonio S, Schinaia L, De Corso E, Pauludetti G (2013) Noninvasive management of cochlear implant’s inner magnet displacement after magnetic resonance: a case report. Laryngoscope 123:783–786

    Article  Google Scholar 

  37. Özgür A, Dursuna E, Celiker FB, Terzi S (2019) Magnet dislocation during 3 T magnetic resonance imaging in a pediatric case with cochlear implant. Braz J Otorhinolaryngol 85(6):799–802

    Article  Google Scholar 

  38. Ray J, Proops D, Donaldson I, Fielden C, Cooper H (2004) Explantation and reimplantation of cochlear implants. Cochlear Implants Int 5:160–167

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany

    Martin Leinung, Andreas Loth, Maximilian Gröger, Timo Stöver & Silke Helbig

  2. Institute of Diagnostic and Interventional Radiology, University Hospital, Frankfurt, Germany

    Iris Burck & Thomas Vogl

Authors
  1. Martin Leinung
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Andreas Loth
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Maximilian Gröger
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Iris Burck
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Thomas Vogl
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Timo Stöver
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Silke Helbig
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Martin Leinung.

Ethics declarations

Conflict of interest

There are no conflicts of interest to disclose by the authors.

Human and animal rights

The submitted manuscript does not report data derived from experimental or clinical observations in human or animal subjects.

Informed consent

For the same reason informed consent was neither necessary nor applicable.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Leinung, M., Loth, A., Gröger, M. et al. Cochlear implant magnet dislocation after MRI: surgical management and outcome. Eur Arch Otorhinolaryngol 277, 1297–1304 (2020). https://doi.org/10.1007/s00405-020-05826-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00405-020-05826-x

Keywords

Search

Navigation