Heather Osborn - Academia.edu (original) (raw)
Papers by Heather Osborn
Objective To identify which factors influence medical students' decision to choose a career ... more Objective To identify which factors influence medical students' decision to choose a career in family medicine and pediatrics, and which factors influence their decision to choose careers in non-front-line specialties. Design Survey that was created based on a comprehensive literature review to determine which factors are considered important when choosing practice specialty. Setting Ontario medical school. Participants An open cohort of medical students in the graduating classes of 2008 to 2011 (inclusive). Main outcome measures The main factors that influenced participants' decision to choose a career in primary care or pediatrics, and the main factors that influenced participants' decision to choose a career in a non-frontline specialty. Results A total of 323 participants were included in this study. Factors that significantly influenced participants' career choice in family medicine or pediatrics involved work-life balance (acceptable hours of practice [P = ...
Cureus, 2019
Background and Objectives Lymph node metastases (LNM) in soft tissue sarcoma (STS) of the trunk a... more Background and Objectives Lymph node metastases (LNM) in soft tissue sarcoma (STS) of the trunk and extremity are rare but are associated with worse survival. Established risk factors for LNM in this group are based on small institutional retrospective reviews. This study identifies the risk factors associated with LNM in otherwise non-metastatic trunk/extremity STS patients using the National Cancer Database (NCDB) and sought out to delineate a high-risk group that may be considered for pathologic nodal evaluation. Methods Open Access Original Article
Head & Neck, 2019
Background: A reliable method of measuring functional outcomes is essential to inform treatment d... more Background: A reliable method of measuring functional outcomes is essential to inform treatment decisions in head and neck cancer. Methods: Members of the American Head and Neck Society were surveyed regarding their use of functional outcome assessment tools. Qualitative statistical analysis was performed to identify major tools used and to clarify obstacles to functional outcome assessment. A comprehensive literature review was performed to identify available tools. Results: A total of 142 surgeons were surveyed. 44.12% of respondents use at least 1 tool to assess functional outcomes. The most frequently used tools were modified barium swallow, MD Anderson Dysphagia Inventory, and functional endoscopic evaluation of swallow (FEES). 72.65% of respondents reported barriers to assessment, most frequently a lack of support to administer the tests or to collect, apply or analyze the results. Review of the literature revealed 173 available tools. Conclusions: Although a wide variety of validated tools are available in the literature to assess functional outcomes after head and neck surgery, major obstacles to their use persist. The lack of a standard measure that is practical and transferable continues to impair research progression in this field.
International Journal of Pediatric Otorhinolaryngology, 2017
The Laryngoscope, 2017
Objectives: Unplanned 30-day readmission rate following hospital discharge is an important metric... more Objectives: Unplanned 30-day readmission rate following hospital discharge is an important metric of healthcare quality. This study sought to characterize the rate, risk factors, and common causes of readmission in head and neck cancer patients following free or pedicled flap reconstruction. Study Design: Retrospective cohort study. Methods: Charts were reviewed of all patients who underwent free or pedicled flap reconstruction following resection of head and neck cancer at the Massachusetts Eye and Ear Infirmary 2009 to 2014. Readmission risk factors were evaluated by univariate and multivariate analysis. Results: Of 682 patients with free (76%) or pedicled flap reconstruction, 135 patients (19.8%) were readmitted. Factors not associated with readmission included age, gender, American Society of Anesthesiologists status, operative time, prior radiation therapy, primary cancer site, and free (vs. pedicled) flap type. Significant readmission risk factors included surgical site infections (SSI) (45.2% vs. 9.9%), use of hardware (18.5% vs. 11.3%), and clean-contaminated or contaminated surgery (15.2% vs. clean 8.2%). Surgical site infections (P < 0.001) and use of hardware (P 5 0.03) remained predictive of readmission on multiple regression analysis. Primary reasons for readmission included wound complications (61.5%) and supportive care (15.6%). The median time to readmission was 8 days, and 41% of readmissions occurred within 1 week. Seventy percent of readmissions occurred within 2 weeks, including 77% of readmissions for SSIs and 86% for supportive care. Conclusion: Readmissions occurred in nearly one-fifth of patients following flap surgery. SSIs and use of hardware were risk factors, whereas wound complications were the most common cause of readmission.
Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale
Objective:To compare the laryngeal preservation rates and voice outcomes after treatment of early... more Objective:To compare the laryngeal preservation rates and voice outcomes after treatment of early glottic cancer between transoral laser microsurgery (TLM) and radiotherapy (RT).Design:Multicenter, retrospective consecutive cohort of stage 1 and 2 glottic carcinoma treated with TLM or RT.Setting:Three Canadian academic cancer centres.Methods and Main Outcome Measures:The patients were those of the regional cancer registries associated with each of the participating universities between 2002 and 2010. The primary oncologic end point was organ preservation. The primary functional outcome measure was the Voice Handicap Index (VHI-10).Results:A total of 234 patients were treated for early glottic cancer (143 TLM, 91 RT). At 2 years, the laryngeal preservation rate for stage 1 disease was 100% TLM and 92% RT (p < .004); for stage 2 disease, it was 100% TLM and 88% RT (p = not significant). There was only one laryngectomy in the TLM group over 5 years posttreatment. There were function...
Otology & Neurotology, 2015
Microscopic techniques are an essential part of otolaryngologic practice. These procedures demand... more Microscopic techniques are an essential part of otolaryngologic practice. These procedures demand advanced psychomotor and visuospatial skills, and trainees possess these abilities to varying degrees. No method currently exists to predict who will possess an aptitude for microscopic surgery. Our goal was to determine whether performance can be predicted by background experiences or skills. Retrospective cohort study. Tertiary academic hospital. Students with no previous surgical experience. Subjects were surveyed on a wide range characteristics thought to affect surgical aptitude, with a primary focus on video gaming and musical training. Subjects performed a microsurgical task using a novel simulator and their performance was assessed by blinded investigators. Forty-six students were assessed. There was no correlation between video gaming and improved microsurgical performance. Rather, video gamers obtained worse scores, although this difference did not reach significance. The majority of students played a musical instrument. Within this group, musicians who began playing at younger ages obtained higher scores, with the highest scores obtained by musicians who began playing before age 6. However, musicians did not obtain higher scores than non-musicians, regardless of their age of initiation. No improvement in microsurgical aptitude was seen in subjects who had a history of video gaming or musical instrument playing.
Otolaryngology–Head and Neck Surgery, 2012
Objective Patients considering surgery face many uncertainties and concerns. This investigation s... more Objective Patients considering surgery face many uncertainties and concerns. This investigation sought to develop an objective assessment tool for characterizing the areas of greatest concern among those considering thyroidectomy. Study Design Prospective cohort design. Setting Tertiary-care otolaryngology practice. Subjects Participants included individuals presenting with a thyroid nodule found to be of intermediate risk (15%-20%) of cancer based on fine-needle aspiration (FNA) biopsy and amendable to hemithyroidectomy. Methods As part of validating a clinical measure concerning perioperative concerns, patients presenting with thyroid nodules amendable to hemithyroidectomy were voluntarily recruited. Thirty individuals (6 men, 24 women) completed a novel 18-item questionnaire during their initial clinical visit and again 3 days later. Outcome measures included descriptive statistics and test-retest reliability. Results Individual patients have both general and specific preoperativ...
The Journal of Laryngology & Otology, 2011
Background:Cochlear implantation has been used to rehabilitate profoundly deafened adults for mor... more Background:Cochlear implantation has been used to rehabilitate profoundly deafened adults for more than 25 years. However, surgical labyrinthectomy is often considered a contraindication to cochlear implantation, especially if there is a significant delay between the two procedures. As the role of cochlear implantation continues to expand, this idea requires reconsideration.Case report:A 59-year-old woman presented to our clinic after undergoing bilateral surgical labyrinthectomies for intractable Ménière's disease 21 years prior. Despite the significant time delay, she underwent cochlear implantation with a good audiological outcome and improved quality of life.Conclusion:Changes to the cochlea and vestibule following surgical labyrinthectomy include cochlear ossification and obliteration of the vestibule. These issues have been thought to limit the potential for cochlear implantation, especially when there is a significant delay between the two procedures. However, delayed coc...
The Journal of Laryngology & Otology, 2011
Objective:To present a case of extraskeletal Ewing's sarcoma originating in the masseter musc... more Objective:To present a case of extraskeletal Ewing's sarcoma originating in the masseter muscle, and to review the diagnosis and management of these rare tumours.Methods:Case report and literature review.Results:We report a patient with Ewing's sarcoma of the masseter muscle with mandibular invasion. She was treated with induction chemotherapy, salvage surgery and free flap reconstruction.Conclusion:This case highlights the management of these rare tumours. Aggressive multi-modal treatment, including multi-agent chemotherapy, surgical resection and irradiation, appears to offer the best prognosis. Contemporary reconstructive techniques can restore function and form in cases with challenging defects.
