More details
Hide details
Department of Otorhinolaryngology, Madras ENT Research Foundation (P) Ltd., Chennai, India
Publication date: 2016-12-31
Corresponding author
Sunil Goyal   

Sunil Goyal, Department of Otorhinolaryngology, Madras ENT Research Foundation (P) Ltd., Chennai, India, e-mail:
J Hear Sci 2016;6(4):25-35
Cochlear implantation is a safe surgery for restoration of hearing in severe to profound cochlear hearing loss candidates. Patients with congenital cochlear hearing loss may at times have renal anomalies. Renal dysfunction can contribute to sensorineural hearing loss, and it can affect cochlear implantation in a variety of ways, from minor intraoperative issues to major life-threatening complications. Our study aimed to determine the prevalence of renal association encountered in cochlear implantees over a period of 15 years (Jan 2000–Dec 2014) at our centre; secondly to classify these renal associations, as this has an effect on management; and finally to suggest a protocol for perioperative management of cochlear implantees with renal comorbidity.

Material and Methods:
This is a retrospective study of 1000 consecutive patients who underwent cochlear implantation at the Madras ENT Research Foundation (Chennai) over the period Jan 2000–Dec 2014. All cochlear implantees with bilateral severe to profound cochlear hearing loss and associated renal associations were included. The data for our study were collected from nephrologist referral forms and medical records. The paper gives a nephrologist’s perspective on perioperative care to be given during cochlear implantation. Relevant literature is reviewed.

Overall prevalence of renal disease was 6 out of 1000 implantees (0.6%) in our series. We classify the associated renal associations in cochlear implant candidates into 4 categories, and appropriate management for them is described.

A protocol for evaluating renal associations as they affect cochlear implantation has been designed, and the optimal management of these issues has been discussed.

