title: Acute mastoiditis in children with a cochlear implant.
abstract: OBJECTIVE
  Cochlear implantation is performed at a young age, when children are prone to acute otitis media. Acute mastoiditis is the most common complication of otitis media, but data on its management in the presence of a cochlear implant are sparse. The objective of this study was to assess the characteristics, treatment, and outcome of acute mastoiditis in children with a cochlear implant.
  
  
  METHODS
  The medical files of all children who underwent cochlear implantation at a pediatric tertiary medical center in 2000-2014 were retrospectively reviewed. Those diagnosed with acute mastoiditis after implantation were identified, and data were collected on demographics, history, presentation, method of treatment, complications, association with untreated otitis media with effusion, and long-term middle-ear sequelae.
  
  
  RESULTS
  Of the 370 children (490 ears) who underwent cochlear implantation, 13 (3.5%) were treated for acute mastoiditis (median age at acute mastoiditis, 32 months). Nine had a pre-implantation history of chronic secretory or acute recurrent otitis media, and 5 had been previously treated with ventilation tubes. In all 9 children who had unilateral cochlear implant, the acute mastoiditis episode occurred in the implanted ear. The time from implantation to mastoiditis was 5-61 months. The same treatment protocol as for normal-hearing children was followed, with special attention to the risk of central nervous system complications. Primary treatment consisted of myringotomy with intravenous administration of wide-spectrum antibiotics. Surgical drainage was performed in 8 out of 13 patients, with (n=7) or without (n=1) ventilation-tube insertion, to treat subperiosteal abscess or because of lack of symptomatic improvement. There were no cases of intracranial complications or implant involvement or need for a wider surgical approach. No middle-ear pathology was documented during the average 3.8-year follow-up.
  
  
  CONCLUSIONS
  The relatively high rate of acute mastoiditis and subperiosteal abscess in children with a cochlear implant, predominantly involving the implanted ear, supports the suggestion that recent mastoidectomy may be a risk factor for these complications. Despite the frequent need for drainage, more extensive surgery is usually unnecessary, and recovery is complete and rapid. As infections can occur even years after cochlear implantation, children with otitis media should be closely followed, with possible re-introduction of ventilation tubes.
authors.affiliation: Cochlear Implant Program, Schneider Children's Medical Center of Israel and Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. Electronic address: Reyal@clalit.org.il.
authors.forename: Eyal
authors.initials: E
authors.lastname: Raveh
authors.affiliation: Cochlear Implant Program, Schneider Children's Medical Center of Israel and Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. Electronic address: Davido@clalit.org.il.
authors.forename: David
authors.initials: D
authors.lastname: Ulanovski
authors.affiliation: Cochlear Implant Program, Schneider Children's Medical Center of Israel and Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel; Communications Disorder Program, Haifa University, Haifa, Israel. Electronic address: attiasj@clalit.org.il.
authors.forename: Joseph
authors.initials: J
authors.lastname: Attias
authors.affiliation: Cochlear Implant Program, Schneider Children's Medical Center of Israel and Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel. Electronic address: YOTAMYO@clalit.org.il.
authors.forename: Yotam
authors.initials: Y
authors.lastname: Shkedy
authors.affiliation: Cochlear Implant Program, Schneider Children's Medical Center of Israel and Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel. Electronic address: Merav.Sokolov@clalit.org.il.
authors.forename: Meirav
authors.initials: M
authors.lastname: Sokolov
mesh_terms: D000208:Acute Disease; D002648:Child; D002675:Child, Preschool; D019929:Cochlear Implantation; D003054:Cochlear Implants / Q000009:adverse effects*; D004432:Ear, Middle / Q000601:surgery; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008416:Mastoid / Q000601:surgery; D008417:Mastoiditis / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D010033:Otitis Media / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Acute mastoiditis; Cochlear implantation; Complication; Subperiosteal abscess