Abstract
Objective
The purpose of this study is to retrospectively review the complications of pediatric patients undergoing cochlear implantation at a tertiary referral center.
Method
Institutional review board permission was obtained. A retrospective analysis of all pediatric patients (younger than 18 years) who underwent primary cochlear implantation was performed from January 2001 to December 2005. The patients were reviewed for demographic information, type of hearing loss, cochlear implant device, and complications including implant failure, meningitis, hematoma, implant extrusion, cerebrospinal fluid leak, facial palsy, and wound infection.
Results
One hundred sixty-five patient records were reviewed. Twenty-nine patients were lost to follow-up or were revision cases; therefore, 136 records were analyzed. Of the patients, 53.5% were male. The most common etiology of hearing loss was nonsyndromic, nongenetic, congenital sensorineural hearing loss (60.6%). Other less common etiology of hearing loss included TORCH (toxoplasmosis, other infections, rubella, cytomegalovirus, herpes simplex virus) (8.3%), connexin mutation (5.8%), and enlarged vestibular aqueduct (6.5%). All patients had a follow-up of 3 years. There were no intraoperative complications. The most common complications were flap infections (2.6%) and immediate postoperative hematomas (1.9%). Flap problems mostly occurred within 2 weeks of implantation. Within the study period, there was only one device failure (0.7%).
Conclusions
Cochlear implantation in children continues to be reliable and safe in experienced hands, with a low percentage of severe complications. The patients should have a lifetime follow-up.
1
Introduction
Since the institution of universal newborn hearing screening, 85% to 99% of infants are screened for hearing loss within the first few days of life; all are screened within the first few months. Consequently, more patients are being detected with hearing loss early in life, and more pediatric patients are getting cochlear implants in the course of their hearing rehabilitation . On average and over all degrees of hearing loss, children achieve higher levels in linguistic, academic, and social skills when management of hearing loss is implemented earlier. Congenital severe to profound hearing loss has been shown to limit a child’s ability to develop effective auditory and oral linguistic capabilities and communication . Pediatric cochlear implants provide children with severe to profound hearing loss greater access to sound and improvement in their auditory skills, speech understanding, and oral linguistic development .
Cochlear implant surgery in children presents several additional risks that are not present in adult patients. Children younger than 6 months of age have an increased risk of respiratory failure and bradycardia from anesthesia. In children with other medical comorbidities, there is an increased risk from anesthesia up to 1 year old. The risk of complications in this population has been decreased by the involvement of a pediatric anesthetist during the surgery . In the youngest implant candidates, blood loss should be minimized given their lower total blood volume .
The preoperative evaluation in a child can also present a challenge. Before consideration for cochlear implantation, the degree of hearing loss needs to be established. Current objective testing with sedated auditory brainstem responses, auditory-evoked potentials, and auditory steady-state responses have enabled more accurate evaluation of hearing. Measurement of age-appropriate speech perception skills has proven more challenging.
Postoperative device programming can also be difficult in the pediatric patient. It is important that the thresholds are accurate and the device is set at comfortable levels to enable optimal functioning of the cochlear implant. Greater accuracy leads to a better hearing environment for patients .
Despite the various issues surrounding pediatric cochlear implantation, the procedure continues to be performed in increasing numbers. The purpose of this article was to evaluate cochlear implants in pediatric patients and evaluate their safety.
2
Methods
Institutional review board permission was obtained. We performed a retrospective analysis of all pediatric patients who underwent cochlear implantation from January 2001 to December 2005 at a major academic center. All patients were younger than 18 years at time of implantation. The patients were reviewed for demographic information, type of hearing loss, cochlear implant device, and complications including implant failure, meningitis, hematoma (intracranial and extracranial), implant extrusion, cerebrospinal fluid leak, facial palsy, and wound infection. Patients were excluded from the study if there was insufficient information or if the surgeries were done at other facilities or outside the study period.
2
Methods
Institutional review board permission was obtained. We performed a retrospective analysis of all pediatric patients who underwent cochlear implantation from January 2001 to December 2005 at a major academic center. All patients were younger than 18 years at time of implantation. The patients were reviewed for demographic information, type of hearing loss, cochlear implant device, and complications including implant failure, meningitis, hematoma (intracranial and extracranial), implant extrusion, cerebrospinal fluid leak, facial palsy, and wound infection. Patients were excluded from the study if there was insufficient information or if the surgeries were done at other facilities or outside the study period.
3
Results
One hundred 65 patient records were reviewed. Twenty-nine patients were lost to follow-up or were revision cases; therefore, 136 records were analyzed. All patients were followed at least 3 years after their implantation to be included in the analysis. Of the patients, 53.5% were male. The age distribution of the patients is in Table 1 .
| <2 y | 2–4 y | 4–6 y | 6–8 y | >8 y |
| 29 | 45 | 15 | 9 | 38 |
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