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Abstract
OBJECTIVE A retrospective cross-sectional analysis was conducted of the US Food and Drug Administration's MAUDE (Manufacturer and User Facility Device Experience) database, to evaluate the complication profile of cochlear implantation according to manufacturer. METHODS A review of the MAUDE database was conducted from 1 January 2010 to 31 December 2020. Complications, including infection, extrusion, facial nerve stimulation, meningitis and cerebrospinal fluid leak, were identified using key word searches. The categorised data were analysed using a chi-square test to determine a difference in global complication incidence between three major cochlear implant manufacturers: manufacturer A (Cochlear Limited), manufacturer B (Med-El) and manufacturer C (Advanced Bionics). RESULTS A total of 31 857 adverse events were analysed. Implants of manufacturer C were associated with a statistically higher rate of infection (0.97 per cent), cerebrospinal fluid leak (0.07 per cent), extrusion (0.44 per cent) and facial nerve stimulation (0.11 per cent). Implants of manufacturer B were associated with a statistically higher rate of meningitis (0.07 per cent). CONCLUSION Consideration of patient risk factors along with cochlear implant manufacturers can heighten awareness of cochlear implant complications pre-operatively, intra-operatively and post-operatively.
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Affiliation(s)
- S Jinka
- Northeast Ohio Medical University, Rootstown, Ohio, USA
| | - S Wase
- Northeast Ohio Medical University, Rootstown, Ohio, USA
| | - A Jeyakumar
- Northeast Ohio Medical University, Rootstown, Ohio, USA
- Department of Otolaryngology, Mercy Bon Secours, Youngstown, Ohio, USA
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2
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Baird SM, Wong D, Levi E, Robinson P. Otolaryngological burden of disease in children with primary ciliary dyskinesia in Victoria, Australia. Int J Pediatr Otorhinolaryngol 2023; 173:111722. [PMID: 37699305 DOI: 10.1016/j.ijporl.2023.111722] [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: 06/27/2023] [Revised: 09/04/2023] [Accepted: 09/06/2023] [Indexed: 09/14/2023]
Abstract
OBJECTIVES The aim of this study was to summarize the otolaryngological manifestations amongst children with primary ciliary dyskinesia (cwPCD) to improve diagnosis, investigations and management amongst otolaryngologists. METHODS A retrospective review of primary ciliary dyskinesia (PCD) diagnoses at our institution over an 8-year period between January 2014 and October 2022 was conducted. Patient characteristics, diagnosis, otolaryngological symptomatology, treatment and outcomes were recorded. RESULTS 24 patients were identified. Thirteen patients (54%) had documented conductive hearing loss on audiological evaluation; with 11 (85%) requiring hearing aids. Six patients (25%) underwent middle ear ventilation tube (MEVT) insertion with 67% experiencing post-MEVT otorrhoea. Twenty children (83%) reported chronic nasal discharge however only 3 (13%) reported nasal obstruction. Nine patients (38%) had symptoms consistent with sleep disordered breathing with 79% of them requiring operative management with adenotonsillectomy. CONCLUSION Middle ear effusion is common amongst cwPCD and should be managed with conservative measures due to the significant burden of post-MEVT otorrhoea. Sinonasal symptoms rarely need surgical intervention. Many otolaryngological symptoms of PCD are often underreported, particularly sleep-disordered breathing. Paediatric PCD patients should be managed in a multidisciplinary team with routine and tailored therapies to manage all aspects of the condition.
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Affiliation(s)
- Samantha M Baird
- Department of Otolaryngology, The Royal Children's Hospital, 50 Flemington Rd, Parkville, VIC, 3052, Australia.
| | - Daniel Wong
- Department of Otolaryngology, The Royal Children's Hospital, 50 Flemington Rd, Parkville, VIC, 3052, Australia.
| | - Eric Levi
- Department of Otolaryngology, The Royal Children's Hospital, 50 Flemington Rd, Parkville, VIC, 3052, Australia.
| | - Philip Robinson
- Department of Respiratory Medicine, The Royal Children's Hospital, 50 Flemington Rd, Parkville, VIC, 3052, Australia.
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3
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Potdukhe K, Vishwakarma R, Rao S. Our Experience in 576 Cases of Cochlear Implant Surgery by Veria Technique. Indian J Otolaryngol Head Neck Surg 2023; 75:2017-2024. [PMID: 37636783 PMCID: PMC10447859 DOI: 10.1007/s12070-023-03535-5] [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: 05/28/2022] [Accepted: 01/26/2023] [Indexed: 08/29/2023] Open
Abstract
OBJECTIVE To study and analyse the result obtained in cochlear implantation by Veria technique and evaluate the incidence of surgical complications and their management. METHOD Between Jan 1, 2014 to Jan 1, 2019, 602 cochlear implantations by Veria technique were done out of which 576 patients were analysed retrospectively for the study. The age range was between 18 months and 60 years. RESULT All 576 patients were operated by Veria technique. Out of 576 patients, 57 (9.9%) had abnormal cochlear malformation. Cytomegalovirus (CMV) being the most common non genetic cause of congenital hearing loss accounting to 60%. The overall complication rate of 5.5% was observed in 576 implanted patients. CONCLUSION The analysis of the results shows that this method has certain advantages, which are: it is simple and therefore the learning curve is fast; it is safe for the facial nerve, as the drilling is precisely controlled by the special perforator; it produces minimal bone trauma and due fast healing, it permits early fitting a few days after operation; it can be used for very small children where the mastoid may have not been yet sufficiently developed.
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Affiliation(s)
| | - Rajesh Vishwakarma
- Department of Otorhinolaryngology, Apollo Hospital Ahmedabad, Ahmedabad, India
| | - Saketh Rao
- Civil Hospital Ahmedabad , Ahmedabad, India
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4
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Di Rubbo V, Morelli L, Zangrandi A, Lauda L, Piras G, Sanna M. Late complications of cochlear implant: a case report of necrotizing meningoencephalitis similar to a CPA tumor. Eur Arch Otorhinolaryngol 2023; 280:3485-3488. [PMID: 37020047 DOI: 10.1007/s00405-023-07956-4] [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: 01/27/2023] [Accepted: 03/29/2023] [Indexed: 04/07/2023]
Abstract
OBJECTIVE Report a case of localized necrotizing meningoencephalitis as the cause of functional hearing loss after cochlear implant (CI) surgery. CASE REPORT A 12-year-old with bilateral CI presented to our quaternary center due to severe functional hearing loss after 11 years since left ear CI surgery. CT with contrast was conducted showing a CPA tumor-like mass. Pre-operative computed tomography (CT) scans and magnetic resonance imaging (MRI) performed at the age of 1 year showed no inner ear abnormalities and in particular no evidence of a tumor in the cerebellopontine angle (CPA). CONCLUSION Following removal of the CI and the mass, histopathological, immunohistochemical and cultural examinations revealed a necrotizing meningoencephalitis, with the CI electrode as the focus.
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Affiliation(s)
- Vittoria Di Rubbo
- Department of Otology and Skull Base Surgery, Gruppo Otologico, Piacenza-Rome, Italy
| | - Luca Morelli
- Department of Otology and Skull Base Surgery, Gruppo Otologico, Piacenza-Rome, Italy.
- Audiology Unit, Department of Specialistic Surgical Sciences, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Via Sforza, 35, 20122, Milan, Italy.
| | - Adriano Zangrandi
- Department of Oncohematology, Pathological Anatomy, "Guglielmo da Saliceto" Hospital, Piacenza, Italy
| | - Lorenzo Lauda
- Department of Otology and Skull Base Surgery, Gruppo Otologico, Piacenza-Rome, Italy
| | - Gianluca Piras
- Department of Otology and Skull Base Surgery, Gruppo Otologico, Piacenza-Rome, Italy
| | - Mario Sanna
- Department of Otology and Skull Base Surgery, Gruppo Otologico, Piacenza-Rome, Italy
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5
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Quimby AE, Grose E, Reddy D, Webster R, Malic C, Vaccani JP. Predictors of Surgical Site Infection in Pediatric Cochlear Implantation. Otolaryngol Head Neck Surg 2023; 168:484-490. [PMID: 35671142 DOI: 10.1177/01945998221104933] [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: 03/19/2022] [Accepted: 05/17/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine risk factors for surgical site infection (SSI) after cochlear implantation (CI) in pediatric patients. STUDY DESIGN Case-control study. SETTING A total of 150 hospitals contributing data to the ACS-NSQIP Pediatric database (American College of Surgeons National Surgical Quality Improvement Program) in North America and worldwide. METHODS Pediatric patients (aged <18 years) undergoing CI during the years 2012 to 2017 were identified in the ACS-NSQIP Pediatric database. Uni- and multivariable logistic regression analyses were used to determine the odds ratios (ORs) of SSI (including superficial incisional, deep incisional, organ/space) occurring up to 30 days postoperatively. RESULTS A total of 79 SSIs occurred over a 5-year period (n = 5146). Longer operative time significantly increased the odds of SSI (OR, 1.965; 95% CI, 1.205-3.289). Younger age was also found to raise the odds of SSI, with decreased odds associated with each 6-month increase in age (OR, 0.887; 95% CI, 0.814-0.958). CONCLUSION Longer operative time and younger age appear to significantly increase the odds of SSI in pediatric CI. Body mass index, recent steroid use, American Society of Anesthesiologists class, bilateral vs unilateral implantation, and hospital length of stay do not appear to significantly influence SSI risk. These findings must be interpreted in the context of the limitations inherent to adverse events reporting, which are mitigated by the stringent manner of data collection by the ACS-NSQIP, and those inherent to the definition of SSI. Future prospective studies should investigate the impact of reducing operative time on the risk of SSI and other complications in pediatric CI.
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Affiliation(s)
- Alexandra E Quimby
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Elysia Grose
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Canada
| | - Deepti Reddy
- Clinical Research Unit, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Richard Webster
- Clinical Research Unit, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Claudia Malic
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Ottawa, Ottawa, Canada
- Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Jean-Philippe Vaccani
- Children's Hospital of Eastern Ontario, Ottawa, Canada
- Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ontario, Canada
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6
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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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7
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Ekman B, Laureano J, Balasuriya B, Mahairas A, Bush ML. Comparison of Adult and Pediatric Cochlear Implant Wound Complications: A Meta-Analysis. Laryngoscope 2023; 133:218-226. [PMID: 35561044 DOI: 10.1002/lary.30168] [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: 09/08/2021] [Revised: 04/06/2022] [Accepted: 04/09/2022] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To compare age-related differences in wound complications following cochlear implantation (CI). METHODS We performed a systematic review of PubMed, Cochrane Database, and Web of Science databases to identify original research evaluating the patient-level factors (demographics and medical history) associated with wound complications following CI. Outcomes were expressed as relative risk (RR) with 95% confidence intervals using the inverse variance method. Studies without comparison groups were described qualitatively. RESULTS Thirty-eight studies representing 21,838 cochlear implantations were included. The rate of wound complications ranges from 0% to 22%. Patient age (adult versus pediatric) was the only factor with comparison groups appropriate for meta-analysis. The 10 studies (n = 9547 CI's) included in the meta-analysis demonstrated that adults had a higher incidence of overall wound complications (2.94%) than in children (2.44%) (RR 1.31, 95% CI 1.01-1.69). Adults had a higher incidence of general/unclassified wound complications (2.07%) than in children (1.34%) (RR 1.68, 95% CI 1.12-2.52). There was no difference between adults and children for specific complications such as hematoma, infection, or seroma. Elderly patients (over age 75) have wound complication rates that range from 1% to 4%. No studies contained comparison groups regarding other patient-level factors and CI wound complications. CONCLUSION CI wound complication rates reported in the literature are low; however, adults have a higher risk of these complications than pediatric patients. The reported complication rate in elderly adults is low. There is a gap in CI research in consistently reporting wound complications and rigorous research investigating the impact of patient-level factors and wound complications. LEVEL OF EVIDENCE NA Laryngoscope, 133:218-226, 2023.
