Cochlear Implantation in Healthy and Otitis‐Prone Children: A Prospective Study

Luntz, Michał; Teszler, Christian B.; Shpak, Talma; Feiglin, Hava; Farah‐Sima'an, Afnan

doi:10.1097/00005537-200109000-00023

Cited by 60 publications

(59 citation statements)

References 16 publications

(19 reference statements)

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“…14 However, postmortem study of the temporal bone of implant recipients 2 to 10 years after implantation demonstrated that the opening in the round window around the electrode was sealed with fibrous tissue. 15 In the only prospective study of acute otitis media in implant recipients, Luntz et al 9,16 studied 60 children whom Six (10%) children with implants, 5 of whom were in the otitis media-prone group, had an episode of acute otitis media within 1 month of implantation, a finding that supports the assertion that children are at highest risk of acute otitis media during the immediate postoperative period. All these episodes of acute otitis media were treated successfully with oral antimicrobial agents, typically amoxicillin/ clavulanate.…”

Section: Acute Otitis Media In Cochlear Implant Recipientsmentioning

confidence: 89%

“…To prevent episodes of acute otitis media after cochlear implantation, surgeons may place tympanostomy tubes before or at the time of implantation in children with a history of recurrent acute otitis media or persistent middle-ear effusion. 16,19 A consensus report prepared by 8 cochlear implant surgeons recommended, on the basis of theoretical considerations and a series of otitis media-related meningitis episodes in adults, 20 avoidance of implantation if middle-ear fluid is present. 21 The surgeons stated that if middle-ear fluid is encountered at the time of implantation, they recommended high-volume irrigation of the middle ear, administration of topical antimicrobial agents into the middleear space, and systemic therapy with ceftriaxone.…”

Section: Acute Otitis Media In Cochlear Implant Recipientsmentioning

confidence: 99%

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Cochlear Implants in Children: Surgical Site Infections and Prevention and Treatment of Acute Otitis Media and Meningitis

Rubin¹,

Papsin²

2010

Pediatrics

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The use of cochlear implants is increasingly common, particularly in children younger than 3 years. Bacterial meningitis, often with associated acute otitis media, is more common in children with cochlear implants than in groups of control children. Children with profound deafness who are candidates for cochlear implants should receive all age-appropriate doses of pneumococcal conjugate and Haemophilus influenzae type b conjugate vaccines and appropriate annual immunization against influenza. In addition, starting at 24 months of age, a single dose of 23-valent pneumococcal polysaccharide vaccine should be administered. Before implant surgery, primary care providers and cochlear implant teams should ensure that immunizations are up-to-date, preferably with completion of indicated vaccines at least 2 weeks before implant surgery. Imaging of the temporal bone/inner ear should be performed before cochlear implantation in all children with congenital deafness and all patients with profound hearing impairment and a history of bacterial meningitis to identify those with inner-ear malformations/cerebrospinal fluid fistulas or ossification of the cochlea. During the initial months after cochlear implantation, the risk of complications of acute otitis media may be higher than during subsequent time periods. Therefore, it is recommended that acute otitis media diagnosed during the first 2 months after implantation be initially treated with a parenteral antibiotic (eg, ceftriaxone or cefotaxime). Episodes occurring 2 months or longer after implantation can be treated with a trial of an oral antimicrobial agent (eg, amoxicillin or amoxicillin/clavulanate at a dose of approximately 90 mg/kg per day of amoxicillin component), provided the child does not appear toxic and the implant does not have a spacer/positioner, a wedge that rests in the cochlea next to the electrodes present in certain implant models available between 1999 and 2002. "Watchful waiting" without antimicrobial therapy is inappropriate for children with implants with acute otitis media. If feasible, tympanocentesis should be performed for acute otitis media, and the material should be sent for culture, but performance of this procedure should not result in an undue delay in initiating antimicrobial therapy. For patients with suspected meningitis, cerebrospinal fluid as well as middle-ear fluid, if present, should be sent for culture. Empiric antimicrobial therapy for meningitis occurring within 2 months of implantation should include an agent with broad activity against Gram-negative bacilli (eg, meropenem) plus vancomycin. For meningitis occurring 2 months or longer after implantation, standard empiric antimicrobial therapy for meningitis (eg, ceftriaxone plus vancomycin) is indicated. For patients with meningitis, urgent evaluation by an otolaryngologist is indicated for consideration of imaging and surgical exploration. BACKGROUNDA cochlear implant is an implanted electronic hearing device designed to produce useful hearing sensations to a person ...

