Infection Clinical Trial
Official title:
A New Predictor Marker for Cochlear Implants Infection: Neutrophil/ Lymphocyte Ratio
Introduction: Surgical site infections associated with the cochlear implant can have serious
consequences. Although advances in surgical techniques reduce these complications, it may be
necessary to remove a device that works as a last resort as a result of ongoing infection.
The removal of these devices, which are very expensive, increases the cost and takes the
chance of hearing patients with this device. Therefore, it is very important to identify
patients with a tendency to cochlear implant infection before surgery and to prevent these
infections from occurring. Neutrophil/ lymphocyte ratio (NLR) and platelet/ lymphocyte ratio
(PLR) are indicative of systemic inflammation and have a prognostic value in relation to
mortality and morbidity in many diseases. The aim of this study was to identify patients with
post-operative implant infection tendency in patients to be implanted with cochlear implant
and to plan treatment for possible infections before cochlear implant, to reduce cost by
preventing removal of implanted cochlear implant due to infection and to prevent the
patient's chance of hearing through the cochlear implant from disappearing due to infection.
Methods: In this retrospective study, 13 patients with cochlear implant infection were
included. Preoperative NLR was calculated by dividing the neutrophil (NEU) value by the
lymphocyte (LYM) value and preoperative PLR was calculated by dividing the NEU value by the
LYM value.
A cochlear implant (CI) is a device that restores the sense of hearing in people with severe
to profound hearing loss. This implant consists of two parts: The first is an internal
component, which is surgically implanted under the skin behind the ear and connected to
electrodes that are inserted inside the cochlea. The second is an external component that
sits behind the ear and consists of a speech processor, a microphone, and a battery
compartment. However, complications following device implantation may occur; these
complications include flap erosion, local infections, general infections that may lead to
meningitis, wound healing disorders, electrode insertion, device migration, and facial nerve
injury (1,2). The incidence of infectious complications is quite uncommon, but potentially
serious complication of CI surgery occurs at a rate of 1.7% to 4.1% (3-5). CI infection may
be managed with conservative treatment modalities; however, persistent infection often ends
in implant removal or implant replacement (6).
The body responds to inflammation and stress, including trauma, surgery, or sepsis, by
elevating the neutrophil count and by reducing the lymphocyte count (7). Neutrophil/
lymphocyte ratio (NLR) is an indicator of poor prognostic factor in inflammation and in some
diseases, such as obstructive sleep apnea syndrome, ischemic cardiac diseases, several types
of cancer, and Bell's palsy (8-11). Platelet/ lymphocyte ratio (PLR) is also associated with
inflammation and poor prognosis in patients with different types of cancer (12,13). Platelets
release proinflammatory mediators, such as chemokines and cytokines (14). NLR and PLR can be
calculated from complete blood count (CBC), a cheap and simple means of obtaining information
regarding inflammation. During an inflammatory reaction, the amount of leukocytes in the
circulation changes (9,15).
The relationship of preoperative NLR and PLR with CI infection has not yet been investigated
and it is being aimed to show the predictive value of NLR and PLR in patients who developed
implant infection after CI placement. First outcome is to compare whether there is a
difference between NLR in patients with and without implant infection in patients with
cochlear implant implantation. Secondary outcome is to determine which NLR is susceptible to
infection if there is a difference between NLR between patients with and without implant
infection.
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