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Affiliation(s)
- Brady Ekman
- University of Kentucky College of Medicine, Lexington, Kentucky, U.S.A
| | - Jack Laureano
- University of Kentucky College of Medicine, Lexington, Kentucky, U.S.A
| | - Beverly Balasuriya
- Department of Otolaryngology - Head and Neck Surgery, University of Kentucky Medical Center, Lexington, Kentucky, U.S.A
| | - Anthony Mahairas
- Department of Otolaryngology - Head and Neck Surgery, University of Kentucky Medical Center, Lexington, Kentucky, U.S.A
| | - Matthew L Bush
- Department of Otolaryngology - Head and Neck Surgery, University of Kentucky Medical Center, Lexington, Kentucky, U.S.A
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8
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Onal M, Colpan Keles B, Ulusoy B, Onal O. New validation of a well-known marker in cochlear implant infections: A retrospective, case-controlled, observational study. Laryngoscope Investig Otolaryngol 2022; 7:1992-2001. [PMID: 36544965 PMCID: PMC9764777 DOI: 10.1002/lio2.900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 08/08/2022] [Accepted: 08/11/2022] [Indexed: 11/27/2022] Open
Abstract
Objectives Cochlear implant (CI) infection is the most common complication after CI surgery. We investigated whether the preoperative neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) values could predict the CI infection and the NLR and PLR values obtained at the first admission to the hospital with an CI infection could help the clinician in the diagnosis. Methods This retrospective case-controlled study included 26 patients with postsurgical CI infection. To prevent age-related incompatibility in the blood analysis of the infected group, the patients were divided into three age groups: 0-4 years, 5-18 years, and over 18 years old. To compare the infected group, 29 patients who did not have implant infection after CI surgery and whose age ranges were compatible with the infected group were randomly selected from the hospital records as the control group. The infected group preimplantation (PREs) and postinfection (POSTi) NLR and PLR values were compared with each other and the control group values. The area under the curve, sensitivity, specificity, and cutoff values were calculated by ROC analysis. Results The POSTi NLR values of the infected group patients aged 0-4 years and over 18 years were significantly greater than the PREs NLR values (p = .038 and p = .008, respectively). Significant differences were found between the POSTi NLR values of the infected group patients aged 0-4 years and over 18 years and those of PREs in the control group (p = .011 and p = .015, respectively). Conclusions Preoperative NLR and PLR values cannot predict postoperative CI infection. However, NLR and PLR values increased significantly after CI infection, even if systemic symptoms did not occur. At the first admission to the hospital, NLR values can guide the clinician in diagnosing the CI infection in patients between 0 and 4 years and over 18 years.Trial Registration Clinical Trials.gov Identifier: NCT04120181.
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Affiliation(s)
- Merih Onal
- Department of OtorhinolaryngologyFaculty of Medicine, Selcuk UniversityKonyaTurkey
| | - Bahar Colpan Keles
- Department of OtorhinolaryngologyFaculty of Medicine, Selcuk UniversityKonyaTurkey
| | - Bulent Ulusoy
- Department of OtorhinolaryngologyFaculty of Medicine, Selcuk UniversityKonyaTurkey
| | - Ozkan Onal
- Department of Outcomes Research ConsortiumAnesthesiology Institute, Cleveland ClinicClevelandOhioUSA
- Faculty of Medicine, Selcuk UniversityKonyaTurkey
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9
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McHugh CI, Swedenborg BK, Chen JX, Jung DH, Mankarious LA, Quesnel AM, Cohen MS, Arenberg JG, Franck KH, Santos F. Voluntary Field Recall of Advanced Bionics HiRes Cochlear Implants: A Single-Institution Experience. Otol Neurotol 2022; 43:e1094-e1099. [PMID: 36201555 DOI: 10.1097/mao.0000000000003711] [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: 11/26/2022]
Abstract
OBJECTIVES In 2020, Advanced Bionics (AB) announced a recall of two cochlear implant (CI) models, the "HiRes Ultra" and "HiRes Ultra 3D", because of reports of hearing degradation. The present study examines clinical parameters and patient features in cases of device failure and evaluates outcomes after reimplantation. MATERIALS AND METHODS A series of 52 patients implanted with the recalled devices experienced suspected device failure and subsequently underwent revision CI placement at a tertiary academic medical center between December 2019 and November 2021. RESULTS Consonant-nucleus-consonant scores and individual phonemes increased significantly between patients' preoperative evaluation and primary cochlear implantation. Performance declined significantly before revision and recovered after revision CI placement. Similarly, pure-tone average thresholds improved between preoperative and primary CI, fell before revision surgery, and were corrected with revision implantation. As a group, patients reached their peak hearing performance significantly faster after revision CI (mean ± standard deviation, 53.4 ± 51.8 d) compared with their primary CI (mean ± standard deviation, 260.6 ± 245.9 d). Electrical field imaging performed by AB and device impedance measurements were found to be abnormal in the basally positioned electrodes (electrodes 9-16). CONCLUSION Hearing performance degradation is significant in AB Ultra device failures and seems to be linked to the basal-most electrodes in the array. Revision outcomes have been robust, necessitating continued monitoring of affected patients and support for reimplantation procedures. LEVEL OF EVIDENCE IV.
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Affiliation(s)
| | | | - Jenny X Chen
- Department of Otolaryngology, Massachusetts Eye and Ear
| | - David H Jung
- Department of Otolaryngology, Massachusetts Eye and Ear
| | | | | | | | | | | | - Felipe Santos
- Department of Otolaryngology, Massachusetts Eye and Ear
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10
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Tay S, Bowen AC, Blyth CC, Clifford P, Clack R, Ford T, Herbert H, Kuthubutheen J, Mascaro F, O'Mahoney A, Rodrigues S, Tran T, Campbell AJ. A quality improvement study: Optimizing pneumococcal vaccination rates in children with cochlear implants. Vaccine 2022; 40:4531-4537. [PMID: 35718588 DOI: 10.1016/j.vaccine.2022.06.022] [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: 04/06/2022] [Revised: 05/24/2022] [Accepted: 06/05/2022] [Indexed: 11/16/2022]
Abstract
Children with cochlear implants are at increased risk of invasive pneumococcal disease, with national and international guidelines recommending additional pneumococcal vaccines for these children. This study aimed to examine the pneumococcal immunization status and rate of invasive pneumococcal disease in children with cochlear implants at a tertiary paediatric hospital over a 12-year period. Additionally, the impacts of vaccination reminders and a dedicated immunization clinic on pneumococcal vaccination rates were assessed. This quality improvement study included 200 children who had received a cochlear implant through the Children's Hearing Implant Program at a tertiary paediatric hospital servicing the state of Western Australia. The majority of children (88%) were not up to date with additionally recommended pneumococcal vaccinations. Over the 12-year study period, 2% of children developed invasive pneumococcal disease associated with cochlear implant infections. Generic and personalized electronic immunization reminders improved pneumococcal vaccine up-take in this paediatric cochlear implant setting from 12% (19/153) at baseline to 49% (75/153, p < 0.0001) post implementation. The value of a nurse-led dedicated immunization clinic was also demonstrated with all children (42/42, 100%) up to date with Prevenar13 and the majority (34/42, 81%) up to date with Pneumovax23 post initiation of this referral pathway. These data support the expansion of this model to other medically-at-risk paediatric groups that have been highlighted consistently to be under-vaccinated.
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Affiliation(s)
- S Tay
- Immunisation Service, Department of Infectious Diseases, Perth Children's Hospital, Western Australia, Australia.
| | - A C Bowen
- Immunisation Service, Department of Infectious Diseases, Perth Children's Hospital, Western Australia, Australia; Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Western Australia, Australia
| | - C C Blyth
- Immunisation Service, Department of Infectious Diseases, Perth Children's Hospital, Western Australia, Australia; Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Western Australia, Australia
| | - P Clifford
- Immunisation Service, Department of Infectious Diseases, Perth Children's Hospital, Western Australia, Australia
| | - R Clack
- Children's Hearing Implant Program, Ear Nose and Throat Department, Perth Children's Hospital, Western Australia, Australia
| | - T Ford
- Immunisation Service, Department of Infectious Diseases, Perth Children's Hospital, Western Australia, Australia; Discipline of Paediatrics, School of Medicine, University of Western Australia, Crawley, Australia
| | - H Herbert
- Children's Hearing Implant Program, Ear Nose and Throat Department, Perth Children's Hospital, Western Australia, Australia
| | - J Kuthubutheen
- Children's Hearing Implant Program, Ear Nose and Throat Department, Perth Children's Hospital, Western Australia, Australia; Division of Surgery, University of Western Australia, Western Australia, Australia
| | - F Mascaro
- Immunisation Service, Department of Infectious Diseases, Perth Children's Hospital, Western Australia, Australia
| | - A O'Mahoney
- Immunisation Service, Department of Infectious Diseases, Perth Children's Hospital, Western Australia, Australia
| | - S Rodrigues
- Children's Hearing Implant Program, Ear Nose and Throat Department, Perth Children's Hospital, Western Australia, Australia
| | - T Tran
- Children's Hearing Implant Program, Ear Nose and Throat Department, Perth Children's Hospital, Western Australia, Australia
| | - A J Campbell
- Immunisation Service, Department of Infectious Diseases, Perth Children's Hospital, Western Australia, Australia; Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Western Australia, Australia
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11
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Davidson L, Foley DA, Clifford P, Blyth CC, Bowen AC, Hazelton B, Kuthubutheen J, McLeod C, Rodrigues S, Tay SM, Campbell AJ. Infectious complications and optimising infection prevention for children with cochlear implants. J Paediatr Child Health 2022; 58:1007-1012. [PMID: 35138003 DOI: 10.1111/jpc.15889] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 01/24/2022] [Indexed: 11/30/2022]
Abstract
AIM To describe the clinical epidemiology of children receiving cochlear implants, as well as the management and outcomes of cochlear implant infections and adherence to infection prevention measures. METHODS A retrospective observational study was conducted in children ≤18 years who received cochlear implants in Western Australia's tertiary paediatric hospital. Information was obtained from medical and laboratory records regarding demographics, indication for implant, implant infection and preoperative Staphylococcus aureus screening/decolonisation. Immunisation history was examined using the Australian Immunisation Register. RESULTS Overall, 118 children received cochlear implants, with 158 devices inserted (599 cochlear implant insertion-years). An implant infection rate of 3.8% (6/158) was identified during the study period (four pneumococcal and two community-acquired methicillin resistant S. aureus infections). All required surgical management, with an overall median duration of antibiotic therapy of 37 days (interquartile range (IQR) 29-48) and median length of stay of 8 days (IQR 8-9.5). All devices were retained and there were no relapses or deaths. Half of the children who developed cochlear implant infections (50%, 3/6) were up-to-date with additional pneumococcal vaccinations and no children (0%, 0/118) received S. aureus screening/decolonisation before implant insertion. CONCLUSIONS Favourable outcomes were achieved with cochlear implant retention; however, the treatment was burdensome for families. We demonstrate significant scope to improve adherence to existing infection prevention strategies and provide direction for optimising preventative measures in the future. These include ensuring parental education, additional pneumococcal vaccinations and S. aureus decolonisation which are delivered as an infection prevention bundle to the growing population of infants receiving cochlear implants.
