Postoperative Früh- und Spätkomplikationen bei Kindern und Erwachsenen nach CI-Implantation

Zusammenfassung

Hintergrund: Cochlea-Implantate (CI) haben in den letzten 20 Jahren Einzug in die Regelversorgung sowohl bei congenital gehörlosen Kindern, bei ertaubten Kindern und Erwachsenen erhalten. Der Erfolg des Sprachverstehens bei Erwachsenen ist so ausgezeichnet, dass ein verbessertes Sprachverstehen im Geräusch auch bei einseitig Normalhörenden mit dem CI erreicht wird. Bei früh implantierten Kindern wird eine Hör-Sprachentwicklung erreicht, die der normalhörender Kinder vergleichbar ist. Dennoch ist dieses operative Verfahren, nämlich die Implanta­tion eines Fremdkörpers in einen nicht sterilen Raum, mit Komplikationen verbunden.

Material und Methoden: Die vorliegende Untersuchung dokumentiert die aufgetretenen Komplikationen in einem Patientenkollektiv, implantiert über einen Zeitraum von 21 Jahren. Unterteilt in den Schweregrad der Komplikation nach Behandlungsausmaß (konservativ bis operativ) konnte gezeigt werden, dass die Auftretenswahrscheinlichkeit von schweren perioperativen Komplikationen in der 2. Dekade im Vergleich zur ersten Dekade von 3,92% auf 1,8% gesenkt werden konnte. Auch haben die Hersteller gelernt, sichtbar an der sinkenden Zahl an Implantatdefekten.

Schlussfolgerung: Zusammenfassend konnte aufgezeigt werden, dass die uneingeschränkte nachhaltige postoperative Kontrolle und damit verbundene Modifikation von Therapiekonzepten zu einer Reduktion der Komplikationen ­führte.

Abstract

Complications in Children and Adults with Cochlear Implant

Background: Cochlear Implants (CI) are developed in the last 20 years to a regular therapy in congenital deaf children/newborns and deafened teens and adults. The success of speech understanding with the CI in adults is so extraordinary that meanwhile also unilateral deaf, contralateral normal hearing persons are implanted. In case of early implanted children a nearly normal speech development is possible in most of the cases.

Material und Methods: Nevertheless the surgical procedures is a challenge concerning the potential complications combined with a foreign body, the CI, in a non-steril part of the ear.

Results:This paper reports on the complications in a patients collective, implanted within 21 years. Separated within the severity of the complications and their therapeutic consequences (conservative and surgical) it could be shown that the incidence of severe perioperative complications within the second decade could be reduced from 3.92% (first decade) to 1.8%. Also the companies have learned to construct the products more save.

Conclusion: In summary the reliable and complete postoperative control and the modification of therapy concepts leads to a constant reduction of complications.

