Otitis media with effusion in paediatric cochlear implantees: the role of peri-implant grommet insertion.
BACKGROUND
Otitis media with effusion (OME) is a common disease coincident with the need for cochlear implantation in 44% of the 45 children (mean = 4.8 years) currently implanted at our centre. Our suspicion that peri-implant effusion contributed to complications generated our interest in studying this issue.


METHODS
Retrospective review of patient records was carried out with the focus on clinical and audiological evidence of OME before, during and after implantation. Operative records were reviewed to determine any effect OME had on the procedure and postoperative complications.


RESULTS
Of our 45 implanted patients, 10 males and 10 female had OME prior to or after implantation. Pre-implant, 19 children had OME diagnosed and 11 received grommets (6 had multiple sets). Peri-implantation, 11 children had OME. These children with peri-implant effusions had 2 of 3 major, 2 of 2 intermediate and 1 of 2 minor complications. Children with peri-implant effusions also accounted for 3 of 4 cases in which there were bothersome middle ear effusions or granulation tissue at operation. The 6 children in whom grommets were placed within two months of cochlear implantation accounted for only one case of effusion at implantation and their courses were complicated only by a keloid in one child and a late flap disruption in another.


CONCLUSIONS
Insertion of grommets prior to cochlear implantation in children with peri-implant OME may provide some protection against intra-operative and some post-operative complications. Our management policy in patients with OME now aims at placing grommets such that they are in and patent at the time of implantation.
Papsin
B C
BC
Department of Paediatric Otolaryngology, Great Ormond Street Hospital for Children NHS Trust, London, UK.
Bailey
C M
CM
Albert
D M
DM
Bellman
S C
SC
D002648:Child; D002675:Child, Preschool; D003054:Cochlear Implants; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D008876:Middle Ear Ventilation; D010034:Otitis Media with Effusion / Q000150:complications* / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D012189:Retrospective Studies