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Sykopetrites V, Di Maro F, Sica E, Cristofari E. Acquired cholesteatoma after cochlear implants: case series and literature review. Eur Arch Otorhinolaryngol 2024; 281:1285-1291. [PMID: 37776344 DOI: 10.1007/s00405-023-08251-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 09/16/2023] [Indexed: 10/02/2023]
Abstract
PURPOSE To assess the prevalence and management of acquired cholesteatoma after cochlear implantation in pediatric and adult patients. METHODS Retrospective case review of pediatric and adult cochlear implants (CI) followed at a tertiary referral center and literature review of acquired cholesteatoma after CI surgery, to identify its prevalence, cause, and treatment. RESULTS Nine pediatric CIs were diagnosed with cholesteatoma in seven patients after 6.4 ± 4 years from CI surgery, and two adults after 11.3 and 21.7 years from CI surgery. Thirty-four pediatric cases and 26 adult cases are described in the literature. Cholesteatoma has a prevalence of 0.54% in pediatric CIs, and 1.79% in adult CIs (case series and literature). Adult cases were diagnosed significantly later compared to pediatric cases (Mann-Whitney test, p = 0.0460). Three pediatric cholesteatomas were treated with conservative surgery and preservation of the CI; they all developed recurrent disease. The remaining pediatric cases underwent subtotal petrosectomy with simultaneous CI explantation and staged reimplantation. Only one case recurred. The adult cases underwent simultaneous subtotal petrosectomy, explantation, and reimplantation. Similarly, 33.3% of cases treated with conservative/reconstructive surgery in the literature required revision surgery or conversion to subtotal petrosectomy against 6.2% of subtotal petrosectomies in the literature. CONCLUSIONS Cholesteatoma after CI is a rare and late-onset complication of CIs. It is more prevalent in the adult CI population, although it affects children significantly earlier. The treatment of choice is subtotal petrosectomy and CI explantation with simultaneous or staged reimplantation.
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Affiliation(s)
- Vittoria Sykopetrites
- Department of Audiovestibology, ASST dei Sette Laghi, Via Lazio, 21100, Varese, VA, Italy.
| | - Flavia Di Maro
- Department of Audiovestibology, ASST dei Sette Laghi, Via Lazio, 21100, Varese, VA, Italy
| | - Eleonora Sica
- Department of Audiovestibology, ASST dei Sette Laghi, Via Lazio, 21100, Varese, VA, Italy
| | - Eliana Cristofari
- Department of Audiovestibology, ASST dei Sette Laghi, Via Lazio, 21100, Varese, VA, Italy
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Ciorba A, Fancello V, Sacchet B, Borin M, Malagutti N, Bianchini C, Stomeo F, Pelucchi S. Acute mastoiditis in cochlear implanted children: A single-centre experience. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2024; 75:17-22. [PMID: 37722656 DOI: 10.1016/j.otoeng.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 04/12/2023] [Indexed: 09/20/2023]
Abstract
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.
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Affiliation(s)
- Andrea Ciorba
- ENT & Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, 44121 Ferrara, Italy
| | - Virginia Fancello
- ENT & Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, 44121 Ferrara, Italy.
| | - Beatrice Sacchet
- ENT & Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, 44121 Ferrara, Italy
| | - Michela Borin
- ENT & Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, 44121 Ferrara, Italy
| | - Nicola Malagutti
- ENT & Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, 44121 Ferrara, Italy
| | - Chiara Bianchini
- ENT & Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, 44121 Ferrara, Italy
| | - Francesco Stomeo
- ENT & Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, 44121 Ferrara, Italy
| | - Stefano Pelucchi
- ENT & Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, 44121 Ferrara, Italy
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Dharmarajan S, Dham R, Kurkure R, Arumugam SV, Maheswari S, Kameswaran M. Role of Immediate Pre-Operative Tympanometry in Cochlear Implantation: MERF Protocol and Experience. Indian J Otolaryngol Head Neck Surg 2021; 73:351-355. [PMID: 34471625 DOI: 10.1007/s12070-021-02591-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 04/26/2021] [Indexed: 11/27/2022] Open
Abstract
(1) To study the association between an immediate pre-operative tympanometric profile in patients undergoing cochlear implantation with their intraoperative findings. (2) To analyse the intraoperative middle ear findings that require a staged cochlear implantation in patients presenting with a B-type tympanogram. (3) To study the complications in this group of patients during the 1-year follow-up. This retrospective non-interventional cohort study is done over a period of 6 years. Bilaterally profound deaf children, less than 6 years of age, and no history of otitis media with effusion were included in the study. Children who met the inclusion criteria were divided into 4 groups based on their tympanometric profiles that are A, As, B, and C type tympanogram and, their intraoperative findings were categorized as normal, mild oedema, minimal granulation with mild oedema, moderate to extensive granulation with or without oedematous mucosa and glue. Then finally, depending on the intraoperative middle ear and mastoid finding, a single-stage surgery or a two stage surgery was decided upon. A total of 1025 patients were implanted during the study period, 975 patients met our inclusion criteria. In our series, we found a statistically significant difference (p < 0.0001) between the tympanograms and their respective intra-operative middle ear findings. A statistically significant difference was seen (p < 0.0001) between patients who underwent a single-stage cochlear implant and those who underwent a two-staged surgery, regarding their intraoperative middle ear findings. No statistical significance was seen in the occurrence of complications between the groups undergoing a single stage and a two-staged surgery (p > 0.5). This study showcases the importance of immediate pre-operative tympanometry in cochlear implant surgeries. Two-stage surgery is a decision taken on the operating table, depending on the extent of pathology and visibility of the round window niche.
