0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Original Article |

Medical and Surgical Complications in Pediatric Cochlear Implantation FREE

Natalie Loundon, MD; Marion Blanchard, MD; Gilles Roger, MD; Françoise Denoyelle, MD, PhD; Erea Noël Garabedian, MD
[+] Author Affiliations

Author Affiliations: Service d’Oto-rhino-laryngologie Pédiatrique et de Chirurgie Cervico-faciale, Université Paris VI–Institut National de la Santé et de la Récherche Médicale U587, Hôpital d’Enfants Armand-Trousseau, Paris, France.


Arch Otolaryngol Head Neck Surg. 2010;136(1):12-15. doi:10.1001/archoto.2009.187.
Text Size: A A A
Published online

Objectives  To report complications of cochlear implantation (CI) in children and to analyze risk factors.

Design  Retrospective study from January 1, 1990, through April 30, 2008, with a mean follow-up of 5.5 years (range, 1 month to 17 years).

Setting  Tertiary academic center.

Patients  Four hundred thirty-four patients younger than 16 years. Mean age at CI was 4.7 (range, 0.6-16.0) years. Forty-one children (9.4%) underwent CI when younger than 24 months. Forty-three (9.9%) had inner ear malformations.

Main Outcome Measures  Complications after CI, classified into early (0-8 days) or delayed (>8 days) and major or minor. Spontaneous failures of internal devices were excluded. Correlation to age at CI, local trauma, and inner ear malformations were analyzed using the χ2 test.

Results  Forty-three patients (9.9%) experienced complications. Delayed complications occurred in 28 patients (65.1%), with a mean delay of 2.2 (range, 0.1-8.4) years. Twenty-four patients (5.5%) had major complications, consisting of severe cutaneous infections (15 patients), magnet displacement (3), meningitis (2), cholesteatoma (2), cerebrospinal fluid leak (1), and electrode misplacement (1). Nineteen (4.4%) had minor complications, consisting of vertigo (9 patients), soft-tissue infection (5), persistent otitis media (4), and facial palsy (1). Complications led to reimplantation in 13 of the 43 patients (30.2%). Trauma to the mastoid area (14 patients) and inner ear malformations (51) were highly correlated with major delayed complications (P < .001) and early minor complications (P < .001), respectively. Young age at CI was not correlated with any type of complication.

Conclusions  Complications of CI in children are common, with trauma as a major factor. Inner ear malformations should prompt specific preventive management. Cochlear implantation in young children did not appear to be a risk factor in this study.

The success of cochlear implantation (CI) as an auditory rehabilitative tool requires a thorough knowledge of indications, limitations, and potential risks. Since 1990, the number of pediatric CIs has increased significantly, and more specific pediatric evaluation of the medical and surgical risks can be collected. This study reports on the complications occurring in a pediatric population and analyzes the predisposing risk factors.

PATIENTS

This study included 434 children younger than 16 years who underwent CI from January 1, 1990, through April 30, 2008, in the Ear, Nose, and Throat Department, Hôpital d’Enfants Armand-Trousseau. All of the patients were followed up at least annually, either in our department or through a standardized medical questionnaire administered by a local otolaryngologist. Mean age at CI was 4.7 (range, 0.6-16.0) years. Forty-one children (9.4%) underwent CI when they were younger than 24 months. Forty-three (9.9%) had inner ear malformations (eg, dilation of the vestibular aqueduct, cochlear dysplasia, and various malformations of the semicircular canals). Mean follow-up was 5.5 years (range, 1 month to 17.0 years). Nine patients (2.1%) were lost to follow-up. The complications were categorized as early or late and as major or minor. Early complications occurred within 8 days after CI. A major complication was defined by the need for surgery or the occurrence of any ear-related medical condition requiring a new admission and/or an extended hospital stay.

