title: Recurrent cochlear implant infection treated with exteriorization and partial mastoid obliteration.
abstract: OBJECTIVE
  Preoperative chronic otitis media (COM) is a risk factor for postoperative infection after cochlear implantation (CI), but its management varies by surgeon. Our case highlights a strategy for implant preservation in a patient with a history of recurrent cochlear implant infection.
  
  
  METHODS
  A 70-year-old woman with a history of chronic lymphocytic leukemia presented in 2005 with bilateral COM and sensorineural hearing loss meeting CI candidacy. Four months after left mastoid obliteration with abdominal fat graft and external auditory canal closure, a left CI was placed. Subsequent postauricular cellulitis resolved with oral antibiotics. A similar two-stage CI was performed on the right without complication. During the following year, numerous left-sided infections and fluid collections developed but were treated unsuccessfully with intravenous (IV) antibiotics and operative debridement. With concern for biofilm colonization, the implant was explanted and the electrode left in the cochlea. After reimplantation in 2010, infections resumed despite long-term IV antibiotics and incision and drainage. Intervention and technique In 2012, the left mastoid cavity was exteriorized and converted to standard canal wall-down anatomy. Bone pâté was placed over the electrode, followed by cadaveric acellular dermis and a split-thickness skin graft. After more than 2 years, her better-performing CI remains infection-free.
  
  
  CONCLUSIONS
  After 6 years of postoperative infections unresponsive to aggressive medical management, surgical interventions, and period of device removal, our patient's infections resolved after mastoid exteriorization and multilayered protection of the electrode. This strategy may enable implant preservation in patients with recurrent post-CI infection in an obliterated cavity.
authors.forename: Kareem O
authors.initials: KO
authors.lastname: Tawfik
authors.forename: Justin S
authors.initials: JS
authors.lastname: Golub
authors.forename: J Thomas
authors.initials: JT
authors.lastname: Roland
authors.forename: Ravi N
authors.initials: RN
authors.lastname: Samy
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019929:Cochlear Implantation / Q000009:adverse effects* / Q000379:methods; D003054:Cochlear Implants / Q000009:adverse effects* / Q000382:microbiology; D005260:Female; D006319:Hearing Loss, Sensorineural / Q000150:complications / Q000601:surgery; D006801:Humans; D008416:Mastoid / Q000601:surgery*; D010033:Otitis Media / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery*; D012008:Recurrence; D012092:Replantation / Q000009:adverse effects / Q000379:methods; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: Biofilm; Chronic otitis media; Cochlear implant; Eustachian tube obliteration; Explantation; External auditory canal closure; Infection; Mastoid obliteration