Management of Acute Otitis Media in Cochlear Implant Recipients: To Tube or Not to Tube?

Background

The optimal age range for cochlear implantation (CI) in prelingually deafened children coincides with the peak incidence of otitis media (OM). It is expected that by age 3 years, half of all children in the general population will have experienced multiple episodes of acute OM (AOM). AOM following CI theoretically portends a high risk of infectious complications. Despite this, the overall risk of infectious sequelae in pediatric CI remains relatively low.

Myringotomy tube (MT) placement is the mainstay of surgical treatment for recurrent AOM or for prolonged middle ear effusion in the pediatric population. However, much like in stapedectomy surgery, a perception exists among some CI surgeons that the middle ear space and ear drum should be intact (and free of any foreign body) at the time of CI, and that an MT should be avoided in the setting of CI so as to prevent any theoretical complication related to the MT specifically.

Therefore, debate remains as to the exact role of MT placement in children undergoing CI. Should best practice dictate a more aggressive approach, placing an MT sooner so as to avoid infectious sequelae of OM, or should an MT be avoided to maintain an intact middle ear space?

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