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MacKay CI, Kuthubutheen J, Campbell AJ. An overview of risk factors, management and prevention of cochlear implant infections. Curr Opin Infect Dis 2024; 37:220-225. [PMID: 38545833 DOI: 10.1097/qco.0000000000001011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
PURPOSE OF REVIEW With cochlear implantation becoming increasingly performed worldwide, an understanding of the risk factors, preventive measures, and management of cochlear implant (CI) infection remains important given the significant morbidity and cost it conveys. RECENT FINDINGS At the turn of the 21st century there was a decrease in rates of CI infection, particularly meningitis, following the discontinuation of positioner use for CI. However, in more recent years rates of CI infection have remained largely static. Recently, studies evaluating preventive measures such as pneumococcal vaccination, S. aureus decolonization and surgical antibiotic prophylaxis have emerged in the literature. SUMMARY Prompt recognition of CI infection and appropriate investigation and management are key, however at present treatment is largely informed by cohort and case-control studies and expert opinion. Preventive measures including pneumococcal vaccination, S. aureus decolonization and preoperative antibiotic prophylaxis play a role in reducing rates of CI infection. However, there remains a need for well designed clinical trials to provide higher level evidence to better guide preventive measures for, and management decisions of, CI infections in the future.
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Affiliation(s)
- Conor I MacKay
- Department of Infectious Diseases, Perth Children's Hospital
| | - Jafri Kuthubutheen
- Department of Otolaryngology Head and Neck Surgery, Perth Children's Hospital
- Division of Surgery, Medical School, University of Western, Australia
| | - Anita J Campbell
- Department of Infectious Diseases, Perth Children's Hospital
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands
- Division of Paediatrics, School of Medicine, University of Western Australia, Perth, Australia
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Hamed N, Alajmi N, Alkoblan FI, Alghtani YA, Abdelsamad Y, Alhussien A, Alhajress RI, Alhabib SF. The Chronological Evolution of Cochlear Implant Contraindications: A Comprehensive Review. J Clin Med 2024; 13:2337. [PMID: 38673610 PMCID: PMC11050773 DOI: 10.3390/jcm13082337] [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: 03/19/2024] [Revised: 04/13/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
Cochlear implantation has emerged as a transformative intervention in addressing profound hearing loss, offering a paradigm shift in auditory rehabilitation for individuals with restricted auditory function. Throughout its history, the understanding of contraindications for cochlear implant (CI) surgery has evolved significantly. This review comprehensively analyzes the chronological advancements in the understanding of CI contraindications, examining studies conducted from historical timelines to the present. Recent research has revealed significant developments in the field, prompting a reevaluation of established criteria and resulting in expanded indications for CI. The chronological evolution of contraindications underscores the transformative nature of the field, offering potential improvements in outcomes and enhancing the quality of life for individuals with profound hearing loss. In conclusion, this narrative review emphasizes the dynamic nature of the field, where the reevaluation of contraindications has created new opportunities and broader indications for CI. The emerging prospects, including improved outcomes and enhanced quality of life, hold promise for individuals with profound hearing loss.
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Affiliation(s)
- Nezar Hamed
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University Medical City (KSUMC), King Saud University, P.O. Box 245, Riyadh 11411, Saudi Arabia; (N.A.); (F.I.A.); (Y.A.A.); (A.A.); (R.I.A.)
| | - Norah Alajmi
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University Medical City (KSUMC), King Saud University, P.O. Box 245, Riyadh 11411, Saudi Arabia; (N.A.); (F.I.A.); (Y.A.A.); (A.A.); (R.I.A.)
| | - Faisal Ibrahim Alkoblan
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University Medical City (KSUMC), King Saud University, P.O. Box 245, Riyadh 11411, Saudi Arabia; (N.A.); (F.I.A.); (Y.A.A.); (A.A.); (R.I.A.)
| | - Yazeed Abdullah Alghtani
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University Medical City (KSUMC), King Saud University, P.O. Box 245, Riyadh 11411, Saudi Arabia; (N.A.); (F.I.A.); (Y.A.A.); (A.A.); (R.I.A.)
| | - Yassin Abdelsamad
- Research Department, MED-EL GmbH, P.O. Box 245, Riyadh 11411, Saudi Arabia;
| | - Ahmed Alhussien
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University Medical City (KSUMC), King Saud University, P.O. Box 245, Riyadh 11411, Saudi Arabia; (N.A.); (F.I.A.); (Y.A.A.); (A.A.); (R.I.A.)
| | - Rafeef Ibrahim Alhajress
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University Medical City (KSUMC), King Saud University, P.O. Box 245, Riyadh 11411, Saudi Arabia; (N.A.); (F.I.A.); (Y.A.A.); (A.A.); (R.I.A.)
| | - Salman F. Alhabib
- King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University Medical City (KSUMC), King Saud University, P.O. Box 245, Riyadh 11411, Saudi Arabia; (N.A.); (F.I.A.); (Y.A.A.); (A.A.); (R.I.A.)
