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Published on: August 4, 2023
Meningitis Risk in Patients with Inner Ear Malformations after Cochlear Implants: A Systematic Review and
Shravan Gowrishankar1, Alex Fleet1, Michele Tomasoni2
1School of Clinical Medicine, University of Cambridge, Cambridge, UK.
Objective:
The objective of this study is to determine the rate of postoperative meningitis after cochlear implantation in those with inner ear malformations (IEMs) via meta-analysis.
Data Sources:
Medline, EMBASE, and the Cochrane Library.
Methods:
This study was reported following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) checklist. Proportion meta-analysis was conducted through an inverse variance random-effect model based on arcsin transformation and presented as forest plots. Quality assessment of the included studies was performed through the National Institutes of Health Quality Assessment Tool.
Results:
Overall, 38 of 2966 studies met the inclusion criteria and were included in the analysis. There were 10 cases of meningitis after cochlear implantation in 1300 malformed ears. The overall rate of meningitis after cochlear implantation in IEMs was 0.12% (95% confidence interval, 0.006-0.380%; I2 = 0%). Cases occurred in incomplete partition (n = 5), Mondini deformity (n = 2), common cavity (n = 2), and enlarged internal auditory canal (n = 1). Six of 10 cases of postoperative meningitis occurred with an intraoperative cerebrospinal fluid leak.
Conclusion:
In those with IEMs, the risk of meningitis after cochlear implantation is very low.
Insights
The risk of meningitis after cochlear implantation in patients with inner ear malformations (IEMs) is very low, with a rate of 0.12%. This meta-analysis highlights the safety of cochlear implantation in this population.
Area of Science:
- Otolaryngology
- Neurosurgery
- Medical device safety
Background:
- Inner ear malformations (IEMs) present unique challenges for cochlear implantation.
- Determining the risk of postoperative meningitis is crucial for patient selection and surgical planning.
Approach:
- A comprehensive meta-analysis was conducted using data from Medline, EMBASE, and the Cochrane Library.
- The study followed PRISMA guidelines, employing a random-effect model for proportion meta-analysis.
- Quality assessment was performed using the National Institutes of Health Quality Assessment Tool.
Key Points:
- The analysis included 38 studies with 1300 malformed ears.
- The overall rate of postoperative meningitis was 0.12% (95% CI: 0.006-0.380%).
- Meningitis cases were associated with specific IEMs, and 60% occurred with intraoperative cerebrospinal fluid leaks.
Conclusions:
- Cochlear implantation in patients with IEMs carries a very low risk of meningitis.
- The findings support the safety and efficacy of cochlear implantation in this patient group.