SURGICAL TECHNIQUE

The surgical procedures were performed by senior surgeons (N.L., G.R., F.D., and E.N.G.) who specialize in this area. Surgical techniques underwent few changes during the study period, with mastoidectomy and posterior tympanotomy allowing access to the promontory. All cochleostomies were accomplished anteriorly and superiorly to the round window. The following aspects of the procedure have been modified, mostly since 2000: a smaller retroauricular incision, without the collection of bone dust; systematic monitoring of the facial nerve; and antibiotic prophylaxis (ie, ceftriaxone sodium therapy for 3 days). The first fitting was programmed postoperatively. The following devices were implanted: Nucleus (Cochlear Limited, Lane Cove, Australia) in 88.7% of patients, Clarion (Advanced Bionics Corporation, Valencia, California) in 5.0% of patients, and Digisonic (Neurelec, Vallauris, France) in 2.7% of patients. Statistical correlation to age at CI, local trauma, and inner ear malformation were studied using the χ2 test.

Overall, complications occurred in 43 patients (9.9%), including major complications in 24 (5.5%) and minor complications in 19 (4.4%). Complications were delayed in 28 of these cases (65.1%). The mean time after surgery before delayed complications was 2.2 (range, 0.1-8.4) years.

MAJOR EARLY POSTOPERATIVE COMPLICATIONS

Three patients had major early postoperative complications. Vestibular misplacement occurred in a 14-year-old girl who presented with a Mondini deformity (Pendred syndrome); a gusher was observed at cochleostomy. Computed tomography revealed the vestibular electrode misplacement, and the patient underwent reimplantation a few days later.

Varicella-zoster virus meningitis occurred 4 days after surgery in a 3-year-old boy with Mondini dysplasia. The varicella-zoster virus was thought to be responsible for the meningitis because the chickenpox skin eruption occurred a few days later. The child recovered completely after medical treatment. No other complication occurred during 4 years of follow-up.

A persistent cerebrospinal fluid leak occurred in a 10-year-old girl with a common cavity malformation; a gusher was observed at cochleostomy. Treatment with intravenous hyperosmolar solution (acetazolamide sodium [Diamox]) achieved resolution in 3 days. No other complication occurred during 10 years of follow-up.

MINOR EARLY POSTOPERATIVE COMPLICATIONS

Minor early postoperative complications occurred in 12 patients. Partial facial nerve palsy was observed in a child aged 14 months, which resolved itself in a few days. The chorda tympani had been injured during the drilling.

When unbalanced walking, nystagmus, or dizziness was observed, vertigo was reported; this occurred in 9 patients. Vestibular function tests were not systematically planned preoperatively and postoperatively until recently. All 9 patients presented with signs of vertigo within the first postoperative days. Three of these had inner ear malformations, representing 3 of 43 (7.0%) in that group. Vertigo rapidly resolved in all cases with medical treatment (ondansetron hydrochloride and acetylleucine).

Two children had hematoma of the scalp that resolved spontaneously within 15 days. In both cases, a large skin flap had been obtained during surgery.

MAJOR LATE POSTOPERATIVE COMPLICATIONS

Major late postoperative complications occurred in 21 patients. Two of these had severe middle ear disease. Both patients developed cholesteatoma and a retraction pocket ipsilateral to the ear undergoing implantation 5 years after surgery (age at CI, 6 and 11 years). The contralateral ear was healthy. In both cases, bone dust had been used to fill in the mastoid cavity. Both patients had received cartilage grafts to reinforce the eardrum. The patient with the cholesteatoma had undergone reimplantation at the same time because of traumatic extrusion of the electrodes.

Severe cutaneous infections or hematoma developed in 15 patients. Cutaneous lesions occurred in 20 patients, and surgery was needed for 15 of these (75%), with reimplantation in 11 patients because of recurrent infectious problems or device failure. Mean delay to initial CI was 28 months (range, 1.5 months to 7 years). Mean age at CI in this group was 4.0 (1.3-9.9) years. One patient had undergone CI before the age of 2 years.

