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Retrospective complication rate comparison between surgical techniques in paediatric cochlear implantation
H Bruijnzeel1,2, F Ziylan1, G Cattani1
1Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center, Utrecht, The Netherlands.
Insights
The SupraMeatal Approach for pediatric cochlear implantation led to more complications, particularly infections, compared to the Mastoidectomy with Posterior Tympanotomy Approach. This suggests Mastoidectomy with Posterior Tympanotomy is preferable for young children.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Neurosurgery
Background:
- Cochlear implantation is a common procedure for pediatric hearing loss.
- Surgical approach selection is critical for minimizing complications in young children.
Purpose of the Study:
- To compare the rates and types of complications between the Mastoidectomy with Posterior Tympanotomy (MPT) and SupraMeatal Approach (SMA) for pediatric cochlear implantation.
- To identify risk factors associated with complications in pediatric cochlear implantation.
Main Methods:
- Retrospective cohort study of 144 children under 5 years old who received cochlear implants between 1996 and 2014.
- Complications were categorized by severity (minor/major) and timing (intraoperative, early/late postoperative).
- Surgical technique (MPT vs. SMA) and intraoperative challenges were analyzed for correlation with complications.
Main Results:
- The SMA group experienced significantly more overall complications (61.5% vs. 20.6%, P < .001) than the MPT group.
- Infectious complications were more frequent in the SMA group (P < .05).
- Complications were linked to the surgical technique, not the age at implantation, and no correlation with intraoperative difficulties was found.
Conclusions:
- The SupraMeatal Approach is associated with a higher incidence of complications, including infections, in pediatric cochlear implantation compared to the Mastoidectomy with Posterior Tympanotomy Approach.
- The Mastoidectomy with Posterior Tympanotomy Approach is recommended for cochlear implantation in young children to reduce the risk of complications.
Objective:
To compare paediatric complication occurrence between the Mastoidectomy with Posterior Tympanotomy and the SupraMeatal Approach for cochlear implantation.
Design:
Retrospective cohort study.
Setting:
Children receiving a cochlear implant before 5 years of age between 1996 and 2014 in our tertiary center.
Participants:
A total of 144 patients receiving a cochlear implant (121 by Mastoidectomy with Posterior Tympanotomy and 23 by SupraMeatal Approach) operated on 165 ears (129 and 39 respectively).
Main Outcome Measures:
The severity (minor or major) using Cohen and Hoffman criteria and time of occurrence of complications (intraoperative, early postoperative or late postoperative) were identified. Intraoperative surgical challenges were correlated to complication occurrence.
Results:
The mean age at implantation was 2.13 ± 1.14 years old. Patients operated by the SupraMeatal Approach (1.27 ± 0.69 years old) were significantly (P < .001) younger than those receiving a cochlear implant by Mastoidectomy with Posterior Tympanotomy Approach (2.40 ± 1.12). Most complications were minor (Mastoidectomy with Posterior Tympanotomy Approach: 64.0%; SupraMeatal Approach: 73.1%) and occurred early postoperatively (Mastoidectomy with Posterior Tympanotomy Approach: 61.5%; SupraMeatal Approach: 76.9%). More overall complications occurred in SupraMeatal compared to Mastoidectomy with Posterior Tympanotomy Approach cases (61.5% versus 20.6%; P < .001). Younger SupraMeatal Approach cohort patients (6 - 12 and 18 - 24 months; P < .008 and P = .016) most often developed these complications. When looking at specific complications, more infectious complications occurred in patients receiving a cochlear implant through the SupraMeatal Approach (P < .05). Logistic regression showed that the surgical technique and not the age at implantation was responsible for the documented complications. No relationship between complications and intraoperative difficulties was identified.
Conclusion:
In our institution, cochlear implantation in young patients through the SupraMeatal Approach resulted in significantly more (infectious) complications than those operated through the Mastoidectomy with Posterior Tympanotomy Approach. Outcomes from our institution recommends using the Mastoidectomy with Posterior Tympanotomy Approach when opting for a cochlear implant surgical technique in young children who are more prone to develop infectious complications.
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