Retrospective complication rate comparison between surgical techniques in paediatric cochlear implantation

Abstract

OBJECTIVE: To compare paediatric complication occurrence between the SupraMeatal Approach and the Mastoidectomy with Posterior Tympanotomy Approach for cochlear implantation. DESIGN: Retrospective cohort study. SETTING: Postoperative complications in children younger than 5 years of age, receiving a cochlear implant between 1996 and 2014 at our institution were assessed. PARTICIPANTS: 144 patients receiving a cochlear implant (121 by Mastoidectomy with Posterior Tympanotomy Approach and 23 by SupraMeatal Approach) operated on 165 ears (129 and 39, respectively). MAIN OUTCOME MEASURES: The severity (minor or major) using Hoffman and Cohen criteria and time of occurrence of complications (intraoperative, early postoperative or late postoperatively) were identified. Intraoperative surgical challenges were correlated to complication occurrence. RESULTS: The mean age-at-implantation was 2.13 ± 1.14 years old. Patients operated by the SupraMeatal Approach (1.27 ± 0.69 years old) were significantly (p <.001) younger than those receiving a cochlear implant by Mastoidectomy with Posterior Tympanotomy Approach (2.40 ± 1.12). Most complications were minor (Mastoidectomy with Posterior Tympanotomy Approach: 64.0%; SupraMeatal Approach: 73.1%) and occurred early postoperatively (Mastoidectomy with Posterior Tympanotomy Approach: 61.5%; SupraMeatal Approach: 76.9%). More overall complications occurred in SupraMeatal Approach cases compared to Mastoidectomy with Posterior Tympanotomy Approach cases (61.5% vs. 20.6%; p <.001). Younger SupraMeatal Approach cohort patients (6-12 and 18-24 months; p <.008 and p =.016) most often developed these complications. When looking at specific complications, more infectious complications occurred in patients receiving a cochlear implant through the SupraMeatal Approach (p <.05). Logistic regression showed that the surgical technique and not the age-at-implantation was responsible for the documented complications. No relationship between complications and intraoperative difficulties was identified. CONCLUSION: In our institution, cochlear implantation in young patients through the SupraMeatal Approach resulted in significantly more (infectious) complications than those operated through the Mastoidectomy with Posterior Tympanotomy Approach. Outcomes from our institution recommends using the Mastoidectomy with Posterior Tympanotomy Approach when opting for a cochlear implant surgical technique in young children who are more prone to developing infectious complications. This article is protected by copyright. All rights reserved.