Management of Acute Otitis Media in Cochlear Implant Recipients: To Tube or Not to Tube?

Background

The optimal age range for cochlear implantation (CI) in prelingually deafened children coincides with the peak incidence of otitis media (OM). It is expected that by age 3 years, half of all children in the general population will have experienced multiple episodes of acute OM (AOM). AOM following CI theoretically portends a high risk of infectious complications. Despite this, the overall risk of infectious sequelae in pediatric CI remains relatively low.

Myringotomy tube (MT) placement is the mainstay of surgical treatment for recurrent AOM or for prolonged middle ear effusion in the pediatric population. However, much like in stapedectomy surgery, a perception exists among some CI surgeons that the middle ear space and ear drum should be intact (and free of any foreign body) at the time of CI, and that an MT should be avoided in the setting of CI so as to prevent any theoretical complication related to the MT specifically.

Therefore, debate remains as to the exact role of MT placement in children undergoing CI. Should best practice dictate a more aggressive approach, placing an MT sooner so as to avoid infectious sequelae of OM, or should an MT be avoided to maintain an intact middle ear space?

Best Practice

Although there is a lack of prospective controlled studies analyzing the role and potential complications related to the use of an MT for AOM in pediatric CI, the preponderance of published evidence and policy statements argue in favor of using an MT in acute otitis-prone children undergoing CI. There appears to be little evidence demonstrating an increased rate of infectious complications after CI in children with an MT, and there appears to be a demonstrable level of AOM control with MT use in these children. Further, there are no reported cases of intracranial or device complications related specifically to MT use in CI. The question as to whether MTs should be used in CI candidates with persistent middle ear fluid but without infection remains understudied and unanswered. Based on the published literature, one can reasonably conclude that a history of recent OM in a child younger than 4 years of age should not delay CI. Subsequent episodes of AOM can be managed by conventional therapy, including MT placement if necessary. Read the full article in The Laryngoscope.