Acute Otitis Media with Cochlear Implant

Advancements in medicine can benefit our patients, but remember they can also complicate our decision making as a physician.  In this case, that acute otitis media you are diagnosing may not be as simple as it seems.

• Recent publication (Pediatrics, 2010) suggests that physicians should have a heightened awareness of bacterial meningitis in patients with cochlear implants who have fever, even without evidence of AOM.

• Cochlear implants increase the risk of bacterial meningitis, especially within the first few months after surgery.

• If AOM is identified, systemic antibiotics should be started.

• If within the first 2 months after surgery, then parenteral antibiotics (ceftriaxone or cefotaxime) are preferred.

• If AOM develops 2 months or more after implants are placed and the patient is not toxic, then a trial of outpatient therapy with oral antibiotics (amoxicillin or amoxicillin/clavulanate) may be tried with close follow-up.

• If meningitis is suspected, then obtain CSF and treat appropriately.  If middle ear fluid is present, then the fluid should be obtained as well.

Rubin, L.G. and B. Papsin, Cochlear implants in children: surgical site infections and prevention and treatment of acute otitis media and meningitis. Pediatrics. 126(2): p. 381-91.