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Faibish G, Kaplan D, Knaanie A, Elsaeid S, Ziv O. The effect of ventilation tube insertion in pediatric cochlear implantation candidates with otitis media with effusion on postoperative complications. Int J Pediatr Otorhinolaryngol 2024; 176:111784. [PMID: 37988918 DOI: 10.1016/j.ijporl.2023.111784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 10/28/2023] [Accepted: 11/09/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVE Otitis media with effusion (OME) is a common finding in pediatric cochlear implant(CI) candidates and may be managed by inserting ventilation tubes. This study aimed to compare postoperative complication rates in children who underwent CI without and with OME, including patients who were treated without and with ventilation tube insertion. METHODS A population-based retrospective cohort study was conducted, including all CI patients, under ten years of age, at our institution, between 2007 and 2020. The study's population was divided into three groups based on their middle ear status at CI: 1) OME previously treated with VT, 2) untreated OME, and 3) normal-aerated ears. Postoperative complications of the groups were reviewed and served as our primary outcome measure. RESULTS Of the 257 implanted ears included, 53, 42, and 162 ears belonged to the VT-treated OME, untreated OME, and aerated groups, respectively. Acute mastoiditis (AM) rate was significantly higher in the OME group compared to the aerated groups (9.5 % vs. 2.5 %, p = 0.0134) and in the VT-treated compared to the untreated OME groups (15.1 % vs. 2.3 %, p = 0.0356). Similarly, the rate of developing chronic suppurative otitis media without cholesteatoma (CSOMWC) was significantly higher in the OME compared to the aerated groups (12.6 % vs. 2.5 %, p = 0.0011) and in the VT-treated compared to the untreated OME groups (18.8 % vs. 4.7 %, p = 0.0366). Other complications rated were very low and similar between the groups. No other statistical difference was found between the groups. CONCLUSION VT insertion in pediatric CI candidates with OME increased postoperative AM and CSOMWC. We believe that, at least in our population, VT introduction prior to CI, for OME, surgery should be avoided.
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Affiliation(s)
- Guy Faibish
- Faculty of Health Sciences, Joyce & Irving Goldman Medical School at Ben Gurion University of the Negev, Israel
| | - Daniel Kaplan
- Faculty of Health Sciences, Joyce & Irving Goldman Medical School at Ben Gurion University of the Negev, Israel; Department of Otolaryngology - Head and Neck Surgery, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | | | - Sabri Elsaeid
- Faculty of Health Sciences, Joyce & Irving Goldman Medical School at Ben Gurion University of the Negev, Israel; Department of Otolaryngology - Head and Neck Surgery, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Oren Ziv
- Faculty of Health Sciences, Joyce & Irving Goldman Medical School at Ben Gurion University of the Negev, Israel; Department of Otolaryngology - Head and Neck Surgery, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Gowrishankar SV, Fleet A, Tomasoni M, Durham R, Umeria R, Merchant SA, Shah SFH, Muzaffar J, Mohammed H, Kuhn I, Tysome J, Smith ME, Donnelly N, Axon P, Bance M, Borsetto D. The Risk of Meningitis After Cochlear Implantation: A Systematic Review and Meta-Analysis. Otolaryngol Head Neck Surg 2023; 169:467-481. [PMID: 36864717 DOI: 10.1002/ohn.309] [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: 11/29/2022] [Revised: 02/05/2023] [Accepted: 02/08/2023] [Indexed: 03/04/2023]
Abstract
OBJECTIVE This study aims to estimate the rate of postoperative meningitis (both immediate and long-term) in patients following cochlear implants (CIs). It aims to do so through a systematic review and meta-analysis of published studies tracking complications after CIs. DATA SOURCES MEDLINE, Embase, and Cochrane Library. REVIEW METHODS This review was performed in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies tracking complications following CIs in patients were included. Exclusion criteria included non-English language studies and case series reporting <10 patients. Bias risk was evaluated using the Newcastle-Ottawa Scale. Meta-analysis was performed through DerSimonian and Laird random-effects models. RESULTS A total of 116/1931 studies met the inclusion criteria and were included in the meta-analysis. Overall, there were 112 cases of meningitis in 58,940 patients after CIs. Meta-analysis estimated an overall rate of postoperative meningitis of 0.07% (95% confidence interval [CIs], 0.03%-0.1%; I2 = 55%). Subgroup meta-analysis showed this rate had 95% CIs crossing 0% in implanted patients who received the pneumococcal vaccine, antibiotic prophylaxis, those with postoperative acute otitis media (AOM), and those implanted less than 5 years. CONCLUSION Meningitis is a rare complication following CIs. Our estimated rates of meningitis after CIs appear lower than prior estimates based on epidemiological studies in the early 2000s. However, the rate still appears higher than the baseline rate in the general population. The risk was very low in implanted patients who received the pneumococcal vaccine, antibiotic prophylaxis, received unilateral or bilateral implantations, developed AOM, those implanted with a round window or cochleostomy techniques, and those under 5 years.
