Ear surgery in infants under one year of age: Its risks and implications for cochlear implant surgery

Objective: Neonatal hearing screening programs allow early identification of infants with congenital severe hearing impairment. Increasing evidence suggests that early cochlear implantation (CI) facilitates auditory rehabilitation and bilateral implantation exceeds the benefit of unilateral Cl fitting. Elective surgery before the age of 12 months has, therefore, become increasingly popular. A team approach between the surgeon and the anesthesia team is required to guarantee the safety for the patient. The implanting surgeon should also be aware of the special constraints relevant at this age group. Study Design: Our personal experience at a tertiary children's hospital and a review of the German and English literature published on this subject between 1980 and 2007. Setting: Tertiary referral otology and skull base center with affiliated children's hospital. Patients: Patients younger than I year of age undergoing Cl surgeries were analyzed concerning surgical techniques, and anesthesiological aspects of elective surgeries in small infants were evaluated. Interventions and Outcome Measures: The main focus was on CI surgeries in very young infants. Risk factors involving the surgical planning, intervention, and perioperative anesthesia care were evaluated. Results: The age of the patient and the pediatric experience of the anesthesiologist, but not the duration of the surgery, are relevant risk factors. This review article is intended to highlight the surgical and anesthesiological considerations when performing CI surgery in very young infants and anticipates familiarizing the implanting surgeon with important aspects of hemostasis, pharmacokinetics, and cardiopulmonary reserves in small pediatric patients. Conclusion: Elective ear surgery in infants below 1 year of age should be performed in institutions where a continuous experience with this type of patient exists and all the facilities of pediatric perioperative anesthesia care are readily available.