Meningitis occurred in 1 patient (4 years after surgery) during ipsilateral acute middle ear infection at 6 years of age. Culture of the purulent paracentesis and cerebrospinal fluids yielded Streptococcus pneumoniae with intermediate sensitivity to penicillin. The patient's vaccine status was up to date, and there were no identifiable risk factors. Successful outcome was achieved with intravenous combined antibiotic therapy. No further complications were observed during 3 years of follow-up.

Implant magnet migration occurred in 3 patients. The migration was secondary to local trauma in 2 patients and to cerebral magnetic resonance imaging in 1. In the latter case, the implant magnet (Nucleus device) moved despite tight dressing, following the recommendation of the manufacturer.1 One of the 3 children had undergone CI before 2 years of age.

Fifteen children experienced local trauma. For 12 of them (80.0%), this was important trauma to the mastoid area and resulted in a major complication.

MINOR LATE POSTOPERATIVE COMPLICATIONS

Minor late postoperative complications occurred in 7 patients. Four of these consisted of middle ear abnormalities. Two patients had persistent otitis media requiring postoperative grommets after unsuccessful medical treatment. These children had undergone CI at 2.5 and 3.2 years of age and needed the grommets 6 and 12 months later, respectively. The other 2 patients underwent CI at 21 months and 7 years of age and had acute otitis media at 2 and 6 weeks postoperatively, respectively. Medical treatment was successful, with no further complications during follow-up.

Three patients had soft-tissue problems, including hematoma and flap infections. All of these cases resolved with local dressings and antibiotics. These complications occurred during the first 6 months after CI. The ages of these patients at CI were 2.5, 3.5, and 8.0 years.

Literature documenting the surgical outcomes after CI gives complication rates for pediatric and adult populations.210 Some studies focus on particular complications1118 or specific populations, such as very young children.1924 Various classifications have been proposed: early vs late complications (with early meaning 1 week or 3 months2,8) and major vs minor with or without spontaneous implant failure in the complication rate.4,8,25,26 For early complications, we preferred to consider these as occurring during the week after surgery. These criteria were previously proposed by Bhatia et al7 and enabled us to make a distinction in survey and management. The definition of a major complication after this surgical procedure is based on the following medical and surgical criteria: the need for further surgery or reimplantation (excluding a spontaneous implant failure) and the need for hospitalization. We decided not to include spontaneous device failures because they did not depend on surgery or medical treatment.7

The overall complication rate in our series was almost the lowest reported among children, at 2.3% to 8% for major complications and 3.8% to 16% for minor complications.7,18,2729 The long duration of follow-up and the low rate of loss to follow-up are important for assessing rates as precisely as possible. However, we did not have a large series of very young children, which could have modified the rates of some complications such as middle ear abnormalities. Rate variation can be mostly attributed to follow-up duration, methodological differences, and the type of population (eg, very young children). Kandogan et al26 reported a major complication rate of 12.3%, which included spontaneous implant failure and perioperative leakage. In our series, inner ear malformations were frequent, representing about 10% of the overall population. The complication rate was significantly higher than that found in the rest of the population (P = .01) and correlated with major (P = .001) and minor (vertigo) (P < .001) early complications. Inner ear malformations are known to aggravate technical difficulties during surgery, such as persistent cerebrospinal fluid leak, misplacement of the electrode, meningitis, and facial nerve injury.21,30 Hyperosmolar solution has been used systematically for some years, and no major complications have been seen in that time in our population.

Vertigo, although representing two-thirds of minor early complications in our population, still remained infrequent. In children, vestibular dysfunction is clinically underestimated, in particular in our series.31 In the study by Jacot et al,32 ipsilateral postoperative areflexia was observed in 10% of cases, with only 3% reporting clinical signs. Systematic vestibular examination before and after CI would provide a more precise rate, especially in young children.