JAMA, 2013
A 15-YEAR-OLD PREVIOUSLY HEALTHY MALE PRESENTS TO THE EMERGENCY DEpartment with acute onset of se... more A 15-YEAR-OLD PREVIOUSLY HEALTHY MALE PRESENTS TO THE EMERGENCY DEpartment with acute onset of severe pleuritic retrosternal and epigastric pain after swallowing a mouthful of cold soda. He has no previous surgeries or major illnesses, no history of trauma, and no recent emesis. Following the onset of pain he waited several hours and ate 4 chili dogs before presenting to the emergency department. Findings from a general physical examination revealed a healthy, well-appearing young man with mild epigastric tenderness but an otherwise benign abdomen and stable vital signs. A lateral chest radiograph (FIGURE, A) revealed a small amount of pneumomediastinum, and a soft tissue lateral neck radiograph revealed retropharyngeal and paratracheal air. Radiography was followed by performance of a computed tomography scan in the emergency department (Figure, B). What Would You Do Next?
Joseph Babinski is famous for his 1896 description of the Babinski sign, an abnormal plantar refl... more Joseph Babinski is famous for his 1896 description of the Babinski sign, an abnormal plantar reflex associated with dysfunction of the pyramidal system. He is less well-known for his “other” Babinski sign: paradoxical raising of the eyebrow associated with closure of the eye, a feature typical of hemifacial spasm. As Babinksi noted in 1905, hemifacial spasm (HFS) is a disorder of painless, involuntary facial twitches confined to the muscles supplied by the facial nerve. While benign, it causes significant morbidity due to excessive closure of one eye, and the social effects of an abnormal appearance. Unfortunately, facial twitches are often attributed to stress or anxiety, leading to a delay in diagnosis. A vigilant search for organic causes is essential when these symptoms arise, as highly efficacious treatment options for HFS are available and can significantly improve quality of life. HFS occurs more commonly in females (2:1) and has an overall prevalence of approximately 10/100,...
Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale, 2011
Radiation therapy (RT) and transoral laser microsurgery (TLM) are established treatments for earl... more Radiation therapy (RT) and transoral laser microsurgery (TLM) are established treatments for early glottic squamous cell carcinoma (SCC). Similar oncologic outcomes have been reported with both modalities, leading physicians to consider other factors when making clinical recommendations. One such factor is voice-related quality of life. This investigation sought to characterize differences in self-reported voice outcomes in patients undergoing RT or TLM for the treatment of Tis or T1a glottic SCC. A retrospective cohort study was conducted of all individuals who received either RT or TLM for the treatment of Tis or T1a glottic SCC between 2004 and 2009 at the London Regional Cancer Program. The primary outcome measure was voice-related quality of life, as assessed by the Voice-Related Quality of Life questionnaire (V-RQOL). Secondary outcomes included local control, overall survival, and laryngectomy-free survival. Fifty-seven patients were eligible for this study; 34 received RT an...
Cochlear Implants International, 2013
Early treatment of profound bilateral sensorineural hearing loss with cochlear implantation has b... more Early treatment of profound bilateral sensorineural hearing loss with cochlear implantation has become routine, resulting in an increased proportion of children implanted at younger ages. These children are at a relatively high risk for acute otitis media (AOM), and are more likely to develop mastoiditis in the implanted ear. Despite the significant risks associated with mastoiditis, including compromise of the implant, there are no specific guidelines on the management of this population. We propose a treatment algorithm emphasizing early but conservative operative intervention. A retrospective chart review included eight patients, who experienced mastoiditis, in the context of cochlear implantation at our center from August 2005 to November 2012. During this period 806 implant surgeries were completed. The median age at which mastoiditis occurred was 37 months, and the mean time from implantation to mastoiditis was 9.56 months. All patients underwent drainage of the middle ear in conjunction with intravenous antibiotics, and two additionally underwent post-auricular incision and drainage. Recent mastoidectomy may be a risk factor for the development of a post-auricular abscess in children, who develop AOM following cochlear implantation. A treatment algorithm was developed, which emphasizes early operative drainage in conjunction with aggressive antibiotic therapy. Conclusions A consistent approach to the management of mastoiditis in children with cochlear implants has not been established. Rapid initiation of aggressive antibiotic therapy and a low threshold for conservative operative intervention results in effective resolution of infection while allowing preservation of the implant.
