Meningitis in Cochlear Implant Recipients: The North American Experience
Meningitis in Cochlear Implant Recipients: The North American Experience
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DOI：
10.1097/00129492-200405000-00013
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发表时间：
2004-05
影响因子：
2.1
通讯作者：
N. Cohen;Jr Jt Roland;M. Marrinan
中科院分区：
文献类型：
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作者：
N. Cohen;Jr Jt Roland;M. Marrinan
简介：直到最近，植入物后脑膜炎很少被报道和感觉是不常见的。然而，在2002年春季，欧洲和北美报告的种植后脑膜炎病例数量突然增加。目的：由于手术并发症往往被低估，我们决定调查北美所有人工耳蜗中心，以确定人工耳蜗植入后脑膜炎的真实发病率，并了解更多的人口统计学和危险因素。研究设计：我们进行了一项前瞻性研究。设计了一种调查工具，询问外科医生植入物的数量以及他们是否见过植入物后的脑膜炎病例。如果答案是肯定的，他们被要求回答一份20分的问卷。该仪器已被送往北美所有401个人工耳蜗中心。环境：三级保健转诊中心。患者：我们研究了北美所有接受人工耳蜗植入的患者。主要结局指标：植入物后脑膜炎病例数、患者年龄、使用的器械、耳蜗和颞骨异常、治疗和结局。结果：脑膜炎比以前认为的更常见。危险因素包括年轻、耳蜗发育不良、颞骨异常和使用两部分电极系统。这项调查促使美国食品和药物管理局和疾病控制与预防中心对其中一部分病例进行了更深入的分析。结论：植入物后脑膜炎与患者、手术和器械因素有关。通过意识到相关的危险因素，坚持合理的手术原则，如用软组织填塞耳蜗造口，适当地为患者接种疫苗，消除任何潜在的创伤性电极阵列，脑膜炎的发生率应显著降低。
Introduction: Until recently, postimplant meningitis was infrequently reported and felt to be uncommon. However, in the spring of 2002, there was a sudden increase in the number of reported cases of postimplantation meningitis in both Europe and North America. Objective: Because complications of surgery often tend to be underreported, we decided to survey all cochlear implant centers in North America to determine the true incidence of postimplant meningitis and to learn more about the demographics and risk factors. Study Design: We conducted a prospective study. A survey instrument was designed asking surgeons the number of implants performed and whether they had seen any cases of meningitis after implantation. If the answer was affirmative, they were asked to respond to a 20-point questionnaire. This instrument was sent to all 401 cochlear implant centers in North America. Setting: Tertiary care referral centers. Patients: We studied all patients having received cochlear implants in North America. Main Outcome Measures: Number of cases of postimplant meningitis, age of patients, device used, cochlear and temporal bone abnormalities, treatment, and outcomes. Results: Meningitis is more common than previously thought. Risk factors included young age, cochlear dysplasia, temporal bone abnormalities, and the use of a two-part electrode system. This survey led to the involvement by the U.S. Food and Drug Administration and the Centers for Disease Control and Prevention in a much more intensive analysis of a subset of the cases. Conclusions: Postimplant meningitis is related to patient, surgical, and device factors. By being aware of the risk factors involved, adhering to sound surgical principles such as packing of the cochleostomy with soft tissue, appropriately vaccinating patients, and eliminating any potentially traumatic electrode arrays, the incidence of meningitis should be significantly diminished.