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Affiliation(s)
- Shravan V Gowrishankar
- Department of Otolaryngology-Head and Neck Surgery, Cambridge University Hospitals NHS Trust, Cambridge, UK
- Department of Clinical Medicine, University of Cambridge, School of Clinical Medicine, Cambridge, UK
| | - Alex Fleet
- Department of Otolaryngology-Head and Neck Surgery, Cambridge University Hospitals NHS Trust, Cambridge, UK
- Department of Clinical Medicine, University of Cambridge, School of Clinical Medicine, Cambridge, UK
| | - Michele Tomasoni
- Department of Otolaryngology-Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Rory Durham
- Department of Clinical Medicine, University of Cambridge, School of Clinical Medicine, Cambridge, UK
| | - Rishi Umeria
- Department of Clinical Medicine, University of Cambridge, School of Clinical Medicine, Cambridge, UK
| | - Serena A Merchant
- Department of Clinical Medicine, University of Cambridge, School of Clinical Medicine, Cambridge, UK
| | - Syed F H Shah
- Department of Clinical Medicine, University of Cambridge, School of Clinical Medicine, Cambridge, UK
| | - Jameel Muzaffar
- Department of Otolaryngology-Head and Neck Surgery, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Hassan Mohammed
- Department of Otolaryngology-Head and Neck Surgery, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Isla Kuhn
- Cambridge University Medical Library, Cambridge, UK
| | - James Tysome
- Department of Otolaryngology-Head and Neck Surgery, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Matthew E Smith
- Department of Otolaryngology-Head and Neck Surgery, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Neil Donnelly
- Department of Otolaryngology-Head and Neck Surgery, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Patrick Axon
- Department of Otolaryngology-Head and Neck Surgery, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Manohar Bance
- Department of Otolaryngology-Head and Neck Surgery, Cambridge University Hospitals NHS Trust, Cambridge, UK
- Department of Clinical Medicine, University of Cambridge, School of Clinical Medicine, Cambridge, UK
| | - Daniele Borsetto
- Department of Otolaryngology-Head and Neck Surgery, Cambridge University Hospitals NHS Trust, Cambridge, UK
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Tobe Y, Yamazaki H, Shirakawa C, Shinohara S, Fujiwara K, Naito Y. Management of Already Inserted Ventilation Tubes During Pediatric Cochlear Implantation: To Remove or Leave the Tube? Otol Neurotol 2023; 44:e140-e145. [PMID: 36728465 DOI: 10.1097/mao.0000000000003797] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Ventilation tube (VT) insertion is usually recommended before cochlear implantation (CI) in pediatric cochlear implant candidates with recurrent acute otitis media (AOM) or chronic otitis media with effusion (OME). However, there is no consensus on whether the VT is beneficial even after CI, that is, whether the tube should be removed or left in place during CI. This study aimed to assess the effect of tube placement after CI, especially on the incidence of post-CI AOM, in pediatric cochlear implant recipients who had undergone VT insertion before CI because of recurrent AOM or chronic OME. STUDY DESIGN A retrospective medical record review. SETTING A tertiary referral cochlear implant center. PATIENTS This study recruited 58 consecutive ears of children who underwent VT insertion followed by CI at age 7 years or younger between 2004 and 2021. Before October 2018, we removed the VT simultaneously with CI (removed group, 39 ears), while since then, the tube has remained in place during CI (retained group, 19 ears). INTERVENTION Therapeutic. MAIN OUTCOME MEASURE The primary outcome was the proportion of ears that developed AOM at post-CI 6 months in the removed and retained groups. RESULTS The age at CI was significantly higher in the removed group than in the retained group (mean [standard deviation]: the removed group, 2.9 [1.2] yr; the retained group: 1.5 [0.8] yr; p < 0.001). The removed group showed a significantly higher proportion of ears with post-CI AOM (8 of 39 ears; 20.5%) than the retained group (none of 19 ears; 0%) 6 months after CI ( p = 0.044). The AOM-free proportion at post-CI 12 months was 76.9% in the removed group and 83.3% in the retained group, demonstrating no significant difference ( p = 0.49), probably