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Inicio Acta Otorrinolaringológica Española Acute mastoiditis in cochlear implanted children: A single-centre experience
Journal Information
Vol. 75. Issue 1.
Pages 17-22 (January - February 2024)
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Vol. 75. Issue 1.
Pages 17-22 (January - February 2024)
Original article
Acute mastoiditis in cochlear implanted children: A single-centre experience
La mastoiditis aguda en niños con implante coclear: experiencia de un solo centro
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Andrea Ciorba, Virginia Fancello
Corresponding author
virginia.fancello@unife.it

Corresponding author.
, Beatrice Sacchet, Michela Borin, Nicola Malagutti, Chiara Bianchini, Francesco Stomeo, Stefano Pelucchi
ENT & Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, 44121 Ferrara, Italy
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Table 1. Relevant medical history of CI children affected by AM.
Table 2. Clinical-laboratory findings during AM episodes.
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Abstract
Background

Acute mastoiditis (AM) is the most common complication of acute otitis media and primarily affects children under the age of two; current data on its prevalence in paediatric patients with cochlear implant (CI) are still scant. Proper management of AM in CI children is crucial in order to avoid the implications (financial and emotional) of an explant.

Aim of this paper is to describe the cases of AM occurred among young patients with CI in follow up at our department, also in order to evaluate its prevalence, potential predisposing factors, clinical course and therapeutic strategies.

Patients and methods

Retrospective study. Medical records of all paediatric patients with CI, who had at least one year of follow-up, were searched aiming to identify those who developed AM, from January 1st 2002 to January 31st 2022. The following data were collected and analysed: demographic features, implant type and side, interval between CI surgery and AM, treatment, laboratory tests, clinical course, vaccination history, associated diseases.

Results

AM was developed by six (1.3%) of the 439 children with CI (541 implanted ears). In total, 9 episodes (2.05 %) were recorded, as three patients reported two consecutive infections. Average time interval between CI surgery, to the first or only AM diagnosis, was 13.8 months (range 3–30 months). Furthermore, 3/6 of patients had a history of recurrent acute otitis media; 2/6 an autism spectrum disorder, associated to a combined immune deficiency in one case. All patients were hospitalized and promptly treated by intravenous antibiotic therapy; 4/6 also underwent a mastoidectomy. CI was not explanted in any cases of this series.

Conclusions

Over a 20-year period, AM rate in CI children was 1.3%, which is consistent with the current literature rates of 1–4.7%. All cases were successfully treated, preserving the integrity of the device. In our experience, the early parenteral antibiotic therapy and, when necessary, surgical treatment were adequate to eradicate the infection.

Keywords:
Acute mastoiditis
Cochlear implant
Deafness
Resumen
Introducción

La mastoiditis aguda (MA) es la complicación más común de la otitis media aguda y afecta principalmente los niños menores de dos años; los datos actuales sobre su prevalencia en pacientes pediátricos con implante coclear (IC) son aún escasos. El manejo adecuado de la MA en los niños con IC es crucial para evitar las implicaciones (económicas y emocionales) de un explante. El objetivo de este articulo es describir los casos de MA ocurridos en pacientes jóvenes con IC en seguimiento en nuestro servicio, también para evaluar su prevalencia, posibles factores predisponentes, curso clínico y estrategias terapéuticas.

Pacientes y métodos

Estudio retrospectivo. Se realizaron búsquedas en las historias clínicas de todos los pacientes pediátricos con IC, que tenían al menos un año de seguimiento, con el objetivo de identificar a aquellos que desarrollaron la MA, desde el 1 de enero de 2002 hasta el 31 de enero de 2022.

Se recopilaron y analizaron los siguientes datos: características demográficas, tipo de implante y lado, intervalo entre cirugia del IC y MA, tratamiento, exámenes de laboratorio, evolución clínica, antecedentes vacunales, enfermedades asociadas.

Resultados

La MA fue desarrollada por seis (1,3%) de los 439 niños con IC (541 oídos implantados).

En total se registraron 9 episodios (2,05 %), ya que tres pacientes reportaron dos infecciones consecutivas. El intervalo de tiempo promedio entre la cirugía del IC y el primer o único diagnóstico de la MA fue de 13,8 meses (rango 3-30 meses). Además, 3/6 de los pacientes tenían antecedentes de otitis media aguda recurrente; 2/6 un trastorno del espectro autista, asociado a una inmunodeficiencia combinada en un caso. Todos los pacientes fueron hospitalizados y tratados de inmediato con terapia antibiótica intravenosa; 4/6 también se sometieron a una mastoidectomía. El IC no fue explantado en ningún caso de esta serie.

Conclusiones

Durante un período de 20 años, la tasa de MA en los niños con IC fue del 1,3 %, lo que es consistente con las tasas actuales de la literatura del 1 al 4,7 %. Todos los casos fueron tratados con éxito, preservando la integridad del dispositivo. Según nuestra experiencia, la antibioterapia parenteral precoz y, en su caso, el tratamiento quirúrgico fueron adecuados para erradicar la infección.

Parablas clave:
Mastoiditis aguda
Implante coclear
Sordera

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