Infectious Complications Following Cochlear Implant: Risk Factors, Natural History, and Management Patterns

Abstract

Objective To describe the natural history, detail the treatment patterns, and identify the risk factors for cochlear implant (CI) infections in a large US cohort. Study Design Retrospective study based on insurance claims. Setting Optum Data Mart database: 6101 patients who received CIs from 2003 to 2019. Methods Infections, treatments patterns, and timelines were described. A multivariable logistic regression model was used to assess the association between postoperative oral antibiotics and CI infection. Results The cohort includes 4736 (77.6%) adults and 1365 (22.4%) children. Between adult and pediatric patients, rates of CI infection (5.1% vs 4.5%, P = .18) and explantation (1.2% vs 0.8%, P = .11) were not significantly different. Infections typically occurred within 5 months of surgery. Children were diagnosed with CI infection earlier than adults (median difference, –1.5 months; P = .001). Postoperative oral antibiotic supply was not associated with lower risk of CI infection in either children or adults. However, among adults, otitis media was associated with higher odds of CI infection (odds ratio, 1.41; P < .001), while higher income was associated with lower odds of CI infection (odds ratio, 0.71; P = .03). Conclusions Postoperative oral antibiotics were not associated with lower risk of infection or interventions. Otitis media episodes and lower income were associated with increased risk of infection among adults as well as intervention overall. Infection typically presented within the first 6 months after surgery, with children presenting earlier than adults. Overall, our findings serve as a resource for providers to consider in their care of patients with CIs.

Mitigating Infection Risk in Upper Airway Stimulation

“…The observed infection rate at our institution is comparable with rates reported for other implanted devices, such as the implantable cardioverter defibrillator (0.5-1%), 15 and lower than rates reported for cochlear implants (3-5%) 16 -18 and vagal nerve stimulators (2.1-8.4%). 19 Additional studies are needed to assess the variation in infection rates for the UAS device across various institutions.…”

An overview of risk factors, management and prevention of cochlear implant infections

“…Mastoiditis occurs less frequently with rates in children post cochlear implantation ranging from 1% to 6% [7,16,22,23]. The presence of acute or chronic OM significantly increases the risk of CI infection in both children and adults via contiguous spread [5,[8][9][10]21,24]. Risk of OM post implantation is increased in those who were prone to OM prior to implantation [25].…”

“…The need for explantation in the management of CI infections is uncommon with rates between 0.65% and 1.8% of CI recipients [37,[41][42][43]. Attempts initially at device salvage should be considered given favourable outcomes with this approach [14,24]. Biofilm formation may require CI removal in infections unresponsive to optimized antibiotic and surgical management.…”