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Affiliation(s)
- Lucy Davidson
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - David A Foley
- Department of Infectious Diseases, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Patricia Clifford
- Department of Infectious Diseases, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Christopher C Blyth
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia.,Department of Infectious Diseases, Perth Children's Hospital, Nedlands, Western Australia, Australia.,Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Western Australia, Australia.,Department of Microbiology, Pathwest Laboratory Medicine, QEII Medical Centre, Nedlands, Western Australia, Australia
| | - Asha C Bowen
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia.,Department of Infectious Diseases, Perth Children's Hospital, Nedlands, Western Australia, Australia.,Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Briony Hazelton
- Department of Infectious Diseases, Perth Children's Hospital, Nedlands, Western Australia, Australia.,Department of Microbiology, Pathwest Laboratory Medicine, QEII Medical Centre, Nedlands, Western Australia, Australia
| | - Jafri Kuthubutheen
- Department of ENT, Perth Children's Hospital, Nedlands, Western Australia, Australia.,Division of Surgery, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Charlie McLeod
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia.,Department of Infectious Diseases, Perth Children's Hospital, Nedlands, Western Australia, Australia.,Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Stephen Rodrigues
- Department of ENT, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Siu Min Tay
- Department of Paediatrics, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Anita J Campbell
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia.,Department of Infectious Diseases, Perth Children's Hospital, Nedlands, Western Australia, Australia.,Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Western Australia, Australia
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12
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Asfour L, Smyth D, Whitchurch CB, Cavaliere R, Roland JT. Fluorescence in situ hybridization and microbial community profiling analysis of explanted cochlear implants. Acta Otolaryngol 2022; 142:395-401. [PMID: 35549817 DOI: 10.1080/00016489.2022.2070931] [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: 11/01/2022]
Abstract
BACKGROUND Cochlear implant (CI) infections affect a small, but significant number of patients. Unremitting infections can lead to explantation. Fluorescence in situ hybridization (FISH) and microbial community profiling (MCP) are methods of studying microbial environments of explanted devices that can provide information to reduce morbidity and costs of infected CIs. AIMS/OBJECTIVES To describe the results and clinical significance of bacterial analyses conducted on explanted CIs. MATERIAL AND METHODS Between 2013 and 2017, 12 explanted devices underwent microbiological analysis in addition to the manufacturer's device failure analysis. Patients' clinical history, infection status and outcome were reviewed and correlated with microbial analysis results. RESULTS From 2013 to 2017, 12 Cochlear™ devices from 11 patients underwent additional MCP or FISH analysis. Five devices were explanted due to suspected implant associated infection, and seven were explanted for other reasons. FISH analysis revealed biofilm presence on all infected devices, only partial correlation of cultures with biofilm composition and confirmation that biofilm formation occurs preferentially at particular device interfaces and geometries. MCP analysis presented challenges in data analysis inherent to its technique but correlated with cultures of infected devices and suggested a diverse microbial composition of explanted devices. CONCLUSIONS AND SIGNIFICANCE Microbial analysis of explanted devices can aid in further elucidating treatment approaches to infected CIs.
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Affiliation(s)
- Leena Asfour
- Department of Otolaryngology—Head & Neck Surgery, New York University School of Medicine, New York City, NY, USA
| | - Daniel Smyth
- Cochlear Limited, 1 University Avenue, Macquarie University, Sydney, Australia
| | | | - Rosalia Cavaliere
- The ithree Institute, University of Technology Sydney, Ultimo, Australia
| | - J. Thomas Roland
- Department of Otolaryngology—Head & Neck Surgery, New York University School of Medicine, New York City, NY, USA
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13
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Holtmann LC, Deuß E, Meyer M, Kaster F, Bastian T, Schleupner MC, Hagedorn E, Lang S, Arweiler-Harbeck D. Detection accuracy of soft tissue complications during remote cochlear implant follow-up. Cochlear Implants Int 2022; 23:249-256. [PMID: 35477412 DOI: 10.1080/14670100.2022.2067644] [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: 10/18/2022]
Abstract
PURPOSE After cochlear implantation (CI), long-term follow-up is obligatory. Remote-care options which provide a standard of care comparable to in-person consultations, could be an attractive addition to a cochlear implant centre's portfolio. The aim of this study was to evaluate the accuracy of photographs of the skin covering the implant to reliably detect skin irritations or soft tissue complications. METHODS During routine follow-up consultations, 109 CI patients were examined in person and asked to take a photograph of the skin covering the implant using their smartphones. Photographs were digitally and remotely evaluated by two CI physicians who were blinded to the findings during the in-person examination. RESULTS In nine cases, skin abnormalities were detected by the CI physician upon in-person examination, seven of which required immediate treatment. Both digital evaluators reliably detected all treatment-requiring conditions. Overall, more skin irritations were suspected digitally compared to in-person examination. Without additional information from the patients' medical record, sensitivity was 100% and specificity was 63%; with additional information provided, sensitivity was 100%, and specificity increased to 65.3%. CONCLUSION Digital photographic assessment of the skin covering the implant is a highly sensitive method to detect skin irritations and could reduce the number of necessary in-person consultations.
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Affiliation(s)
- L C Holtmann
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medicine Essen, University of Duisburg-Essen, Essen, Germany
| | - E Deuß
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medicine Essen, University of Duisburg-Essen, Essen, Germany
| | - M Meyer
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medicine Essen, University of Duisburg-Essen, Essen, Germany
| | - F Kaster
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medicine Essen, University of Duisburg-Essen, Essen, Germany
| | - T Bastian
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medicine Essen, University of Duisburg-Essen, Essen, Germany
| | - M C Schleupner
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medicine Essen, University of Duisburg-Essen, Essen, Germany
| | - E Hagedorn
- CIC Ruhr Acoustics Bagus, Essen, Germany
| | - S Lang
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medicine Essen, University of Duisburg-Essen, Essen, Germany
| | - D Arweiler-Harbeck
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medicine Essen, University of Duisburg-Essen, Essen, Germany
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14
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Ozdemir O, Yigit O, Can E, Kalaycik Ertugay C. Cochlear Implant Complications in a Tertiary Referral Center in Istanbul. Audiol Neurootol 2022; 27:321-327. [PMID: 35320809 DOI: 10.1159/000522281] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 01/25/2022] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE All surgeons should inform the patients about complications and also their clinic's complication rates of cochlear implantation (CI). We aimed to review the complications of CI in 1,148 pediatric and adult patients. METHODS It is a retrospective case review study enrolled in a tertiary referral center in Istanbul where CI was mostly performed. A total of 1,148 pediatric and adult CIs (unilateral or bilateral CI and revision surgery) performed by the same experienced surgeon in our institution were examined. Complications were noted as major and minor. RESULTS The mean age of first CI of 702 children and 157 adult patients was 10.2 years (1-75 years). The overall complication rate was 13.68%, comprising 8.28% of minor and 5.4% of major complications. Swelling (wound seroma or hematoma) was the most common minor complication. The most common cause of major complications was related to implanted devices. Despite the high rates of minor complications in children, there was no statistically significant difference between children and adults (p = 0,194). CONCLUSIONS Our clinic has a low major complication rate. Surgeons should be aware of postoperative complications, apply appropriate procedures, and inform patients about their surgical complication rates.
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Affiliation(s)
- Ozan Ozdemir
- Department of Otorhinolaryngology/Head and Neck Surgery, University of Health Sciences Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Ozgur Yigit
- Department of Otorhinolaryngology/Head and Neck Surgery, University of Health Sciences Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Efe Can
- Department of Otorhinolaryngology/Head and Neck Surgery, University of Health Sciences Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Cigdem Kalaycik Ertugay
- Department of Otorhinolaryngology/Head and Neck Surgery, University of Health Sciences Istanbul Training and Research Hospital, Istanbul, Turkey
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15
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Moon PK, Qian ZJ, Ahmad IN, Stankovic KM, Chang KW, Cheng AG. Infectious Complications Following Cochlear Implant: Risk Factors, Natural History, and Management Patterns. Otolaryngol Head Neck Surg 2022; 167:745-752. [PMID: 35192408 DOI: 10.1177/01945998221082530] [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: 11/16/2022]
Abstract
OBJECTIVE To describe the natural history, detail the treatment patterns, and identify the risk factors for cochlear implant (CI) infections in a large US cohort. STUDY DESIGN Retrospective study based on insurance claims. SETTING Optum Data Mart database: 6101 patients who received CIs from 2003 to 2019. METHODS Infections, treatments patterns, and timelines were described. A multivariable logistic regression model was used to assess the association between postoperative oral antibiotics and CI infection. RESULTS The cohort includes 4736 (77.6%) adults and 1365 (22.4%) children. Between adult and pediatric patients, rates of CI infection (5.1% vs 4.5%, P = .18) and explantation (1.2% vs 0.8%, P = .11) were not significantly different. Infections typically occurred within 5 months of surgery. Children were diagnosed with CI infection earlier than adults (median difference, -1.5 months; P = .001). Postoperative oral antibiotic supply was not associated with lower risk of CI infection in either children or adults. However, among adults, otitis media was associated with higher odds of CI infection (odds ratio, 1.41; P < .001), while higher income was associated with lower odds of CI infection (odds ratio, 0.71; P = .03). CONCLUSIONS Postoperative oral antibiotics were not associated with lower risk of infection or interventions. Otitis media episodes and lower income were associated with increased risk of infection among adults as well as intervention overall. Infection typically presented within the first 6 months after surgery, with children presenting earlier than adults. Overall, our findings serve as a resource for providers to consider in their care of patients with CIs.
