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Cochlear implant infections

Authors
Tahaniyat Lalani, MBBS, MHS
Daniel J Sexton, MD
Debara L Tucci, MD
Section Editors
Stephen B Calderwood, MD
Sheldon L Kaplan, MD
Deputy Editor
Anna R Thorner, MD

INTRODUCTION

Cochlear implants are medical devices that electronically stimulate the auditory nerves in the cochlea (inner ear), allowing persons with severe to profound hearing loss to perceive sound.

Cochlear implants consist of an internal device implanted surgically behind the ear and external components that are placed after healing. Implants are composed of four basic parts: a microphone (that detects sound), a speech processor (that selects and arranges sounds), a transmitter (that receives signals from the processor and converts them into electrical impulses), and surgically implanted electrodes (that conduct electrical impulses to the brain) (figure 1). Transmission between the external and internal components takes place via radiofrequency via a magnetic link across the skin.

Infection is an important complication of cochlear implants, and the type varies with age. Surgical wound infections are more common in adults, whereas meningitis and the complications of acute otitis media in patients with implants (such as mastoiditis and meningitis) are more common in children.

The pathogenesis, clinical presentation, microbiology, diagnosis, prevention, and treatment of cochlear implant infections will be reviewed here. General information about cochlear implants is discussed separately. (See "Hearing impairment in children: Treatment", section on 'Cochlear implants' and "Hearing amplification in adults", section on 'Cochlear implants'.)

PATHOGENESIS

The pathogenesis of prosthetic implant infections involves a complex interaction between the host, the device, and microbes causing the infection. In animal models, the presence of a subcutaneous foreign body reduces the minimal inoculum of Staphylococcus aureus required to cause infection by a factor of more than 100,000 to as little as 100 colony-forming units [1]. At least two factors contribute to this increase in risk: foreign bodies do not have a microcirculation, which is crucial for both host defense and the delivery of antibiotics [1], and the interaction between neutrophils and the foreign body can induce a neutrophil defect that may enhance susceptibility to infection [2].

                     

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Literature review current through: Nov 2016. | This topic last updated: Thu Sep 01 00:00:00 GMT 2016.
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