Management of otitis media-related diseases in children with a cochlear implant

Abstract

In all, 19 of 186 children with a CI were identified as having otitis media, and 4 of them as having cholesteatoma. Among the others, 10 were identified as having acute otitis media, 4 as having middle ear effusion, and 1 as having mastoiditis in the implanted ear. Surgery was performed in children with cholesteatoma and mastoiditis. The CIs of three children were eventually explanted to eradicate cholesteatoma.

Complications of post-cochlear implantation in 1027 adults and children

“…Primary acquired cholesteatoma can occur in any child with a cochlear implant and is a distinct possibility. Interestingly, Lin et al suggest that CI may predispose to secondary acquired cholesteatoma by interfering with the normal process of middle ear pneumatization or by inducing mucosal changes by acting as a foreign body or a nidus of infection 23. There is evidence that biofilm formation on the cochlear implant can also result in chronic otitis media 24.…”

Infections After Cochlear Implantation

“…Although CI was previously thought to increase the incidence of AOM, it has recently seen that this is not true. The incidence of AOM in children with CI is approximately 10% and is similar to children without implants [3][4][5]. Post-CI middle ear infections can be seen at any time, and most frequently occur within the first 2 years after surgery [4].…”

“…Main reason for early and aggressive treatment of otitis media is that the infection of the middle ear cavity is considered a risk factor for postimplant meningitis. Second, this treatment is necessary to prevent the development of the retraction pocket, adhesion of the tympanic membrane, and the formation of cholesteatoma [3]. Third, otitis media in the implanted ear that is not well treated can cause device failure, leading to explantation [9].…”

“…The pathogenesis of CSOM that develops after cochlear implantation is unclear. However, the implant may create a potential focus for infection by creating a foreign body reaction and cause a predisposition to CSOM and cholesteatoma by disrupting mastoid aeration [3]. Cholesteatoma can also be seen as an iatrogenic complication after CI surgery.…”

“…The child cannot communicate or may lose the progress of speech-language in a critical period of the development [2]. In addition, middle ear infection is a risk factor for postimplant meningitis [3]. Therefore, it requires to be alert to the infections and the things to be done for both diagnosis and treatment should be applied quickly.…”