Luntz Michal, Khalaila Jawad, Brodsky Alexander, Shpak Talma
Department of Otolaryngology-Head and Neck Surgery, Bnai Zion Medical Center. Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
Harefuah. 2007 Feb;146(2):106-10, 166.
The age at which cochlear implantation (CI) is performed in children generally corresponds to the age at which the prevalence of otitis media (OM) is highest. The risks of problematic middle ear infection and of potential spread of middle ear infection along the electrode array into the cochlea and the central nervous system are relatively high. Thus, it is necessary to establish a practicable protocol aimed at controlling OM prior to and after CI in young candidates.
To assess the risk for otitis media after cochlear implantation in otitis media (OM)-prone and non-OM-prone children who were treated according to a structured protocol designed to control OM prior to implantation.
Of 113 children referred for cochlear implantation during the study period, and were implanted under the age of 7 years, 70 were classified as OM-prone (Group A) and 43 as non-OM-prone (group B). Group A patients were managed according to a structured protocol aimed at pre-implantation control of OM. Postimplantation follow-up ranged from 6 to 75 months (average 35.5 months).
In the OM-prone group of children, the mean age at referral and at implantation was significantly lower and the mean interval between referral and implantation significantly higher than in the healthy group. During the first month after implantation 18 children suffered from acute otitis media, the vast majority of them (16) belonged to the OM-prone children (22.8% of this group) and 2 subjects belonged to the non-OM-prone children (4.6% of this group). During the late post-operative period 28 of the OM-prone children (40%) and 4 of the non-OM-prone children (9.3%) developed acute OM in the implanted ear. Eleven (9.7 %) of these cases, (10 belonging to the OM-prone group B (14%), and one belonging to the non-OM-prone group A (2.3%)) proved to be recurrent and therapeutically challenging. Three subjects developed acute mastoiditis without intracranial complications. Each episode of mastoiditis or otitis media was controlled conservatively without any need of surgical drainage of the mastoid. This group of challenging cases did not differ from the OM-prone children who did not prove to be OM-challenging post-CI in regards to age at referral, age at CI and average number of ventilation tube (VT) operations prior to CI. Most pathogen isolations (65%) from OM or from VT drainage developed after CI were typical pathogens for acute otitis media (AOM). However, the percentage of non-typical AOM pathogen isolation increased with time after CI.
Early referral led to early implantation, even in children susceptible to OM. The incidence of OM decreased after implantation in both groups, but was still significantly higher in the OM-prone group. Meanwhile, prior to CI it is not possible to predict the cases that become therapeutically challenging at a later stage.
儿童接受人工耳蜗植入（CI）的年龄通常与中耳炎（OM）患病率最高的年龄相符。中耳感染出现问题以及中耳感染沿电极阵列扩散至耳蜗和中枢神经系统的风险相对较高。因此，有必要制定一个切实可行的方案，以控制年轻人工耳蜗植入候选者在植入前和植入后的中耳炎。
评估根据旨在控制植入前中耳炎的结构化方案进行治疗的易患中耳炎（OM）和不易患中耳炎的儿童人工耳蜗植入后发生中耳炎的风险。
在研究期间转诊接受人工耳蜗植入且年龄在7岁以下的113名儿童中，70名被归类为易患中耳炎组（A组），43名被归类为不易患中耳炎组（B组）。A组患者按照旨在控制植入前中耳炎的结构化方案进行管理。植入后的随访时间为6至75个月（平均35.5个月）。
在易患中耳炎的儿童组中，转诊时和植入时的平均年龄显著更低，转诊与植入之间的平均间隔显著更长，高于健康组。植入后的第一个月，18名儿童患急性中耳炎，其中绝大多数（16名）属于易患中耳炎儿童（占该组的22.8%），2名属于不易患中耳炎儿童（占该组的4.6%）。在术后后期，28名易患中耳炎儿童（40%）和4名不易患中耳炎儿童（9.3%）在植入耳发生急性中耳炎。其中11例（9.7%）（10例属于易患中耳炎的B组（14%），1例属于不易患中耳炎的A组（2.3%））被证明为复发性且治疗具有挑战性。3名受试者发生急性乳突炎但无颅内并发症。每例乳突炎或中耳炎均通过保守治疗得到控制，无需进行乳突手术引流。这组具有挑战性的病例在转诊年龄、人工耳蜗植入年龄以及人工耳蜗植入前的平均通气管（VT）手术次数方面，与人工耳蜗植入后未被证明具有中耳炎挑战性的易患中耳炎儿童并无差异。人工耳蜗植入后从中耳炎或VT引流中分离出的大多数病原体（65%）是急性中耳炎（AOM）的典型病原体。然而，非典型AOM病原体分离的百分比随人工耳蜗植入后的时间增加。
早期转诊导致早期植入，即使在易患中耳炎的儿童中也是如此。两组植入后中耳炎的发生率均有所下降，但易患中耳炎组仍然显著更高。同时，在人工耳蜗植入前，无法预测后期治疗具有挑战性的病例。