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Affiliation(s)
- Peter K Moon
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Stanford University, Palo Alto, California, USA
| | - Z Jason Qian
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Stanford University, Palo Alto, California, USA
| | - Iram N Ahmad
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Stanford University, Palo Alto, California, USA
| | - Konstantina M Stankovic
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Stanford University, Palo Alto, California, USA
| | - Kay W Chang
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Stanford University, Palo Alto, California, USA
| | - Alan G Cheng
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Stanford University, Palo Alto, California, USA
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16
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Košec A, Živko J, Marković S, Bedeković V, Ries M, Ajduk J. Impact of preoperative antibiotic use in preventing complications of cochlear implantation surgery. Cochlear Implants Int 2021; 23:134-138. [PMID: 34915825 DOI: 10.1080/14670100.2021.2013586] [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: 10/19/2022]
Abstract
OBJECTIVE To examine the impact of preoperative antibiotic prophylaxis on the occurrence of postoperative complications. MATERIALS AND METHODS Data of 491 patients undergoing cochlear implantation were included in a non-randomized retrospective comparative cohort study. Demographic data, cochlear implant and surgical details, use of preoperative antibiotics and occurrence of postoperative complications were analyzed using a binary logistic regression model. RESULTS There were 317 patients (64.56%) who did not receive preoperative antibiotic prophylaxis and 174 (35.44%) patients who received preoperative antibiotic prophylaxis with ceftriaxone. The overall rate of complications requiring surgical treatment was 2.85%. Younger patient age was identified as a positive predictive factor for administering preoperative antibiotic prophylaxis (p<0.001, OR 1.05 CI 95% 1.0124-1.0826). No difference in complication rate was observed between the two groups. No correlation between sex, age, manufacturer, surgeon and postoperative complications were noted (p=0.45). CONCLUSION There is insufficient evidence to inform decision making regarding preoperative intravenous ceftriaxone use for prevention of infection after cochlear implantation surgery, with data failing to show that administration of preoperative antibiotics leads to a decrease in complication rate. Considering a very low overall complication rate, with few complications related to infection, routine use of preoperative antibiotic prophylaxis should be analyzed further.
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Affiliation(s)
- A Košec
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Center Sestre milosrdnice, Vinogradska cesta 29, Zagreb, Croatia.,School of Medicine, University of Zagreb, Šalata 3b, Zagreb, Croatia
| | - J Živko
- School of Medicine, University of Zagreb, Šalata 3b, Zagreb, Croatia
| | - S Marković
- School of Medicine, University of Zagreb, Šalata 3b, Zagreb, Croatia
| | - V Bedeković
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Center Sestre milosrdnice, Vinogradska cesta 29, Zagreb, Croatia.,School of Medicine, University of Zagreb, Šalata 3b, Zagreb, Croatia
| | - M Ries
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Center Sestre milosrdnice, Vinogradska cesta 29, Zagreb, Croatia.,School of Medicine, University of Zagreb, Šalata 3b, Zagreb, Croatia
| | - J Ajduk
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Center Sestre milosrdnice, Vinogradska cesta 29, Zagreb, Croatia.,School of Medicine, University of Zagreb, Šalata 3b, Zagreb, Croatia
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17
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Chweya CM, Smith AJ, May MM, Lohse CM, Neff BA, Driscoll CLW, Carlson ML. Prevalence of Surgical, Anesthetic, and Device-related Complications Among Infants Implanted Before 9 and 12 Months of Age Versus Older Children: Evidence for the Continued Expansion of Pediatric Cochlear Implant Candidacy Criteria. Otol Neurotol 2021; 42:e666-e674. [PMID: 33710142 DOI: 10.1097/mao.0000000000003060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare the prevalence of surgical, anesthetic, and device-related complications among infants and older children receiving cochlear implantation (CI). STUDY DESIGN Retrospective chart review. SETTING Tertiary academic referral center. PATIENTS Pediatric patients who underwent CI from November 1990 to January 2020. INTERVENTION CI. MAIN OUTCOME MEASURES Surgical, anesthetic, and device-related complication rates were compared by age group (<12 versus 12-23 versus 24+ months with subset analysis of <9 versus 9-11 months). RESULTS A total of 406 primary pediatric CI surgeries encompassing 482 ears were analyzed, including 45 ears in 23 patients implanted less than 9 months and 89 ears in 49 patients less than 12 months. No anesthetic complications occurred. Postoperative surgical and device-related complication rates were not significantly different among the less than 12, 12 to 23, and 24+ month groups (16% versus 16% versus 12%; p = 0.23) or between the less than 9 and 9 to 11 month groups (22% versus 9%; p = 0.09). Thirty-day readmission was significantly higher for patients less than 12 months compared with patients 24+ months (6% versus <1%; p = 0.011), but was not significantly higher compared with patients 12 to 23 months (6% versus 3%; p = 0.65). Reoperation rates did not differ significantly among the less than 12, 12 to 23, and 24+ month groups (10% versus 7% versus 6%; p = 0.31). CONCLUSIONS The prevalence of surgical, anesthetic, and device related complications was not significantly different among infants implanted less than 9 or less than 12 months of age when compared with older children. These data provide evidence for the continued expansion of pediatric cochlear implant candidacy criteria to include appropriately selected infants less than 9 months of age.
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Affiliation(s)
| | | | | | - Christine M Lohse
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Brian A Neff
- Department of Otolaryngology-Head and Neck Surgery
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18
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"Benefits of the pedicled osteoplastic flap as a surgical approach of mastoidectomy in cochlear implant surgery". Eur Arch Otorhinolaryngol 2021; 279:2259-2268. [PMID: 34110455 PMCID: PMC8190168 DOI: 10.1007/s00405-021-06907-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 05/25/2021] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To evaluate the esthetic and functional results of an osteoplastic flap for mastoid cavity closure in cochlear implant surgery. STUDY DESIGN Double-blind, prospective, randomized clinical trial. SETTING tertiary referral center. INTERVENTION(S) On hundred and twenty-six patients were randomized in 2 groups for cochlear implant surgery. Cases (n: 63) underwent simple mastoidectomy using an anteriorly pedicled osteoplastic flap for mastoid closure. In controls (n: 63), a traditional periosteal flap was used. Evaluation with the POSAS questionnaire was performed 1 year after surgery to assess surgical wound esthetics. Sixteen patients from each group had postoperative CT-scans and wideband tympanometry to assess mastoid aeration and middle ear absorbance. Gender and time after surgery were correlated. MAIN OUTCOME MEASURE(S) Evaluation of the quality of the surgical wound with the application of a questionnaire validated in the medical literature and translated into Portuguese language called POSAS, considering the perception of the blinded patient and doctor regarding the surgical technique proceeded. A lower POSAS score suggests better esthetics of the surgical wound. Secondary outcomes are volumetric measurement of aeration inside mastoid cavity using 3D computer tomography exam, which aims to analyze the influence of fibrocicatricial retraction in the surgical wound into the mastoid and the interference of its aeration volume in the absorption of sound in the middle ear, using the wideband tympanometry exam. RESULTS The POSAS questionnaire in the Case group showed a lower level of local pain and itchiness, a skin color and thickness more similar to the surrounding skin and less irregularity and stiffness, with no influence from time after surgery and gender compared to the Control group. The median tomographic volume was 6.37 cc in the cases and 4.60 cc in controls. Wideband tympanometry showed general smaller sound absorbance in the Case group results, specially, at 1000 Hz frequency. No intraoperative or postoperative complications were observed with the osteoplastic flap. CONCLUSIONS This technique is an effective and safe alternative to alleviate common problems of mastoid surgery for cochlear implantation. In addition to esthetic benefits, it has less interference in middle ear physiology of sound absorbance and less fibrous tissue into the mastoid cavity during the follow-up of more than 1 year.
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19
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Abstract
OBJECTIVE Infectious complications occurring in cochlear implant (CI) recipients is of potentially major impact. A better understanding of severe infections in this cohort is necessary. DESIGN Single-center, retrospective cohort study. Level of Evidence 2B. SETTING Single-center, retrospective cohort study at a tertiary referral hospital. PARTICIPANTS AND INTERVENTIONS We included all patients who received a CI at our institution between 1983 and end of 2018 (4,622 implantations). MAIN OUTCOMES Prevalence, incidence, risk factors, and functional outcomes in severe implant infections. RESULTS There was an overall prevalence of 0.65% of severe CI infections. The cumulative incidence decreased after the year 2000, with lower infection rates with newer implant models. Patients with local risk factors were more susceptible to implant infection. In most patients, delayed re-implantation was successful. Speech-perception after re-implantation was comparable to pre-revision performance. CONCLUSIONS Modified implant design and improved surgical technique has led to a decrease in the prevalence and incidence of infected implants. In severe implant infections, active surgical and antimicrobial management is required, to achieve good long-term results.
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20
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Cervicofacial surgery and implantable hearing device extrusion: management of challenging cases. The Journal of Laryngology & Otology 2021; 135:212-216. [PMID: 33641688 DOI: 10.1017/s0022215121000505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To describe our management of implantable hearing device extrusion in cases of previous cervicofacial surgery. METHODS A review was conducted of a retrospectively acquired database of surgical procedures for implantable hearing devices performed at our department between January 2011 and December 2019. Cases of device extrusion and previous cervicofacial surgery are included. Medical and surgical management is discussed. RESULTS Four cases of implant extrusion following cervicofacial surgery were identified: one involving a Bonebridge system and three involving cochlear implants. In all cases, antibiotic treatment was administered and surgical debridement performed. The same Bonebridge system was implanted in the middle fossa. The three cochlear implants were removed, and new devices were implanted in a more posterior region. CONCLUSION Previous cervicofacial surgery is a risk factor for hearing implant extrusion. The middle fossa approach is the best option for the Bonebridge system. Regarding the cochlear implant, it is always suitable to place it in a more posterior area. An inferiorly based fascio-muscular flap may be a good option to reduce the risk of extrusion.
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21
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Rayamajhi P, Kurkure R, Castellino A, Kumar S, Ha M, Nandhan R, Kameswaran M. A clinical profile of revision cochlear implant surgery: MERF experience. Cochlear Implants Int 2020; 22:61-67. [PMID: 32990179 DOI: 10.1080/14670100.2020.1823128] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Objective: To study the prevalence of revision cochlear implant study in a tertiary care referral center. To assess the various indications and surgical outcomes of revision cochlear implant surgery. Methods: A retrospective chart review of revision cochlear implant surgery done from June 1997 to December 2019. All the surgeries that were done in children of 12 years and below were included. The revision surgeries were either with or without explantation and reimplantation. The causes included were device failures, electrode extrusion/malposition, magnet migration, persistent foreign body reaction, facial twitching, wound infection, and cholesteatoma. Results: A total of 1636 pediatric cochlear implantation surgery were performed during the study period of 22 years. There were 94 (5.7%) revision surgeries done for various indications during this period. Out of them, 67 patients (71.3%) had device failure thus being the commonest indication for revision surgery, followed by infection in 12.8% of the total patients. Among the total revision, 81 (86.2%) patients had explantation and reimplantation of the new device. Conclusion: Indications of revision cochlear implant surgery are manifold that can be either device-related or patient-related. Revision surgery needs a highly skilled and experienced team of surgeons, audiologists, and habilitationists for achieving optimal results.
