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Published on: March 24, 2023
Cochlear implantation in children with otitis media: second stage of a long-term prospective study
Michal Luntz1, Christian B Teszler, Talma Shpak
1Head and Neck Surgery, Department of Otolaryngology, Faculty of Medicine, Bnai Zion Medical Center, Technion--Israel Institute of Technology, PO Box 4940, Haifa 31048, Israel. luntz@b-zion.org.il
Insights
Pediatric cochlear implant recipients prone to otitis media (OM) experienced a higher incidence of post-implantation OM despite pre-implantation protocols. Continuous ventilation tube use is recommended for OM-prone children until their susceptibility decreases.
Area of Science:
- Pediatric Otolaryngology
- Cochlear Implantation Outcomes
- Middle Ear Disease Management
Background:
- Otitis media (OM) is a common concern in children undergoing cochlear implantation.
- Managing OM in OM-prone children requires specific pre-implantation strategies.
- Understanding post-implantation OM incidence is crucial for optimizing outcomes.
Purpose of the Study:
- To evaluate the outcomes of cochlear implantation in OM-prone versus non-OM-prone children.
- To assess the effectiveness of a structured protocol for pre-implantation OM control.
- To determine the incidence and characteristics of post-implantation OM in these pediatric groups.
Main Methods:
- Prospective study comparing 34 OM-prone (Group A) and 26 non-OM-prone (Group B) children.
- Group A received a structured protocol including ventilating tubes for pre-implantation OM control.
- Post-implantation follow-up ranged from 3 to 45 months (average 20 months).
Main Results:
- OM-prone children had lower mean ages at referral and implantation, with a longer interval between referral and implantation.
- Thick middle ear mucosa requiring removal was noted in 19 OM-prone children during surgery.
- Post-implantation acute OM occurred in 38% of OM-prone children versus 7.6% of non-OM-prone children.
Conclusions:
- While early referral facilitated early implantation, OM incidence remained higher in OM-prone pediatric cochlear implant recipients.
- Recurrent OM and mastoiditis complications were observed exclusively in the OM-prone group.
- Continuous use of ventilating tubes is recommended for OM-prone pediatric implantees until OM susceptibility diminishes.
Objective:
To present the findings of the second stage of an ongoing prospective study of the outcome of cochlear implantation in otitis media (OM)-prone and non-OM-prone children who were treated according to a structured protocol designed to control OM prior to implantation.
Patients And Methods:
Of 60 children referred for cochlear implantation during the study period, 34 were classified as OM-prone (Group A) and 26 as non-OM-prone (group B). Group A patients were managed according to a structured protocol aimed at pre-implantation control of OM. A ventilating tube (with or without adenoidectomy) was inserted in the affected ear(s) of these children, if necessary more than once. Post-implantation follow-up ranged from 3 to 45 months (average 20 months).
Results:
In the OM-prone group of children, the mean age at referral and at implantation was significantly lower and the mean interval between referral and implantation significantly higher than in the healthy group. During implantation, 21 children (19 from the OM-prone group A) had thick middle ear mucosa that had to be removed to allow identification of the round window niche. After implantation, 13 of the OM-prone children (38%) and 2 of the non-OM-prone children (7.6%) developed acute OM in the implanted ear. Five of these cases, all belonging to the OM-prone group, proved to be recurrent and therapeutically challenging, and 2 of them also developed acute mastoiditis. There were no other OM-related complications.
Conclusions:
Early referral led to early implantation, even in children susceptible to OM. The incidence of OM decreased after implantation, but was still significantly higher in the OM-prone group. On the basis of these results, we recommend the continuous use of a ventilating tube in OM-prone pediatric implantees until they outgrow their susceptibility to OM.