Middle ear abnormalities, although frequent in young children, did not constitute a significant cause of complications in this series. All of the patients had been treated for ear, nose, and throat infections, and, if needed, grommets were inserted before surgery. Some studies have noted a low rate of middle ear abnormalities after CI, when aggressive preoperative treatment was organized.3336 Also, the percentage of children younger than 2 years was limited in this series, contributing to a lower observed rate. However, chronic middle ear abnormalities can develop over time, as seen in our study, with retraction and cholesteatoma a few years after surgery, highlighting the need for long-term medical follow-up.

Soft-tissue complications were the most frequent problem, contributing to nearly 40% of cases and requiring surgical intervention for more than 70% of cases. Such lesions are theoretically more likely to occur in children, with an increased risk at a younger age. The thinness of the skin and bone sometimes does not allow sufficient impaction and protection of the device, and direct trauma and a tight magnet can lead to injury of the scalp. Despite several surgical procedures (muscle flap or impacted bony site), recurrent infections lead to ipsilateral reimplantation in most cases, without complications. Infectious recurrences were probably related to the biofilm covering of the device.37,38

Local trauma is of major concern in young children.39 The major complication rate of the study shows a significant difference from that found in the general population of those with implants (P < .001). The late meningitis case highlights the need for reiterated, precise information concerning the infectious risks, even in children undergoing CI who have no particular risk factors and have been correctly vaccinated.12,13 More widely, we believe that pediatric teams should plan for the transition from adolescence to adulthood and reiterate information even a few years after surgery so that adults who undergo CI are aware of the required minimal medical follow-up to ensure their safety.

Complications of CI in children are not rare and may be largely delayed. Trauma to the mastoid area was shown to correlate with major delayed complications and inner ear malformations. The finding of complications several years after surgery highlights the need for long-term medical follow-up in this population and the importance of repeatedly providing information to the patients and their family. The specific features of pediatric CI warrant a specialized, experienced care center.

Correspondence: Natalie Loundon, MD, Service d’Oto-rhino-laryngologie Pédiatrique et de Chirurgie Cervico-faciale, Hôpital d’Enfants Armand-Trousseau, 26 Avenue du Dr Arnold Netter, 75012 Paris, France (natalie.loundon@trs.aphp.fr).

Submitted for Publication: April 1, 2009; final revision received July 24, 2009; accepted September 2, 2009.

Author Contributions: Drs Loundon and Blanchard had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Loundon and Denoyelle. Acquisition of data: Loundon and Garabedian. Analysis and interpretation of data: Loundon, Blanchard, and Roger. Drafting of the manuscript: Loundon, Blanchard, Denoyelle, and Garabedian. Critical revision of the manuscript for important intellectual content: Loundon and Roger. Statistical analysis: Loundon and Roger. Administrative, technical, and material support: Loundon and Denoyelle. Study supervision: Loundon.

Financial Disclosure: None reported.

Previous Presentation: This study was presented at the American Society of Pediatric Otolaryngology Annual Meeting; May 23, 2009; Seattle, Washington.

