Infectious complications and ventilation tubes in pediatric cochlear implant recipients

Javia, Luv; Brant, Jason A.; Guidi, Jessica; Rameau, Anaïs; Pross, Seth E.; Cohn, Samuel; Kazahaya, Ken; Dunham, Brian; Germiller, John A.

doi:10.1002/lary.25569

Cited by 12 publications

(11 citation statements)

References 29 publications

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“…The fibrous capsule that forms over the receiver-stimulator unit isolates it from the middle ear and mastoid cavity ( Nisenbaum et al., 2020 ). Sometimes, a tympanostomy tube is required which is generally safe in the presence of a CI and rarely leads to further complications ( Javia et al., 2016 ). When untreated, a mastoid abscess may develop and involve the device, thereby comprising it due to biofilm formation ( Im et al., 2015 ).…”

Section: Discussionmentioning

confidence: 99%

Cochlear Implantation in Infants: Evidence of Safety

et al. 2021

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The aim of this study was to investigate surgical, anesthetic, and device-related complications associated with cochlear implantation (CI) in children younger than 1 year of age. This was a multicenter, retrospective chart review of all children with severe-to-profound sensorineural hearing loss who underwent cochlear implantation with a Cochlear Nucleus Implant System before 1 year of age. Endpoints included perioperative course, major and minor surgical, anesthetic and device-related complications, and 30-day readmission rates. One hundred thirty-six infants (242 ears) met criteria. The mean age at implantation was 9.4 months (standard deviation 1.8). Six-month follow-up was reported in all patients. There were no major anesthetic or device-related complications. Adverse events were reported in 34 of implanted ears (14%; 7 major, 27 minor). Sixteen adverse events occurred ≤30 days of surgery, and 18 occurred >30 days of surgery. The 30-day readmission rate was 1.5%. The rate of adverse events did not correlate with preexisting medical comorbidities or duration under anesthesia. There was no significant difference detected in complication rate for patients younger than 9 months of age versus those 9 to 11 months of age. This study demonstrates the safety of CI surgery in infants and supports reducing the indication for cochlear implantation to younger than 1 year of age for children with bilateral, profound sensorineural hearing loss obtaining a Cochlear Nucleus Implant System.

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Section: Discussionmentioning

confidence: 99%

Cochlear Implantation in Infants: Evidence of Safety

et al. 2021

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“…197 The authors concluded that the preponderance of published evidence and policy statements argue in favor of using tubes in children with recurrent AOM undergoing cochlear implantation, with no evidence showing increased infectious complications from the presence of a tube. The issue of tympanostomy tubes for OME prior to cochlear implantation is less well studied, with a case series 198 concluding that infectious complications are rarely associated with the presence of tubes and that tube insertion is safe. A more recent literature review concluded that chronic OME and recurrent AOM should have tympanostomy tubes placed to treat any middle ear infection before cochlear implantation.…”

Section: Action Statement Profilementioning

confidence: 99%

Clinical Practice Guideline: Tympanostomy Tubes in Children (Update)

Rosenfeld

Tunkel

Schwartz

et al. 2022

Otolaryngol.--head neck surg.

164

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Objective Insertion of tympanostomy tubes is the most common ambulatory surgery performed on children in the United States. Tympanostomy tubes are most often inserted because of persistent middle ear fluid, frequent ear infections, or ear infections that persist after antibiotic therapy. All these conditions are encompassed by the term otitis media (middle ear inflammation). This guideline update provides evidence-based recommendations for patient selection and surgical indications for managing tympanostomy tubes in children. The guideline is intended for any clinician involved in managing children aged 6 months to 12 years with tympanostomy tubes or children being considered for tympanostomy tubes in any care setting as an intervention for otitis media of any type. The target audience includes specialists, primary care clinicians, and allied health professionals. Purpose The purpose of this clinical practice guideline update is to reassess and update recommendations in the prior guideline from 2013 and to provide clinicians with trustworthy, evidence-based recommendations on patient selection and surgical indications for managing tympanostomy tubes in children. In planning the content of the updated guideline, the guideline update group (GUG) affirmed and included all the original key action statements (KASs), based on external review and GUG assessment of the original recommendations. The guideline update was supplemented with new research evidence and expanded profiles that addressed quality improvement and implementation issues. The group also discussed and prioritized the need for new recommendations based on gaps in the initial guideline or new evidence that would warrant and support KASs. The GUG further sought to bring greater coherence to the guideline recommendations by displaying relationships in a new flowchart to facilitate clinical decision making. Last, knowledge gaps were identified to guide future research. Methods In developing this update, the methods outlined in the American Academy of Otolaryngology–Head and Neck Surgery Foundation’s “Clinical Practice Guideline Development Manual, Third Edition: A Quality-Driven Approach for Translating Evidence Into Action” were followed explicitly. The GUG was convened with representation from the disciplines of otolaryngology–head and neck surgery, otology, pediatrics, audiology, anesthesiology, family medicine, advanced practice nursing, speech-language pathology, and consumer advocacy. Action Statements The GUG made strong recommendations for the following KASs: (14) clinicians should prescribe topical antibiotic ear drops only, without oral antibiotics, for children with uncomplicated acute tympanostomy tube otorrhea; (16) the surgeon or designee should examine the ears of a child within 3 months of tympanostomy tube insertion AND should educate families regarding the need for routine, periodic follow-up to examine the ears until the tubes extrude. The GUG made recommendations for the following KASs: (1) clinicians should not perform tympanostomy tube insertion in children with a single episode of otitis media with effusion (OME) of less than 3 months’ duration, from the date of onset (if known) or from the date of diagnosis (if onset is unknown); (2) clinicians should obtain a hearing evaluation if OME persists for 3 months or longer OR prior to surgery when a child becomes a candidate for tympanostomy tube insertion; (3) clinicians should offer bilateral tympanostomy tube insertion to children with bilateral OME for 3 months or longer AND documented hearing difficulties; (5) clinicians should reevaluate, at 3- to 6-month intervals, children with chronic OME who do not receive tympanostomy tubes, until the effusion is no longer present, significant hearing loss is detected, or structural abnormalities of the tympanic membrane or middle ear are suspected; (6) clinicians should not perform tympanostomy tube insertion in children with recurrent acute otitis media who do not have middle ear effusion in either ear at the time of assessment for tube candidacy; (7) clinicians should offer bilateral tympanostomy tube insertion in children with recurrent acute otitis media who have unilateral or bilateral middle ear effusion at the time of assessment for tube candidacy; (8) clinicians should determine if a child with recurrent acute otitis media or with OME of any duration is at increased risk for speech, language, or learning problems from otitis media because of baseline sensory, physical, cognitive, or behavioral factors; (10) the clinician should not place long-term tubes as initial surgery for children who meet criteria for tube insertion unless there is a specific reason based on an anticipated need for prolonged middle ear ventilation beyond that of a short-term tube; (12) in the perioperative period, clinicians should educate caregivers of children with tympanostomy tubes regarding the expected duration of tube function, recommended follow-up schedule, and detection of complications; (13) clinicians should not routinely prescribe postoperative antibiotic ear drops after tympanostomy tube placement; (15) clinicians should not encourage routine, prophylactic water precautions (use of earplugs or headbands, avoidance of swimming or water sports) for children with tympanostomy tubes. The GUG offered the following KASs as options: (4) clinicians may perform tympanostomy tube insertion in children with unilateral or bilateral OME for 3 months or longer (chronic OME) AND symptoms that are likely attributable, all or in part, to OME that include, but are not limited to, balance (vestibular) problems, poor school performance, behavioral problems, ear discomfort, or reduced quality of life; (9) clinicians may perform tympanostomy tube insertion in at-risk children with unilateral or bilateral OME that is likely to persist as reflected by a type B (flat) tympanogram or a documented effusion for 3 months or longer; (11) clinicians may perform adenoidectomy as an adjunct to tympanostomy tube insertion for children with symptoms directly related to the adenoids (adenoid infection or nasal obstruction) OR in children aged 4 years or older to potentially reduce future incidence of recurrent otitis media or the need for repeat tube insertion.