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Affiliation(s)
- Pabina Rayamajhi
- Department of ENT, Madras ENT Research Foundation, Chennai 600028, India
| | - Rahul Kurkure
- Department of ENT, Madras ENT Research Foundation, Chennai 600028, India
| | - Ashish Castellino
- Department of ENT, Madras ENT Research Foundation, Chennai 600028, India
| | - Santhosh Kumar
- Department of ENT, Madras ENT Research Foundation, Chennai 600028, India
| | - Manjunath Ha
- Department of ENT, Madras ENT Research Foundation, Chennai 600028, India
| | - Raghu Nandhan
- Department of ENT, Madras ENT Research Foundation, Chennai 600028, India
| | - Mohan Kameswaran
- Department of ENT, Madras ENT Research Foundation, Chennai 600028, India
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22
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Parent V, Codet M, Aubry K, Bordure P, Bozorg-Grayeli A, Deguine O, Eyermann C, Franco-Vidal V, Guevara N, Karkas A, Klopp N, Labrousse M, Lebreton JP, Lerosey Y, Lescanne E, Loundon N, Marianowski R, Merklen F, Mezouaghi K, Mom T, Moreau S, Mosnier I, Noël-Petroff N, Parietti-Winkler C, Piller P, Poncet C, Radafy E, Roman S, Roux-Vaillard S, Schmerber S, Tavernier L, Truy E, Vincent C, Godey B. The French Cochlear Implant Registry (EPIIC): Cochlear implantation complications. Eur Ann Otorhinolaryngol Head Neck Dis 2020; 137 Suppl 1:S37-S43. [PMID: 32861600 DOI: 10.1016/j.anorl.2020.07.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate peri- and post-operative complications related to cochlear implantations. We searched for risk factors predicting these complications and analyzed the complications in the youngest and most elderly. STUDY DESIGN Retrospective analysis of cochlear implant patients. MATERIALS AND METHODS All patients who underwent cochlear implantation in France between January 2012 and December 2016 were anonymized and registered in the EPIIC database. This population included 3483 adults and 2245 children. Their demographic and surgical data and their incidence of peri- or post-operative complications, including their severity, whether major or minor, were all indicated. RESULTS The global complication rate was 6.84%. The risk of complication was higher in initial implantation versus reimplantation (P<0.0001). The risk was also higher for bilateral implantation versus unilateral (P<0.0001). Complications were more frequent for patients with cochlear malformation (P=0.002). There was no difference in complication rates across age groups; babies under 1 year old, and the elderly over 80 and even over 90, did not have more complications than the rest of the population. Patients treated in the daily care unit had no more complications than those who were hospitalized for one night or more (P=0.64). CONCLUSION Cochlear implantation is a safe technique with a low incidence of complications. The absence of increased risk in patients at the extremes of the age spectrum justifies offering this solution to all, without age limitation.
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Affiliation(s)
- V Parent
- Service ORL et chirurgie cervico-faciale, hôpital Pontchaillou, 2, rue Henri-le-Guilloux, 35033 Rennes cedex 9, France
| | - M Codet
- Service ORL et chirurgie cervico-faciale, hôpital Pontchaillou, 2, rue Henri-le-Guilloux, 35033 Rennes cedex 9, France
| | - K Aubry
- CHU de Limoges, Limoges, France
| | | | | | | | | | | | | | - A Karkas
- CHU de St Etienne, Saint-Etienne, France
| | - N Klopp
- CHU d'Amiens, Amiens, France
| | | | | | | | | | | | | | - F Merklen
- CHU de Montpellier, Montpellier, France
| | | | - T Mom
- CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | | | - I Mosnier
- Hôpital Pitié-Salpétrière, Paris, France
| | | | | | - P Piller
- CH de Nouméa, Nouméa, Nouvelle-Calédonie
| | - C Poncet
- Hôpital Rothschild, Paris, France
| | - E Radafy
- CH du Lamentin, Martinique, France
| | - S Roman
- CHU de Marseille, Marseille, France
| | | | | | | | - E Truy
- CHU de Lyon, Lyon, France
| | | | - B Godey
- Service ORL et chirurgie cervico-faciale, hôpital Pontchaillou, 2, rue Henri-le-Guilloux, 35033 Rennes cedex 9, France.
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23
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Dubey S, Singh J, Bhardwaj B. Bhopal Technique of Cochlear Implantation: A Surgical Review of 50 Cases. Indian J Otolaryngol Head Neck Surg 2020; 72:375-380. [PMID: 32728549 DOI: 10.1007/s12070-020-01889-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 05/28/2020] [Indexed: 11/26/2022] Open
Abstract
Cochlear Implant is the new age treatment for profound deafness especially in children who are unable to hear since birth. This is a life changing technology where in a surgically implanted device can stimulate the auditory nerve through electrical currents enabling the generation of auditory potential. Various surgical techniques have been described in literature but debate exists over Posterior Tympanotomy and Trans-canal "Veria" technique. We are presenting our experience of 50 cases with modified trans-canal technique "The Bhopal Technique" which combines the best of both. 50 patients with bilateral profound deafness in age group 1-5 years were included in this observational study. These children underwent cochlear implantation by Bhopal Technique. The data was categorised into age, gender, certain surgical parameters like time taken; exposure and complications. In present study. The average time taken for surgery was 77.6 min, with electrode insertion in first attempt in about 43 cases. Round Window exposure was adequate in 37 cases while scala tympani was entered in 49 cases. Average time taken for cochleostomy was 44.6 s. Most common complication was wound hyperemia followed by Perilymph Gusher. Explantation was seen in 1 case. Minor complications included Vertigo and Tinnitus. There was one tympanic membrane perforation at 3 months follow up and response to AVT was excellent in 12 children at 6 month follow up. Bhopal technique is emerging as a promising technique for upcoming cochlear implant surgeons due to its low complication rate, better exposure of surgical landmarks and comparable outcomes to Veria and Posterior tympanotomy techniques.
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Affiliation(s)
- Satyaparkash Dubey
- Senior ENT Consultant and Cochlear Implant Surgeon, Divya Advanced ENT Clinic, Bhopal, Madhya Pradesh India
| | - Jaskaran Singh
- ENT Department, Sri Guru Ram Das University of Health Sciences, Amritsar, India
- Mohali, India
| | - Bhanu Bhardwaj
- ENT Department, Sri Guru Ram Das University of Health Sciences, Amritsar, India
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Lander DP, Durakovic N, Kallogjeri D, Jiramongkolchai P, Olsen MA, Piccirillo JF, Buchman CA. Incidence of Infectious Complications Following Cochlear Implantation in Children and Adults. JAMA 2020; 323:182-183. [PMID: 31935017 PMCID: PMC6990693 DOI: 10.1001/jama.2019.18611] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This cohort study uses data from state health care databases to determine the incidence and timing of infectious complications following cochlear implant surgery among patients in 5 US states between 2006 and 2016.
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Affiliation(s)
- Daniel P. Lander
- Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Nedim Durakovic
- Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Dorina Kallogjeri
- Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Pawina Jiramongkolchai
- Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Margaret A. Olsen
- Division of Infectious Diseases, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Jay F. Piccirillo
- Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Craig A. Buchman
- Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
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Lindquist NR, Vinh DB, Appelbaum EN, Vrabec JT, Huang AT. Microvascular free tissue transfer and cochlear implants: A case series and literature review. Laryngoscope 2019; 130:1552-1557. [PMID: 31654455 DOI: 10.1002/lary.28300] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 08/17/2019] [Accepted: 08/27/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The use of microvascular free tissue transfer (MVFTT) for defects of the scalp and lateral temporal bone in patients with cochlear implants (CI) is uncommon. Herein, we report our experience with the utility, indications, and outcomes for MVFTT in patients with cochlear implants. METHODS A retrospective review of patients at our institution from September 2016 to December 2017 identified subjects with coexistent cochlear implant and ipsilateral MVFTT of the lateral temporal bone or scalp. Information including demographics, indication for MVFTT, timing of CI and MVFTT, donor site, and previous radiation to the head and neck was collected. To assess the current literature on MVFTT in CI patients, a MEDLINE search was performed using key search terms. RESULTS Two patients with cochlear implants and MVFTT of the ipsilateral temporal bone or scalp were identified. One patient underwent MVFTT for advanced device extrusion with stable audiometric parameters rather than locoregional reconstruction or device explantation. The second patient had primary cochlear implantation at oncologic lateral temporal bone resection (LTBR) and MVFTT for locally advanced squamous cell carcinoma and concurrent profound sensorineural hearing loss (SNHL). A literature review identifies MVFTT as an option for advanced device extrusion, treatment of osteoradionecrosis, and reconstruction after primary oncologic surgery. CONCLUSION MVFTT is an important reconstructive tool for patients with functional, exposed cochlear implants. Cochlear implantation for severe to profound SNHL should be considered at the time of primary oncologic surgery and MVFTT of the lateral temporal bone or scalp. LEVEL OF EVIDENCE IV Laryngoscope, 130:1552-1557, 2020.
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Affiliation(s)
- Nathan R Lindquist
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, U.S.A
| | - Daniel B Vinh
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, U.S.A
| | - Eric N Appelbaum
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, U.S.A
| | - Jeffrey T Vrabec
- Department of Otolaryngology, Houston Methodist Hospital, Houston, Texas, U.S.A
| | - Andrew T Huang
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, U.S.A
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Leonhard L, Roche J, Wieland A, Pyle GM. The Temporoparietal Fascia Flap is an Effective Strategy for Cochlear Implant Wound Coverage. Ann Otol Rhinol Laryngol 2019; 129:135-141. [PMID: 31559861 DOI: 10.1177/0003489419877429] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To report the rate of major soft tissue complications after cochlear implantation and to describe the use of the temporoparietal fascia (TPF) flap for such complications. STUDY DESIGN Retrospective case series. SETTING Tertiary care, University Hospital. SUBJECTS AND METHODS Chart review of all patients who underwent cochlear device implantation over a 5-year period to identify patients and to determine the rate of soft tissue complications. Five patients with major soft tissue complications underwent TPF flap with device salvage or explantation/reimplantation. RESULTS The rate of major skin complications was 6 out of 281 (2.1%) over 5 years, with 5 patients undergoing TPF flap. The average follow-up was 25.8 months (range, 5-58 months). TPF flap represented the definitive, successful solution for all 5 patients. One postoperative hematoma occurred after TPF flap, with no long-term sequelae. The average hospital length of stay was 2.2 nights (range, 1-5 nights). One patient required IV antibiotics for 4 weeks; the remaining patients were treated with a postoperative course of oral antibiotics. The original device remained in place for 4 patients, while one case required device explantation and staged re-implantation. Post-TPF flap hearing results were equal to if not superior to their preoperative results. CONCLUSION Major soft tissue complications following cochlear device implantation are rare. The temporoparietal fascia flap is an excellent option for reconstruction of device site soft tissue dehiscences when local wound care and primary closure are not sufficient, and can potentially prevent explantation of a functional implant.
