Impact of socioeconomic status on the occurrence of complications after cochlear implantation - A case study

Abstract

INTRODUCTION Cochlear implantation is a powerful tool for helping children with severe to profound sensorineural hearing loss gain the ability to hear, achieve age-appropriate reading skills, and develop communication skills equal to those of their hearing counterparts. Although it’s a reliable and safe procedure cochlear implantation surgery, like any other surgical procedures, has some minor and major complications. Major complications are those that are require surgery whereas minor complications are those that can be medically treated. The overall rate of complications among cochlear implant patients ranges from 6% do 20%. According to the time of appearance can be classified as immediate (< 1 week) or delayed (≥1 week) events. One of the quite worrying and potentially devastating are the postoperative wound infections after cochlear implantation. Because of the risk of the implant infection in this cases, which can lead to device removal with loss of the implant function, every effort must be made to prevent this infections, or if they occur to be timely and appropriately treated which will enable salvage of the implant and its function. AIM Тo emphasize the importance of socioeconomic status as risk factors for the occurrence of postoperative wound infection after cochlear impantation. MATERIALS AND METHODS We report the case of 4-year-old child with delayed postoperative surgical wound infection. The one appeared 14 days after the cochlear implantation (postoperatively). Anamnestic data obtained from the mother indicates that after discharging from the hospital the child was repeatedly itchy the wound. On examination a half of the surgical wound was reddish with mild discharge and starting dehiscence at one point. The swab obtained from the wound was positive for Vancomycin resistant-Enterococcus faecium. RESULTS

An outpatient medical care with antiseptic dressing, topical and oral antibiotics was started immediately. Because of no response, even worsening of the local status, 7 days after a revision surgery was required. With the employment of timely and appropriate intraoperative wound debridement and re-suture the healthy edges without using a flap, the implant was salvaged. DISCUSSION/CONCLUSIONS As reported in the literature, in children from families with lower socioeconomic background incidence of complications is higher comparing to the children that come from families with higher income level. The reason for this can be poor hygienic conditions and habits, as well as negligent care of the parents. Тhis case is just another(one more) confirmation that the socioeconomic status can represents a possible risk factor for the occurrence of postoperative complications in children after CI surgery. Specially in an environment where because of financial barriers, access to the cochlear implantation is limited, special attention should be paid to the socioeconomic status of the candidates for CI. This indicates that a special approach in pre-operative preparation and postoperative care in the candidates for cochlear implantation with lower socio-economic back-ground is needed. Involvement of a motivated social workers in the care of the cochlear implant children is necessary for additional support and education if this group of parents and children, in order to prevent and reduce the negative impact of the socioeconomic background of the CI surgery outcomes.