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Affiliation(s)
| | - Ruchima Dham
- Madras ENT Research Foundation (Pvt) Ltd, 1, First Cross, Street, Off Second Main Road, RA Puram, Chennai, Tamil Nadu 600028 India
| | | | - Senthil Vadivu Arumugam
- Madras ENT Research Foundation (Pvt) Ltd, 1, First Cross, Street, Off Second Main Road, RA Puram, Chennai, Tamil Nadu 600028 India
| | - Sudha Maheswari
- Madras ENT Research Foundation (Pvt) Ltd, 1, First Cross, Street, Off Second Main Road, RA Puram, Chennai, Tamil Nadu 600028 India
| | - Mohan Kameswaran
- Madras ENT Research Foundation (Pvt) Ltd, 1, First Cross, Street, Off Second Main Road, RA Puram, Chennai, Tamil Nadu 600028 India
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Halawani R, Aldhafeeri A, Alajlan S, Alzhrani F. Complications of post-cochlear implantation in 1027 adults and children. Ann Saudi Med 2019; 39:77-81. [PMID: 30955015 PMCID: PMC6464671 DOI: 10.5144/0256-4947.2019.77] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The number of cochlear implant (CI) recipients is increasing so there needs to be greater awareness of possible CI complications. OBJECTIVES Describe complications of CI. DESIGN Retrospective, descriptional. SETTINGS Tertiary health care center. PATIENTS AND METHODS Data was collected by retrospective chart review on complications for recipients implanted for the period from January 2006 to June 2017. MAIN OUTCOME MEASURES Major and minor post cochlear implantation complications. SAMPLE SIZE 1027 cochlear implant recipients. RESULTS Post-operative complications were reported in 105 patients (10.2%). Minor complications were most often encountered (9.5%). Swelling (wound seroma or hematoma) was the most common complication. The major complication rate was only 7/105, 0.7%. Meningitis did not occur and cholesteatoma occurred in only one patient. CONCLUSION CI is a safe surgical procedure at our center. We believe that this is probably due to the preoperative protocol, the surgical technique used, and the postoperative care conducted for all our patients. Despite this, it is important that both physicians and patients have knowledge of the possible consequences and risks posed by CI, especially in view of the fact that these patients require lifetime follow-up. LIMITATIONS Further studies are needed, and should include more ENT centers across all regions of Saudi Arabia. CONFLICT OF INTEREST None.
