Author(s)
Jeffrey Hyzer, MD
Daniela Carvalho, MD
Nicholas Portugal, Au.D.
Affiliation(s)
Rady Childrens Health
Abstract:
INTRODUCTION:
Cochlear implantation (CI) has transformed treatment for children with hearing loss. However, conditions such as eustachian tube dysfunction (ETD), acute otitis media (AOM), and mastoiditis pose risks for CI patients, sometimes requiring tympanostomy tube (TT) placement. This study reviews TT placement rates and complications in pediatric CI patients.
METHODS:
Retrospective review of pediatric CI patients at a tertiary care children’s hospital between 2010 and 2025, with assessment of cases that required TT placement.
RESULTS:
640 patients underwent CI from 2010 - 8/2025. 101 (15.7%) patients required TT for either recurrent acute otitis media (RAOM) or chronic otitis media with effusion (COME). From 2018-2023, 160 patients underwent CI. Of these, TT were placed in 23 patients (14.37%). 16 were placed preoperatively (69.56%) and 7 postoperatively (30.4%). The average age at implantation in this cohort was 5.63 years. Among the patients who required TT before CI, 12 (75%) were due to COME and 4 (25%) due to RAOM. In children post-CI, 3 (42.85%) were due to COME, 2 (28.5%) due to RAOM, and 2 (28.5%) due to otomastoiditis. Notably, both children with otomastoiditis had congenital CMV. The tube status was also examined, and 15 (65.2%) of patients healed with appropriate tube extrusion, 5 (21.7%) currently have tubes, 2 (8.6%) required a tympanoplasty pre-CI, and 1 (4.3%) required removal with myringoplasty.
DISCUSSION:
We present a novel, large pediatric cohort in which all patients underwent CI by a single surgeon, along with the associated rates of TT placement. In our cohort, only two children developed mastoiditis, an annual rate of 0.02%—higher overall risk than the overall pediatric population (0.000135% per year). Notably, both children had congenital CMV (cCMV).
The rate of TT placement in our cohort suggests that middle ear disease is not uncommon in the CI population and that TTs are a safe procedure for patients with CI. This preliminary data is also the first to report on TT placement before and after implantation, providing essential information for clinicians caring for children with CI.