Cochlear Implantation of the Common Cavity Malformation may be Performed During or Before CSF Leak Repair

surgically repaired. • Traditionally, the areas of communication between the subarachnoid space and the middle ear are identified, and the inner ear and defect are packed with muscle and fascia. Occasionally, total petrosectomy and middle ear obliteration with abdominal fat grafts may be necessary. • Such procedures make later cochlear implantation difficult or impossible, even in experienced hands.3,4 • These measures were not necessary for the case reported here. Given the language benefit she derived from her first implant on the left, and the potential for further benefit with binaural hearing, the decision was made to perform a cochlear implantation at the time of the CSF leak repair on the right. Cochlear implantation at a later date might not have been possible due to fibrosis and scarring caused by the repair. • Post-implantation intracochlear/intracavity fibrosis may be responsible for sealing off any potential sites of either CSF egress or bacterial ingress. • Awareness of the risk of meningitis in children with cochlear implants has grown over the last decade.8,9 In response, the CDC has developed guidelines for vaccination against Streptococcus pneumoniae and Haemophilus influenza type B, including use of the 7-valent 23-valent pneumococcal polysaccharide vaccine (PPV23) (Pneumovax pneumococcal conjugate vaccine (PCV7) (Prevnar®) and the ®), as well as the HIB vaccine.10 • However, proper immunization does not fully eliminate the risk of meningitis, as demonstrated in this case. Children under two years old who have not had the 23-valent vaccine are still susceptible to those serotypes. In addition, we do not have vaccines against all bacterial causes of meningitis, as evidenced in this case by the development of non type B Haemophilus infection. • In children who have inner ear malformations that can lead to CSF leaks, the additional risk of meningitis requires that vaccination strategies apply even more rigorously, both before and after implantation. • In addition to immunization awareness, changes in devices and surgical techniques have resulted in a decreased incidence of meningitis associated with cochlear implantation over the last decade.8,9 Cochlear Implantation of the Common Cavity Malformation may be Performed During or Before CSF Leak Repair Benjamin R. Roman, MD1 , Daniel H. Coelho, MD2; J. Thomas Roland, Jr., MD1 1Department of Otolaryngology, Head and Neck Surgery, New York University School of Medicine, New York, NY. 2Department of Otolaryngology, MCV/Virginia Commonwealth University School of Medicine, Richmond, VA USA