Soriano JR. Branchio-oto-renal syndrome. J Nephrol, 2003; 16(4): 603–5.
Kashtan CE. Alport syndrome: An inherited disorder of renal, ocular, and cochlear basement membranes. Medicine, 1999; 78(5): 338–60.
Humes HD. Insights into ototoxicity. Analogies to nephrotoxicity. Ann NY Acad Sci, 1999; 884: 15–18.
Meena RS, Aseri Y, Singh B, Verma P. Hearing loss in patients of chronic renal failure: A study of 100 cases. Indian J Otolaryngol Head Neck Surg, 2012; 64(4): 356–59.
Vilayur E, Gopinath B, Harris DC, Burlutsky G, McMahon CM, Mitchell P. The association between reduced GFR and hearing loss: A cross-sectional population-based study. Am J Kidney Dis, 2010; 56(4): 661–69.
Sharifian M, Esfandiar N, Mazaheri S, Kariminejad A, Mohkam M, Dalirani R et al. Distal renal tubular acidosis and its relationship with hearing loss in children: preliminary report. Iran J Kidney Dis, 2010; 4(3): 202.
Kheterpal S, Tremper KK, Englesbe MJ, O’Reilly M, Shanks AM, Fetterman DM et al. Predictors of postoperative acute renal failure after noncardiac surgery in patients with previously normal renal function. Anesthesiology, 2007; 107(6): 892–902.
Sayer JA, Georgina C, Simmons NL. Nephrocalcinosis: Molecular insights into calcium precipitation within the kidney. Clin Sci, 2004; 106(6): 549–61.
Fraser F, Sproule J, Halal F, Optiz JM. Frequency of the branchio‐oto‐renal (BOR) syndrome in children with profound hearing loss. Am J Med Geneti, 1980; 7(3): 341–49.
Gorlin RJ, Toriello HV, Cohen MM. Hereditary hearing loss and its syndromes: Oxford University Press, USA, 1995.
König R, Fuchs S, Dukiet C. Branchio-oto-renal (BOR) syndrome: Variable expressivity in a five-generation pedigree. Eur J Pediatr, 1994; 153(6): 446–50.
Colville D, Savige J. A review of the ocular manifestations. Ophthalmic Genet, 1997; 18(4): 161–73.
Yorgason JG, Fayad JN, Kalinec F. Understanding drug ototoxicity: Molecular insights for prevention and clinical management. Expert Opin Drug Saf, 2006; 5(3): 383–99.
Gatland D, Tucker B, Chalstrey S, Keene M, Baker L. Hearing loss in chronic renal failure-hearing threshold changes following haemodialysis. J R Soc Med, 1991; 84(10): 587–89.
Mancini M, Strologo LD, Bianchi P, Tieri L, Rizzoni G. Sensorineural hearing loss in patients reaching chronic renal failure in childhood. Pediatr Nephrol, 1996; 10(1): 38–40.
Mitschke H, Schmit P, Zazgornik J, Kopsa H, Pils P. Effect of renal transplantation on uremic deafness: A long-term study. Audiology, 1977; 16(6): 530–34.
Antonelli A, Bonfioli F, Garrubba V, Ghisellini M, Lamoretti M, Nicolai P et al. Audiological findings in elderly patients with chronic renal failure. Acta Oto-Laryngologica Suppl, 1990; 476: 54–68.
Patterson DM, Telischi FF, Connell SS, Ulubil SA, Hodges AV, Eshraghi AA et al. Cochlear implantation in organ transplantation. Laryngoscope, 2008; 118(1): 116–19.
Iverson KC, McKinnon BJ. Cochlear implantation after renal transplantation. Am J Otolaryngol, 2012; 33(1): 150–53.
Cortina G, Wiesmayr S, Jungraithmayr T, Roussinow D, Nekahm‐Heis D, Zorowka P et al. Successful implantation of a cochlear implant in a four‐yr‐old boy after kidney transplantation: A case report. Pediatr Transplant, 2009; 13(7): 933–35.
Seri M, Pecci A, Di Bari F, Cusano R, Savino M, Panza E et al. MYH9-related disease: May-Hegglin anomaly, Sebastian syndrome, Fechtner syndrome, and Epstein syndrome are not distinct entities but represent a variable expression of a single illness. Medicine, 2003; 82(3): 203–15.
Kohlhase J, Wischermann A, Reichenbach H, Froster U, Engel W. Mutations in the SALL1 putative transcription factor gene cause Townes-Brocks syndrome. Nat Genet, 1998; 18(1): 81–83.
Bagshaw SM, George C, Bellomo R. A comparison of the RIFLE and AKIN criteria for acute kidney injury in critically ill patients. Nephrol Dial Transplant, 2008; 23(5): 1569–74.
KDIGO Working Group. KDIGO clinical practice guideline for glomerulonephritis. Kidney Inter Suppl, 2012; 2: 139–274.
Chertow GM, Burdick E, Honour M, Bonventre JV, Bates DW. Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. J Am Soc Nephrol, 2005; 16(11): 3365–70.
Kheterpal S, Tremper KK, Heung M, Rosenberg AL, Englesbe M, Shanks AM et al. Development and validation of an acute kidney injury risk index for patients undergoing general surgery: Results from a national data set. J Am Soc Anesthesiol, 2009; 110(3): 505–15.
Loef BG, Epema AH, Smilde TD, Henning RH, Ebels T, Navis G et al. Immediate postoperative renal function deterioration in cardiac surgical patients predicts in-hospital mortality and long-term survival. J Am Soc Nephrol, 2005; 16(1): 195–200.
Basile DP, Anderson MD, Sutton TA. Pathophysiology of acute kidney injury. Compr Physiol, 2012; 2(2): 1303–53.
Stacul F, van der Molen AJ, Reimer P, Webb JA, Thomsen HS, Morcos SK et al. Contrast induced nephropathy: Updated ESUR contrast media safety committee guidelines. Eur Radiol, 2011; 21(12): 2527–41.
Hoshino A, Enomoto S, Kawahito H, Kurata H, Nakahara Y, Nakamura T. [Prevention of contrast-induced nephropathy using cardiac catheterization combined with hydration, oral Nacetylcysteine, sodium bicarbonate and iso-osmolar contrast agents] J Cardiol, 2007; 50(2): 119–26 [in Japanese].
Burden R, Tomson C, Joint Specialty Committee on Renal Disease of the Royal College of Physicians of London and the Renal Association. Identification, management and referral of adults with chronic kidney disease: Concise guidelines. Clin Med, 2005; 5(6): 635–42.
London GM, editor. The Clinical Epidemiology of Cardiovascular Diseases in Chronic Kidney Disease: Cardiovascular Disease in Chronic Renal Failure – Pathophysiologic Aspects. Seminars in Dialysis; 2003: Wiley Online Library.
Craig R, Hunter J. Recent developments in the perioperativemanagement of adult patients with chronic kidney disease. Br J Anaesth, 2008; 101(3): 296–310.
Dalrymple LS, Go AS. Epidemiology of acute infections among patients with chronic kidney disease. Clin J Am Soc Nephrol, 2008; 3(5): 1487–93.
Krishnan M. Preoperative care of patients with kidney disease. Am Fam Physician, 2002; 66(8): 1471–76.
Parham WA, Mehdirad AA, Biermann KM, Fredman CS. Hyperkalemia revisited. Tex Heart Inst J, 2006; 33(1): 40–47.
Lee TH. Reducing cardiac risk in noncardiac surgery. New Engl J Med, 1999; 341(24): 1838–40.
Brienza N, Giglio MT, Marucci M, Fiore T. Does perioperative hemodynamic optimization protect renal function in surgical patients? A meta-analytic study. Crit Care Med, 2009; 37(6): 2079–90.
Huerta C, Castellsague J, Varas-Lorenzo C, Rodríguez LAG. Nonsteroidal anti-inflammatory drugs and risk of ARF in the general population. Am J Kidney Dis, 2005; 45(3): 531–39.
Munar MY, Singh H. Drug dosing adjustments in patients with chronic kidney disease. Am Fam Physician, 2007; 75(10): 1487–96.
Pham PCT, Toscano E, Pham PMT, Pham PAT, Pham SV, Pham PTT. Pain management in patients with chronic kidney disease. NDT Plus, 2009: sfp001.
Gardner JS, Blough D, Drinkard CR, Shatin D, Anderson G, Graham D et al. Tramadol and seizures: A surveillance study in a managed care population. Pharmacotherapy, 2000; 20(12): 1423–31.
Reichle FM, Conzen PF, Peter K. Nephrotoxicity of halogenated inhalational anaesthetics: fictions and facts. Eur Surg Res, 2002; 34(1–2): 188–95.
Journals System - logo
Scroll to top