title: The management of acute mastoiditis in children with cochlear implants: saving the device.
abstract: OBJECTIVE
  Early treatment of profound bilateral sensorineural hearing loss with cochlear implantation has become routine, resulting in an increased proportion of children implanted at younger ages. These children are at a relatively high risk for acute otitis media (AOM), and are more likely to develop mastoiditis in the implanted ear. Despite the significant risks associated with mastoiditis, including compromise of the implant, there are no specific guidelines on the management of this population. We propose a treatment algorithm emphasizing early but conservative operative intervention.
  
  
  METHODS
  A retrospective chart review included eight patients, who experienced mastoiditis, in the context of cochlear implantation at our center from August 2005 to November 2012. During this period 806 implant surgeries were completed.
  
  
  RESULTS
  The median age at which mastoiditis occurred was 37 months, and the mean time from implantation to mastoiditis was 9.56 months. All patients underwent drainage of the middle ear in conjunction with intravenous antibiotics, and two additionally underwent post-auricular incision and drainage.
  
  
  CONCLUSIONS
  Recent mastoidectomy may be a risk factor for the development of a post-auricular abscess in children, who develop AOM following cochlear implantation. A treatment algorithm was developed, which emphasizes early operative drainage in conjunction with aggressive antibiotic therapy. Conclusions A consistent approach to the management of mastoiditis in children with cochlear implants has not been established. Rapid initiation of aggressive antibiotic therapy and a low threshold for conservative operative intervention results in effective resolution of infection while allowing preservation of the implant.
authors.affiliation: University of Toronto, Toronto, Canada.
authors.forename: Heather A
authors.initials: HA
authors.lastname: Osborn
authors.forename: Sharon L
authors.initials: SL
authors.lastname: Cushing
authors.forename: Karen A
authors.initials: KA
authors.lastname: Gordon
authors.forename: Adrian L
authors.initials: AL
authors.lastname: James
authors.forename: Blake C
authors.initials: BC
authors.lastname: Papsin
mesh_terms: D000208:Acute Disease; D019980:Amoxicillin-Potassium Clavulanate Combination / Q000008:administration & dosage*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D002444:Cefuroxime / Q000008:administration & dosage; D002506:Cephalexin / Q000008:administration & dosage; D002511:Cephalosporins / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D002981:Clindamycin / Q000008:administration & dosage; D019929:Cochlear Implantation / Q000009:adverse effects*; D003054:Cochlear Implants / Q000009:adverse effects* / Q000382:microbiology; D004322:Drainage; D005260:Female; D006319:Hearing Loss, Sensorineural / Q000601:surgery*; D006801:Humans; D007223:Infant; D007262:Infusions, Intravenous; D008297:Male; D008417:Mastoiditis / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology; D010033:Otitis Media / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology; D016459:Prosthesis-Related Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D000097670:Cefprozil
chemical_list: D019980:Amoxicillin-Potassium Clavulanate Combination; D000900:Anti-Bacterial Agents; D002444:Cefuroxime; D002506:Cephalexin; D002511:Cephalosporins; D002981:Clindamycin; D000097670:Cefprozil