Revision surgeries and medical interventions in young cochlear implant recipients.

OBJECTIVE: To report devices failures and postoperative or medical complications after cochlear implantation in children and to discuss revision surgeries and medical interventions occurring during follow-up. METHODS: In this retrospective study in a tertiary referral pediatric hospital, we included a consecutive sample of children younger than 15 years old who received implants between January 1994 and June 2010. All complications and treatments were systematically reviewed. RESULTS: One hundred and forty children were included in this study. Four children received bilateral cochlear implantation. Mean age at implantation was 43.6 months (age ranged from 11 months to 15 years). Overall, 74 children were boys (52.1%) and 35 children (25%) received implants before the age of two. Inner ear malformations were found in 19 children (13.5%), while 18 children (12.9%) experienced complications: cochlear reimplantations (n=8), other revision surgeries (n=3) and medical treatment (n=7). Excluding device failures, 13 children (9.2%) experienced complications. Postoperative infection was the principal cause of these complications (10 cases). Four children younger than 2 years at implantation suffered complication postoperatively. In these children, there was no statistically significant increase in complications compared to older children (P>0.05). Complete electrode insertion was achieved in 7 of the 8 reimplanted children. CONCLUSION: Cochlear implantation could be considered a safe and reliable rehabilitation for deafened young children. Reimplantation was feasible and complete electrode insertion was achievable. Long-term follow up was mandatory to minimize and control surgical complication.

Conservative management of acute mastoiditis in children.

OBJECTIVE: To determine whether treatment of acute mastoiditis in children using antibiotics combined with retroauricular puncture and grommet insertion is effective compared with "standard management" with mastoidectomy. DESIGN: Retrospective study. SETTING: Tertiary pediatric center. PATIENTS: We identified 50 patients younger than 14 years with acute mastoiditis (mean age, 32 months). Individuals with subacute mastoiditis and cholesteatoma were excluded from this study. All the children had received antibiotic drug treatment. Before 2002, a subperiosteal abscess (SA) was managed by mastoidectomy. Beginning in 2002, however, conservative management was initially attempted to avoid mastoidectomy. MAIN OUTCOME MEASURE: The proportion of cured children after conservative management of SA in acute mastoiditis. RESULTS: Acute mastoiditis occurred in 30 patients already treated with antibiotics before hospital admission. On examination, 1 child had facial palsy. All the patients except 1 (who had temporozygomatic swelling) had postauricular swelling. Myringotomy or retroauricular puncture isolated bacteria in 38 patients. Streptococcus pneumoniae was identified in 28 patients. Computed tomography (43 patients) diagnosed 31 SAs, including 3 cases of sigmoid sinus thrombosis and 1 subdural abscess. All the children were cured without complications regardless of the type of treatment. Comparing the periods before and after 2002, the number of SAs was similar (15 and 16, respectively), but the number of mastoidectomies was reduced (16 and 1, respectively). The hospital length of stay of patients who underwent aspiration was shorter than that of patients who underwent cortical mastoidectomy. CONCLUSION: Antibiotic drug use combined with retroauricular puncture and grommet insertion is an effective alternative to mastoidectomy in the treatment of acute mastoiditis with SA in children.

Three-dimensional modeling of the temporal bone for surgical training.

INTRODUCTION: The anatomy of the temporal bone (TB) can only be mastered by repeated surgical and anatomic dissections, and surgical teaching initiative had a major effect on outcomes. The aim of this study was to investigate the validity of an artificial TB model devoted to surgical training and education. MATERIALS AND METHODS: A helical computed tomographic (CT) scan was used to acquire high-resolution data of cadaveric TB. Digital imaging and communications in medicine (DICOM) data were converted into.stl files after data processing. Cadaveric TBs were prototyped using stereolithography. The validation of the prototype needed several steps. First of all, we have studied on CT scan the positional relationship between the facial nerve and other structures of the cadaveric TBs and prototyped bones. Otoendoscopy of the middle ear and the internal acoustic canal and visualization of anatomic landmarks during TB drilling of the cadaveric TBs and prototyped bones were also performed. RESULTS: Seven normal CT scans of cadaveric TB were selected to make prototyped bone using stereolithography. Measurements of volume and distance showed no significant difference between prototypes and cadaver TBs. Classic mastoid surgical procedures were performed in the Anatomy Department: exposing sigmoid sinus, facial nerve, labyrinth, dura mater, jugular bulb, and internal carotid artery. Two simulations of implantable middle ear prosthesis were made successfully. CONCLUSION: These prototypes made using stereolithography seem to be a good anatomic model for surgical training. This model could also be interesting for surgical planning in congenital ear anomalies before middle ear prosthesis implantation.