Pediatric cochlear implant explantation and reimplantation over a 32-year period.

OBJECTIVES: Cochlear implantation is indicated for pediatric patients with bilateral severe to profound sensorineural hearing loss. The literature reports large variability in cochlear implant (CI) device survival and rates of explantation and reimplantation. This retrospective chart review summarizes CI survival and rates of explantation and reimplantation in pediatric CI recipients at a Canadian tertiary pediatric hospital over 32 years. METHODS: A retrospective chart review of all pediatric patients who received a Cochlear Corporation® CI between April 1988 and June 2020 was undertaken. Rates of explantation/reimplantation were collected and categorized based on device type and reason for failure (medical, device, and inconclusive failure). Device survival analysis based on implant model was also completed utilizing Kaplan-Meier curves. RESULTS: 512 CIs were implanted over the 32-year period by four surgeons (77.1%, 18.16%, 4.49%, and 0.20%, respectively). Patient age ranged from seven months to 20.4 years. The overall explantation and reimplantation rate was 3.32% (17/512 implants), with seven as a result of device failure (1.37%), nine events of medical failure (1.76%), and one inconclusive failure (0.20%). Cumulative CI survival rates at 5, 10, 15, and 20 years were 98.15%, 96.33%, 95.53%, and 94.39%. CONCLUSION: The overall institutional CI failure, explantation, and reimplantation rates are lower than the average reported rates in the literature.

Utility and safety of methylene blue demarcation of preauricular sinuses and branchial sinuses and fistulae in children.

OBJECTIVE: To report our experience at British Columbia's Children's Hospital (BCCH) with the use of methylene blue (MB) to demarcate preauricular sinuses (PASs) and branchial sinuses and fistulae (BSF) in children under general anesthesia just prior to surgical excision. METHODS: A retrospective chart review was performed of all cases at BCCH between March 2003 and April 2006 in which MB was used to demarcate PASs and BSF. A review of the literature regarding the utility and safety of topical MB was performed. RESULTS: MB demarcation of 20 PASs enabled precise resection with the involved auricular cartilage and obviated the need for en bloc resection. In 11 BSF, MB differentiated between sinuses and fistulae, identified the branchial cleft involved, demonstrated (in two patients) a thin fistula that was not visible on high-resolution contrast-enhanced computed tomography, and enabled excision with the use of small incisions and minimal dissection. In our series, there have been no recurrences and no complications from the use of MB. CONCLUSIONS: MB demarcation of PASs and BSF enables minimally invasive surgery and helps ensure complete resection. This is an extremely useful and relatively safe technique that has been underreported in the otolaryngology literature.

Foreign body aspiration in infants and toddlers: recent trends in British Columbia.

OBJECTIVES: The objectives of this study were to (1) examine recent trends in the demographics and presentation of children with foreign body aspiration at British Columbia's Children's Hospital and (2) develop safety guidelines regarding feeding nuts and other hard, crunchy foods to infants and toddlers. METHODS: The methods used were a retrospective chart review and a review of swallowing mechanics in early childhood. RESULTS: Between July 1997 and July 2001, 51 children under 3 years of age underwent rigid bronchoscopy for suspected foreign body aspiration. Of these patients, 27 (53%) were 18 months of age or younger. Of these 27 infants and toddlers, 24 (89%) had a witnessed choking event and 22 (81%) had an airway foreign body. Nuts, raw carrots, and popcorn kernels accounted for 14 (64%) of the foreign bodies aspirated by these infants and toddlers. Before 2 years of age, children are poorly equipped to grind and swallow hard, crunchy food because they lack second molars and are still adjusting to the descent of the larynx. CONCLUSIONS: Infants and toddlers in British Columbia have been aspirating foreign bodies at an alarmingly high rate. Most cases would have been prevented with better public awareness. Caregivers should be informed that children under 3 years of age should never be fed nuts or other hard, crunchy foods. A public awareness campaign is warranted.