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Section: Acute Otitis Media In Cochlear Implant Recipientsmentioning

confidence: 89%

Section: Acute Otitis Media In Cochlear Implant Recipientsmentioning

confidence: 99%

Cochlear Implants in Children: Surgical Site Infections and Prevention and Treatment of Acute Otitis Media and Meningitis

Rubin¹,

Papsin²

2010

Pediatrics

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“…A survey showed that 56% of surgeons would place a cochlear implant in a patient with a clean, dry ventilation tube, and more than half of the surgeons would place a ventilation tube in a child with serous otitis media, let the ear recover, and perform the cochlear implant at a second operation [11]. However, recent reports have demonstrated that CI could be performed safely in patients with a history of AOM or chronic otitis media, and that a significant delay was not warranted in these patients [6,7]. A prospective study [3,7], with a cohort of 60 children of which 34 were classified as OM-prone, reported that no complications were observed in the OM-prone children receiving a cochlear implant, even in the children experiencing an episode of AOM after implantation.…”

Section: Discussionmentioning

confidence: 99%

“…However, recent reports have demonstrated that CI could be performed safely in patients with a history of AOM or chronic otitis media, and that a significant delay was not warranted in these patients [6,7]. A prospective study [3,7], with a cohort of 60 children of which 34 were classified as OM-prone, reported that no complications were observed in the OM-prone children receiving a cochlear implant, even in the children experiencing an episode of AOM after implantation. Some authors are of the opinion that CI can usually be achieved safely in one stage in patients with otitis media [1,2,3,4,8].…”

Section: Discussionmentioning

confidence: 99%

“…Since the well-established benefits of cochlear implants and improved surgical techniques have made CI feasible in the presence of otitis media, children with otitis media do not require a delay in implantation [1,2,3,4,5,6,7,8]. In this report, we review our experience by retrospectively studying data collected from 30 children with OME receiving CI in one stage.…”

Section: Introductionmentioning

confidence: 99%

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Cochlear Implantation with Round Window Insertion in Children with Otitis Media with Effusion

Sun

Sun²,

Hou³

2014

ORL

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Aims: To discuss indications and surgical techniques for cochlear implantation (CI) in children with profound sensorineural hearing loss and otitis media with effusion (OME). Methods: Between January 2003 and May 2013, a total of 550 patients received cochlear implants at the Anhui Provincial Hospital, Hefei, China. Of these, 30 children with OME underwent CI with round window insertion in one stage. Results: One-stage operations of CI with round window insertion were carried out in 30 children with OME. All electrodes were implanted successfully. CI was performed without complications and the electrode arrays were protected well. All implant devices worked normally and all patients performed well during an average follow-up period of 12 months. None of the patients experienced any immediate or delayed postoperative infection-related complications. Conclusions: CI with round window insertion could be safely and effectively performed in one stage in children with profound sensorineural hearing loss and OME. It is unnecessary to delay implantation to control OME, but it remains a challenging problem in operation.

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Detection of Bacteria in Healthy Middle Ears During Cochlear Implantation

Tonnaer¹,

Mylanus²,

Mulder³

et al. 2009

Arch Otolaryngol Head Neck Surg

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The presence of bacteria in the tympanic cavity, which is generally assumed to be sterile in healthy individuals, may provide an explanation for infectious complications after cochlear implantation. However, the possibility that the electrode array of a cochlear implant will actually become contaminated during insertion is unlikely because of the small amounts and dispersed presence of bacteria, which may account for the relatively low incidence of infectious complications after cochlear implantation.

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Cochlear Implantation in Healthy and Otitis‐Prone Children: A Prospective Study

Cited by 60 publications

References 16 publications

Cochlear Implants in Children: Surgical Site Infections and Prevention and Treatment of Acute Otitis Media and Meningitis

Cochlear Implants in Children: Surgical Site Infections and Prevention and Treatment of Acute Otitis Media and Meningitis

Cochlear Implantation with Round Window Insertion in Children with Otitis Media with Effusion

Detection of Bacteria in Healthy Middle Ears During Cochlear Implantation

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