Acute otitis media and mastoiditis following cochlear implantation.
OBJECTIVE
To examine the incidence of acute otitis media (AOM) and mastoiditis in children after cochlear implantation (CI) and to evaluate the role of mastoidectomy in decreasing the rate of AOM in implanted children by comparing two surgical techniques: the Posterior tympanotomy approach (MPTA, with mastoidectomy) and the Suprameatal approach (SMA, without mastoidectomy).


METHODS
A retrospective study was conducted on 234 children up to 16 years of age who underwent CI between 1993 and 2003 in our department. The children were divided into two groups according to the surgical technique that had been used for the implantation: the MPTA group and the SMA group.


RESULTS
Part of the children with a history of pre-implantation AOM (22 of 29 in MPTA group and 26 of 38 in SMA group) did not suffer from AOM post-CI (p=0.59), and an incidence of AOM after CI in children who did not have history of AOM prior to implantation (13 patients of MPTA group and 15 patients of SMA group) was unrelated to surgical approach (p=0.65). The incidence of pre-implantation AOM was similar for the two groups and declined after CI unrelated to performing of mastoidectomy in surgical technique. Overall, 47 children (20.1%) had post-CI AOM compared to 67 children (28.6%) who had pre-CI AOM. Mastoiditis developed in 11 children (4.7%), all 11 in the MPTA group. A subperiosteal abscess was incised and drained with the retroauricular approach in three of these children and the others were managed with intravenously administered ceftriaxone 50mg/kg/day for 3-5 consecutive days, followed by a course of oral cephalexin until there is complete clinical resolution of the effusion in the middle ear. The implants were preserved in all cases. Seven out of 11 children with mastoiditis had no history of AOM prior to implantation.


CONCLUSIONS
AOM and mastoiditis represent common complications of CI that can be successfully treated with the prompt use of antibiotics. However, the subperiosteal abscess could require surgical drainage. In our opinion, the decrease of incidence of AOM in implanted children is the result of natural history of otitis media and is unrelated to the surgical approach.
Migirov
Lela
L
Department of Otolaryngology and Head & Neck Surgery, Sheba Medical Center, and Sackler School of Medicine, Tel Aviv University, Tel Hashomer 5262l, Israel. smigirov@leumit.co.il
Yakirevitch
Arkadi
A
Henkin
Yael
Y
Kaplan-Neeman
Ricky
R
Kronenberg
Jona
J
D000038:Abscess / Q000209:etiology / Q000628:therapy; D000208:Acute Disease; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002443:Ceftriaxone / Q000627:therapeutic use; D002506:Cephalexin / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D019929:Cochlear Implantation / Q000009:adverse effects* / Q000379:methods*; D004322:Drainage; D005260:Female; D006801:Humans; D007223:Infant; D007557:Israel / Q000453:epidemiology; D008297:Male; D008417:Mastoiditis / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology*; D010033:Otitis Media / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies
D000900:Anti-Bacterial Agents; D002443:Ceftriaxone; D002506:Cephalexin