title: Cochlear implantation in children with Jervell and Lange-Nielsen syndrome - a cautionary tale.
abstract: OBJECTIVE
  Jervell and Lange-Nielsen (JLN) syndrome is a rare cause of congenital profound hearing loss associated with a prolonged QT interval on the electrocardiogram. Children presenting for cochlear implantation with this condition may be asymptomatic but are at risk of sudden death. SCREENING AND SUBSEQUENT: careful management is therefore required to ensure a successful outcome. We present our experience of cochlear implantation in children with JLN syndrome, including two who died unexpectedly, and suggest a protocol for management of such cases. Clinical presentation Four cases of cochlear implantation in JLN syndrome are described. None had any previous cardiological family history. Two were diagnosed pre-operatively but, despite appropriate management under a cardiologist, died from cardiac arrest; the first in the perioperative period following reimplantation for infection, and the second unrelated to his cochlear implant surgery. The other two patients were diagnosed only subsequent to their implantation and continue to use their implants successfully.
  
  
  CONCLUSIONS
  These cases highlight the variation in presentation of JLN syndrome, and the spectrum of disease severity that exists. Our protocol stresses the importance of careful assessment and counselling of parents by an experienced implant team.
authors.affiliation: Manchester Cochlear Implant Programme, Manchester Royal Infirmary, UK. steve_broomfield@hotmail.com
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Broomfield
authors.forename: Iain A
authors.initials: IA
authors.lastname: Bruce
authors.forename: Lise
authors.initials: L
authors.lastname: Henderson
authors.forename: Richard T
authors.initials: RT
authors.lastname: Ramsden
authors.forename: Kevin M J
authors.initials: KM
authors.lastname: Green
mesh_terms: D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D019929:Cochlear Implantation / Q000379:methods*; D016757:Death, Sudden, Cardiac / Q000209:etiology*; D017809:Fatal Outcome; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D029593:Jervell-Lange Nielsen Syndrome / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D008297:Male; D008403:Mass Screening; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality*; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000401:mortality / Q000601:surgery; D012086:Reoperation; D012307:Risk Factors