Deneuve  SLoundon  NLeboulanger  NRouillon  IGarabedian  EN Cochlear implant magnet displacement during magnetic resonance imaging. Otol Neurotol 2008;29 (6) 789- 790
PubMed Link to Article
Arnoldner  CBaumgartner  WDGstoettner  WHamzavi  J Surgical considerations in cochlear implantation in children and adults: a review of 342 cases in Vienna. Acta Otolaryngol 2005;125 (3) 228- 234
PubMed Link to Article
Arnold  WBrockmeier  SJ Medical, surgical, and technical complications with the COMBI-40. Am J Otol 1997;18 (6) ((suppl)) S67- S68
PubMed
Stratigouleas  EDPerry  BPKing  SMSyms  CA  III Complication rate of minimally invasive cochlear implantation. Otolaryngol Head Neck Surg 2006;135 (3) 383- 386
PubMed Link to Article
Ramos  ACharlone  Rde Miguel  I  et al.  Complications in cochlear implantation [in Spanish]. Acta Otorrinolaringol Esp 2006;57 (3) 122- 125
PubMed Link to Article
Postelmans  JTCleffken  BStokroos  RJ Post-operative complications of cochlear implantation in adults and children: five years' experience in Maastricht. J Laryngol Otol 2007;121 (4) 318- 323
PubMed Link to Article
Bhatia  KGibbin  KPNikolopoulos  TPO’Donoghue  GM Surgical complications and their management in a series of 300 consecutive pediatric cochlear implantations. Otol Neurotol 2004;25 (5) 730- 739
PubMed Link to Article
Kempf  HGJohann  KLenarz  T Complications in pediatric cochlear implant surgery. Eur Arch Otorhinolaryngol 1999;256 (3) 128- 132
PubMed Link to Article
Johnson  IJGibbin  KPO’Donoghue  GM Surgical aspects of cochlear implantation in young children: a review of 115 cases. Am J Otol 1997;18 (6) ((suppl)) S69- S70
PubMed Link to Article
Francis  HWBuchman  CAVisaya  JM  et al. CDaCI Investigative Team, Surgical factors in pediatric cochlear implantation and their early effects on electrode activation and functional outcomes. Otol Neurotol 2008;29 (4) 502- 508
PubMed Link to Article
Fayad  JNWanna  GBMicheletto  JNParisier  SC Facial nerve paralysis following cochlear implant surgery. Laryngoscope 2003;113 (8) 1344- 1346
PubMed Link to Article
Reefhuis  JHonein  MAWhitney  CG  et al.  Risk of bacterial meningitis in children with cochlear implants. N Engl J Med 2003;349 (5) 435- 445
PubMed Link to Article
Cohen  NLRoland  JT  JrMarrinan  M Meningitis in cochlear implant recipients: the North American experience. Otol Neurotol 2004;25 (3) 275- 281
PubMed Link to Article
Cunningham  CD  IIISlattery  WH  IIILuxford  WM Postoperative infection in cochlear implant patients. Otolaryngol Head Neck Surg 2004;131 (1) 109- 114
PubMed Link to Article
Filipo  RPatrizi  MLa Gamma  RD’Elia  CLa Rosa  GBarbara  M Vestibular impairment and cochlear implantation. Acta Otolaryngol 2006;126 (12) 1266- 1274
PubMed Link to Article
Viccaro  MMancini  PLa Gamma  RDe Seta  ECovelli  EFilipo  R Positional vertigo and cochlear implantation. Otol Neurotol 2007;28 (6) 764- 767
PubMed Link to Article
Yun  JMColburn  MWAntonelli  PJ Cochlear implant magnet displacement with minor head trauma. Otolaryngol Head Neck Surg 2005;133 (2) 275- 277
PubMed Link to Article
Ovesen  TJohansen  LV Post-operative problems and complications in 313 consecutive cochlear implantations. J Laryngol Otol 2009;123 (5) 492- 496
PubMed Link to Article
James  ALPapsin  BC Cochlear implant surgery at 12 months of age or younger. Laryngoscope 2004;114 (12) 2191- 2195
PubMed Link to Article