Schlüsselwörter

Cochlea-Implantat - Komplikationen - Kinder - Erwachsene - Chirurgie

Key words

Cochlear Implant - adults - children

• Literatur

• 1 Collins MM, Hawthorne MH, el-Hmd K. Cohlear implantation in a district general hospital: problems and complications in the first five years. J Laryngol Otol 1997; 111: 325-332
• 2 Arnoldner C, Baumgartner WD, Gstoetter W, Hamzavi J. Surgical considerations in cochlear implantation in children and adults: a review of 342 cases in Vienna. Acta Otolaryngol 2005; 125: 228-234
• 3 Bhatia K, Gibbin KP, Nikolopoulos TP, O’Donoghue GM. Surgical complications and their management in a series of 300 consecutive pediatric cochlear implantations. Otol Neurotol 2004; 25: 730-739
• 4 Dutt SN, Ray J, Hadjihannas E, Cooper H, Donaldson I, Proops DW. Medical and surgical complications of the second 100 adult cochlear implant patients in Birmingham. J Laryngol Otol 2005; 119: 759-764
• 5 Green KM, Bhatt YM, Saeed SR, Ramsden RT. Complications following adult cochlear implantation: experience in Manchester. J Laryngol Otol 2004; 118: 417-420
• 6 Kandogan T, Levent O, Gurol G. Complications of paediatric cochlear implantation: experience in Izmir. J Laryngol Otol 2005; 119: 606-610
• 7 Kempf HG, Tempel S, Johann K, Lenarz T. Komplikationen der Cochlear Implant-Chirurgie bei Kindern und Erwachsenen. Laryngorhinootologie 1999; 78: 529-537
• 8 Kempf HG, Johann K, Lenarz T. Complications in pediatric cochlear implant surgery. Eur Arch Otorhinolaryngol 1999; 256: 128-132
• 9 Migirov L, Yakirevitch A, Kronenberg J. Surgical and medical complications following cochlear implantation: comparison of two surgical approaches. ORL J Otorhinolaryngol Relat Spec 2006; 68: 213-219
• 10 Migirov L, Taitelbaum-Swead R, Hildesheimer M, Kronenberg J. Revision surgeries in cochlear implant patients: a review of 45 cases. Eur Arch Otorhinolaryngol 2007; 264: 3-7
• 11 Miyamoto RT, Young M, Myres WA, Kessler K, Wolfert K, Kirk KI. Complications of pediatric cochlear implantation. Eur Arch Otorhinolaryngol 1996; 253: 1-4
• 12 Postelmans JT, Cleffken B, Stokroos RJ. Post-operative complications of cochlear implantation in adults and children: five years’ experience in Maastricht. J Laryngol Otol 2007; 121: 318-323
• 13 Webb RL, Lehnhardt E, Clark GM, Laszig R, Pyman BC, Franz BK. Surgical complications with the cochlear multiple-channel intracochlear implant: experience at Hannover and Melbourne. Ann Otol Rhinol Laryngol 1991; 100: 136
• 14 Cohen NL, Hoffman RA, Stroschein M. Medical or surgical complications related to the Nuclus multichannel cochlear implant. Ann Otol Rhinol Laryngol Suppl 1988; 135: 8-13
• 15 Kim CS, Oh HS, Chang SO, Kim HM, Hur DG. Management of complications in cochlear implantation. Acta Otolaryngol 2008; 128: 408-414
• 16 Lin YS, Lee FP, Peng SC. Complications in children with long-term cochlear implants. ORL J Otorhinolaryngol Relat Spec 2006; 68: 237-242
• 17 Hoffman RA, Cohen NL. Complications of cochlear implant surgery. Ann Otol Rhinol Laryngol Suppl 1995; 166: 420-422
• 18 Telian SA, El-Kashlan HK, Arts HA. Minimizing wound complications in cochlear implant surgery. Am J Otol 1999; 20: 331-334
• 19 Gibson W, Harrison HC, Prowse C. A new incision for placement of cochlear implants. J Laryngol Otol 1995; 109: 821-825
• 20 Ray J, Gibson W, Sanli H. Surgical complications of 844 consecutive cochlear implantations and observations on large versus small incisions. Cochlear Implants Int 2004; 5: 87-95
• 21 Cunningham 3rd CD, Slaterry 3rd WH, Luxford WM. Postoperative infection in cochlear implant patients. Otolaryngol Head Neck Surg 2004; 131: 109-114
• 22 Hopfenspirger MT, Levine SC, Rimell FL. Infectious Complications in Pediatric Cochlear Implants. Laryngoscope 2007; 117: 1825-1829
• 23 Revai K, Dobbs LA, Nair S, Patel JA, Grady JJ, Chonmaitree T. Incidence of acute otitis media and sinusitis complicating upper respiratory tract infection: the effect of age. Pediatrics 2007; 119: 1408-1412
• 24 Luntz M, Hodges AV, Balkany T, Dolan-Ash S, Schloffman J. Otits media in children with cochlear implants. Laryngoscope 1996; 106: 1403-1405
• 25 Dahm MC, Clark GM, Franz BK, Shepherd RK, Burton MJ, Robins-Browne R. Cochlear implantation in children: labyrinthitis following pneumococcal otitis media in unimplanted and implanted cat cochleas. Acta Otolaryngol 1994; 114: 620-625
• 26 Reefhuis J, Honein MA, Whitney CG, Chamany S, Mann EA, Biernath KR, Broder K, Manning S, Avashia S, Victor M, Costa P, Devine O, Graham A, Boyle C. Risk of bacterial meningitis in children with cochlear implant. N Engl J Med 2003; 349: 435-445
• 27 Cohen NL, Roland Jr JT, Marrinan M. Meningitis in cochlear implant recipients: the North American experience. Otol Neurotol 2004; 25: 275-281
• 28 Wei BP, Shepherd RK, Robins-Browne R, Clark GM, O’Leary SJ. Threshold shift: effects of cochlear implantation on the risk of pneumococcal meningitis. Otolaryngol Head Neck Surg 2007; 136: 589-596
• 29 Arnold W, Bredberg G, Gstoetter W, Helms J, Hildmann H, Kiratzidis T, Muller J, Ramsden RT, Roland P, Walterspiel JN. Meningitis following cochlear implantation: pathomechanisms, clinical symptoms, conservative and surgical treatments. ORL J Otorhinolaryngol Relat Spec 2002; 64: 382-389
• 30 Hey C, Rose M, Kujumdshiev S, Gstoetter W, Schubert R, Zielen S. Does the 23-Valent Penumococcal Vaccine protect Cochlear Implant Receipients?. Laryngoscope 2005; 115: 1586-1590
• 31 Muckle RP, Levine SC. Facial nerve stimulation produced by cochlear implants in patients with cochlear otosclerosis. Am J Otolaryngol 1994; 15: 394-398
• 32 Cushing SL, Papsin BC, Gordon KA. Incidence and characteristics of facial nerve stimulation in children with cochlear implants. Laryngoscope 2006; 116: 1787-1791
• 33 Battmer RD, Pesch J, Stover T, Lesinski-Schiedat A, Lenarz M, Lenarz T. Elimination of facial nerve stimulation by reimplantation in cochlear implant subjects. Otol Neurotol 2006; 27: 922
• 34 Luetje CM, Jackson K. Cochlear implants in children: what constitutes a complication?. Otolaryngol Head Neck Surg 1997; 117: 247
• 35 Balkany TJ, Whitley M, Shapira Y, Angeli SI, Brown K, Eter E, Van De Water T, Telischi FF, Eshraghi AA, Treaba C. The temporalis pocket technique for cochlear implantation: an anatomic and clinical study. Otol Neurotol 2009; 30: 903-907
• 36 Guevara N, Sterkers O, Bébéar JP, Meller R, Magnan J, Mosnier I, Amstutz I, Lerosey Y, Triglia JM, Roman S, Gahide I. Multicenter evaluation of the digisonic SP cochlear implant fixation system with titanium screws in 156 patients. Ann Otol Rhinol Laryngol 2010; 119: 501-505