Cochlear Implants in Children: Surgical Site Infections and Prevention and Treatment of Acute Otitis Media and Meningitis

Abstract

The use of cochlear implants is increasingly common, particularly in children younger than 3 years. Bacterial meningitis, often with associated acute otitis media, is more common in children with cochlear implants than in groups of control children. Children with profound deafness who are candidates for cochlear implants should receive all age-appropriate doses of pneumococcal conjugate and Haemophilus influenzae type b conjugate vaccines and appropriate annual immunization against influenza. In addition, starting at 24 months of age, a single dose of 23-valent pneumococcal polysaccharide vaccine should be administered. Before implant surgery, primary care providers and cochlear implant teams should ensure that immunizations are up-to-date, preferably with completion of indicated vaccines at least 2 weeks before implant surgery. Imaging of the temporal bone/inner ear should be performed before cochlear implantation in all children with congenital deafness and all patients with profound hearing impairment and a history of bacterial meningitis to identify those with inner-ear malformations/cerebrospinal fluid fistulas or ossification of the cochlea. During the initial months after cochlear implantation, the risk of complications of acute otitis media may be higher than during subsequent time periods. Therefore, it is recommended that acute otitis media diagnosed during the first 2 months after implantation be initially treated with a parenteral antibiotic (eg, ceftriaxone or cefotaxime). Episodes occurring 2 months or longer after implantation can be treated with a trial of an oral antimicrobial agent (eg, amoxicillin or amoxicillin/clavulanate at a dose of approximately 90 mg/kg per day of amoxicillin component), provided the child does not appear toxic and the implant does not have a spacer/positioner, a wedge that rests in the cochlea next to the electrodes present in certain implant models available between 1999 and 2002. "Watchful waiting" without antimicrobial therapy is inappropriate for children with implants with acute otitis media. If feasible, tympanocentesis should be performed for acute otitis media, and the material should be sent for culture, but performance of this procedure should not result in an undue delay in initiating antimicrobial therapy. For patients with suspected meningitis, cerebrospinal fluid as well as middle-ear fluid, if present, should be sent for culture. Empiric antimicrobial therapy for meningitis occurring within 2 months of implantation should include an agent with broad activity against Gram-negative bacilli (eg, meropenem) plus vancomycin. For meningitis occurring 2 months or longer after implantation, standard empiric antimicrobial therapy for meningitis (eg, ceftriaxone plus vancomycin) is indicated. For patients with meningitis, urgent evaluation by an otolaryngologist is indicated for consideration of imaging and surgical exploration. BACKGROUNDA cochlear implant is an implanted electronic hearing device designed to produce useful hearing sensations to a person ...

Contralateral Implantation in Children Affected by Postimplant Meningitis

“…piM has been recognized to be associated with anatomical predisposing malformations [Herther and Schindler, 1985;Hayashi et al, 1989;Ohlms et al, 1990;Phelps et al, 1994;Belmont and Arimand, 2004;Biernath et al, 2006;Ben-Shoshan et al, 2007;Parner et al, 2007], higher incidence of middle ear infections [Arnold et al, 2002], surgical placement and permanence of the implant itself [Biernath et al, 2006;Wei et al, 2007;Rubin and Papsin, 2010] and history of preimplant meningitis [Center for Disease Control and Prevention, 2006]. Although piM incidence is currently decreasing due to a more appropriate and widespread preventive vaccination [Lalwani and Cohen, 2012], it is not clear how to address the resulting changes in performance.…”

“…most frequent risk factors were abnormal inner ear anatomy [Herther and Schindler, 1985;Hayashi et al, 1989;Ohlms et al, 1990;Phelps et al, 1994;Belmont and Arimand, 2004;Biernath et al, 2006;Parner et al, 2007], higher incidence of middle ear infections [Arnold et al, 2002], surgical placement and permanence of the implant [Biernath et al, 2006;Wei et al, 2007;Rubin and Papsin, 2010] and history of preimplant meningitis [Center for Disease Control and Prevention, 2006]. The route of infection is correlated to the underlying predisposing factor: for acute otitis media it is through the oval and round window, the labyrinth fluids, following perineural or perivascular pathways into the internal auditory canal [Arnold et al, 2002]; in malformed cochlea it is through the cochlear aqueduct, as the connection to the subarachnoid space [Ohlms et al, 1990;Phelps et al, 1994], and in patients implanted with CI with a silicon positioner the route is through the enlarged cochleostomy [US Food and Drug Administration, 2007].…”

Delayed cochlear implantation in post-meningitic deafness and hereditary complement C2 deficiency

“…[2][3][4][5][6][7][8] The CI itself has been also associated with an increased risk of pneumococcal meningitis, mainly in patients with inner ear malformations. [9] However, the CI may be the only means to recover the auditory function in post-meningitic patients with severe to profound sensorineural hearing loss (SNHL). The peri-operative infective risks in case of C2D should be carefully balanced in each patient against the speech perception benefits offered by the CI.…”

Two are Better than One: Combining ZnO and MgF2 Nanoparticles Reduces Streptococcus pneumoniae and Staphylococcus aureus Biofilm Formation on Cochlear Implants

“…[ 2 ] In particular, children who have a CI may experience acute otitis media that can lead to inner-ear infections, device infections, device extrusion or failure, and/ or meningitis. Many of the CI-associated infections result from biofi lm formation on the implant.…”

“…S. pneumoniae and S. aureus are the most common pathogen causing CI-associated infections. [1][2][3]8 ] Therefore, there is an urgent need to fi nd innovative and creative solutions to inhibit their growth and biofi lm formation on CIs. In the last several years, the application of inorganic nanoparticles on medical implants has been found to represent a promising strategy to minimize medical implant associated infections.…”