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Affiliation(s)
- Lucas Leonhard
- Department of Surgery, Division of Otolaryngology, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Joseph Roche
- Department of Surgery, Division of Otolaryngology, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Aaron Wieland
- Department of Surgery, Division of Otolaryngology, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - G Mark Pyle
- Department of Surgery, Division of Otolaryngology, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
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Kirchner GJ, Ghazaryan H, Lieber AM, Sunkerneni AR, McKinnon BJ. Cost-effectiveness of Preoperative Staphylococcus aureus Screening and Decolonization in Cochlear Implantation. OTO Open 2019; 3:2473974X19866391. [PMID: 31428733 PMCID: PMC6684140 DOI: 10.1177/2473974x19866391] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 07/09/2019] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Infection following cochlear implantation is medically and economically devastating. The cost-effectiveness (CE) of colonization screening and decolonization for infection prophylaxis in cochlear implantation has not been examined. STUDY DESIGN An analytic observational study of data collected from purchasing records and the literature. METHODS Costs of Staphylococcus aureus colonization screening and decolonization were acquired from purchasing records and the literature. Infection rates after cochlear implantation and average total costs for evaluation and treatment were obtained from a review of the literature. A break-even analysis was performed to determine the required absolute risk reduction (ARR) in infection rate to make colonization screening or decolonization CE. RESULTS Nasal screening ($144.07) is CE if the initial infection rate (1.7%) had an ARR of 0.60%. Decolonization with 2% intranasal mupirocin ointment ($5.09) was CE (ARR, 0.02%). A combined decolonization technique (2% intranasal mupirocin ointment, chlorhexidine wipes, chlorhexidine shower, and prophylactic vancomycin: $37.57) was CE (ARR, 0.16%). Varying infection rate as high as 15% demonstrated that CE did not change by maintaining an ARR of 0.16%. CE of the most expensive decolonization protocol was enhanced as the cost of infection treatment increased, with an ARR of 0.03% at $125,000. CONCLUSIONS Prophylactic S aureus decolonization techniques can be CE for preventing infection following cochlear implantation. Decolonization with mupirocin is economically justified if it prevents at least 1 infection out of 5000 implants. S aureus colonization screening needed high reductions in infection rate to be CE.
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Affiliation(s)
- Gregory J. Kirchner
- Department of Otolaryngology–Head and Neck Surgery, College of Medicine, Drexel University, Philadelphia, Pennsylvania, USA
| | - Hovhannes Ghazaryan
- Department of Otolaryngology–Head and Neck Surgery, College of Medicine, Drexel University, Philadelphia, Pennsylvania, USA
| | - Alexander M. Lieber
- Department of Otolaryngology–Head and Neck Surgery, College of Medicine, Drexel University, Philadelphia, Pennsylvania, USA
| | - Anisha Reddy Sunkerneni
- Department of Otolaryngology–Head and Neck Surgery, College of Medicine, Drexel University, Philadelphia, Pennsylvania, USA
| | - Brian J. McKinnon
- Department of Otolaryngology–Head and Neck Surgery, College of Medicine, Drexel University, Philadelphia, Pennsylvania, USA
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Cochlear implantation after solid organ transplantation: long term results and review of the literature. Eur Arch Otorhinolaryngol 2019; 276:2747-2754. [PMID: 31227869 DOI: 10.1007/s00405-019-05524-3] [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: 03/05/2019] [Accepted: 06/17/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To analyze rate and type of complications in cochlear implant (CI) recipients receiving immunosuppressive therapy following solid organ transplant (SOT). STUDY DESIGN Retrospective case series. English language literature review. SETTING Tertiary referral center. INTERVENTION Cochlear implantation surgery following solid organ transplantation (SOT) and immunosuppressive therapy. METHODS Data of patients who received CI after SOT and with at least one year of follow up were reviewed. Main outcome measures were the rate and type of complications, classified as major (requiring a second surgical procedure) and minor (requiring medical therapy). A search was performed in PubMed database on January 2019 using the keywords: organ transplant; cochlear implant, complications, deafness, solid organ transplant, immunosuppressive therapy. Only studies reporting on patients who have been implanted after the transplant procedure and with a follow up period of at least 1 year were considered. Final analysis was performed on pooled data. RESULTS Four patients received CI surgery following SOT. Age at treatment ranged from 40 to 47 years (mean 44.25 years). Follow-up after implantation averaged 5.25 years (range 1-10 years), without complications. Review of the available literature on the subject yielded seven papers; a total of 26 procedures in 22 patients satisfied inclusion criteria. Pooled data from the present series and from the literature were analyzed; the global rate of complications was 16.6%, with 10% major (3 of 30 procedures) and 6.6% minor (2 of 30 procedures). The three reported cases of major complications appear unrelated to SOT. Major complications were found in one case over 16 procedures in pediatric patients (6.2%), while in adults the percentage raised to 14.3% (2/14 procedures). CONCLUSIONS Cochlear implantation is a safe and effective intervention, even during immunosuppressive therapy after organ transplantation.
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Soft tissue reactions following cochlear implantation. Eur Arch Otorhinolaryngol 2018; 276:343-347. [DOI: 10.1007/s00405-018-5233-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 12/01/2018] [Indexed: 10/27/2022]
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Olsen LB, Larsen S, Wanscher JH, Faber CE, Jeppesen J. Postoperative infections following cochlear implant surgery. Acta Otolaryngol 2018; 138:956-960. [PMID: 30015553 DOI: 10.1080/00016489.2018.1482422] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION The aim of this study was to report the frequency and management of postoperative wound infections and to investigate bacteriology and biofilm formation following 653 consecutive cochlear implantations in adults. METHODS A retrospective file review of 653 consecutive adult cochlear implantations between 1994 and 2015 at the Department of Otorhinolaryngology at Odense University Hospital. A reporting consensus was used to classify infections. RESULTS The major and minor infection rates were 2% and 8%, respectively. The explantation rate due to infection was 1%. The most common pathogen found was Staphylococcus aureus and biofilm formation was found in 73% of the explantations. CONCLUSION Postoperative infection occurred in 10% of the implantations. However, few of these were severe. Staphylococcus aureus was the most common pathogen and the presence of biofilm seemed to be associated with a higher risk of explantation.
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Affiliation(s)
| | - Sára Larsen
- Department of Otorhinolaryngology, Odense University Hospital, Odense, Denmark
| | | | | | - Jonas Jeppesen
- Department of Otorhinolaryngology, Odense University Hospital, Odense, Denmark
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Abstract
OBJECTIVE Immunosuppressed individuals who have undergone organ transplants, especially children, pose particular challenges in terms of treatment. The aim of this study was to analyze the postoperative complication rate of organ transplant recipients who have also received a cochlear implant (CI). STUDY DESIGN Retrospective case series. SETTING Tertiary referral center. INTERVENTION The case series includes 13 kidney, liver, lung, and heart transplant patients. Age at treatment ranged from 2 to 71 years, with a total of 17 CIs. MAIN OUTCOME MEASURES Postoperative complications were classified into major and minor, early (within 3 mo postoperatively) and late (>3 mo postoperatively). The results were compared with those for 13 1:1 matched pairs obtained and from our database and a healthy patient collective from our department. RESULTS The global postoperative complication rate was 29.4%. The proportion of patients suffering major complications was 17.6%, with 17.6% having minor complications. Complications that occurred early accounted for 13.3%, and late for 26.7%. No adults, and 33.0% of children, showed any complications after cochlear implantation. The global complication rate (29.4%) was significantly increased compared with the matched pairs (0%, p = 0.013) and department data (13.8%, p = 0.006; Cramers v = 0.102). CONCLUSION This study demonstrates that organ transplant recipients, and especially children, are at increased risk of postoperative complications after cochlear implantation in comparison with healthy CI recipients.
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Risk factors for complications in cochlear implant surgery. Eur Arch Otorhinolaryngol 2018; 275:895-903. [PMID: 29429025 DOI: 10.1007/s00405-018-4901-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 02/05/2018] [Indexed: 12/31/2022]
Abstract
PURPOSE The objective of this study was to achieve uniform reporting of complications and failures in cochlear implantation, to analyze complications and failures and to identify risk factors for complications in a series of over 1300 cochlear implantations. METHODS In a retrospective chart review and observational study, data from all cochlear implantations from 1987 to 2015 were entered in a custom-made database. Complications were classified using the contracted form of the Clavien-Dindo system and risk factors were identified by statistical analysis. RESULTS A complication rate of 18.4% and a device failure rate of 2.9% were found. There was a higher rate of hematoma in patients with a clotting disorder and when a subtotal petrosectomy was performed, a higher rate of wound infections in patients who were not vaccinated against Streptococcus pneumoniae and a higher rate of meningitis in patients with an inner ear malformation. CONCLUSIONS The use of a strict definition of a medical complication and device failure-in combination with the Clavien-Dindo classification system-enables uniform and objective registration of adverse events and prevents any tendency to downgrade complications. Complication and failure rates in this series are comparable to those reported in the literature. These results stress the need for pneumococcal vaccination, which may prevent general wound infections, but is especially important for patients with inner ear malformation, who have an increased risk of (postoperative) meningitis.
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The Effect of Soft Tissue Infections on Device Performance in Adult Cochlear Implant Recipients. Otol Neurotol 2018; 38:694-700. [PMID: 28353621 DOI: 10.1097/mao.0000000000001387] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to examine the effect of cochlear implant (CI) site infection and its subsequent management on CI mapping and CI performance. Risk factors for CI infections and pathogens causing infections were reviewed. Treatment options for CI infections were examined. STUDY DESIGN Retrospective case review. SETTING Tertiary referral center. PATIENTS Adult patients with a significant CI soft tissue infection from the Northern Cochlear Implant Programme, New Zealand over a 10-year period (August 2004 until August 2014). INTERVENTION Patients were treated with intravenous antibiotics, washout and debridement or ex-plantation and reimplantation of CI. MAIN OUTCOME MEASURE CI mapping results and implant performance before and after management of CI infections were compared. RESULTS There were nine CI infections. Most patients (7/9) were treated with washout and debridement. One patient required removal of the CI and one patient was deemed medically unfit for a general anaesthetic and was managed conservatively with antibiotics alone. Seven patients received long-term antibiotics. Four patients were able to maintain CI performance after salvage treatment of the CI infection. Three patients had poorer CI performance after salvage treatment. One patient had reimplantation and became a nonuser due to only partial reinsertion. CONCLUSION The pathophysiology of CI infections is complex. Infections can occur many years after CI surgery. The most common bacteria identified were Staphylococcus aureus, Pseudomonas aeruginosa, and skin commensals. Biofilms are present around implants that are removed from patients and biofilms may play a role in CI infections, but the mechanism of infection is not clear.
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Shiras S, Vaid N, Vaid S, Kothadiya A. Surgical complications and their management in cochlear implantees less than 5 years of age: The KEMH Pune experience. Cochlear Implants Int 2017; 19:67-71. [PMID: 29188760 DOI: 10.1080/14670100.2017.1407521] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate the incidence of surgical complications of cochlear implantation and their management at K.E.M. hospital Pune. METHODS It was a retrospective and prospective observational study conducted from February 2006 to December 2015 in the paediatric age group of 12 months to 5 years (213 cases). The complications were divided into major and minor groups based on the classification proposed by Cohen and Hoffman. RESULTS The mean age of implantation was 3.03 years (ranged from 1 to 4.11 years). Sixteen patients had complications. The overall incidence of complications was 7.51% which comprised of major (2.34%) and minor (5.16%) complications. The commonest major complications were flap-related issues and the commonest minor complication was facial paresis. DISCUSSION The results of our study were compared with similar studies conducted in the past. All surgical complications were treated conservatively or surgically with success. CONCLUSIONS Cochlear implantation is the safe procedure in children between the age group of 12 months and less than 5 years.
