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Pediatric cochlear implants. Surgical aspects: the Nottingham pediatric cochlear implant programme
R V Lloyd1, K P Gibbin, G M O'Donoghue
1University Hospital, Department of Otolaryngology, Nottingham, United Kingdom.
Insights
Cochlear implantation in young children offers significant benefits for profound deafness rehabilitation. Surgical outcomes in the first 50 pediatric cases at Nottingham demonstrate a low complication rate, highlighting the procedure's safety and efficacy.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Audiology
Background:
- Cochlear implantation is a key rehabilitation method for profoundly deaf children.
- The Nottingham pediatric cochlear implant program has extensive experience with young patients.
Purpose of the Study:
- To review the surgical aspects of cochlear implantation in young children.
- To analyze surgical outcomes and complications in the first 50 pediatric cases.
Main Methods:
- Detailed description of surgical steps, including extended endaural incision, posterior tympanotomy, and cochleostomy.
- Prophylactic antibiotic use and meticulous hemostasis.
- Intraoperative electrophysiological testing and management of osteogenesis.
Main Results:
- Low incidence of surgical complications, with no cases of facial weakness, hematoma, extrusion, or infection.
- One explantation due to pain from extracochlear implant placement.
- One case of retraction pocket cholesteatoma.
Conclusions:
- Surgical implantation of cochlear devices in young children is associated with a low complication rate.
- The benefits of cochlear implantation significantly outweigh the risks.
- This study validates the safety and effectiveness of the surgical technique in a pediatric cohort.
Abstract:
The implantation of young children is widely accepted as a means of rehabilitating profoundly/totally deaf children. This paper will review the surgical aspects of implanting young children based on the first 50 children implanted in the Nottingham paediatric cochlear implant programme. Having thoroughly counselled the children's parents, the child is operated on under prophylactic antibiotic cover. The incision (extended endaural) is made directly down to bone and a full-thickness flap is elevated. Meticulous attention is paid to haemostasis. The steps involved in posterior tympanotomy, cochleostomy and implant insertion, often in the presence of osteogenesis, will be described. Electrophysiological testing is done systematically peroperatively. Surgical complications were few. There was no cases of facial weakness, haematoma, implant extrusion or infection. One patient, whose implant was laid in an extracochlear gutter, developed pain on electrical stimulation and was explanted. Another patient developed a retraction pocket cholesteatoma. These few complications are far outweighed by the overwhelming benefits accrued from implantation.