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Published on: February 29, 2020
Chronic suppurative otitis media following paediatric cochlear implantation
A Bibas1, S Phillips, C M Bailey
1Great Ormond Street Hospital for Sick Children, London, UK. thanosbibas@hotmail.com
Insights
Chronic suppurative otitis media (CSOM) after cochlear implantation is rare (1.38% incidence). Management involves individualized surgical approaches, aiming to preserve the implant when possible, and preventative measures are recommended.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Infectious Diseases
Background:
- Chronic suppurative otitis media (CSOM) is a potential complication following cochlear implantation in children.
- Understanding its incidence, timing, and management is crucial for optimizing patient outcomes.
Purpose of the Study:
- To report and discuss the management of CSOM in children post-cochlear implantation.
- To identify risk factors and recommend preventative strategies.
Main Methods:
- Retrospective review of 650 pediatric cochlear implant cases.
- Identification and analysis of nine patients who developed CSOM post-implantation.
- Review of surgical interventions and outcomes.
Main Results:
- CSOM incidence was 1.38% (9/650 patients).
- Symptoms (otorrhea/abscess) appeared a mean of 3.66 years post-implantation.
- Surgical management varied, with some cases preserving the implant and others requiring explantation.
Conclusions:
- CSOM post-cochlear implantation can arise from surgical defects or de novo.
- Individualized surgical management, including canal-wall up/down techniques, is essential.
- Preventative measures include prompt otitis media treatment and careful surgical technique.
Abstract:
The objective of this study was to report and discuss the management of chronic suppurative otitis media (CSOM) following cochlear implantation in children. The study was a retrospective review of 650 patients receiving an implant at two paediatric tertiary referral centres for cochlear implantation. Nine patients were identified who developed CSOM following cochlear implantation (incidence 1.38%). The mean time interval between implantation and symptom development was 3.66 years (range 2-8 years) and the mean time interval between implantation and CSOM surgery was 5.02 years (range 2.2-8 years). All patients presented with otorrhoea and/or abscess formation over the implant site. Two patients underwent a modified radical mastoidectomy and seven underwent a combined approach tympanoplasty, three of whom required posterior canal wall reconstruction with cortical bone and one with cartilage. In four cases it was possible to remove the cholesteatoma without removing the implant. All but two patients were fitted with a contralateral implant. In the explanted ears the cochlear implant electrode was cut at the cochleostomy site, which was then covered with muscle. Chronic suppurative otitis media following cochlear implantation may occur either as a result of a posterior canal wall defect related to surgery or possibly de novo. Attempts should be made to save the implant, but explantation with reimplantation of the contralateral ear may be the only option. In these cases the intracochlear part of the electrode array should be left in situ to facilitate possible future reimplantation. Surgical options for management of CSOM should be individualized and may include both canal-wall up and canal-wall down techniques. To reduce the incidence of CSOM following implantation the authors recommend: (1) prompt treatment and careful follow-up of patients with a history of otitis media with effusion, (2) avoidance of excessive thinning of the posterior canal wall during mastoidectomy and (3) reconstruction of any accidental trauma to the annulus or posterior canal wall during posterior tympanotomy.
