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Cochlear implantation in infants: special surgical and medical aspects
Lela Migirov1, Eldar Carmel, Jona Kronenberg
1Department of Otolaryngology Head and Neck Surgery, Sheba Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Israel. sabim@bezeqint.net
Insights
Cochlear implantation (CI) in infants is feasible, with minor complications. Improving implant technology and surgical techniques can reduce device-related issues and enhance outcomes for young children.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Biomedical Engineering
Background:
- Cochlear implantation (CI) is a vital treatment for pediatric hearing loss.
- Assessing complication rates in infants undergoing CI is crucial for surgical refinement.
Purpose of the Study:
- To detail the medical and surgical aspects of CI in infants.
- To compare complication rates in infants versus older children receiving CI.
Main Methods:
- Retrospective study design.
- Analysis of 15 infants and 57 children (1-2 years old) undergoing CI with at least 12 months follow-up.
Main Results:
- Major complications occurred in 6.7% of infants versus 17.5% of toddlers (P = .297).
- Minor postoperative issues were observed in 13.3% of infants and 21.1% of toddlers (P = .502).
- Device failure was the most common complication in older children (10.5%).
Conclusions:
- CI surgery is feasible in infants, with generally minor, manageable complications.
- Enhancing cochlear implant technology and employing non-mastoidectomy techniques can reduce surgical risks.
- Recommendations include pediatric anesthesiologist presence and shorter surgical times to minimize complications.
Objective:
To present medical and surgical aspects of cochlear implantation (CI) in infants and to compare the rate of complications of CI in infants with that of older children.
Design:
Retrospective study.
Method:
Fifteen infants and 57 children aged 1 to 2 years at the time of CI with a follow-up of at least 12 months were studied.
Results:
Major complications (requiring explantation or revision surgery) occurred in 6.7% infants vs. 17.5% toddlers, P = .297. The rates for minor postoperative problems were 13.3% vs. 21.1%, respectively, P = .502. There were no incidents of surgery- or anesthesia-related complications in the present study. Device failure was found as a most common complication in older children (10.5%). Such patient-related complications as foreign body reaction, protrusion of the positioner and recurrent otitis media can result in device malfunction. Indeed, the rate of major complications supposed to increase with long-term follow-up.
Conclusions:
The surgical procedure for CI in infants is feasible and patient-related complications are usually minor and may be managed conservatively. Because most postoperative major problems are implant-related, improving cochlear implant technology can enhance the reliability of the devices and prevent untoward events that need for explantations and reimplantations. To reduce the risk of general anesthesia in infants we recommended the presence of pediatric anesthesiologist at surgery. Shortening time of surgery with using of nonmastoidectomy techniques for CI can reduce the time of bacterial exposure of the wound and prevent surgical complications related to the facial nerve and chorda tympani damage as well as electrode misplacement.