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Systematic Hearing Performance Evaluation Process for Adolescents with Cochlear Implantation at Early Ages
Published on: March 24, 2023
Safe cochlear implantation in a child with Wolff-Parkinson-White syndrome
Shilpa Susan Mathew1, Smithamol Pb2, Naina Picardo3
1Otorhinolaryngology, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India shilpamathew11@gmail.com.
Insights
Wolff-Parkinson-White (WPW) syndrome, a heart condition, was incidentally found in a toddler undergoing cochlear implantation. Perioperative strategies ensured safe surgery despite the risk of arrhythmias.
Area of Science:
- Pediatric Cardiology
- Cardiac Electrophysiology
- Anesthesiology
Background:
- Wolff-Parkinson-White (WPW) syndrome is a congenital cardiac condition involving abnormal electrical conduction via an accessory pathway.
- While often asymptomatic in children, WPW syndrome carries a risk of life-threatening arrhythmias, especially under physiological stress.
- Routine preoperative electrocardiogram (ECG) screening can detect occult cardiac conditions in pediatric patients.
Purpose of the Study:
- To describe perioperative management strategies for cochlear implantation in a toddler with incidentally diagnosed asymptomatic Wolff-Parkinson-White syndrome.
- To emphasize the importance of multidisciplinary planning and anesthetic precautions for pediatric patients with undiagnosed cardiac conditions.
Main Methods:
- A toddler diagnosed with bilateral profound sensorineural hearing loss underwent preoperative assessment for cochlear implantation.
- An incidental finding of Wolff-Parkinson-White (WPW) pattern on routine ECG prompted cardiology evaluation.
- Specialized anesthetic and surgical protocols were implemented to mitigate arrhythmia risks during the procedure.
Main Results:
- Cochlear implantation proceeded without cardiac ablation, as no structural heart disease was identified.
- The surgery was successfully completed with no perioperative arrhythmias or complications.
- The case demonstrates the feasibility of proceeding with elective surgery in select pediatric cases with asymptomatic WPW syndrome.
Conclusions:
- Routine preoperative ECG screening is crucial for identifying asymptomatic cardiac abnormalities like WPW syndrome in children.
- Multidisciplinary collaboration between cardiology, anesthesiology, and surgery is essential for safe management of pediatric patients with cardiac conditions.
- Careful perioperative planning and monitoring can ensure successful outcomes for elective procedures in children with occult arrhythmogenic conditions.
Abstract:
Wolff-Parkinson-White (WPW) syndrome is a congenital cardiac conduction abnormality. It is characterised by ventricular pre-excitation that arises from abnormal electrical conduction through an accessory pathway which bypasses the normal cardiac conduction. It is often asymptomatic in children but carries a risk of life-threatening arrhythmias, particularly during physiological stress. We report the perioperative strategies adopted in the management of a cochlear implantation in a toddler who was incidentally noted to have asymptomatic WPW syndrome during preoperative assessment. The child was evaluated for speech delay and diagnosed with bilateral congenital profound sensorineural hearing loss. A routine ECG revealed WPW pattern. Subsequent cardiology evaluation reported no evidence of any structural heart disease and it was decided to proceed with cochlear implantation without cardiac ablation. In anticipation of potential arrhythmias, several anaesthetic and surgical measures were taken to ensure safe and successful surgery. This case highlights the importance of routine preoperative ECG screening, multidisciplinary planning and follow-up to ensure safe cochlear implantation in children with occult arrhythmogenic conditions.