Abstract：
BACKGROUND: Acute mastoiditis (AM) is the most common complication of acute otitis media and primarily affects children under the age of two; current data on its prevalence in paediatric patients with cochlear implant (CI) are still scant. Proper management of AM in CI children is crucial in order to avoid the implications (financial and emotional) of an explant. Aim of this paper is to describe the cases of AM occurred among young patients with CI in follow up at our department, also in order to evaluate its prevalence, potential predisposing factors, clinical course and therapeutic strategies.
METHODS: Retrospective study. Medical records of all paediatric patients with CI, who had at least one year of follow-up, were searched aiming to identify those who developed AM, from January 1st 2002 to January 31st 2022. The following data were collected and analysed: demographic features, implant type and side, interval between CI surgery and AM, treatment, laboratory tests, clinical course, vaccination history, associated diseases.
RESULTS: AM was developed by six (1.3%) of the 439 children with CI (541 implanted ears). In total, 9 episodes (2.05 %) were recorded, as three patients reported two consecutive infections. Average time interval between CI surgery, to the first or only AM diagnosis, was 13.8 months (range 3-30 months). Furthermore, 3/6 of patients had a history of recurrent acute otitis media; 2/6 an autism spectrum disorder, associated to a combined immune deficiency in one case. All patients were hospitalized and promptly treated by intravenous antibiotic therapy; 4/6 also underwent a mastoidectomy. CI was not explanted in any cases of this series.
CONCLUSIONS: Over a 20-year period, AM rate in CI children was 1.3%, which is consistent with the current literature rates of 1-4.7%. All cases were successfully treated, preserving the integrity of the device. In our experience, the early parenteral antibiotic therapy and, when necessary, surgical treatment were adequate to eradicate the infection.
METHODS: Retrospective study. Medical records of all paediatric patients with CI, who had at least one year of follow-up, were searched aiming to identify those who developed AM, from January 1st 2002 to January 31st 2022. The following data were collected and analysed: demographic features, implant type and side, interval between CI surgery and AM, treatment, laboratory tests, clinical course, vaccination history, associated diseases.
RESULTS: AM was developed by six (1.3%) of the 439 children with CI (541 implanted ears). In total, 9 episodes (2.05 %) were recorded, as three patients reported two consecutive infections. Average time interval between CI surgery, to the first or only AM diagnosis, was 13.8 months (range 3-30 months). Furthermore, 3/6 of patients had a history of recurrent acute otitis media; 2/6 an autism spectrum disorder, associated to a combined immune deficiency in one case. All patients were hospitalized and promptly treated by intravenous antibiotic therapy; 4/6 also underwent a mastoidectomy. CI was not explanted in any cases of this series.
CONCLUSIONS: Over a 20-year period, AM rate in CI children was 1.3%, which is consistent with the current literature rates of 1-4.7%. All cases were successfully treated, preserving the integrity of the device. In our experience, the early parenteral antibiotic therapy and, when necessary, surgical treatment were adequate to eradicate the infection.
摘要：
背景：急性乳突炎（AM）是急性中耳炎最常见的并发症，主要影响2岁以下儿童；目前关于其在接受人工耳蜗植入（CI）的儿科患者中患病率的数据仍然很少。正确管理AMinCI儿童对于避免外植体的影响（财务和情感）至关重要。本文的目的是描述在我们部门随访的年轻CI患者中发生的AM病例。为了评估其患病率，潜在的诱发因素，临床过程和治疗策略。
方法：回顾性研究。所有患有CI的儿科患者的医疗记录，这些患者至少有一年的随访，被搜索的目的是识别那些开发AM的人，从2002年1月1日至2022年1月31日。收集并分析了以下数据：人口统计特征，植入物类型和侧面，CI手术和AM之间的间隔，治疗,实验室测试,临床课程，疫苗接种史,相关疾病。
结果：在439名CI患儿（541只植入耳朵）中，有6名（1.3%）患了AM。总的来说,记录了9次(2.05%)，因为三名患者报告了两次连续感染。CI手术之间的平均时间间隔，第一次或唯一的AM诊断，为13.8个月（范围3-30个月）。此外，3/6的患者有复发性急性中耳炎病史；2/6的自闭症谱系障碍，在一个病例中与联合免疫缺陷有关。所有患者均住院并及时接受静脉抗生素治疗；4/6还接受了乳突切除术。在本系列的任何情况下，CI均未移植。
结论：在20年的时间里，CI儿童的AM率为1.3%，这与目前1-4.7%的文献率一致。所有病例均得到成功治疗,保持设备的完整性。根据我们的经验,早期肠胃外抗生素治疗，必要时,手术治疗足以根除感染。
方法：回顾性研究。所有患有CI的儿科患者的医疗记录，这些患者至少有一年的随访，被搜索的目的是识别那些开发AM的人，从2002年1月1日至2022年1月31日。收集并分析了以下数据：人口统计特征，植入物类型和侧面，CI手术和AM之间的间隔，治疗,实验室测试,临床课程，疫苗接种史,相关疾病。
结果：在439名CI患儿（541只植入耳朵）中，有6名（1.3%）患了AM。总的来说,记录了9次(2.05%)，因为三名患者报告了两次连续感染。CI手术之间的平均时间间隔，第一次或唯一的AM诊断，为13.8个月（范围3-30个月）。此外，3/6的患者有复发性急性中耳炎病史；2/6的自闭症谱系障碍，在一个病例中与联合免疫缺陷有关。所有患者均住院并及时接受静脉抗生素治疗；4/6还接受了乳突切除术。在本系列的任何情况下，CI均未移植。
结论：在20年的时间里，CI儿童的AM率为1.3%，这与目前1-4.7%的文献率一致。所有病例均得到成功治疗,保持设备的完整性。根据我们的经验,早期肠胃外抗生素治疗，必要时,手术治疗足以根除感染。
