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Ear surgery in infants under one year of age: its risks and implications for cochlear implant surgery
Martin Jöhr1, Ambrose Ho, Christoph Schlegel Wagner
1Paediatric Anesthesia, Department of Anesthesia, Kantonsspital, Luzern, Switzerland.
Insights
Early cochlear implantation (CI) in infants under 12 months is increasingly common for severe hearing impairment. Surgeon and anesthesia team experience are key risk factors for safe, successful elective pediatric CI surgery.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Anesthesiology
Background:
- Neonatal hearing screening identifies infants with congenital severe hearing impairment.
- Early cochlear implantation (CI) offers significant auditory rehabilitation benefits, with bilateral CI exceeding unilateral.
- Elective CI surgery in infants under 12 months is gaining popularity.
Purpose of the Study:
- To analyze surgical techniques and anesthesiological aspects of elective cochlear implantation in infants under one year of age.
- To identify risk factors associated with CI surgery in this pediatric population.
- To familiarize implanting surgeons with critical considerations for pediatric CI.
Main Methods:
- Review of personal experience at a tertiary children's hospital.
- Literature review of German and English publications from 1980-2007.
- Analysis of patients under 1 year undergoing CI, focusing on surgical and anesthesiological factors.
Main Results:
- Infant age and anesthesiologist's pediatric experience are significant risk factors.
- Surgery duration was not identified as a relevant risk factor.
- Key considerations include hemostasis, pharmacokinetics, and cardiopulmonary reserves in infants.
Conclusions:
- Elective ear surgery in infants under 1 year requires specialized pediatric perioperative anesthesia care.
- Such procedures should be performed in institutions with extensive experience in managing this patient group.
- A collaborative approach between surgical and anesthesia teams is crucial for patient safety.
Objective:
Neonatal hearing screening programs allow early identification of infants with congenital severe hearing impairment. Increasing evidence suggests that early cochlear implantation (CI) facilitates auditory rehabilitation and bilateral implantation exceeds the benefit of unilateral CI fitting. Elective surgery before the age of 12 months has, therefore, become increasingly popular. A team approach between the surgeon and the anesthesia team is required to guarantee the safety for the patient. The implanting surgeon should also be aware of the special constraints relevant at this age group.
Study Design:
Our personal experience at a tertiary children's hospital and a review of the German and English literature published on this subject between 1980 and 2007.
Setting:
Tertiary referral otology and skull base center with affiliated children's hospital.
Patients:
Patients younger than 1 year of age undergoing CI surgeries were analyzed concerning surgical techniques, and anesthesiological aspects of elective surgeries in small infants were evaluated.
Interventions And Outcome Measures:
The main focus was on CI surgeries in very young infants. Risk factors involving the surgical planning, intervention, and perioperative anesthesia care were evaluated.
Results:
The age of the patient and the pediatric experience of the anesthesiologist, but not the duration of the surgery, are relevant risk factors. This review article is intended to highlight the surgical and anesthesiological considerations when performing CI surgery in very young infants and anticipates familiarizing the implanting surgeon with important aspects of hemostasis, pharmacokinetics, and cardiopulmonary reserves in small pediatric patients.
Conclusion:
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.