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Acute mastoiditis in cochlear implanted children: A single-centre experience
Andrea Ciorba1, Virginia Fancello1, Beatrice Sacchet1
1ENT & Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, 44121 Ferrara, Italy.
Insights
Acute mastoiditis (AM) in children with cochlear implants (CI) occurred at a rate of 1.3% over 20 years. Prompt antibiotic and surgical treatment successfully preserved all cochlear implant devices.
Area of Science:
- Otolaryngology
- Pediatric Infectious Diseases
- Medical Device Technology
Background:
- Acute mastoiditis (AM) is a common complication of acute otitis media, predominantly affecting young children.
- Data on AM prevalence in pediatric cochlear implant (CI) patients are limited.
- Managing AM in CI recipients is critical to prevent device explantation and associated burdens.
Purpose of the Study:
- To report on cases of AM in pediatric CI patients.
- To evaluate the prevalence, predisposing factors, clinical course, and treatment strategies for AM in this population.
Main Methods:
- Retrospective study of pediatric CI patients with at least one year of follow-up (January 2002 - January 2022).
- Data collected included demographics, implant details, interval to AM, treatments, and clinical outcomes.
- Identification of AM cases through medical record review.
Main Results:
- Six patients (1.3%) developed AM among 439 CI recipients (9 episodes total).
- Average time to AM diagnosis was 13.8 months post-CI surgery.
- Predisposing factors included recurrent otitis media and autism spectrum disorder; one patient had immune deficiency.
- All patients received intravenous antibiotics, and four underwent mastoidectomy; no CI explantations were necessary.
Conclusions:
- The AM rate of 1.3% in CI children aligns with existing literature.
- Successful treatment was achieved in all cases, preserving CI function.
- Early antibiotic therapy and timely surgical intervention are effective in managing AM in pediatric CI patients.
Background:
Acute mastoiditis (AM) is the most common complication of acute otitis media and primarily affects children under the age of two; current data on its prevalence in paediatric patients with cochlear implant (CI) are still scant. Proper management of AM in CI children is crucial in order to avoid the implications (financial and emotional) of an explant. Aim of this paper is to describe the cases of AM occurred among young patients with CI in follow up at our department, also in order to evaluate its prevalence, potential predisposing factors, clinical course and therapeutic strategies.
Patients And Methods:
Retrospective study. Medical records of all paediatric patients with CI, who had at least one year of follow-up, were searched aiming to identify those who developed AM, from January 1st 2002 to January 31st 2022. The following data were collected and analysed: demographic features, implant type and side, interval between CI surgery and AM, treatment, laboratory tests, clinical course, vaccination history, associated diseases.
Results:
AM was developed by six (1.3%) of the 439 children with CI (541 implanted ears). In total, 9 episodes (2.05 %) were recorded, as three patients reported two consecutive infections. Average time interval between CI surgery, to the first or only AM diagnosis, was 13.8 months (range 3-30 months). Furthermore, 3/6 of patients had a history of recurrent acute otitis media; 2/6 an autism spectrum disorder, associated to a combined immune deficiency in one case. All patients were hospitalized and promptly treated by intravenous antibiotic therapy; 4/6 also underwent a mastoidectomy. CI was not explanted in any cases of this series.
Conclusions:
Over a 20-year period, AM rate in CI children was 1.3%, which is consistent with the current literature rates of 1-4.7%. All cases were successfully treated, preserving the integrity of the device. In our experience, the early parenteral antibiotic therapy and, when necessary, surgical treatment were adequate to eradicate the infection.
