in paediatric cochlear implantation: a review of 300 cases. LELA MIGIROV, Department of Otolaryngology Head and Neck Surgery, Sheba. Medical Center, Tel ...
194
Cochlear Implants International Cochlear Implants Int. 7(4), 194–201, 2006 Published online in Wiley InterScience (www.interscience.wiley.com) DOI: 10.1002/cii.319
Surgical and medical complications in paediatric cochlear implantation: a review of 300 cases LELA MIGIROV, Department of Otolaryngology Head and Neck Surgery, Sheba Medical Center, Tel Hashomer, Israel CHAVA MUCHNIK and RICKY KAPLAN-NEEMAN, Speech and Hearing Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel JONA KRONENBERG, Department of Otolaryngology Head and Neck Surgery, Sheba Medical Center, Tel Hashomer, Israel ABSTRACT The aim of the study was to investigate an incidence of surgical and medical complications in different age groups of cochlear implant children. A retrospective study design was used. Patients’ medical records were reviewed for age at the time of implantation, cause of deafness and complications. The incidence of complications was compared between the young (aged up to 2 years, n = 61) and older children (aged 216 years, n = 239). Some 300 paediatric cochlear implantations were performed in our department between January 1993 and March 2005. Major complications, such as facial nerve paralysis, electrode misplacement, foreign body reaction, flap breakdown, protrusion of the positioner and cholesteatoma were rare (3%). Disequilibrium was found to be the most common complication, followed by wound problems and mastoiditis without significant differences between the two groups. However, magnet or receiver-stimulator displacement were more common in the young children (p = 0.028). Most surgical and medical complications could be treated successfully, and only 2% required explantation of the device. Generally, operating on a child aged under 2 years was not particularly different from operating on an older child. Copyright © 2006 John Wiley & Sons, Ltd. Keywords: cochlear implantation; complication Introduction Cochlear implant systems provide hearing sensation to thousands of people with impaired hearing. Cochlear implantation (CI) in children differs from the CI in adults for various reasons: most paediatric CI is performed in congenitally deaf children without hearing experience; the cause of deafness in some of these patients is a malformed inner ear, which could lead to difficulties in the introduction of the
Surgical and medical complications in paediatric cochlear implantation
electrode; a thin skin covering the implant site could lead to flap or wound complications; acute infection of the middle ear and mastoid is common in childhood, especially in young children, and, finally, intense physical activity of children may result in trauma to the implant site and lead to corresponding complications. Different authors described various surgical and medical complications of CI and divided them into major and minor categories. Meningitis, facial nerve paralysis, misplaced or compressed electrode, device extrusion, wound or flap breakdown, foreign body reaction (FBR) and cholesteatoma represent the group of major complications that may require special treatment regimens, revision surgery or explantation of the device (Cohen and Hoffman, 1991; Arnold and Brockmeier, 1997; Johnson et al., 1997; Kempf et al., 1999; Lenarz et al., 1999; Kronenberg et al., 2001; Arnold et al., 2002; Hehar et al., 2002; Fayad et al., 2003b; Gibbin et al., 2003; Bhattia et al., 2004). Complications such as seroma, eardrum defect, magnet/ receiver-stimulator displacement and infection of the middle ear and mastoid were defined as minor and could be treated conservatively or with minor surgical procedures (Kempf et al., 2000; Fayad et al., 2003b; Migirov and Kronenberg, 2005). Since the age range of the cohort children was wide, we supposed that the occurrence of complications could differ between toddlers and older children. Paediatric implantations have been performed in our department since 1993. The current paper analyses the first 300 paediatric CIs and summarizes our experience of surgical and medical complications in two age groups of children. Method A retrospective study was conducted on 300 consecutive paediatric CIs performed in our department between January 1993 and March 2005, and these were followed-up for a period of at least six months. Patients’ medical records were reviewed for age at the time of implantation, cause of deafness, and surgical and medical complications. The incidence of complications was compared between the young children (aged up to 2 years, n = 61) and the older ones (aged between 2 and 16 years, n = 239). The age distribution of the implanted children is presented in Table 1. Table 1: Age distribution of children receiving cochlear implantation (CI) Age (years)
N
