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Author Spotlight: Advancements in Impedance Monitoring for Cochlear Implant Surgery
Published on: August 4, 2023
Pressure ulcers and skin infections after cochlear implantation: A delayed yet serious issue
Hui-Shan Hsieh1, Chee-Yee Lee2, Hung-Pin Wu3
1Department of Otolaryngology, Xiamen Chang Gung Hospital, Fujian, 361000, China.
Insights
Skin flap pressure injuries after cochlear implantation (CI) affect 6.8% of pediatric patients, especially younger children. Early detection and device adjustment can prevent serious complications.
Area of Science:
- Otolaryngology
- Biomedical Engineering
- Pediatric Surgery
Background:
- Skin flap infection is a common complication following cochlear implantation (CI).
- Pressure ulcers over the antenna site can lead to serious complications.
- Understanding the causes and effective management is crucial for patient outcomes.
Purpose of the Study:
- To identify the causes of skin flap pressure ulcers in pediatric CI patients.
- To propose effective wound management strategies for these injuries.
- To analyze the incidence and severity of pressure injuries based on device type and patient age.
Main Methods:
- Retrospective assessment of 250 pediatric patients who underwent CI.
- Data collection on demographics, infection causes, and onset time.
- Classification of pressure injuries using the National Pressure Ulcer Advisory Panel staging system.
Main Results:
- 17 patients (6.8%) developed 23 pressure injuries.
- Stage 1 injuries (69.6%) resolved with device adjustment and topical antibiotics.
- Stage 2 and 3 injuries (30.4%) required oral antibiotics and device discontinuation.
- Lower incidence observed with ESPrit processor; higher incidence in younger children (≤7 years).
Conclusions:
- Early detection and prompt treatment are vital to prevent implant-threatening infections.
- Younger children are at higher risk due to thinner scalps.
- Improved antenna designs may reduce the incidence of pressure injuries.
Objectives:
Skin flap infection is one of the most common complications of cochlear implantation (CI). We identified the causes of skin flap pressure ulcer over the antenna site and proposed wound management strategies.
Methods:
A total of 250 consecutive pediatric patients who underwent CI to treat profound hearing loss were retrospectively assessed. Data on demographic characteristics, the cause of skin infection, and the time of onset were obtained.
Results:
Seventeen patients (17/250, 6.8%) had a total of 23 skin pressure injuries in the area covering the antenna. We used the National Pressure Ulcer Advisory Panel pressure injury staging system to grade injury severity. Twelve patients had 16 (16/23, 69.6.%) stage 1 pressure injuries; the skin reaction resolved after the patients stopped wearing the device for a brief period, loosened the magnet to relieve pressure on the coil, and received topical antibiotics. Five patients with six (6/23, 26.1%) stage 2 pressure injuries and one (1/23, 4.3%) stage 3 injury, were treated with oral antibiotics. The patient with the stage 3 injury was instructed not to wear the external device for 10-14 days. The incidence of skin reactions associated with the ESPrit speech processor (0/17, 0%) was significantly lower than that associated with the Freedom (2/17, 11.8%), N5 (8/17, 47.1%), and N6 (7/17, 41.1%; p < 0.05) processors. Pressure injuries were more common in younger children (≤7 years, 100%) than in older children (>7 years, 0%; p < 0.05) most likely due to their thinner scalps.
Conclusions:
Early detection and treatment can prevent implant-threatening infections, particularly in younger children. We believe that better antenna designs will reduce this complication.
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