Colletti  VCarner  MMiorelli  VGuida  MColletti  LFiorino  FG Cochlear implantation at under 12 months: report on 10 patients. Laryngoscope 2005;115 (3) 445- 449
PubMed Link to Article
Hoffman  RADowney  LLWaltzman  SBCohen  NL Cochlear implantation in children with cochlear malformations. Am J Otol 1997;18 (2) 184- 187
PubMed
Sennaroglu  LSarac  SErgin  T Surgical results of cochlear implantation in malformed cochlea. Otol Neurotol 2006;27 (5) 615- 623
PubMed Link to Article
Papsin  BC Cochlear implantation in children with anomalous cochleovestibular anatomy. Laryngoscope 2005;115 (1, pt 2) ((suppl 106)) 1- 26
PubMed Link to Article
Odabasi  OMobley  SRBolanos  RAHodges  ABalkany  T Cochlear implantation in patients with compromised healing. Otolaryngol Head Neck Surg 2000;123 (6) 738- 741
PubMed Link to Article
Ahn  JHChung  JWLee  K-S Complications following cochlear implantation in patients with anomalous inner ears: experiences in Asan Medical Center. Acta Otolaryngol 2008;128 (1) 38- 42
PubMed Link to Article
Kandogan  TLevent  OGurol  G Complications of paediatric cochlear implantation: experience in Izmir. J Laryngol Otol 2005;119 (8) 606- 610
PubMed Link to Article
Hopfenspirger  MTLevine  SCRimell  FL Infectious complications in pediatric cochlear implants. Laryngoscope 2007;117 (10) 1825- 1829
PubMed Link to Article
de Jong  ALNedzelski  JPapsin  BC Surgical outcomes of paediatric cochlear implantation: the Hospital for Sick Children's experience. J Otolaryngol 1998;27 (1) 26- 30
PubMed
Venail  FSicard  MPiron  JP  et al.  Reliability and complications of 500 consecutive cochlear implantations. Arch Otolaryngol Head Neck Surg 2008;134 (12) 1276- 1281
PubMed Link to Article
Loundon  NLeboulanger  NMaillet  J  et al.  Cochlear implant and inner ear malformation proposal for an hyperosmolar therapy at surgery. Int J Pediatr Otorhinolaryngol 2008;72 (4) 541- 547
PubMed Link to Article
Licameli  GZhou  GKenna  MA Disturbance of vestibular function attributable to cochlear implantation in children. Laryngoscope 2009;119 (4) 740- 745
PubMed Link to Article
Jacot  EVan Den Abbeele  TDebre  HRWiener-Vacher  SR Vestibular impairments pre- and post-cochlear implant in children. Int J Pediatr Otorhinolaryngol 2009;73 (2) 209- 217
PubMed Link to Article
Luntz  MTeszler  CBShpak  TFeiglin  HFarah-Sima’an  A Cochlear implantation in healthy and otitis-prone children: a prospective study. Laryngoscope 2001;111 (9) 1614- 1618
PubMed Link to Article
Fayad  JNTabaee  AMicheletto  JNParisier  SC Cochlear implantation in children with otitis media. Laryngoscope 2003;113 (7) 1224- 1227
PubMed Link to Article
Luntz  MTeszler  CBShpak  T Cochlear implantation in children with otitis media: second stage of a long-term prospective study. Int J Pediatr Otorhinolaryngol 2004;68 (3) 273- 280
PubMed Link to Article
Hellingman  CADunnebier  EA Cochlear implantation in patients with acute or chronic middle ear infectious disease: a review of the literature. Eur Arch Otorhinolaryngol 2009;266 (2) 171- 176
PubMed Link to Article
Antonelli  PJLee  JCBurne  RA Bacterial biofilms may contribute to persistent cochlear implant infection. Otol Neurotol 2004;25 (6) 953- 957
PubMed Link to Article
Pawlowski  KSWawro  DRoland  PS Bacterial biofilm formation on a human cochlear implant. Otol Neurotol 2005;26 (5) 972- 975
PubMed Link to Article
Cullen  RDFayad  JNLuxford  WMBuchman  CA Revision cochlear implant surgery in children. Otol Neurotol 2008;29 (2) 214- 220
PubMed Link to Article

