title: Characteristics of CI children with complicated middle ear infections.
abstract: To describe cases of complicated middle ear infections in children with cochlear implants (CI), i.e., episodes of acute otitis media (AOM) and acute mastoiditis (AM), resulting in hospitalization.
  
  
  
  A total of 206 children under 16 years (300 implantations) were implanted between 1 January 2008 and 31 December 2014 at the West Danish CI Center, Department of Otorhinolaryngology Head and Neck Surgery, Aarhus, Denmark. By means of two prospective local databases, episodes of AOM or AM and demographics were retrieved including biochemistry, microbiology, length of follow- up, and variable treatment modalities (intravenous (IV) antibiotics, revision mastoidectomy, and insertion of ventilation tubes).
  
  
  
  Overall rate of AOM and/or AM was 9.2% (AOM: 9%, AM: 1.9%). Mean age at CI was 46 months. Mean follow-up was 45 months. Mean time from CI operation to AOM or AM was 3 and 4 months, respectively. Children younger than 2 years were at highest risk of AOM and/or AM. All had antibiotics prescribed before admittance, and two- thirds of infected ears had already ventilation tubes inserted. Bacteria could not be detected in more than half of cases. The most frequently isolated strains were pneumococci and nontypable Haemophilus influenzae. The majority of patients were successfully treated with IV cefuroxime (64% of cases) and insertion of ventilation tubes. None of the children developed facial nerve paralysis, intracranial infections, or septicemia.
  
  
  
  Almost 10% of CI children required at least one hospitalization due to AOM and/or AM compared with 0.1 per thousand of non-CI children. This discrepancy can be explained by a low threshold for active treatment of otitis media in CI children and hence referral to a CI center. The results suggest that benzylpenicillin might be an appropriate initial treatment of AOM and AM. However, cephalosporin was the most preferred antibiotic. Most CI children were already treated with ventilation tubes at admission and almost all children without ventilation tubes, had a tube inserted during admission. Insertion of ventilation tubes is still much debated and more research in this field is needed.
  
  
  
  AOM and/or AM were seen in Danish children with CI as often as in other western countries. Treatment of complicated middle ear infections was sufficient with IV cephalosporin and ventilation tube insertion. Special attention should be paid to children younger than 4 years and the associated microbiology including serotyping should be monitored.
authors.affiliation: a Department of Clinical Medicine , Aarhus University , Palle Juul-Jensens Boulevard 82, DK-8200 Aarhus N , Denmark.
authors.forename: Søren
authors.initials: S
authors.lastname: Hoberg
authors.affiliation: b Department of Otorhinolaryngology and Head and Neck Surgery , Aarhus University Hospital , Noerrebrogade 44, DK-8000 Aarhus C , Denmark.
authors.forename: Christian
authors.initials: C
authors.lastname: Danstrup
authors.affiliation: a Department of Clinical Medicine , Aarhus University , Palle Juul-Jensens Boulevard 82, DK-8200 Aarhus N , Denmark.
authors.forename: Bjarke
authors.initials: B
authors.lastname: Laursen
authors.affiliation: b Department of Otorhinolaryngology and Head and Neck Surgery , Aarhus University Hospital , Noerrebrogade 44, DK-8000 Aarhus C , Denmark.
authors.forename: Niels Krintel
authors.initials: NK
authors.lastname: Petersen
authors.affiliation: b Department of Otorhinolaryngology and Head and Neck Surgery , Aarhus University Hospital , Noerrebrogade 44, DK-8000 Aarhus C , Denmark.
authors.forename: Nichlas
authors.initials: N
authors.lastname: Udholm
authors.affiliation: b Department of Otorhinolaryngology and Head and Neck Surgery , Aarhus University Hospital , Noerrebrogade 44, DK-8000 Aarhus C , Denmark.
authors.forename: Gintaras Audrius
authors.initials: GA
authors.lastname: Kamarauskas
authors.affiliation: a Department of Clinical Medicine , Aarhus University , Palle Juul-Jensens Boulevard 82, DK-8200 Aarhus N , Denmark.|c Department of Otorhinolaryngology , Region Hospital Holstebro , Laegaardvej 12, DK-7500 Holstebro , Denmark.
authors.forename: Therese
authors.initials: T
authors.lastname: Ovesen
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D019929:Cochlear Implantation / Q000009:adverse effects*; D003054:Cochlear Implants / Q000009:adverse effects*; D016208:Databases, Factual; D003718:Denmark / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D034381:Hearing Loss / Q000601:surgery; D006760:Hospitalization; D006801:Humans; D007223:Infant; D008297:Male; D008417:Mastoiditis / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D008876:Middle Ear Ventilation; D010033:Otitis Media / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D011183:Postoperative Complications; D011446:Prospective Studies; D012086:Reoperation / Q000379:methods; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: Acute mastoiditis; Acute otitis media; Children; Cochlear implant; Treatment