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Published on: February 29, 2020
Acute mastoiditis in children with a cochlear implant
Eyal Raveh1, David Ulanovski1, Joseph Attias2
1Cochlear Implant Program, Schneider Children's Medical Center of Israel and Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Insights
Acute mastoiditis in children with cochlear implants is manageable, often affecting the implanted ear. Prompt treatment with antibiotics and drainage leads to complete recovery without implant damage.
Area of Science:
- Otolaryngology
- Pediatric Infectious Diseases
- Neurosurgery
Background:
- Cochlear implantation is common in young children, a demographic susceptible to acute otitis media.
- Acute mastoiditis, a complication of otitis media, has limited documented management strategies in pediatric cochlear implant recipients.
Purpose of the Study:
- To evaluate the characteristics, treatment, and outcomes of acute mastoiditis in children who have undergone cochlear implantation.
Main Methods:
- Retrospective review of medical records of children who received cochlear implants between 2000-2014.
- Identification and data collection on patients diagnosed with acute mastoiditis post-implantation, including demographics, history, treatment, and outcomes.
Main Results:
- 13.5% of 370 cochlear implant recipients developed acute mastoiditis, typically in the implanted ear.
- Treatment involved myringotomy, antibiotics, and surgical drainage in most cases; no intracranial complications or implant issues were reported.
- Average follow-up of 3.8 years showed no persistent middle-ear pathology.
Conclusions:
- Recent mastoidectomy may increase the risk of acute mastoiditis and subperiosteal abscess in pediatric cochlear implant patients.
- While drainage is often necessary, extensive surgery is usually avoided, with rapid and complete recovery.
- Close monitoring for otitis media is crucial, even years post-implantation, with potential re-insertion of ventilation tubes.
Objectives:
Cochlear implantation is performed at a young age, when children are prone to acute otitis media. Acute mastoiditis is the most common complication of otitis media, but data on its management in the presence of a cochlear implant are sparse. The objective of this study was to assess the characteristics, treatment, and outcome of acute mastoiditis in children with a cochlear implant.
Methods:
The medical files of all children who underwent cochlear implantation at a pediatric tertiary medical center in 2000-2014 were retrospectively reviewed. Those diagnosed with acute mastoiditis after implantation were identified, and data were collected on demographics, history, presentation, method of treatment, complications, association with untreated otitis media with effusion, and long-term middle-ear sequelae.
Results:
Of the 370 children (490 ears) who underwent cochlear implantation, 13 (3.5%) were treated for acute mastoiditis (median age at acute mastoiditis, 32 months). Nine had a pre-implantation history of chronic secretory or acute recurrent otitis media, and 5 had been previously treated with ventilation tubes. In all 9 children who had unilateral cochlear implant, the acute mastoiditis episode occurred in the implanted ear. The time from implantation to mastoiditis was 5-61 months. The same treatment protocol as for normal-hearing children was followed, with special attention to the risk of central nervous system complications. Primary treatment consisted of myringotomy with intravenous administration of wide-spectrum antibiotics. Surgical drainage was performed in 8 out of 13 patients, with (n=7) or without (n=1) ventilation-tube insertion, to treat subperiosteal abscess or because of lack of symptomatic improvement. There were no cases of intracranial complications or implant involvement or need for a wider surgical approach. No middle-ear pathology was documented during the average 3.8-year follow-up.
Conclusions:
The relatively high rate of acute mastoiditis and subperiosteal abscess in children with a cochlear implant, predominantly involving the implanted ear, supports the suggestion that recent mastoidectomy may be a risk factor for these complications. Despite the frequent need for drainage, more extensive surgery is usually unnecessary, and recovery is complete and rapid. As infections can occur even years after cochlear implantation, children with otitis media should be closely followed, with possible re-introduction of ventilation tubes.
