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Updated: Mar 17, 2026
Author Spotlight: Advancements in Impedance Monitoring for Cochlear Implant Surgery
Published on: August 4, 2023
A Systematic Review of Perioperative Versus Prophylactic Antibiotics for Cochlear Implantation
Samantha Anne1, Stacey L Ishman2, Seth Schwartz3
1Department of Otolaryngology-Head and Neck Surgery, The Cleveland Clinic, Cleveland, Ohio, USA annes@ccf.org.
Background:
Previous Cochrane review of prophylactic antibiotic use in clean and clean-contaminated ear surgery showed no benefit; however, these studies did not address cochlear implant (CI) surgery specifically.
Objective:
Systematically review effects of perioperative antibiotics on risk of infections and related complications in CI surgery SEARCH METHODS: PubMed, EMBASE, Medline, CINAHL, and Cochrane library were searched from inception to March 2015. Manual searches of bibliographies were also completed.
Selection Criteria:
We included all studies that describe perioperative antibiotic use in CI surgery. Outcome measures included infection, meningitis, implant extrusion, and adverse antibiotics effects. Two independent evaluators reviewed each abstract and article.
Results:
One hundred and seventy-three studies were identified in search. Three met inclusion criteria and were reviewed. Articles were low quality; no randomized trials were identified. For included studies, numerous antibiotic types and dosing regimens were used. Recorded outcome measures were heterogeneous, and detailed information was frequently unavailable. Overall infection rate was low (3%-4.5%); single dose antibiotic prophylaxis showed low rate of complications (1%) in 2 studies.
Conclusions:
There is insufficient evidence to make definitive conclusions about the role of perioperative antibiotics in CI surgery. Reported infection rates are low; however, decision to use antibiotics should be based on assessment of risks and benefits to each patient.
Insights
Evidence is insufficient to confirm the benefits of prophylactic antibiotics for cochlear implant (CI) surgery. While infection rates are low, patient-specific risk-benefit assessments are crucial for antibiotic decisions.
Area of Science:
- Otolaryngology
- Neurosurgery
- Infectious Disease
Background:
- Previous reviews found no benefit of prophylactic antibiotics in general ear surgery.
- These reviews did not specifically evaluate cochlear implant (CI) surgery.
Purpose of the Study:
- To systematically review the effects of perioperative antibiotics on infection risk and complications in CI surgery.
Main Methods:
- Searched multiple databases (PubMed, EMBASE, Medline, CINAHL, Cochrane) from inception to March 2015.
- Included studies on perioperative antibiotic use in CI surgery, assessing infection, meningitis, implant extrusion, and adverse effects.
- Two independent evaluators reviewed all identified abstracts and articles.
Main Results:
- Only three studies met inclusion criteria; all were of low quality, with no randomized trials.
- Heterogeneous antibiotic regimens and outcome measures were reported, with limited detailed information.
- Overall infection rates were low (3%-4.5%), and single-dose prophylaxis showed a 1% complication rate in two studies.
Conclusions:
- Insufficient evidence exists to definitively establish the role of perioperative antibiotics in CI surgery.
- Low reported infection rates suggest caution, emphasizing individualized risk-benefit analysis for antibiotic use.
