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Published on: February 29, 2020
Bacterial infection complications in children with cochlear implants in the Czech Republic
Zdenek Kabelka1, Daniel Groh, Rami Katra
1Department of Otolaryngology, Charles University, 2nd Medical School and Faculty Hospital Motol, V Uvalu 84, Praha 150 06, Czech Republic. Zdenek.Kabelka@fnmotol.cz
Insights
Serious wound infections after cochlear implantation are rare but can necessitate device explantation. Leaving the electrode in the cochlea may allow for future reimplantation in the same ear.
Area of Science:
- Otolaryngology
- Neurosurgery
- Infectious Diseases
Background:
- Wound infections following cochlear implantation are uncommon.
- Meticulous surgical techniques minimize severe postoperative complications.
- Minor infections often resolve with conservative treatment, but serious infections can arise from specific bacteria.
Purpose of the Study:
- To analyze the incidence and management of wound infections after cochlear implantation in a pediatric cohort.
- To evaluate treatment outcomes, including explantation and reimplantation strategies.
- To discuss the implications of explantation based on bacteriological findings.
Main Methods:
- Retrospective case series.
- Analysis of 360 pediatric cochlear implantations performed between 1994 and 2009.
- Review of infection cases, treatment protocols, and bacteriological data.
Main Results:
- No major surgical complications were observed in 360 pediatric cases.
- Four serious wound infections occurred, leading to device explantation in two cases due to refractory Pseudomonas aeruginosa.
- Two patients with abscesses were successfully treated with antibiotics and drainage; explanted patients were successfully reimplanted contralaterally.
Conclusions:
- Explantation of cochlear implants due to infection can be managed, with successful reimplantation possible.
- Leaving the electrode within the cochlea during explantation may facilitate future reimplantation in the same ear.
- Microbiological analysis supports informed decisions regarding infection management and reimplantation strategies.
Objective:
Studies describing wound infections after cochlear implantation are rare. Meticulous operative techniques and sufficient surgical skill can help to avoid severe postoperative complications. Minor complications such as seromas, superficial wound infections, skin emphysema, and swelling can all be successfully treated using conservative methods. Serious problems, however, could be caused by Pseudomonas aeruginosa and Staphylococcus aureus infections.
Study Design:
Retrospective case series.
Setting:
Pediatric cochlear implant center in the Czech Republic.
Results:
In our cohort of 360 children operated on between 1994 and 2009, there were no major surgical complications. However, there were four serious wound infections, two of which resulted in explantation of the device. Two patients with a well-bordered abscess formation were successfully treated with antibiotics and drainage. Explantation was required in another two children with refractory P. aeruginosa infection. Despite favorable sensitivity to a number of antibiotics, intravenous and intensive local treatment failed. After explantation, the operative sites healed immediately. Both children were successfully implanted contralaterally 6 months later. Detailed bacteriological tests from different parts of the device were performed.
Conclusion:
The consequences of explantation were discussed in our cochlear implant center. Confirmed by the microbiological results and reports in the scientific literature, it seems preferable to cut the electrode near the cochlear array and leave it inside the cochlea in order to use the same ear for reimplantation at a later date.
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