Cochlear Implant Device Failures Falling Under the 2020 FDA Voluntary Field Corrective Action: A Systematic Review and Meta-analysis

Objective: To compare the rate of device failure for those cochlear implants (CIs) involved in the 2020 Food and Drug Administration (FDA) voluntary field corrective action (VFCA). Databases Reviewed: Medline, Embase, and Scopus. Methods: A systematic review was performed according to the PRISMA guidelines. Publications reporting institutional experiences with implants affected by the VFCA were included. Outcomes assessed included etiology of, rate of, and time to failure and pre-/ post-device failure speech perception testing. All outcomes reported in at least two independent studies were included in a meta-analysis. Results: Six studies met criteria for analysis. The overall pooled failure rate was 23.7% (95% CI, 11.6–38.4%). The pooled device, inconclusive, and medical failure rates were 21.5%, 0.2%, and 0.7%, respectively. Pediatric failure rates were higher than those of adults (46.9% [95% CI, 11.2–84.5%] versus 32.6% [95% CI, 8.2–63.7%]). WRS declined with primary implant failure (55.1% [95% CI, 48.0–62.1%] to 34.1% [95% CI, 30.2–38.0%]) but improved after reimplantation (34.1% [95% CI, 30.2–38.0%] to 50.1% [95% CI, 45.2–55.1%]). Conclusions: The rate of pooled reported failure for CIs falling under the 2020 VFCA in the literature thus far is 23.7%. The overwhelming majority of these failures were device related, the rates of which were higher in children. Speech perception improved significantly after reimplantation.