Objective To identify which factors influence medical students' decision to choose a career ... more Objective To identify which factors influence medical students' decision to choose a career in family medicine and pediatrics, and which factors influence their decision to choose careers in non-front-line specialties. Design Survey that was created based on a comprehensive literature review to determine which factors are considered important when choosing practice specialty. Setting Ontario medical school. Participants An open cohort of medical students in the graduating classes of 2008 to 2011 (inclusive). Main outcome measures The main factors that influenced participants' decision to choose a career in primary care or pediatrics, and the main factors that influenced participants' decision to choose a career in a non-frontline specialty. Results A total of 323 participants were included in this study. Factors that significantly influenced participants' career choice in family medicine or pediatrics involved work-life balance (acceptable hours of practice [P = ...
Cureus, 2019
Background and Objectives Lymph node metastases (LNM) in soft tissue sarcoma (STS) of the trunk a... more Background and Objectives Lymph node metastases (LNM) in soft tissue sarcoma (STS) of the trunk and extremity are rare but are associated with worse survival. Established risk factors for LNM in this group are based on small institutional retrospective reviews. This study identifies the risk factors associated with LNM in otherwise non-metastatic trunk/extremity STS patients using the National Cancer Database (NCDB) and sought out to delineate a high-risk group that may be considered for pathologic nodal evaluation. Methods Open Access Original Article
Head & Neck, 2019
Background: A reliable method of measuring functional outcomes is essential to inform treatment d... more Background: A reliable method of measuring functional outcomes is essential to inform treatment decisions in head and neck cancer. Methods: Members of the American Head and Neck Society were surveyed regarding their use of functional outcome assessment tools. Qualitative statistical analysis was performed to identify major tools used and to clarify obstacles to functional outcome assessment. A comprehensive literature review was performed to identify available tools. Results: A total of 142 surgeons were surveyed. 44.12% of respondents use at least 1 tool to assess functional outcomes. The most frequently used tools were modified barium swallow, MD Anderson Dysphagia Inventory, and functional endoscopic evaluation of swallow (FEES). 72.65% of respondents reported barriers to assessment, most frequently a lack of support to administer the tests or to collect, apply or analyze the results. Review of the literature revealed 173 available tools. Conclusions: Although a wide variety of validated tools are available in the literature to assess functional outcomes after head and neck surgery, major obstacles to their use persist. The lack of a standard measure that is practical and transferable continues to impair research progression in this field.
International Journal of Pediatric Otorhinolaryngology, 2017
The Laryngoscope, 2017
Objectives: Unplanned 30-day readmission rate following hospital discharge is an important metric... more Objectives: Unplanned 30-day readmission rate following hospital discharge is an important metric of healthcare quality. This study sought to characterize the rate, risk factors, and common causes of readmission in head and neck cancer patients following free or pedicled flap reconstruction. Study Design: Retrospective cohort study. Methods: Charts were reviewed of all patients who underwent free or pedicled flap reconstruction following resection of head and neck cancer at the Massachusetts Eye and Ear Infirmary 2009 to 2014. Readmission risk factors were evaluated by univariate and multivariate analysis. Results: Of 682 patients with free (76%) or pedicled flap reconstruction, 135 patients (19.8%) were readmitted. Factors not associated with readmission included age, gender, American Society of Anesthesiologists status, operative time, prior radiation therapy, primary cancer site, and free (vs. pedicled) flap type. Significant readmission risk factors included surgical site infections (SSI) (45.2% vs. 9.9%), use of hardware (18.5% vs. 11.3%), and clean-contaminated or contaminated surgery (15.2% vs. clean 8.2%). Surgical site infections (P < 0.001) and use of hardware (P 5 0.03) remained predictive of readmission on multiple regression analysis. Primary reasons for readmission included wound complications (61.5%) and supportive care (15.6%). The median time to readmission was 8 days, and 41% of readmissions occurred within 1 week. Seventy percent of readmissions occurred within 2 weeks, including 77% of readmissions for SSIs and 86% for supportive care. Conclusion: Readmissions occurred in nearly one-fifth of patients following flap surgery. SSIs and use of hardware were risk factors, whereas wound complications were the most common cause of readmission.
Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale
Objective:To compare the laryngeal preservation rates and voice outcomes after treatment of early... more Objective:To compare the laryngeal preservation rates and voice outcomes after treatment of early glottic cancer between transoral laser microsurgery (TLM) and radiotherapy (RT).Design:Multicenter, retrospective consecutive cohort of stage 1 and 2 glottic carcinoma treated with TLM or RT.Setting:Three Canadian academic cancer centres.Methods and Main Outcome Measures:The patients were those of the regional cancer registries associated with each of the participating universities between 2002 and 2010. The primary oncologic end point was organ preservation. The primary functional outcome measure was the Voice Handicap Index (VHI-10).Results:A total of 234 patients were treated for early glottic cancer (143 TLM, 91 RT). At 2 years, the laryngeal preservation rate for stage 1 disease was 100% TLM and 92% RT (p < .004); for stage 2 disease, it was 100% TLM and 88% RT (p = not significant). There was only one laryngectomy in the TLM group over 5 years posttreatment. There were function...
Otology & Neurotology, 2015
Microscopic techniques are an essential part of otolaryngologic practice. These procedures demand... more Microscopic techniques are an essential part of otolaryngologic practice. These procedures demand advanced psychomotor and visuospatial skills, and trainees possess these abilities to varying degrees. No method currently exists to predict who will possess an aptitude for microscopic surgery. Our goal was to determine whether performance can be predicted by background experiences or skills. Retrospective cohort study. Tertiary academic hospital. Students with no previous surgical experience. Subjects were surveyed on a wide range characteristics thought to affect surgical aptitude, with a primary focus on video gaming and musical training. Subjects performed a microsurgical task using a novel simulator and their performance was assessed by blinded investigators. Forty-six students were assessed. There was no correlation between video gaming and improved microsurgical performance. Rather, video gamers obtained worse scores, although this difference did not reach significance. The majority of students played a musical instrument. Within this group, musicians who began playing at younger ages obtained higher scores, with the highest scores obtained by musicians who began playing before age 6. However, musicians did not obtain higher scores than non-musicians, regardless of their age of initiation. No improvement in microsurgical aptitude was seen in subjects who had a history of video gaming or musical instrument playing.
Otolaryngology–Head and Neck Surgery, 2012
Objective Patients considering surgery face many uncertainties and concerns. This investigation s... more Objective Patients considering surgery face many uncertainties and concerns. This investigation sought to develop an objective assessment tool for characterizing the areas of greatest concern among those considering thyroidectomy. Study Design Prospective cohort design. Setting Tertiary-care otolaryngology practice. Subjects Participants included individuals presenting with a thyroid nodule found to be of intermediate risk (15%-20%) of cancer based on fine-needle aspiration (FNA) biopsy and amendable to hemithyroidectomy. Methods As part of validating a clinical measure concerning perioperative concerns, patients presenting with thyroid nodules amendable to hemithyroidectomy were voluntarily recruited. Thirty individuals (6 men, 24 women) completed a novel 18-item questionnaire during their initial clinical visit and again 3 days later. Outcome measures included descriptive statistics and test-retest reliability. Results Individual patients have both general and specific preoperativ...
The Journal of Laryngology & Otology, 2011
Background:Cochlear implantation has been used to rehabilitate profoundly deafened adults for mor... more Background:Cochlear implantation has been used to rehabilitate profoundly deafened adults for more than 25 years. However, surgical labyrinthectomy is often considered a contraindication to cochlear implantation, especially if there is a significant delay between the two procedures. As the role of cochlear implantation continues to expand, this idea requires reconsideration.Case report:A 59-year-old woman presented to our clinic after undergoing bilateral surgical labyrinthectomies for intractable Ménière's disease 21 years prior. Despite the significant time delay, she underwent cochlear implantation with a good audiological outcome and improved quality of life.Conclusion:Changes to the cochlea and vestibule following surgical labyrinthectomy include cochlear ossification and obliteration of the vestibule. These issues have been thought to limit the potential for cochlear implantation, especially when there is a significant delay between the two procedures. However, delayed coc...
The Journal of Laryngology & Otology, 2011
Objective:To present a case of extraskeletal Ewing's sarcoma originating in the masseter musc... more Objective:To present a case of extraskeletal Ewing's sarcoma originating in the masseter muscle, and to review the diagnosis and management of these rare tumours.Methods:Case report and literature review.Results:We report a patient with Ewing's sarcoma of the masseter muscle with mandibular invasion. She was treated with induction chemotherapy, salvage surgery and free flap reconstruction.Conclusion:This case highlights the management of these rare tumours. Aggressive multi-modal treatment, including multi-agent chemotherapy, surgical resection and irradiation, appears to offer the best prognosis. Contemporary reconstructive techniques can restore function and form in cases with challenging defects.
