Ear Surgery in Infants Under One Year of Age

Abstract

Elective ear surgery in infants below 1 year of age should be performed in institutions where a continuous experience with this type of patient exists and all the facilities of pediatric perioperative anesthesia care are readily available.

Cochlear Implantation after Bacterial Meningitis in Infants Younger Than 9 Months

“…Specialized pediatric anesthesiologists are therefore an indispensable part of the pediatric cochlear implant team [5, 34]. Key points in the anesthesiological technique include the parental presence at induction, which significantly reduces separation anxiety and distress in the infant [35].…”

“…Because of the length of the procedure, wiring under the child or folds in clothes and draping can cause skin injury. It is important to minimize heat loss, as infants are particularly vulnerable to hypothermia because of a large body-surface-to-weight ratio [5]. The operation theatre should therefore be preheated, and a temperature control blanket should be applied.…”

“…The operation theatre should therefore be preheated, and a temperature control blanket should be applied. Conversely, prolonged surgery in a small surgical field using draping that covers a large surface area could increase the body temperature, and the body temperature should thus be monitored during the procedure [5]. If bilateral implantations are performed, the alternating position of the head should be anticipated.…”

“…On the one hand, a growing body of evidence indicates that hearing rehabilitation is more effective when the patient is implanted at a young age [1–4]. On the other hand, a certain period of time is needed to determine a reliable hearing threshold, to allow for improvement of hearing due to maturation of the auditory system after birth, and to test the performance of the patient with hearing aids [5]. Furthermore, the benefits of cochlear implantation before the age of 9 months should be weighed against the higher risk of anesthesia at this young age [5].…”

“…On the other hand, a certain period of time is needed to determine a reliable hearing threshold, to allow for improvement of hearing due to maturation of the auditory system after birth, and to test the performance of the patient with hearing aids [5]. Furthermore, the benefits of cochlear implantation before the age of 9 months should be weighed against the higher risk of anesthesia at this young age [5]. In case of sensorineural hearing loss caused by acute bacterial meningitis, different considerations apply.…”