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Published on: August 4, 2023
The impact of blood loss during cochlear implantation in very young children
Andreas Anagiotos1, Dirk Beutner
1Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany. andreas.anagiotos@uk-koeln.de
Insights
Intraoperative bleeding during cochlear implantation in young children is clinically significant, often causing a notable drop in hemoglobin. Preoperative planning should include banked blood and careful consideration for bilateral procedures.
Area of Science:
- Pediatric Otolaryngology
- Surgical Hemorrhage Management
Background:
- Cochlear implantation in very young children presents unique physiological challenges.
- Intraoperative bleeding during pediatric cochlear implantation requires further investigation regarding its clinical significance.
Purpose of the Study:
- To assess the clinical importance of intraoperative bleeding in cochlear implantations for children under 16 months.
- To determine if bleeding impacts the clinical management and surgical planning for this demographic.
Main Methods:
- Retrospective chart review of 14 cochlear implantations in children aged 16 months or younger.
- Analysis of pre- and postoperative hemoglobin concentrations to quantify blood loss.
Main Results:
- A postoperative decrease in hemoglobin was observed in 93% of cases (13/14), with a mean reduction of -1.9 g/dl.
- Significant bleeding occurred during muscle-periosteal flap detachment and mastoidectomy.
- One 2-month-old infant required a packed red blood cell transfusion due to substantial blood loss.
Conclusions:
- Intraoperative bleeding during cochlear implantation in very young children is clinically significant and can lead to rapid cardiovascular decompensation.
- Surgical planning must account for potential blood loss, recommending the availability of banked blood.
- The extent of intraoperative bleeding should influence decisions regarding simultaneous bilateral cochlear implantation.
Abstract:
The aim of this study was to investigate if the intraoperative bleeding during cochlear implantation in very young children had any clinical importance and if it should influence the clinical management of such cases. A retrospective chart review of the pre- and postoperative hemoglobin concentration was performed on 14 implantations in children aged 16 months or younger at the time of surgery (11 males and 3 females). A postoperative decrease of the hemoglobin value was noted in 13 cases (93 %), with a mean difference between pre- and postoperative measurement of -1.9 g/dl. The most remarkable case was that of a 2-month-old newborn with a bilateral profound hearing loss caused by bacterial meningitis. In the course of the asynchronous bilateral cochlear implantation and due to a remarkable bleeding, a transfusion of packed red blood cells was performed. The increased loss of blood was reported at the time of detaching and lifting up the muscle-periosteal-flap from the mastoid bone as well as at the time of the mastoidectomy. The special physiological properties of this age can contribute to a rapid cardiovascular decompensation in the case of increased blood loss. The consideration of these aspects is of great importance in the stage of planning the cochlear implantation, which in this group of patients should include the requirement of banked human blood. In addition, the intraoperative bleeding should be taken into account during the decision for a simultaneous bilateral implantation.