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Affiliation(s)
- Sayali Shiras
- a Department of E.N.T. , K.E.M. Hospital , Pune , India
| | - Neelam Vaid
- a Department of E.N.T. , K.E.M. Hospital , Pune , India
| | - Sanjay Vaid
- b Head & Neck division , Star Imaging & Research Centre , Pune , India
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Qin F, Li W, Qiu J, Zhang L, Zhong M. After cochlear implantation: Complications related to flap around implants. J Otol 2016; 11:198-201. [PMID: 29937830 PMCID: PMC6002636 DOI: 10.1016/j.joto.2016.12.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 12/05/2016] [Accepted: 12/05/2016] [Indexed: 11/29/2022] Open
Abstract
Objective To report complications related to flap around implants after cochlear implantation, possible causes of such complications and treatments. Methods and material We performed a retrospective analysis of children in whom complications related to flap around implants occurred after undergoing cochlear implantation in our department from 2005 to 2016. Results Complications among 1500 cochlear implantation (CI) recipients by the same surgeon included hematoma (n = 20) and seroma around implants (n = 15), of which most (n = 10) recovered in 2 weeks after effective drainage, utility of antibiotics and pressure dressing, but 5 developed flap necrosis and had to undergo contralateral re-implantation. Four patients developed abscess around implants, of whom 2 recovered after 2 weeks of drainage, gentamicin irrigation and use of antibiotics, but 2 patients ended up with flap necrosis and had to receive contralateral reimplantation. Conclusions Immediate drainage, pressure dressing and antibiotics can be used to effectively control seroma around implants. For seroma lasting for more than two weeks without improvement, surgical drainage may be need.
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Affiliation(s)
- Feifei Qin
- Department of Otorhinolaryngology, The First Affiliated Hospital of Anhui Medical University, China
| | - Wen Li
- Department of Otorhinolaryngology, The First Affiliated Hospital of Anhui Medical University, China
| | - Jianxin Qiu
- Department of Otorhinolaryngology, The First Affiliated Hospital of Anhui Medical University, China
| | - Li Zhang
- Department of Otorhinolaryngology, The First Affiliated Hospital of Anhui Medical University, China
| | - Mei Zhong
- Department of Otorhinolaryngology, The First Affiliated Hospital of Anhui Medical University, China
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Ayub B, Young NM. Cochlear implantation of solid organ transplant patients receiving immunosuppressive therapy. Int J Pediatr Otorhinolaryngol 2016; 91:19-22. [PMID: 27863635 DOI: 10.1016/j.ijporl.2016.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 10/02/2016] [Accepted: 10/04/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To evaluate the incidence of infectious complications and healing problems in cochlear implant (CI) patients receiving immunosuppressive therapy following solid organ transplant. STUDY DESIGN IRB-approved retrospective chart review of implanted patients. SETTING Tertiary care children's hospital. METHODS Seven patients of the more than 1000 implanted during the time period between 1991 and 2014 underwent cochlear implantation while on immunosuppressive therapy after having received a solid organ transplant. Their charts were reviewed for demographic and medical information pre- and post-implantation. The 4 males and 3 females ranged in age at CI from 2.4 to 18.8 years, with a mean of 9.0 years. Postimplant follow-up averaged 3.9 years (range: 0.1-13.1). Main outcome measures were occurrence of wound healing, infectious complications, whether open-set word recognition was achieved, and communication mode(s). RESULTS No wound infections or delayed healing, mastoiditis, or bacterial meningitis occurred after cochlear implantation. All seven patients had received at least one pneumococcal vaccination prior to implantation. Five of 6 (83%) developed open-set speech perception, of whom 4 (67%) use only oral communication. CONCLUSION In our series of patients receiving immunosuppressive therapy following solid organ transplantation, none developed wound healing or infectious complications after cochlear implantation. History of solid organ transplantation alone should not be a contraindication to cochlear implant candidacy which would deprive the child of the potential benefits of hearing, including language development.
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Affiliation(s)
- Bushra Ayub
- Division of Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Ave, Chicago, IL 60611, USA.
| | - Nancy M Young
- Division of Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Ave, Chicago, IL 60611, USA; Department of Otolaryngology-Head and Neck Surgery, Feinberg School of Medicine, Northwestern University, 675 N St Clair St #15-200, Chicago, IL 60611, USA; Knowles Hearing Center, Northwestern University, 2240 Campus Drive, 1-240, Evanston, IL 60208-3550, USA.
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Patnaik U, Sikka K, Agarwal S, Kumar R, Thakar A, Sharma SC. Cochlear re-implantation: lessons learnt and the way ahead. Acta Otolaryngol 2016; 136:564-7. [PMID: 26898701 DOI: 10.3109/00016489.2015.1136430] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Conclusion A cochlear re-implantation procedure is undesirable; however, the cochlear implant surgeon may have to perform a re-implantation procedure occasionally for various reasons. Following standard techniques, implant performance comparable with primary implantation may be achieved. Objective To study the causes and outcomes of cochlear re-implantation in an Asian Indian population. Study design Retrospective analysis of clinical charts over an 18-year period with prospective follow-up of patients. Methods The charts of 534 patients, who underwent cochlear implant, at an Otorhinolaryngology institutional Centre, from January 1997 to January 2015 were studied. Of these, the charts of 18 patients who underwent cochlear re-implantation were studied. The causes and audiological and speech outcomes were analysed. Results Eighteen patients (3.4%) underwent cochlear re-implantation for various reasons. The commonest indication was device failure in seven patients (39%), followed by electrode extrusion in five (28%), trauma in three (11%), electrode migration in two (11%) and improper electrode placement in one (6%) patient. The audiological performance tests and speech tests either remained the same or improved from those achieved for patients undergoing primary implantation, in 87% patients.
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Affiliation(s)
- Uma Patnaik
- Department of Otolaryngology-Head & Neck Surgery, All India Institute of Medical Sciences & Army Hospital, Research & Referral, New Delhi, India
| | - Kapil Sikka
- Department of Otolaryngology-Head & Neck Surgery, All India Institute of Medical Sciences & Army Hospital, Research & Referral, New Delhi, India
| | - Shivani Agarwal
- Department of Otolaryngology-Head & Neck Surgery, All India Institute of Medical Sciences & Army Hospital, Research & Referral, New Delhi, India
| | - Rakesh Kumar
- Department of Otolaryngology-Head & Neck Surgery, All India Institute of Medical Sciences & Army Hospital, Research & Referral, New Delhi, India
| | - Alok Thakar
- Department of Otolaryngology-Head & Neck Surgery, All India Institute of Medical Sciences & Army Hospital, Research & Referral, New Delhi, India
| | - Suresh C. Sharma
- Department of Otolaryngology-Head & Neck Surgery, All India Institute of Medical Sciences & Army Hospital, Research & Referral, New Delhi, India
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Gawęcki W, Karlik M, Borucki Ł, Szyfter-Harris J, Wróbel M. Skin flap complications after cochlear implantations. Eur Arch Otorhinolaryngol 2016; 273:4175-4183. [PMID: 27245752 PMCID: PMC5104790 DOI: 10.1007/s00405-016-4107-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 05/17/2016] [Indexed: 11/02/2022]
Abstract
The objective of the study was to analyse and present the surgical management strategy for major skin flap complications (MSFC) after cochlear implantations. Patients fitted with a titanium-silicone-coated implant of the same kind, operated on between 1994 and 2013 with a standardised procedure (1076 medical charts) were analysed. Analysis aimed to identify and study individuals with skin problems related to the cochlear implant treatment, i.e. requiring surgical treatment in hospital defined as MSFC and focused on incidence, risk factors and treatment of MSFC. MSFC were diagnosed in 1.76 % of patients: 2.06 % of children and 1.35 % of adults, 2.43 % after implantation with a long "C"-shaped incision and 1.28 % after short retroauricular incision. Registered risk factors included head trauma, acute otitis media, poor hygiene in children, and general comorbidities in adults. The primary intervention was dependent on skin complication severity and included revision surgery with wound closure over an implant (52.6 %) and revision surgery with explantation (47.4 %). Revision surgery without explantation was successful in 40 % and the most effective approach was debridement with a two-layer rotational flap. Explantation led to ultimate wound healing in all cases. Major skin flap complications after cochlear implantation are rare, but their treatment is complex and difficult. Revision surgery with resection of infected tissue, formation of a rotational two-layer flap preceded and supplemented by intensive targeted antibiotic therapy can be effective and should be the first treatment option. Spontaneous implant explantation, abscess formation or unsuccessful primary treatment necessitate implant removal as the ultimate solution.
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Affiliation(s)
- Wojciech Gawęcki
- Department of Otolaryngology and Laryngological Oncology, Poznań University of Medical Sciences, Poznań, Poland.
| | - Michał Karlik
- Department of Phoniatrics and Audiology, Poznań University of Medical Sciences, Poznań, Poland
| | - Łukasz Borucki
- Department of Otolaryngology and Laryngological Oncology, Poznań University of Medical Sciences, Poznań, Poland
| | | | - Maciej Wróbel
- Department of Otolaryngology and Laryngological Oncology, Poznań University of Medical Sciences, Poznań, Poland
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Rangabashyam M, Poh SS, Low WK. Electrode array extrusion through the posterior canal wall presenting as a delayed post-cochlear implant complication. Cochlear Implants Int 2015; 16:341-4. [PMID: 25831156 DOI: 10.1179/1754762815y.0000000006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
UNLABELLED OBJECTIVES AND IMPORTANCE: Cochlear implantation is an established, reliable, and safe procedure with a low complication rate. Electrode array extrusion through the posterior aspect of external ear canal is a potential major complication of cochlear implant surgery that may result in revision surgery or explantation. Although there have been previous case reports of such extrusions through the tympanic membrane, this is the first well-documented report of an extrusion through the posterior canal wall which was previously intact. CLINICAL PRESENTATION In this case report, we present a case of electrode array extruding through an initially intact posterior canal wall presenting as a delayed post-operative complication in a 13-year old Asian boy. INTERVENTION With reference to existing relevant literature, the case is discussed focusing on its management, possible contributing factors, and prevention strategies. CONCLUSION Excessive thinning of the bony wall should be avoided as it can potentially break down. Abutment on the posterior canal wall by a coiled electrode array in the mastoid cavity exerting undue pressure on the bony wall can further contribute to additional stress. The implant surgeon must be cognizant of mastoid growth patterns in children. Life-long regular follow-up in implanted patients is crucial.
