Is Prophylactic Peri-Operative Antibiotic Indicated in Cochlear Implantation?

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BACKGROUND

Cochlear implants (CI) are neuroprosthetic devices used for sensorineural hearing rehabilitation in pediatric and adult populations. The surgical procedure is well-tolerated, with complication rates around 3%–4%. Despite this success, the sequelae of complications, particularly infections, in CI recipients can be costly both to the patient’s health and the broader healthcare system. As indications for implantation expand, so does the potential for excessive antibiotic use, and with the rise of antibiotic resistance, judicious prescribing of these medications is imperative. There is a lack of consensus regarding the role of prophylactic peri-operative antibiotics in pediatric and adult CI surgery. This review seeks to evaluate the current literature on the efficacy of prophylactic peri-operative antibiotic use after CI surgery.

BEST PRACTICE

The risk of complications after (CI) surgery remains low (3%–4%), but the severity of complications may be influencing prescribing patterns in the peri-operative period, despite a lack of evidence. Available single-center, multicenter, and database studies point to a single intra-operative dose of antibiotics being sufficient in preventing post-operative infection after cochlear implants in both pediatric and adult populations. Unfortunately, these studies are not without their own limitations, including retrospective design, variations in surgeon and institutional practices, and local microbial profiles. Until more definitive evidence can be drawn from a randomized controlled trial, antibiotic prescribing patterns will likely remain provider dependent. The exception may be in children who have a higher incidence of otitis media, which may impact post-CI infection, as indicated by Sayed-Hassan et al. Future directions for this research could include a randomized controlled trial at a single center to better define the role of prophylactic peri-operative antibiotics in CI surgery.