Should ventilation tubes be removed or retained during pediatric cochlear implantation? Study sheds light

The proportion of ears that developed acute otitis media at post-CI six months in the removed and retained groups was determined (primary outcome).

The authors reported the following findings:

· The age at CI was significantly higher in the removed group than in the retained group (mean: the removed group, 2.9 yr; the retained group: 1.5 yr).

· The removed group showed a remarkably higher proportion of ears with post-CI AOM (8 of 39 ears; 20.5%) than the retained group (none of 19 ears; 0%) 6 months after CI.

· The AOM-free proportion at post-CI 12 months was 76.9% in the removed group and 83.3% in the retained group, demonstrating no significant difference, probably because the VT was spontaneously extruded in the retained group at a median of 6.5 months after CI.

· Throughout the study period, 17 ears (13 from the removed group) were affected by post-CI AOM. Of these, three ears in the removed group and two in the retained group after spontaneous extrusion of the VT were hospitalized and treated with intravenous antibiotics for AOM that had failed to respond to oral antibiotic therapy.

· Only one ear in the removed group required an explanation of the infected implant.

· None suffered from chronic tympanic membrane perforation or secondary cholesteatoma after VT insertion or meningitis associated with post-CI AOM.

"Our findings indicate that in cochlear implantation for children who already have a ventilation tube because of a recurrent AOM, or chronic AOM, leaving the tube in position, rather than its removal, may reduce AOM incidence at least within six months after the cochlear implantation, during which most infections from cochlear implant was reported in the pediatric population," the authors concluded.

Reference:

Tobe, Yota∗; Yamazaki, Hiroshi∗†‡§; Shirakawa, Chigusa∥; Shinohara, Shogo∗; Fujiwara, Keizo∗†; Naito, Yasushi∗†. Management of Already Inserted Ventilation Tubes During Pediatric Cochlear Implantation: To Remove or Leave the Tube?. Otology & Neurotology ():10.1097/MAO.0000000000003797, January 5, 2023. | DOI: 10.1097/MAO.0000000000003797