Infectious complications of pediatric cochlear implants are highly influenced by otitis media.

OBJECTIVE: Determine the incidence of ear infections in cochlear implant patients, evaluate the contribution of otitis media to complications, describe the bacteriology of otitis media in the cochlear implant population, the treatment provided at our center, and the long term outcome. METHODS: Data collected included age at implantation, history of otitis media or ear tubes, etiology of hearing loss, inner ear anatomy, postoperative infections, time to infection, route of antibiotic administration, and interventions for infections. Categories of infection were acute otitis media, otitis media with effusion, tube otorrhea, meningitis, scalp cellulitis, and infection at the implant site. RESULTS: Middle ear infections were diagnosed in 37% of implanted ears. Extension of middle ear infections into the implant site occurred in 2.8% of all implants (n = 16). Of the 16 infected devices, 10 were successfully treated with antibiotic therapy and did not require explantation. The retained implant group and explanted group both included some middle ear microbes such as Haemophilus influenzae and Streptococcus pneumoniae, as well as skin flora such as Staphylococcus aureus. CONCLUSION: Otitis media in pediatric cochlear implant patients is a common event and usually does not lead to complications of the cochlear implant. However, when the ear infection spreads to the scalp and the implant site, it is still possible to eliminate the infection using antibiotic therapy, particularly when treatment is directed to the specific organism that is recovered from the infected space and the duration and route of antibiotic treatment is carefully considered.

Iatrogenic esophageal perforation in patients with head and neck cancer: evaluation of the SEER-Medicare database.

OBJECTIVE: 1) Determine rate of iatrogenic esophageal perforation in head and neck cancer patients. 2) Identify risk factors for perforation. 3) Determine effect of perforation on mortality. STUDY DESIGN: Secondary data analysis. SETTING: Surveillance, Epidemiology, and End Results-Medicare-linked database. SUBJECTS AND METHODS: Patients diagnosed with squamous cell carcinoma of the upper aerodigestive tract between January 1995 and December 2002 who underwent esophagoscopy were included. Primary outcome was the rate of iatrogenic esophageal perforation. Secondary outcomes included identification of risk factors for perforation and effect of perforation on mortality. Logistic regression analysis and the chi(2) test were used to evaluate risk factors and 30-day mortality. RESULTS: There were 152 perforations in 126 patients, for a rate of 2.70 percent (95% confidence interval [CI] 2.28-3.20) per patient (n = 4659) and 1.44 percent (1.21-1.67) per esophagoscopy (n = 10,529). Odds of perforation were increased in patients with cancer of the pharynx (odds ratio [OR] 4.49, 1.82-11.08), pyriform sinus (OR 5.00, 2.10-11.93), and larynx (OR 3.39, 1.57-7.34), and those who underwent both surgery and radiation (OR 1.75, 11.12-2.74). Each esophagoscopy increased odds of perforation by 22 percent (17-28). Compared with diagnostic esophagoscopy, perforation was 2.9 times (1.77-4.69) more likely when dilatation was performed. Thirty-day postperforation mortality was 7.1 percent, a three percent absolute increase (-1.5 to 7.5) over the postesophagoscopy rate in patients without perforation. CONCLUSION: Head and neck squamous cell carcinoma patients are a high-risk population for iatrogenic pharyngoesophageal perforation. Perforation is related to esophagoscopy frequency and type, tumor location, and use of multimodality therapy.