title: The value of nuclear scans in cochlear implant infections.
abstract: We discuss the diagnostic value of nuclear scintigraphy in the management of infections after cochlear implantation. A 56-year-old female (Case 1) and a 46-year-old female (Case 2) developed complaints of diffuse headache, 4 and 5 months after cochlear implantation, without other signs of infection during examination, laboratorial testing and initial computed tomography. In Case 1 we performed a technetium 99 m-difosfate scintigraphy, which showed an increased uptake in the right petrosal bone, suggestive of chronic osteomyelitis. This case failed conservative treatment and underwent complete explantation, after which 67gallium-citrate single-photon emission computed tomography normalized during follow-up. In Case 2 inflammation at the site of the cochlear implant was confirmed by performing a positron emission tomography scan, which showed an increased uptake. Case 2 was treated successfully with antibiotics. Both have no signs of recurrent infection. Nuclear scintigraphy can be the single valuable tool in case of a late low-grade infection after cochlear implantation. Delayed low-grade chronic osteomyelitis of the petrosal bone is a rare but dramatic complication after cochlear implantation. It can develop with minimal signs of infection.
authors.affiliation: Department of Otolaryngology and Head and Neck Surgery, Vrije Universiteit Medical Center, Postbox 7057, 1007 MB, Amsterdam, The Netherlands.
authors.forename: Lennaert S
authors.initials: LS
authors.lastname: Hoep
authors.forename: Paul
authors.initials: P
authors.lastname: Merkus
authors.forename: Annelies
authors.initials: A
authors.lastname: van Schie
authors.forename: Rico N P M
authors.initials: RN
authors.lastname: Rinkel
authors.forename: Conrad F
authors.initials: CF
authors.lastname: Smit
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002951:Citrates; D003054:Cochlear Implants / Q000382:microbiology*; D003937:Diagnosis, Differential; D005260:Female; D005708:Gallium; D006801:Humans; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000382:microbiology; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D019785:Technetium Tc 99m Disofenin
chemical_list: D000900:Anti-Bacterial Agents; D002951:Citrates; D019275:Radiopharmaceuticals; D005708:Gallium; C103850:gallium citrate; D019785:Technetium Tc 99m Disofenin