Figures

Tables

References

Deneuve  SLoundon  NLeboulanger  NRouillon  IGarabedian  EN Cochlear implant magnet displacement during magnetic resonance imaging. Otol Neurotol 2008;29 (6) 789- 790
PubMed Link to Article
Arnoldner  CBaumgartner  WDGstoettner  WHamzavi  J Surgical considerations in cochlear implantation in children and adults: a review of 342 cases in Vienna. Acta Otolaryngol 2005;125 (3) 228- 234
PubMed Link to Article
Arnold  WBrockmeier  SJ Medical, surgical, and technical complications with the COMBI-40. Am J Otol 1997;18 (6) ((suppl)) S67- S68
PubMed
Stratigouleas  EDPerry  BPKing  SMSyms  CA  III Complication rate of minimally invasive cochlear implantation. Otolaryngol Head Neck Surg 2006;135 (3) 383- 386
PubMed Link to Article
Ramos  ACharlone  Rde Miguel  I  et al.  Complications in cochlear implantation [in Spanish]. Acta Otorrinolaringol Esp 2006;57 (3) 122- 125
PubMed Link to Article
Postelmans  JTCleffken  BStokroos  RJ Post-operative complications of cochlear implantation in adults and children: five years' experience in Maastricht. J Laryngol Otol 2007;121 (4) 318- 323
PubMed Link to Article
Bhatia  KGibbin  KPNikolopoulos  TPO’Donoghue  GM Surgical complications and their management in a series of 300 consecutive pediatric cochlear implantations. Otol Neurotol 2004;25 (5) 730- 739
PubMed Link to Article
Kempf  HGJohann  KLenarz  T Complications in pediatric cochlear implant surgery. Eur Arch Otorhinolaryngol 1999;256 (3) 128- 132
PubMed Link to Article
Johnson  IJGibbin  KPO’Donoghue  GM Surgical aspects of cochlear implantation in young children: a review of 115 cases. Am J Otol 1997;18 (6) ((suppl)) S69- S70
PubMed Link to Article
Francis  HWBuchman  CAVisaya  JM  et al. CDaCI Investigative Team, Surgical factors in pediatric cochlear implantation and their early effects on electrode activation and functional outcomes. Otol Neurotol 2008;29 (4) 502- 508
PubMed Link to Article
Fayad  JNWanna  GBMicheletto  JNParisier  SC Facial nerve paralysis following cochlear implant surgery. Laryngoscope 2003;113 (8) 1344- 1346
PubMed Link to Article
Reefhuis  JHonein  MAWhitney  CG  et al.  Risk of bacterial meningitis in children with cochlear implants. N Engl J Med 2003;349 (5) 435- 445
PubMed Link to Article
Cohen  NLRoland  JT  JrMarrinan  M Meningitis in cochlear implant recipients: the North American experience. Otol Neurotol 2004;25 (3) 275- 281
PubMed Link to Article
Cunningham  CD  IIISlattery  WH  IIILuxford  WM Postoperative infection in cochlear implant patients. Otolaryngol Head Neck Surg 2004;131 (1) 109- 114
PubMed Link to Article
Filipo  RPatrizi  MLa Gamma  RD’Elia  CLa Rosa  GBarbara  M Vestibular impairment and cochlear implantation. Acta Otolaryngol 2006;126 (12) 1266- 1274
PubMed Link to Article
Viccaro  MMancini  PLa Gamma  RDe Seta  ECovelli  EFilipo  R Positional vertigo and cochlear implantation. Otol Neurotol 2007;28 (6) 764- 767
PubMed Link to Article
Yun  JMColburn  MWAntonelli  PJ Cochlear implant magnet displacement with minor head trauma. Otolaryngol Head Neck Surg 2005;133 (2) 275- 277
PubMed Link to Article
Ovesen  TJohansen  LV Post-operative problems and complications in 313 consecutive cochlear implantations. J Laryngol Otol 2009;123 (5) 492- 496
PubMed Link to Article
James  ALPapsin  BC Cochlear implant surgery at 12 months of age or younger. Laryngoscope 2004;114 (12) 2191- 2195
PubMed Link to Article
Colletti  VCarner  MMiorelli  VGuida  MColletti  LFiorino  FG Cochlear implantation at under 12 months: report on 10 patients. Laryngoscope 2005;115 (3) 445- 449