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“…İmplant sonrası menenjit riskinde artış ile implantın positioner (implant elektrodunun koklea medial duvarına itilmesini sağlayan ve elektrik iletimini artıran parça) ile birlikte kullanılması, iç kulakta malformasyon varlığı ve BOS kaçağı arasında anlamlı derecede ilişki bulunmuştur. Amerika Birleşik Devletleri'nde 478, Kanada'da 482 koklear implantlı pediatrik olguda menenjit sıklığı sırasıyla %0.72 ve %0.8 olarak bildirilmiştir 2,5 . Hollanda'da 28 yıllık bir dönemi kapsayan çalışmada, koklear implantlı çocuk ve erişkin hastalarda menenjit görülme oranı %0.2 olarak bildirilmiştir.…”

Section: Discussionunclassified

Pnömokok Aşılı Koklear İmplantlı Hastada Streptococcus pneumoniae Serotip 24B’ye Bağlı Menenjit

Nepesov¹,

Dinleyici²,

Kılıç³

et al. 2019

Mikrobiyol Bul

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Pnömokok Aşılı Koklear İmplantlı Hastada Streptococcus pneumoniae Serotip 24B'ye Bağlı Menenjit MİKROBİYOLOJİ BÜLTENİ mg/dl) ve protein 706 mg/dl bulunmuştur. Ampirik olarak vankomisin (60 mg/kg/gün) ve seftriakson (100 mg/kg/gün) başlanan hastanın antibiyotik tedavisinin beşinci gününde, BOS kültüründe penisiline duyarlı S.pneumoniae üremiş ve serotip 24B olarak tanımlamıştır. Kan kültüründe de benzer antibiyotik duyarlılığına sahip S.pneumoniae üreyen hastanın yatışının 16. gününde rinore gözlenmesi üzerine opere edilerek fistül traktı onarılmıştır. Ameliyat sonrası üçüncü günde akut bilinç bulanıklığı gelişmesi üzerine çekilen beyin bilgisayarlı tomografide beyin ödemi ve sağ orta serebral arterde trombüs saptanmıştır. Çoklu organ yetmezliği gelişmesi nedeniyle yatışının 42. günü kaybedilmiştir. Mevcut bilgilerimize göre ülkemizde S.pneumoniae serotip 24B'ye bağlı bildirilen, koklear implantlı bir hastada izlenen ilk menenjit olgusudur. Konjuge pnömokok aşısının rutin uygulamaya girmesi ile invaziv pnömokokal hastalık sıklığında azalma görülürken aşı dışı serotiplerde göreceli bir artış söz konusudur. Bu durum pnömokok enfeksiyonu açısından risk faktörüne sahip olmayan hastaların yanı sıra koklear implant gibi risk faktörü bulunan hastaları da yakından ilgilendirmektedir.

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Infectious complications and ventilation tubes in pediatric cochlear implant recipients

Abstract: 4. Laryngoscope, 126:1671-1676, 2016.

Cited by 12 publications

References 29 publications

Cochlear Implantation in Infants: Evidence of Safety

Cochlear Implantation in Infants: Evidence of Safety

Clinical Practice Guideline: Tympanostomy Tubes in Children (Update)

Pnömokok Aşılı Koklear İmplantlı Hastada Streptococcus pneumoniae Serotip 24B’ye Bağlı Menenjit

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