Cochlear implantation in healthy and otitis-prone children: a prospective study

To evaluate and compare the timing of surgery, intraoperative findings, and otitis media-related outcome of cochlear implantation in children who are otitis-prone with their counterparts who are not otitis-prone.

Prospective.

Children referred for cochlear implantation were assigned to a non-otitis-prone group (group A: normal otoscopy on their first visit after referral) or an otitis-prone group (group B: current or a recent history of otitis media at referral). Group B patients were managed using a structured protocol aimed at preimplantation otitis media control. The study reviewed pre-, intra-, and postoperative data.

Of the 18 children studied, 8 were assigned to group A (mean age at referral, 40.6 mo) and 10 to group B (mean age at referral, 31.6 mo). For otitis media control, all otitis-prone children underwent ventilating tube insertion (various numbers of procedures before implantation). Only one otitis-prone child required cortical mastoidectomy also. Time from referral to implantation was similar in the two groups (mean, 6.6 mo). High-resolution computed tomography data showed mastoid pneumatization to be significantly smaller in the otitis-prone group, but the facial recess was not smaller in this group. During implantation, 10 children had inflamed middle ear mucosa. Seven of these belonged to group B. All of these seven children had a round window niche obliterated by the inflamed mucosa, which had to be removed for round window membrane identification. After implantation, only one child had drainage through the ventilating tube for more than 1 week. Two children in group B developed otitis media (1 year postimplantation) that was overcome within 1 week. There were no otitis media-related complications.

If a structured protocol is used for the control of otitis media before cochlear implantation, otitis media should not require a delay in implantation. In otitis media-prone children, the round window niche is often obscured by inflamed mucosa. Its removal is mandatory for identification of the round window membrane. After cochlear implantation, otitis media is not a frequent occurrence.