Ear tubes appear safe in children with cochlear implants, UAB researchers say

Children who are being treated for hearing loss with cochlear implants can safely have ear tubes installed to help clear up infections, say researchers at the University of Alabama at Birmingham (UAB).

Their new study looked at the impact of ear tubes on patients with cochlear implants, and whether leaving the tubes in place or removing them before cochlear implantation made any difference in whether ear, nose and throat physicians had to perform more procedures to reduce infection or improve hearing health. Generally, some doctors avoid recommending ear tubes for fear that they would create complications with cochlear implants.

The researchers found that implant recipients can be treated with ear tubes in much the same way as children without implants have ear infections treated, said Audie Woolley, M.D., an otolaryngologist in the UAB School of Medicine and lead author on the study, which is included in the June issue of Archives of Otolaryngology-Head and Neck Surgery.

'Getting rid of an ear infection and minimising the risk of ear infection, especially for a child who is identified as a good candidate for cochlear implants, is very important,' Woolley said. 'This study shows that the management of the myringotomy tube before cochlear implantation does not adversely affect outcomes.'

Woolley worked with UAB medical resident Nathan Alexander, M.D., and Children's Hospital of Alabama audiologists Richard Sweitzer, Ed.D., and Mandy Lutz Mahalak, M.A., Au.D., to complete the study.

The study involved 78 ears of 62 children between the ages of one year to five years who received ear tubes before cochlear implants. In more than half of the children the tubes were removed before cochlear implantation surgery, and those patients were compared to other patients whose tubes were kept in place until cochlear implantation.

The researchers found all eardrums in which the tubes were removed before or during cochlear implantation healed. A handful of persistent eardrum perforations required another outpatient procedure, but overall there were no cases of meningitis or removal of cochlear implants because of infection in those who had both procedures, Woolley said.

'While manipulation of the eardrum with myringotomy tubes or other procedures is not without risks, we are happy to report that proper management of ear tubes before cochlear implants has very little negative impact on child health and hearing,' he said.

Newborn hearing screening is now widespread, and studies have shown cochlear implants to reverse hearing loss are successful in children younger than 2. As a result, children are increasingly identified as candidates for cochlear implants near the peak age for developing acute otitis media, or middle ear infection, which is commonly treated with an ear tube.

The UAB study showed the indications for tubes and their management in cochlear implantation patients was the same.

Additionally, in children who have already received cochlear implants, tubes can be safely placed in the ears to rid them of acute infections, the study authors said.