Cochlear implantation in children with otitis media: second stage of a long-term prospective study

Objective: To present the findings of the second stage of an ongoing prospective study of the outcome of 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. Patients and methods: Of 60 children referred for cochlear implantation during the study period, 34 were classified as OM-prone (Group A) and 26 as non-OM-prone (group B). Group A patients were managed according to a structured protocol aimed at pre-implantation control of OM. A ventilating tube (with or without adenoidectomy) was inserted in the affected ear(s) of these children, if necessary more than once. Post-implantation follow-up ranged from 3 to 45 months (average 20 months). Results: 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 implantation, 21 children (19 from the OM-prone group A) had thick middle ear mucosa that had to be removed to allow identification of the round window niche. After implantation, 13 of the OM-prone children (38%) and 2 of the non-OM-prone children (7.6%) developed acute OM in the implanted ear. Five of these cases, all belonging to the OM-prone group, proved to be recurrent and therapeutically challenging, and 2 of them also developed acute mastoiditis. There were no other OM-related complications. Conclusions: Early referral led to early implantation, even in children susceptible to OM. The incidence of OM decreased after implantation, but was still significantly higher in the OM-prone group. On the basis of these results, we recommend the continuous use of a ventilating tube in OM-prone pediatric implantees until they outgrow their susceptibility to OM.