Address correspondence: Jiunn Liang Wu MD, Department of Otolaryngology, National ChengKung University Hospital, No 138, Sheng-Li Rd, Tainan 704, Taiwan. Email:jiunn@mail.ncku.edu.tw

Topical antibiotics for cochlear implantation inpaediatric patients with persistent otitis media andcoalescent mastoiditisLI-ANG LEE, TSUN-SHENG HUANG, Department of Otolaryngology, Chang Gung

Memorial Hospital and Chang Gung University, Taipei, Taiwan, Republic of China HUEI-CHEN HSU, SHIN-YI SU, Department of Otolaryngology, Chang Gung

Memorial Hospital, Taipei, Taiwan, Republic of China

Objective Cochlear implantation has become a safe and effective method for auditory rehabilitationof severe to profound sensorineural deaf patients either congenital or acquired. Existingliterature suggests that a middle-ear infection should be treated prior to cochlear implan-tation. We illustrate a method where otitis media and coalescent mastoiditis can betreated during a cochlear implantation procedure, thereby alleviating a staged operation.

Materials and methodsThis prospective study includes five paediatric patients with refractory otitis media andcoalescent mastoiditis who underwent cochlear implantation by the same surgeon(TSH) between January 2000 and June 2002. All patients had received intensiveantibiotic therapy for a period of at least several weeks to one year before implantation.Cochlear implantation was performed in conjunction with an otomastoidectomy toeradicate infection. Followed by a cochleostomy, the middle ear and mastoid cavity weresubsequently rinsed with cephalosporin (500 mg cefamezine in 20 ml normal saline). Weinserted an electrode array (Nucleus CI24M) into the cochlea and then tightly sealed.The middle ear and mastoid cavities were loosely packed using temporalis muscle stripssoaked in gentamicin (40 mg gentamicin in 20 ml normal saline). Postoperatively, allpatients were administered intravenous antimicrobial agents for 7 days.then packed withthe temporalis.

Results There were five boys with a median age of 63 months (range: 23–121 months). Threecochlear implants were performed on the right ear and two on the left. None of thepatients have experienced any immediate or delayed postoperative complications, suchas fever, wound infection or intracranial complication. All cochlear implant recipientshave hearing levels and speech recognition comparable to cochlear implant patientswithout otitis media and mastoiditis.

Conclusions This single intervention method alleviates the need for waiting for the submission ofinfection. As reported in previous studies, a staged operation was necessary when the

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first stage required a waiting period for the complete purge of infection; however, thisstudy showed that the foci of infection can be completely eradicated upon an intraoper-ative treatment accompanying cochlear implantation. This method is safe and therehave been no complications thus far. This study suggests that delaying implantation tocontrol the otitis media may be unnecessary.

Address correspondence to: Tsun-Sheng Huang MD, Department of Otolaryngology, Chang GungMemorial Hospital, 199 Tung-Hwa North Road, Taipei, Taiwan 105, Republic of China. Tel: +8862 2713 5211 ext. 3527. Fax: +886 2 2719 3658.

Auditory neuropathy detected by universalnewborn hearing screeningRAYMOND YS NGO, HENRY KK TAN, A BALAKRISHNAN, DEREK LAZAROO,

SEOK BEE LIM, JOYCE YAN, Paediatric Otolaryngology Service, Department ofPaediatric Surgery, KK Women’s and Children’s Hospital, Singapore

IntroductionThe term auditory neuropathy was first coined by Starr et al. in 1996 to describe tenpatients who had acquired hearing impairment in the presence of normal cochlear outerhair cells. In their report, the patients were children or young adults who later in lifewent on to develop peripheral neuropathy. They attributed the hearing loss to a gener-alized neuropathic disorder and suggested that the lesion may be the auditory nerve.

Following then, other authors (Doyle et al., 1998; Deltenre et al. 1997; Madden etal., 2002) have reported cases in neonates and infants with a similar pattern of absentauditory brainstem response (ABR) but with preserved cochlear outer hair cell function.Hood (1999) describes auditory neuropathy as being distinguished from other types ofauditory abnormalities by the presence of normal otoacoustic emissions (OAEs), absentmiddle-ear muscle reflex and ABRs in the presence of normal radiological results. ABRtesting had shown that this disorder was distinct from a central deafness and the lesionpotentially could be anywhere from the inner hair cells to the auditory cortex.

Auditory neuropathy is not a diagnosis, but a presentation now readily identifiedwith OAE and ABR screening. It is likely to be from multiple aetiologies. It has beenlinked to peripheral neuropathy (Starr et al., 1996), neonatal jaundice (Shapiro et al.,2001), cochlear hypoxia, mitochondrial disorders (Corley and Crabbe, 1999), geneticfactors and platinum toxicity. Auditory dyssynchrony is a postulated hypothesis(Santarelli R, Arslan, 2002).

Since April 2002, universal newborn hearing screening was implemented in KedangKebau Women’s and Children’s Hospital Singapore with automated ABR tests. Allnewborns are screened with automated ABR in the first and second screen. Failures arethen referred for formal assessment of hearing loss. We present nine cases of newbornsdetected to have auditory test patterns consistent with auditory neuropathy on at leastone side.

ResultsPrevious publications on auditory neuropathy have mainly been sporadic case reportsand case series from at risk infants. A total of 54 cases of suspected hearing loss was

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