[Cochlear implantation in children with otitis media: third stage of a long-term prospective study].
BACKGROUND
The age at which cochlear implantation (CI) is performed in children generally corresponds to the age at which the prevalence of otitis media (OM) is highest. The risks of problematic middle ear infection and of potential spread of middle ear infection along the electrode array into the cochlea and the central nervous system are relatively high. Thus, it is necessary to establish a practicable protocol aimed at controlling OM prior to and after CI in young candidates.


OBJECTIVE
To assess the risk for otitis media after cochlear implantation in otitis media (OM)-prone and non-OM-prone children who were treated according to a structured protocol designed to control OM prior to implantation.


METHODS
Of 113 children referred for cochlear implantation during the study period, and were implanted under the age of 7 years, 70 were classified as OM-prone (Group A) and 43 as non-OM-prone (group B). Group A patients were managed according to a structured protocol aimed at pre-implantation control of OM. Postimplantation follow-up ranged from 6 to 75 months (average 35.5 months).


RESULTS
In the OM-prone group of children, the mean age at referral and at implantation was significantly lower and the mean interval between referral and implantation significantly higher than in the healthy group. During the first month after implantation 18 children suffered from acute otitis media, the vast majority of them (16) belonged to the OM-prone children (22.8% of this group) and 2 subjects belonged to the non-OM-prone children (4.6% of this group). During the late post-operative period 28 of the OM-prone children (40%) and 4 of the non-OM-prone children (9.3%) developed acute OM in the implanted ear. Eleven (9.7 %) of these cases, (10 belonging to the OM-prone group B (14%), and one belonging to the non-OM-prone group A (2.3%)) proved to be recurrent and therapeutically challenging. Three subjects developed acute mastoiditis without intracranial complications. Each episode of mastoiditis or otitis media was controlled conservatively without any need of surgical drainage of the mastoid. This group of challenging cases did not differ from the OM-prone children who did not prove to be OM-challenging post-CI in regards to age at referral, age at CI and average number of ventilation tube (VT) operations prior to CI. Most pathogen isolations (65%) from OM or from VT drainage developed after CI were typical pathogens for acute otitis media (AOM). However, the percentage of non-typical AOM pathogen isolation increased with time after CI.


CONCLUSIONS
Early referral led to early implantation, even in children susceptible to OM. The incidence of OM decreased after implantation in both groups, but was still significantly higher in the OM-prone group. Meanwhile, prior to CI it is not possible to predict the cases that become therapeutically challenging at a later stage.
Luntz
Michal
M
Department of Otolaryngology-Head and Neck Surgery, Bnai Zion Medical Center. Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. michal.luntz@b-zion.org.il
Khalaila
Jawad
J
Brodsky
Alexander
A
Shpak
Talma
T
D000208:Acute Disease; D002648:Child; D002675:Child, Preschool; D019929:Cochlear Implantation / Q000009:adverse effects / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D010033:Otitis Media / Q000453:epidemiology / Q000601:surgery*; D011446:Prospective Studies; D012008:Recurrence; D012017:Referral and Consultation; D012189:Retrospective Studies; D016896:Treatment Outcome