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Systematic Hearing Performance Evaluation Process for Adolescents with Cochlear Implantation at Early Ages
Published on: March 24, 2023
Prevention and treatment of meningitis and acute otitis media in children with cochlear implants
1Division of Pediatric Infectious Diseases, Steven and Alexandra Cohen Children's Medical Center of New York, North Shore-Long Island Jewish Health System, New Hyde Park, New York 11040, USA. lrubin@lij.edu
Insights
Children with cochlear implants need timely vaccinations to prevent infections like meningitis and acute otitis media. Prompt antimicrobial treatment is crucial for ear and brain infections post-implantation.
Area of Science:
- Pediatrics
- Infectious Diseases
- Otolaryngology
Background:
- Cochlear implants enhance hearing but may increase risks of otitis media and meningitis.
- Immunization and appropriate antimicrobial therapy are vital for managing infections in this population.
Purpose of the Study:
- To recommend immunization schedules for preventing infections in pediatric cochlear implant recipients.
- To outline antimicrobial treatment guidelines for acute otitis media and meningitis in children with cochlear implants.
Main Methods:
- A comprehensive literature review was conducted.
- Policy recommendations were formulated by the American Academy of Pediatrics.
Main Results:
- All age-appropriate vaccinations, including pneumococcal (13-valent and 23-valent) and Haemophilus influenzae type b vaccines, are recommended.
- Antimicrobial therapy for acute otitis media includes parenteral options initially, followed by amoxicillin or amoxicillin-clavulanate.
- Meningitis treatment involves broad-spectrum antibiotics like meropenem and vancomycin initially, with ceftriaxone and vancomycin recommended later.
Conclusions:
- Vaccination is essential for preventing pneumococcal and Haemophilus influenzae type b infections in cochlear implant users.
- Specific antimicrobial regimens are recommended for acute otitis media and meningitis based on the timing relative to cochlear implantation.
Objective:
To provide recommendations for 1) prevention of acute otitis media and meningitis via immunization and 2) antimicrobial therapy of acute otitis media and meningitis in children with cochlear implants.
Data Sources:
Literature review and policy statement from the American Academy of Pediatrics.
Conclusion:
1) Children who are candidates for cochlear implants or have received cochlear implants should receive all-age appropriate vaccinations, including indicated doses of 13-valent pneumococcal conjugate vaccine, Haemophilus influenzae type b conjugate vaccine, and influenza vaccine. A supplemental dose of 13-valent pneumococcal conjugate vaccine is indicated for children who have received indicated doses of 7-valent pneumococcal vaccine, but have not received 13-valent pneumococcal conjugate vaccine. In addition, children 24 months and older should receive a single dose of 23-valent pneumococcal polysaccharide vaccine. 2) Acute otitis media in children with cochlear implants should be treated with an antimicrobial. During the first 2 months after implant, initial treatment of acute otitis media with a parenteral antimicrobial, e.g., cetriaxone, is indicated. High-dose amoxicillin or amoxicillin-clavulanate is an appropriate antimicrobial choice for empiric treatment of acute otitis media occurring 2 or more months after implant. In cases of meningitis occurring during the first 2 months after implantation, broad spectrum empiric antimicrobial therapy, e.g., meropenem and vancomycin, should be initiated pending the results of CSF culture. Empiric antimicrobial therapy with ceftriaxone and vancomycin is appropriate for cases of meningitis occurring 2 or more months after implant.