JAMA, 2013
A 15-YEAR-OLD PREVIOUSLY HEALTHY MALE PRESENTS TO THE EMERGENCY DEpartment with acute onset of se... more A 15-YEAR-OLD PREVIOUSLY HEALTHY MALE PRESENTS TO THE EMERGENCY DEpartment with acute onset of severe pleuritic retrosternal and epigastric pain after swallowing a mouthful of cold soda. He has no previous surgeries or major illnesses, no history of trauma, and no recent emesis. Following the onset of pain he waited several hours and ate 4 chili dogs before presenting to the emergency department. Findings from a general physical examination revealed a healthy, well-appearing young man with mild epigastric tenderness but an otherwise benign abdomen and stable vital signs. A lateral chest radiograph (FIGURE, A) revealed a small amount of pneumomediastinum, and a soft tissue lateral neck radiograph revealed retropharyngeal and paratracheal air. Radiography was followed by performance of a computed tomography scan in the emergency department (Figure, B). What Would You Do Next?
Joseph Babinski is famous for his 1896 description of the Babinski sign, an abnormal plantar refl... more Joseph Babinski is famous for his 1896 description of the Babinski sign, an abnormal plantar reflex associated with dysfunction of the pyramidal system. He is less well-known for his “other” Babinski sign: paradoxical raising of the eyebrow associated with closure of the eye, a feature typical of hemifacial spasm. As Babinksi noted in 1905, hemifacial spasm (HFS) is a disorder of painless, involuntary facial twitches confined to the muscles supplied by the facial nerve. While benign, it causes significant morbidity due to excessive closure of one eye, and the social effects of an abnormal appearance. Unfortunately, facial twitches are often attributed to stress or anxiety, leading to a delay in diagnosis. A vigilant search for organic causes is essential when these symptoms arise, as highly efficacious treatment options for HFS are available and can significantly improve quality of life. HFS occurs more commonly in females (2:1) and has an overall prevalence of approximately 10/100,...
Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale, 2011
Radiation therapy (RT) and transoral laser microsurgery (TLM) are established treatments for earl... more Radiation therapy (RT) and transoral laser microsurgery (TLM) are established treatments for early glottic squamous cell carcinoma (SCC). Similar oncologic outcomes have been reported with both modalities, leading physicians to consider other factors when making clinical recommendations. One such factor is voice-related quality of life. This investigation sought to characterize differences in self-reported voice outcomes in patients undergoing RT or TLM for the treatment of Tis or T1a glottic SCC. A retrospective cohort study was conducted of all individuals who received either RT or TLM for the treatment of Tis or T1a glottic SCC between 2004 and 2009 at the London Regional Cancer Program. The primary outcome measure was voice-related quality of life, as assessed by the Voice-Related Quality of Life questionnaire (V-RQOL). Secondary outcomes included local control, overall survival, and laryngectomy-free survival. Fifty-seven patients were eligible for this study; 34 received RT an...
Cochlear Implants International, 2013
Early treatment of profound bilateral sensorineural hearing loss with cochlear implantation has b... more Early treatment of profound bilateral sensorineural hearing loss with cochlear implantation has become routine, resulting in an increased proportion of children implanted at younger ages. These children are at a relatively high risk for acute otitis media (AOM), and are more likely to develop mastoiditis in the implanted ear. Despite the significant risks associated with mastoiditis, including compromise of the implant, there are no specific guidelines on the management of this population. We propose a treatment algorithm emphasizing early but conservative operative intervention. A retrospective chart review included eight patients, who experienced mastoiditis, in the context of cochlear implantation at our center from August 2005 to November 2012. During this period 806 implant surgeries were completed. The median age at which mastoiditis occurred was 37 months, and the mean time from implantation to mastoiditis was 9.56 months. All patients underwent drainage of the middle ear in conjunction with intravenous antibiotics, and two additionally underwent post-auricular incision and drainage. Recent mastoidectomy may be a risk factor for the development of a post-auricular abscess in children, who develop AOM following cochlear implantation. A treatment algorithm was developed, which emphasizes early operative drainage in conjunction with aggressive antibiotic therapy. Conclusions A consistent approach to the management of mastoiditis in children with cochlear implants has not been established. Rapid initiation of aggressive antibiotic therapy and a low threshold for conservative operative intervention results in effective resolution of infection while allowing preservation of the implant.