because the VT was spontaneously extruded in the retained group at a median of 6.5 months after CI. Throughout the study period, 17 ears (13 from the removed group) were affected by post-CI AOM. Of these, three ears in the removed group and two in the retained group after spontaneous extrusion of the VT were hospitalized and treated with intravenous antibiotics for AOM that had failed to respond to oral antibiotic therapy. Only one ear in the removed group required an explanation of the infected implant. None suffered from chronic perforation of the tympanic membrane or secondary cholesteatoma after VT insertion or meningitis associated with post-CI AOM. CONCLUSION Our results suggest that in CI for children who already have a VT because of a recurrent AOM or chronic OME, retaining the tube in position, rather than removing the tube, may decrease the incidence of AOM at least within 6 months after CI, during which most cochlear implant device infection was reported in the pediatric population.
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Affiliation(s)
- Yota Tobe
- Department of Otorhinolaryngology, Head and Neck Surgery, Kobe City Medical Center General Hospital
| | | | - Chigusa Shirakawa
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Shogo Shinohara
- Department of Otorhinolaryngology, Head and Neck Surgery, Kobe City Medical Center General Hospital
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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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Mathew R, Bajo FR, Hatton N, Buttfield L, Gowrishankar S, Vickers D, Donnelly N, Tysome J, Bance M, Axon P. Assessment of the cochlear implant pathway for newborn hearing screening referrals. Cochlear Implants Int 2021; 22:345-352. [PMID: 34232110 DOI: 10.1080/14670100.2021.1948163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To evaluate the cochlear implant (CI) assessment pathway for children referred through the newborn hearing screening programme (NHSP) and identify potential reasons for delay in CI surgery at a large UK centre. METHODS Retrospective analysis of electronic notes of children referred through NHSP from 2016 to 2019. Key points in the assessment pathway from referral to switch-on were assessed. RESULTS Of the 46 referrals, 44 went on to have CI surgery. Median age at CI surgery was 15 months (interquartile range (IQR) 13 to 17 months). Only 5% of referrals were implanted before the age of 12 months. Delayed referral and the presence of otitis media with effusion (OME) were associated with delayed implantation. The median period of monitoring for OME was 48 days (IQR 20 to 93 days), with a natural resolution rate of only 11%. The median time from surgery to switch-on was 5 weeks (IQR 4.1 to 5.4 weeks). CONCLUSION Achieving implantation prior to the age of 12 months for NHSP referrals can be challenging for a variety of reasons. The delays in the system and the steps that our implant programme has taken to address these will be highlighted.
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Affiliation(s)
- Rajeev Mathew
- Cambridge University Hospitals Foundation trust, Addenbrooke's Hospital, Cambridge, UK
| | | | - Nicola Hatton
- Cambridge University Hospitals Foundation trust, Addenbrooke's Hospital, Cambridge, UK
| | - Louise Buttfield
- Cambridge University Hospitals Foundation trust, Addenbrooke's Hospital, Cambridge, UK
| | | | - Deborah Vickers
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Neil Donnelly
- Cambridge University Hospitals Foundation trust, Addenbrooke's Hospital, Cambridge, UK
| | - James Tysome
- Cambridge University Hospitals Foundation trust, Addenbrooke's Hospital, Cambridge, UK
| | - Manohar Bance
- Cambridge University Hospitals Foundation trust, Addenbrooke's Hospital, Cambridge, UK.,School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Patrick Axon
- Cambridge University Hospitals Foundation trust, Addenbrooke's Hospital, Cambridge, UK
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Cevizci R, Dilci A, Celenk F, Karamert R, Bayazit Y. Surgical considerations and safety of cochlear implantation in otitis media with effusion. Auris Nasus Larynx 2018; 45:417-420. [DOI: 10.1016/j.anl.2017.07.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 05/19/2017] [Accepted: 07/11/2017] [Indexed: 11/26/2022]
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