Postoperative Infection in Cochlear Implant Patients

Cunningham, Calhoun D.; Slattery, William H.; Luxford, William M.

doi:10.1016/j.otohns.2004.02.011

Cited by 152 publications

(122 citation statements)

References 8 publications

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“…The risk of post-operative facial paresis has decreased from 1.74% in 1995 to 0.41% as per world literature. In our study two patients (0.6%) developed meningitis which is in comparison to a study by Cunningham et al, who reported one case of meningitis (0.2%) in their case series of 450 patients [17].…”

Section: S166supporting

confidence: 54%

A Study of Complications and Morbidity Profile in Cochlear Implantation: The MERF Experience

Raghunandhan

Kameswaran

Kumar

et al. 2011

Indian J Otolaryngol Head Neck Surg

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Cochlear implantation (CI) has been established worldwide as the surgical treatment for individuals with bilateral severe to profound hearing loss. This is a safe and standard procedure in the hands of experienced implant surgeons. Complications due to surgery are minimal and are often encountered in cases with congenital anomalies of the temporal bone and inner ear. Complications in CI are related to malfunctioning of the device or the process of wound healing. In most cochlear implant centers, as the surgeon's skill and clinical expertise in managing various cochlear implant cases improves with years of experience, the complication rates in his series ideally come down over time. Over the years, these well experienced clinics become tertiary referral centers for CI, receiving many difficult cases for implantation and hence such centers report data on complications, which become an important reference for many aspiring implant surgeons. Our study, performed in a premier CI centre in Chennai, looks at the various complications which were encountered in a case series of 300 implantees. Retrospective descriptive study with data collected from operative notes, patient questionnaires, auditory habilitation registers and medical records of cochlear implantees operated between, November 2006 to November 2010. A spectrum of major and minor complications, were categorized. Their incidence rates in relation to the demography of the patient profile and various events during surgical procedure were documented and analyzed.Appropriate management protocols were defined. Our management protocols have been highlighted and the relevant literature reviewed. This report of our experience with 300 cochlear implantees, reveals that complication rates at our center are in comparison with reputed centers worldwide. CI is very safe in the long term and provides optimal auditory awareness with speech perception and intelligibility for profoundly deaf individuals giving them an avid opportunity to integrate within the normal society.

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Section: S166supporting

confidence: 54%

A Study of Complications and Morbidity Profile in Cochlear Implantation: The MERF Experience

Raghunandhan

Kameswaran

Kumar

et al. 2011

Indian J Otolaryngol Head Neck Surg

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“…In the context of infections, generally a 2-step procedure with explantation and later re-implantation is indicated if conservative treatment is not successful. Regarding extra-cochlear infection, the electrode may sometimes remain in situ in the first step [45], [46]. Re-implantations with the purpose of a technological upgrade are controversially discussed.…”

Section: • Medical Complications • Technological Upgradementioning

confidence: 99%

Cochlear Implant – State of the Art

2017

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Cochlear implants are the treatment of choice for auditory rehabilitation of patients with sensory deafness. They restore the missing function of Thomas Lenarz 1 inner hair cells by transforming the acoustic signal into electrical stimuli in the majority of patients including the use of the telephone. Children can achieve a near to normal speech and language development provided their deafness is detected early after onset and implantation is performed quickly thereafter. The diagnostic procedure as well as the surgical technique have been standardized and can be adapted to the individual anatomical and physiological needs both in children and adults. Special cases such as cochlear obliteration might require special measures and re-implantation, which can be done in most cases in a straight forward way. Technology upgrades count for better performance. Future developments will focus on better electrode-nerve interfaces by improving electrode technology. An increased number of electrical contacts as well as the biological treatment with regeneration of the dendrites growing onto the electrode will increase the number of electrical channels. This will give room for improved speech coding strategies in order to create the bionic ear, i.e. to restore the process of natural hearing by means of technology. The robot-assisted surgery will allow for high precision surgery and reliable hearing preservation. Biological therapies will support the bionic ear. Methods are bio-hybrid electrodes, which are coded by stem cells transplanted into the inner ear to enhance auto-production of neurotrophins. Local drug delivery will focus on suppression of trauma reaction and local regeneration. Gene therapy by nanoparticles will hopefully lead to the preservation of residual hearing in patients being affected by genetic hearing loss. Overall the cochlear implant is a very powerful tool to rehabilitate patients with sensory deafness. More than 1 million of candidates in Germany today could benefit from this high technology auditory implant. Only 50,000 are implanted so far. In the future, the procedure can be done under local anesthesia, will be minimally invasive and straight forward. Hearing preservation will be routine.Keywords: cochlear implant, sensory deafness, diagnostics, surgical procedure, results, complications, future developments SummaryCochlear implants are electronical stimulus prostheses for the functional replacement of the inner ear. Because of the rapid technical development and the good results, they could be established as standard therapy for sensory deafness. Cochlear implantation requires an interdisciplinary team and a quality-controlled concepts that reaches from the indication to the life-long control and that is fixed in the AWMF guideline on cochlear implant [1]. Current cochlear implant systems are partially implantable and equipped with a multitude of additional functions similar to hearing aids for sound pre-processing and noise elimination. The intracochlear position of the electrode allows fo...

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“…6,7 Major infections may have serious consequences, including loss of the implant, and may occur more frequently in pediatric patients. 6 In 1 case series, 8 of 9 patients with device exposure (ie, an opening in the skin overlying the device as a result of wound infection and resultant wound dehiscence) ultimately required device removal, compared with 3 of 17 patients with a wound infection without device exposure.…”

Section: Postoperative Wound Infectionsmentioning

confidence: 99%

“…6 In 1 case series, 8 of 9 patients with device exposure (ie, an opening in the skin overlying the device as a result of wound infection and resultant wound dehiscence) ultimately required device removal, compared with 3 of 17 patients with a wound infection without device exposure. 7 Although the use of prophylactic perioperative antimicrobial agents has varied among centers and surgeons, the FDA recommended in 2003 that "[h]ealth care providers should consider prophylactic antibiotic treatment perioperatively in children receiving cochlear implants." 8 This recommendation was made to reduce the risk of meningitis that occurs in the immediate postoperative period, but it is possible that the use of prophylactic antimicrobial agents may also reduce the rate of occurrence of postoperative wound infection, acute otitis media, and implant infection.…”

Section: Postoperative Wound Infectionsmentioning

confidence: 99%

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

Rubin¹,

Papsin²

2010

Pediatrics

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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 ...

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Postoperative Infection in Cochlear Implant Patients

Cited by 152 publications

References 8 publications

A Study of Complications and Morbidity Profile in Cochlear Implantation: The MERF Experience

A Study of Complications and Morbidity Profile in Cochlear Implantation: The MERF Experience

Cochlear Implant – State of the Art

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

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