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Affiliation(s)
- Roa Halawani
- Dr. Roa Halawani King Abdullah Ear Specialist Center (KAESC), College of Medicine,, King Saud University,, Riyadh, Saudi Arabia, PO Box 245 Riyadh 11411, Saudi Arabia, T: +966 1 477 5735, , ORCID: https://orcid.org/0000-0002-48044286
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Petersen H, Walshe P, Glynn F, McMahon R, Fitzgerald C, Thapa J, Simoes-Franklin C, Viani L. Occurrence of major complications after cochlear implant surgery in Ireland. Cochlear Implants Int 2018; 19:297-306. [DOI: 10.1080/14670100.2018.1513386] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Hannes Petersen
- National Cochlear Implant Programme, Beaumont Hospital, Dublin, Ireland
| | - Peter Walshe
- National Cochlear Implant Programme, Beaumont Hospital, Dublin, Ireland
| | - Fergal Glynn
- National Cochlear Implant Programme, Beaumont Hospital, Dublin, Ireland
| | - Rosemary McMahon
- National Cochlear Implant Programme, Beaumont Hospital, Dublin, Ireland
| | - Conall Fitzgerald
- National Cochlear Implant Programme, Beaumont Hospital, Dublin, Ireland
| | - Jyoti Thapa
- National Cochlear Implant Programme, Beaumont Hospital, Dublin, Ireland
| | - Cristina Simoes-Franklin
- National Cochlear Implant Programme, Beaumont Hospital, Dublin, Ireland
- Trinity Centre for Bioengineering, Trinity College Dublin, Ireland
- School of Medicine, Trinity College Dublin, Ireland
| | - Laura Viani
- National Cochlear Implant Programme, Beaumont Hospital, Dublin, Ireland
- School of Medicine, Trinity College Dublin, Ireland
- Royal College of Surgeons Ireland, Dublin, Ireland
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Impact of Chronic Suppurative Otitis Media in Pediatric Cochlear Implant Recipients-Insight into the Challenges from a Tertiary Referral Center in UK. Otol Neurotol 2017; 38:672-677. [PMID: 28333779 DOI: 10.1097/mao.0000000000001372] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Analyze the presentation and evolution of chronic suppurative otitis media (CSOM) in children with cochlear implants (CI) and explore the merit of early intervention. STUDY DESIGN Retrospective patient review. SETTING Tertiary referral hospital and cochlear implant programme. PATIENTS Children with a CI who developed CSOM. INTERVENTION Tympanoplasty. MAIN OUTCOME MEASURES Disease control, recurrence of cholesteatoma, cochlear implant preservation. RESULTS Eight children fit our inclusion criteria with a mean follow up of 8 years. Onset of CSOM symptoms was observed on an average of 5 years after implantation (range, 2-13 yr) and led to surgical intervention in an average of 15.6 months following symptom onset. Cholesteatoma was found in four of the eight patients. Of these, one patient underwent a subtotal petrosectomy and explantation with reimplantation at the same stage but the reimplant failed to function and was explanted subsequently. One patient was initially managed by a canal wall up mastoidectomy and explantation but went on to require subtotal petrosectomy and labyrinthectomy for recurrent disease. One patient underwent a subtotal petrosectomy with explantation and is awaiting a reimplantation. The fourth patient had limited disease around the electrodes that was excised without compromising the implant. In the group of patients with CSOM without cholesteatoma, one underwent an explantation due to recurrent ear infections and a subsequent cartilage tympanoplasty for a retracted eardrum. The remaining three patients underwent successful excision of retraction pockets and repair of eardrums using cartilage with the implant in situ. A mean follow up of 2 years after the implant preservation surgeries shows good functioning of the CI. CONCLUSION Early recognition of CSOM is paramount in patients with CI as delay in treatment can result in the infection spreading via the cochleostomy resulting in loss of the cochlea. Recurrent ear infections in an implanted ear should prompt early examination to exclude the presence of middle ear disease, which may require anesthesia in a young child.
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Hoberg S, Danstrup C, Laursen B, Petersen NK, Udholm N, Kamarauskas GA, Ovesen T. Characteristics of CI children with complicated middle ear infections. Cochlear Implants Int 2017; 18:136-142. [PMID: 28235386 DOI: 10.1080/14670100.2017.1289298] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To describe cases of complicated middle ear infections in children with cochlear implants (CI), i.e., episodes of acute otitis media (AOM) and acute mastoiditis (AM), resulting in hospitalization. METHODS A total of 206 children under 16 years (300 implantations) were implanted between 1 January 2008 and 31 December 2014 at the West Danish CI Center, Department of Otorhinolaryngology Head and Neck Surgery, Aarhus, Denmark. By means of two prospective local databases, episodes of AOM or AM and demographics were retrieved including biochemistry, microbiology, length of follow- up, and variable treatment modalities (intravenous (IV) antibiotics, revision mastoidectomy, and insertion of ventilation tubes). RESULTS Overall rate of AOM and/or AM was 9.2% (AOM: 9%, AM: 1.9%). Mean age at CI was 46 months. Mean follow-up was 45 months. Mean time from CI operation to AOM or AM was 3 and 4 months, respectively. Children younger than 2 years were at highest risk of AOM and/or AM. All had antibiotics prescribed before admittance, and two- thirds of infected ears had already ventilation tubes inserted. Bacteria could not be detected in more than half of cases. The most frequently isolated strains were pneumococci and nontypable Haemophilus influenzae. The majority of patients were successfully treated with IV cefuroxime (64% of cases) and insertion of ventilation tubes. None of the children developed facial nerve paralysis, intracranial infections, or septicemia. DISCUSSION Almost 10% of CI children required at least one hospitalization due to AOM and/or AM compared with 0.1 per thousand of non-CI children. This discrepancy can be explained by a low threshold for active treatment of otitis media in CI children and hence referral to a CI center. The results suggest that benzylpenicillin might be an appropriate initial treatment of AOM and AM. However, cephalosporin was the most preferred antibiotic. Most CI children were already treated with ventilation tubes at admission and almost all children without ventilation tubes, had a tube inserted during admission. Insertion of ventilation tubes is still much debated and more research in this field is needed. CONCLUSION AOM and/or AM were seen in Danish children with CI as often as in other western countries. Treatment of complicated middle ear infections was sufficient with IV cephalosporin and ventilation tube insertion. Special attention should be paid to children younger than 4 years and the associated microbiology including serotyping should be monitored.