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Lodhi F, Coelho DH. Non-tuberculous mycobacterial cochlear implant infection: An emerging pathogen. Cochlear Implants Int 2015; 16:237-40. [DOI: 10.1179/1754762815y.0000000002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Li S, Qin Z, Zhang F, Li L, Qi S, Liu L. Early complications following cochlear implantation in children and their management. Int J Pediatr Otorhinolaryngol 2014; 78:1040-4. [PMID: 24809767 DOI: 10.1016/j.ijporl.2014.03.036] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Revised: 03/26/2014] [Accepted: 03/28/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To report the early postoperative complications of cochlear implantation (CI) in the pediatric population and discuss the intervention measures. METHODS We retrospectively analyzed 260 consecutive pediatric cochlear implantations performed at the First Affiliated Hospital of Zhengzhou University between March 2010 and July 2013. All patients were younger than 12 years old at the time of implantation, with a mean age of 4.3 years, and 47 cases had inner ear malformations. Complications correlated to age at CI and inner ear malformations were analyzed using the χ(2) test. RESULTS Of the 260 patients, early postoperative complications were observed in 17 (6.54%) cases, of which 16 (6.15%) were minor and one (0.38%) was major, none required surgical device removal or reimplantation. Among the 16 minor complications, transient vertigo was the most common (nine cases, 3.46%), three (1.15%) of them with severe CSF gusher during the surgery; followed by transient facial nerve palsy (two cases, 0.77%, both were reversible); external auditory canal injury, subcutaneous hematoma each in two cases (0.77%), and minor dural injury in one case (0.38%). One major complication included an epidural hematoma in a 7-year-old boy who recovered completely without any neurologic deficits following immediate evacuation. Inner ear malformations were significantly associated with the surgical complications, especially vertigo and gusher (P<0.05). CONCLUSIONS Cochlear implantation in children is fairly a safe procedure with a relatively low complication rate. The most common early postoperative complications are minor, but serious and life threatening complications rarely may occur. Awareness of complications helps clinicians to adopt the specific preventive measures and immediate interventions so that the outcome will be successful.
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Affiliation(s)
- Sujuan Li
- Department of Otology, The First Affiliated Hospital of Zhengzhou University, No. 1 Eastern Jianshe Road, Zhengzhou, Henan 450052, China
| | - Zhaobing Qin
- Department of Otology, The First Affiliated Hospital of Zhengzhou University, No. 1 Eastern Jianshe Road, Zhengzhou, Henan 450052, China.
| | - Fan Zhang
- Department of Otology, The First Affiliated Hospital of Zhengzhou University, No. 1 Eastern Jianshe Road, Zhengzhou, Henan 450052, China
| | - Lu Li
- Department of Otology, The First Affiliated Hospital of Zhengzhou University, No. 1 Eastern Jianshe Road, Zhengzhou, Henan 450052, China
| | - Sihan Qi
- Department of Otology, The First Affiliated Hospital of Zhengzhou University, No. 1 Eastern Jianshe Road, Zhengzhou, Henan 450052, China
| | - Lin Liu
- Department of Otology, The First Affiliated Hospital of Zhengzhou University, No. 1 Eastern Jianshe Road, Zhengzhou, Henan 450052, China
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Bhumbra S, Mahboubi M, Blackwood RA. Staphylococcus lugdunensis: Novel Organism causing Cochlear Implant Infection. Infect Dis Rep 2014; 6:5406. [PMID: 25002962 PMCID: PMC4083301 DOI: 10.4081/idr.2014.5406] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 04/30/2014] [Accepted: 05/07/2014] [Indexed: 11/23/2022] Open
Abstract
A majority of cochlear implant infections are caused by Staphylococcus aureus or Pseudomonas aeruginosa. Reported here is a pediatric patient with a cochlear implant infection caused by methicillin-resistant Staphylococcus lugdunensis, a coagulase-negative Staphylococcus that has only recently been determined to be clinically relevant (1988). Unlike other coagulase-negative Staphylococcus, it is more aggressive, carrying a greater potential for tissue destruction. In pediatrics, the organism is uncommon, poorly described, and generally pan-susceptible. Described herein is the presentation and management of this unusual organism in a pediatric setting.
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Affiliation(s)
- Samina Bhumbra
- Division of Pediatric Infectious Diseases, University of Michigan , Ann Arbor, MI, USA
| | - Mona Mahboubi
- Division of Pediatric Infectious Diseases, University of Michigan , Ann Arbor, MI, USA
| | - R Alexander Blackwood
- Division of Pediatric Infectious Diseases, University of Michigan , Ann Arbor, MI, USA
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Farinetti A, Ben Gharbia D, Mancini J, Roman S, Nicollas R, Triglia JM. Cochlear implant complications in 403 patients: Comparative study of adults and children and review of the literature. Eur Ann Otorhinolaryngol Head Neck Dis 2014; 131:177-82. [DOI: 10.1016/j.anorl.2013.05.005] [Citation(s) in RCA: 135] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 05/13/2013] [Accepted: 05/29/2013] [Indexed: 11/25/2022]
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Management of cochlear implant device extrusion: case series and literature review. The Journal of Laryngology & Otology 2014; 128 Suppl 2:S55-8. [PMID: 24460913 DOI: 10.1017/s002221511300323x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION AND AIMS Cochlear implants have enabled an improved quality of life for many patients with deafness. Implant extrusion and skin flap necrosis are the most common complications associated with implant use. We report our management of patients presenting with complications as a result of cochlear implant insertion. The goal of surgery was to achieve a stable, healed wound for use as a cochlear device implantation site. METHODS AND RESULTS We describe a series of patients presenting with skin flap necrosis and/or extrusion of their cochlear implant. The reconstructive options employed are discussed. CONCLUSION Surgeons should be aware of the reconstructive options available in such circumstances, and should choose appropriate management depending on the clinical situation, in order to optimise the functional result for the patient.
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Low WK, Rangabashyam M, Wang F. Management of major post-cochlear implant wound infections. Eur Arch Otorhinolaryngol 2013; 271:2409-13. [PMID: 24096814 DOI: 10.1007/s00405-013-2732-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2013] [Accepted: 09/23/2013] [Indexed: 11/30/2022]
Abstract
In post-cochlear implant (CI) wound infections, a commonly asked question is whether the device could be salvaged and if so, what the challenges were. The aim of this article is to study patients with major post-CI wound infections, identify the risk factors and discuss the management. The case records all CI recipients who developed post-CI wound infections that required parenteral antibiotics treatment or any form of surgery between Jan 1997 and Dec 2011 were retrospectively reviewed. Among the 432 CI surgeries performed by the senior author, 7 developed major post-CI wound infection (1.62 %). In children, the commonest etiology was from stitch abscesses. In four out of the five children who developed stitch abscesses, four were due to the use of non-absorbable polypropylene sutures, a technique which had since been discontinued. In adults, the cause was due to the late effects of prior radiotherapy for head and neck tumors. The commonest organism isolated from wound cultures was Staphylococcus aureus. Salvage surgery (complemented by antibiotics) was attempted in six out of eight patients managed. All were successfully salvaged with surgery entailing either skin flap reconstruction (2 patients), transposition of the CI body to new location (1 patient) or both (3 patients). Skin flap reconstruction surgery alone failed to control the infection in patients with a negative culture result and needed a subsequent transposition surgery of the device. Device transposition surgery was a consistently effective therapeutic approach, but carried a higher risk of iatrogenic damage to the electrode array as it might be embedded in new bone.
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Affiliation(s)
- Wong-Kein Low
- Novena ENT-Head Neck Surgery Specialist Centre, Mount Elizabeth Novena Hospital, #04-21/22/34, 38 Irrawaddy Road, Singapore, 329563, Singapore,
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Black J, Hickson L, Black B, Perry C. Prognostic indicators in paediatric cochlear implant surgery: a systematic literature review. Cochlear Implants Int 2013; 12:67-93. [PMID: 21756501 DOI: 10.1179/146701010x486417] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
- Jane Black
- School of Health and Rehabilitation Sciences, University of Queensland, St Lucia, Brisbane, Australia.
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Benatti A, Castiglione A, Trevisi P, Bovo R, Rosignoli M, Manara R, Martini A. Endocochlear inflammation in cochlear implant users: case report and literature review. Int J Pediatr Otorhinolaryngol 2013; 77:885-93. [PMID: 23578804 DOI: 10.1016/j.ijporl.2013.03.016] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 03/07/2013] [Accepted: 03/10/2013] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Cochlear implantation is a relatively safe procedure with a low complication rate. The overall rate of complications among cochlear implant patients ranges from 6% to 20%. Major complications are those that are life-threatening or require surgery, whereas minor complications are those that can be medically treated. Nonetheless, certain complications, even if highly rare, may require specific investigations and treatments. Among these rare complications are those with endocochlear involvement, such as cochleitis or labyrinthitis, with fibrosis or ossification that could lead to explantation. The aims of the present study were to report a particular case of post-operative cochleitis and to review the rate of complications after cochlear implantation, emphasising those conditions with proven endocochlear involvement. METHODS We refer to the case of an eight-year-old Italian boy affected by the sudden onset of headache, ipsilateral otalgia and facial paresis, who presented to our clinic for inexplicable worsening of the performance of his implant and his residual hearing, six years after surgery. A complete investigation including (clinical history, routine, autoimmune and serological blood tests, electrophysiological measurements from the cochlear implant and neuroimaging) was performed and is herein described. Additionally, a comprehensive review of the literature was conducted using internet search engines; 274 papers were selected, 88 of which were best suited to our purposes. RESULTS In our case, the progression of the symptoms and the performance decrement required explantation, followed by a complete recovery. Reviewing the literature revealed only three reports concerning cases of proven endocochlear phlogosis that required revision surgery. Wound swelling/infection and vertigo remain the two most common complications of cochlear implantation. Failure of the device is the third most frequent complication (10.06% of all complications and 1.53% of cochlear implantations). Other rare conditions (such as granulating labyrinthitis with cochlear fibrosis, ossification and erosion, silicone allergy and the formation of a biofilm around the internal device) are possible and unpredictable. Although rare (approximately 1%), such cases may require explantation. CONCLUSIONS Despite efforts by both surgeons and manufacturers, device-related and surgical complications still occur. These and other rare conditions demand specific management, and their frequency may be underestimated. Further studies are needed to assess more realistic rates of complications and devise more efficient strategies for early diagnosis and treatment.
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Affiliation(s)
- Alice Benatti
- Operative Unit of Otolaryngology and Otosurgery, Padua University, Via Giustiniani, 2, Padua, Italy.
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Hildrew DM, Molony TB. Nucleus N5 CI500 series implant recall. Laryngoscope 2013; 123:2829-33. [DOI: 10.1002/lary.24149] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2012] [Revised: 03/20/2013] [Accepted: 03/20/2013] [Indexed: 11/08/2022]
Affiliation(s)
- Douglas M. Hildrew
- Department of Otolaryngology/ Head and Neck Surgery; Tulane University School of Medicine; New Orleans Louisiana U.S.A
| | - Timothy B. Molony
- Department of Otolaryngology/ Head and Neck Surgery; Ochsner Clinic Foundation; New Orleans Louisiana U.S.A
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