PubMed Link to Article
Hoffman  RADowney  LLWaltzman  SBCohen  NL Cochlear implantation in children with cochlear malformations. Am J Otol 1997;18 (2) 184- 187
PubMed
Sennaroglu  LSarac  SErgin  T Surgical results of cochlear implantation in malformed cochlea. Otol Neurotol 2006;27 (5) 615- 623
PubMed Link to Article
Papsin  BC Cochlear implantation in children with anomalous cochleovestibular anatomy. Laryngoscope 2005;115 (1, pt 2) ((suppl 106)) 1- 26
PubMed Link to Article
Odabasi  OMobley  SRBolanos  RAHodges  ABalkany  T Cochlear implantation in patients with compromised healing. Otolaryngol Head Neck Surg 2000;123 (6) 738- 741
PubMed Link to Article
Ahn  JHChung  JWLee  K-S Complications following cochlear implantation in patients with anomalous inner ears: experiences in Asan Medical Center. Acta Otolaryngol 2008;128 (1) 38- 42
PubMed Link to Article
Kandogan  TLevent  OGurol  G Complications of paediatric cochlear implantation: experience in Izmir. J Laryngol Otol 2005;119 (8) 606- 610
PubMed Link to Article
Hopfenspirger  MTLevine  SCRimell  FL Infectious complications in pediatric cochlear implants. Laryngoscope 2007;117 (10) 1825- 1829
PubMed Link to Article
de Jong  ALNedzelski  JPapsin  BC Surgical outcomes of paediatric cochlear implantation: the Hospital for Sick Children's experience. J Otolaryngol 1998;27 (1) 26- 30
PubMed
Venail  FSicard  MPiron  JP  et al.  Reliability and complications of 500 consecutive cochlear implantations. Arch Otolaryngol Head Neck Surg 2008;134 (12) 1276- 1281
PubMed Link to Article
Loundon  NLeboulanger  NMaillet  J  et al.  Cochlear implant and inner ear malformation proposal for an hyperosmolar therapy at surgery. Int J Pediatr Otorhinolaryngol 2008;72 (4) 541- 547
PubMed Link to Article
Licameli  GZhou  GKenna  MA Disturbance of vestibular function attributable to cochlear implantation in children. Laryngoscope 2009;119 (4) 740- 745
PubMed Link to Article
Jacot  EVan Den Abbeele  TDebre  HRWiener-Vacher  SR Vestibular impairments pre- and post-cochlear implant in children. Int J Pediatr Otorhinolaryngol 2009;73 (2) 209- 217
PubMed Link to Article
Luntz  MTeszler  CBShpak  TFeiglin  HFarah-Sima’an  A Cochlear implantation in healthy and otitis-prone children: a prospective study. Laryngoscope 2001;111 (9) 1614- 1618
PubMed Link to Article
Fayad  JNTabaee  AMicheletto  JNParisier  SC Cochlear implantation in children with otitis media. Laryngoscope 2003;113 (7) 1224- 1227
PubMed Link to Article
Luntz  MTeszler  CBShpak  T Cochlear implantation in children with otitis media: second stage of a long-term prospective study. Int J Pediatr Otorhinolaryngol 2004;68 (3) 273- 280
PubMed Link to Article
Hellingman  CADunnebier  EA Cochlear implantation in patients with acute or chronic middle ear infectious disease: a review of the literature. Eur Arch Otorhinolaryngol 2009;266 (2) 171- 176
PubMed Link to Article
Antonelli  PJLee  JCBurne  RA Bacterial biofilms may contribute to persistent cochlear implant infection. Otol Neurotol 2004;25 (6) 953- 957
PubMed Link to Article
Pawlowski  KSWawro  DRoland  PS Bacterial biofilm formation on a human cochlear implant. Otol Neurotol 2005;26 (5) 972- 975
PubMed Link to Article
Cullen  RDFayad  JNLuxford  WMBuchman  CA Revision cochlear implant surgery in children. Otol Neurotol 2008;29 (2) 214- 220
PubMed Link to Article

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

1,831 Views
30 Citations
×

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
Jobs