Mastoiditis and acute otitis media in children with cochlear implants: Recommendations for medical management

Acute otitis media (OM) or mastoiditis is a very dangerous condition for th e ear after cochlear implantation. However, acute OM is very common in chil dhood and can occasionally occur in an implanted ear. Most cases of acute O M can be successfully treated with intravenous high-dosage antibiotics. In cases of mastoiditis and clinical signs of mastoid abscess, retroauricular drainage is necessary to prevent infection of the implant bed. In a series of 366 children given implants (1 to 14 years), acute OM occurred in 5.6% d uring a follow-up period of 1 to 8 years. Seven ears had to be opened by me ans of myringotomy. Five ears were opened by retroauricular incision with m astoid revision on the implanted side. Adenoidectomy and use of ventilation tubes before cochlear implantation, as well as careful subtotal mastoidect omy during the implantation, can reduce the incidence of acute OM in childr en after implantation. Early and subsequent treatment with operative mastoi d drainage can prevent implant loss and should be performed at the implanta tion center.