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Author Spotlight: Advancements in Impedance Monitoring for Cochlear Implant Surgery
Published on: August 4, 2023
Contemporary surgical issues in paediatric cochlear implantation
Joseph D Wasson1, Robert J S Briggs1
1a Department of Otolaryngology , The University of Melbourne , East Melbourne , Victoria , Australia.
Insights
Paediatric cochlear implantation (CI) addresses surgical challenges like meningitis complications and malformations. Early implantation and soft techniques improve outcomes for hearing loss, but device failure requires careful assessment.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Audiology
Background:
- Pediatric cochlear implantation (CI) is crucial for profound sensorineural hearing loss (SNHL).
- Contemporary surgical issues present unique challenges in young children.
- Evidence-based review is needed to guide surgical practice.
Purpose of the Study:
- To review current surgical issues in pediatric cochlear implantation.
- To synthesize evidence on managing complications and optimizing outcomes.
- To provide guidance on specific pediatric CI scenarios.
Main Methods:
- Narrative literature review.
- Analysis of published evidence on pediatric cochlear implantation.
- Discussion of surgical challenges and their management.
Main Results:
- Surgical challenges include labyrinthitis ossificans, cochlear malformations, auditory neuropathy, and device failure.
- Early CI is recommended for meningitis-induced SNHL.
- Bilateral implantation before 12 months is advised for congenital SNHL, except for auditory neuropathy spectrum disorder.
Conclusions:
- Early CI is vital for pediatric SNHL, with specific timing for different conditions.
- Pre-operative imaging and soft surgical techniques are essential.
- Management of otitis media and device failure requires a structured approach.
Objective:
To review the contemporary surgical issues in paediatric cochlear implantation (CI) based on published evidence.
Design:
Narrative literature review.
Results:
Surgical challenges in paediatric CI are discussed, with respect to post meningitic labyrinthitis ossificans; cochlear malformation; cochlear implantation in infants; auditory neuropathy and cochlear nerve deficiency; bilateral cochlear implantation; hearing preservation; otitis media; and device failure.
Conclusion:
Early CI is recommended if bacterial meningitis causes profound sensorineural hearing loss (SNHL). CI in cochleovestibular malformation requires pre-operative imaging to plan surgical technique, choice of electrode, and to anticipate complication. Children with congenital severe to profound SNHL should undergo early bilateral simultaneous implantation, preferably before 12 months of age, except those with auditory neuropathy spectrum disorder who should be implanted after one year. Soft surgical technique should be deployed in an attempt to preserve any residual hearing. Otitis media with effusion is not a contraindication to cochlear implantation, but active or recurrent acute otitis media requires resolution of infection with grommet insertion pre-operatively. Device failure in CI recipients requires a stepwise audiological, medical, radiological, and device integrity assessment to determine the need for reimplantation.