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Affiliation(s)
- Søren Hoberg
- a Department of Clinical Medicine , Aarhus University , Palle Juul-Jensens Boulevard 82, DK-8200 Aarhus N , Denmark
| | - Christian Danstrup
- b Department of Otorhinolaryngology and Head and Neck Surgery , Aarhus University Hospital , Noerrebrogade 44, DK-8000 Aarhus C , Denmark
| | - Bjarke Laursen
- a Department of Clinical Medicine , Aarhus University , Palle Juul-Jensens Boulevard 82, DK-8200 Aarhus N , Denmark
| | - Niels Krintel Petersen
- b Department of Otorhinolaryngology and Head and Neck Surgery , Aarhus University Hospital , Noerrebrogade 44, DK-8000 Aarhus C , Denmark
| | - Nichlas Udholm
- b Department of Otorhinolaryngology and Head and Neck Surgery , Aarhus University Hospital , Noerrebrogade 44, DK-8000 Aarhus C , Denmark
| | - Gintaras Audrius Kamarauskas
- b Department of Otorhinolaryngology and Head and Neck Surgery , Aarhus University Hospital , Noerrebrogade 44, DK-8000 Aarhus C , Denmark
| | - Therese Ovesen
- a Department of Clinical Medicine , Aarhus University , Palle Juul-Jensens Boulevard 82, DK-8200 Aarhus N , Denmark.,c Department of Otorhinolaryngology , Region Hospital Holstebro , Laegaardvej 12, DK-7500 Holstebro , Denmark
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Osborn HA, Cushing SL, Gordon KA, James AL, Papsin BC. The management of acute mastoiditis in children with cochlear implants: saving the device. Cochlear Implants Int 2013; 14:252-6. [PMID: 23998418 DOI: 10.1179/1754762813y.0000000049] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2023]
Abstract
OBJECTIVE Early treatment of profound bilateral sensorineural hearing loss with cochlear implantation has become routine, resulting in an increased proportion of children implanted at younger ages. These children are at a relatively high risk for acute otitis media (AOM), and are more likely to develop mastoiditis in the implanted ear. Despite the significant risks associated with mastoiditis, including compromise of the implant, there are no specific guidelines on the management of this population. We propose a treatment algorithm emphasizing early but conservative operative intervention. METHODS A retrospective chart review included eight patients, who experienced mastoiditis, in the context of cochlear implantation at our center from August 2005 to November 2012. During this period 806 implant surgeries were completed. RESULTS The median age at which mastoiditis occurred was 37 months, and the mean time from implantation to mastoiditis was 9.56 months. All patients underwent drainage of the middle ear in conjunction with intravenous antibiotics, and two additionally underwent post-auricular incision and drainage. DISCUSSION Recent mastoidectomy may be a risk factor for the development of a post-auricular abscess in children, who develop AOM following cochlear implantation. A treatment algorithm was developed, which emphasizes early operative drainage in conjunction with aggressive antibiotic therapy. Conclusions A consistent approach to the management of mastoiditis in children with cochlear implants has not been established. Rapid initiation of aggressive antibiotic therapy and a low threshold for conservative operative intervention results in effective resolution of infection while allowing preservation of the implant.
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Shui–Hong Z, Qin–Ying W, Shen–Qing W. Middle ear foreign body causing cholesteatoma and external auditory canal granuloma: a case report. J Otol 2012. [DOI: 10.1016/s1672-2930(12)50006-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Abstract
Revision cochlear implant (RCI) surgery has become an important tool for the management of cochlear implantation complications. This review encompasses both common and uncommon indications of RCI, diagnostic and management considerations, outcomes, surgical principles, and emerging applications. In summary, early identification of complications and suboptimal device performance is imperative for children who are in critical periods of communicative development. Independent of indications, most RCI achieve a successful restoration of sound. Although rare, it is prudent to discuss the potential complications of revision surgery and their implications with patients and their families.
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Affiliation(s)
- Alejandro Rivas
- Department of Otolaryngology-Head and Neck Surgery, Division of Otology-Neurotology and Skull Base Surgery, Vanderbilt Bill Wilkerson Center, Vanderbilt University, 1215 21st Avenue South, 7209 Medical Center East, South Tower, Nashville, TN 37232, USA.
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