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Published on: February 29, 2020
The management of acute mastoiditis in children with cochlear implants: saving the device
Heather A Osborn1, Sharon L Cushing, Karen A Gordon
1University of Toronto, Toronto, Canada.
Insights
Children with cochlear implants are at high risk for acute otitis media (AOM) and subsequent mastoiditis. Early operative drainage and aggressive antibiotics are crucial for managing mastoiditis in this population, preserving the implant.
Area of Science:
- Otolaryngology
- Pediatric Otology
- Infectious Disease Management
Background:
- Cochlear implantation is increasingly performed in young children with profound hearing loss.
- Children with cochlear implants face a higher risk of acute otitis media (AOM) and mastoiditis in the implanted ear.
- Existing guidelines for mastoiditis management do not specifically address children with cochlear implants.
Purpose of the Study:
- To propose a treatment algorithm for mastoiditis in pediatric cochlear implant recipients.
- To emphasize early, conservative operative intervention for mastoiditis in this vulnerable population.
Main Methods:
- Retrospective chart review of eight pediatric patients who developed mastoiditis post-cochlear implantation.
- Analysis of treatment outcomes including surgical intervention and antibiotic therapy.
Main Results:
- Mastoiditis occurred at a median age of 37 months, with a mean of 9.56 months post-implantation.
- All patients received intravenous antibiotics and middle ear drainage; two required post-auricular incision and drainage.
- Effective infection resolution was achieved in all cases, preserving cochlear implant function.
Conclusions:
- Acute otitis media following cochlear implantation increases the risk of post-auricular abscess.
- A treatment algorithm advocating prompt antibiotic therapy and early surgical drainage is effective.
- This approach allows for successful management of mastoiditis while preserving the cochlear implant.
Objective:
Early treatment of profound bilateral sensorineural hearing loss with cochlear implantation has become routine, resulting in an increased proportion of children implanted at younger ages. These children are at a relatively high risk for acute otitis media (AOM), and are more likely to develop mastoiditis in the implanted ear. Despite the significant risks associated with mastoiditis, including compromise of the implant, there are no specific guidelines on the management of this population. We propose a treatment algorithm emphasizing early but conservative operative intervention.
Methods:
A retrospective chart review included eight patients, who experienced mastoiditis, in the context of cochlear implantation at our center from August 2005 to November 2012. During this period 806 implant surgeries were completed.
Results:
The median age at which mastoiditis occurred was 37 months, and the mean time from implantation to mastoiditis was 9.56 months. All patients underwent drainage of the middle ear in conjunction with intravenous antibiotics, and two additionally underwent post-auricular incision and drainage.
Discussion:
Recent mastoidectomy may be a risk factor for the development of a post-auricular abscess in children, who develop AOM following cochlear implantation. A treatment algorithm was developed, which emphasizes early operative drainage in conjunction with aggressive antibiotic therapy. Conclusions A consistent approach to the management of mastoiditis in children with cochlear implants has not been established. Rapid initiation of aggressive antibiotic therapy and a low threshold for conservative operative intervention results in effective resolution of infection while allowing preservation of the implant.