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Published on: February 29, 2020
When Opposites Attract: Pediatric Cochlear Implantation in the Setting of Cerebrospinal Fluid Shunts
Anne Morgan Selleck1, Lisa R Park, Kevin D Brown
1Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Insights
Cochlear implantation is safe for children with cerebrospinal fluid shunts, but may require extra procedures. Careful consideration is needed for these pediatric patients undergoing cochlear implant surgery.
Area of Science:
- Otolaryngology
- Neurosurgery
- Pediatric Medicine
Background:
- The U.S. Food and Drug Administration (FDA) has expressed concerns about the safety of cochlear implantation in patients with programmable cerebrospinal fluid (CSF) shunts.
- Cochlear implantation aims to restore hearing in individuals with severe to profound hearing loss.
Purpose of the Study:
- To evaluate the outcomes and potential complications of cochlear implantation in pediatric patients who have a CSF shunt.
- To assess the safety and efficacy of combined cochlear implant and CSF shunt management in children.
Main Methods:
- Retrospective chart review of pediatric subjects with both CSF shunts and cochlear implants (CIs).
- Data collected included age at implantation, hearing loss etiology, medical management, complications, and speech perception outcomes.
- Subjects included twenty pediatric patients with pre-existing CSF shunts undergoing cochlear implantation.
Main Results:
- The average age for cochlear implant candidacy was 30 months, with a mean delay of 21.5 months to implantation.
- In 45% of cases, the shunt's placement influenced the ear chosen for implantation.
- Three subjects required shunt surgery prior to cochlear implantation; three had concurrently activated programmable shunts and CIs, with two experiencing no complications, but one requiring multiple revision surgeries.
Conclusions:
- Pediatric patients with CSF shunts are suitable candidates for cochlear implantation.
- Cochlear implantation in this population necessitates additional procedures and careful management considerations before and after surgery.
- Further research may be warranted to optimize outcomes for children with combined CSF shunts and cochlear implants.
Objective:
The Food and Drug Administration (FDA) has recently raised concern regarding the safety of cochlear implantation in the setting of programmable cerebrospinal fluid shunts. The purpose of this study was to evaluate the outcomes and complications of cochlear implantation in children who have a cerebrospinal fluid shunt.
Study Design:
Retrospective chart review.
Setting:
Tertiary academic referral center.
Patients:
Twenty pediatric subjects with a cerebrospinal fluid shunt and cochlear implant (CI).
Intervention:
Cochlear implantation in the setting of a cerebrospinal fluid shunt.
Main Outcome Measures:
Primary outcome measures included descriptive data regarding age at implantation, etiology of hearing loss, medical management, complications, and speech perception outcomes.
Results:
The average age of CI candidacy was 30 months with an average 21.5 months delay to implantation. In 45% of cases the laterality of the shunt determined the ear to be implanted. Three of the subjects required a surgical intervention on the shunt before cochlear implantation. Three subjects had a concurrently programmable shunt and activated CI. Two of the three subjects had no complications as a result of the two devices; however, the third subject had significant interactions requiring multiple revision surgeries. For those with the cognitive ability to perform open set, recoded speech perception, the average postoperative Consonant Nucleus Consonant word score in the best aided condition was 65.2% (n = 5).
Conclusions:
Children with a cerebrospinal fluid shunt are viable candidates for cochlear implantation, although they often require additional procedures and considerations before and after implantation.
