A New Predictor Marker for Cochlear Implants Infection

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.

Study Overview

• Status: Completed
• Conditions: Infection; Cochlear Hearing Loss; Implant Infection
• Intervention / Treatment: Other: There is no intervention.

Detailed Description

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.

• Study Type: Observational
• Enrollment (Actual): 13

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

This study included 13 patients who developed implant infection after receiving cochlear implant at the Department of Otorhinolaryngology, Selcuk University Hospital between March 2014 - August 2018.

The control group consists of 13 age- and gender-matched subjects who underwent CI surgery but showed no complications.

Description

Inclusion Criteria:

1) Patients who developed implant infection after receiving cochlear implant at the Department of Otorhinolaryngology, Selcuk University Hospital between March 2014 - August 2018.

-

Exclusion Criteria:

1) Patients who had hematological disorders. 2) Diseases that retard tissue healing, such as diabetes, renal failure, or skin disease those who had experienced an impact on the head implant area.

-

Study Plan

How is the study designed?

Design Details

• Observational Models: Case-Control
• Time Perspectives: Retrospective

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Control; The control group consists of 13 age- and gender-matched subjects who underwent CI surgery but showed no complications. The members of the control group were selected based on hospital records.	Other: There is no intervention.; There is no intervention.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Difference between NLR in patients with and without implant infection	Our 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.	2014-2018

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Determine which NLR is susceptible to infection	Our 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.	2014-2018

Collaborators and Investigators

• Sponsor: Selçuk University

Publications and helpful links

General Publications

• Kanaan N, Winkel A, Stumpp N, Stiesch M, Lenarz T. Bacterial growth on cochlear implants as a potential origin of complications. Otol Neurotol. 2013 Apr;34(3):539-43. doi: 10.1097/MAO.0b013e3182829792.
• Brady AJ, Farnan TB, Toner JG, Gilpin DF, Tunney MM. Treatment of a cochlear implant biofilm infection: a potential role for alternative antimicrobial agents. J Laryngol Otol. 2010 Jul;124(7):729-38. doi: 10.1017/S0022215110000319. Epub 2010 Mar 10.
• Wei BP, Shepherd RK, Robins-Browne RM, Clark GM, O'Leary SJ. Threshold shift: effects of cochlear implantation on the risk of pneumococcal meningitis. Otolaryngol Head Neck Surg. 2007 Apr;136(4):589-96. doi: 10.1016/j.otohns.2006.11.039.
• Zahorec R. Ratio of neutrophil to lymphocyte counts--rapid and simple parameter of systemic inflammation and stress in critically ill. Bratisl Lek Listy. 2001;102(1):5-14. English, Slovak.
• Seretis C, Gourgiotis S, Gemenetzis G, Seretis F, Lagoudianakis E, Dimitrakopoulos G. The significance of neutrophil/lymphocyte ratio as a possible marker of underlying papillary microcarcinomas in thyroidal goiters: a pilot study. Am J Surg. 2013 Jun;205(6):691-6. doi: 10.1016/j.amjsurg.2012.08.006. Epub 2013 Feb 4.
• Senturk M, Azgin I, Ovet G, Alatas N, Agirgol B, Yilmaz E. The role of the mean platelet volume and neutrophil-to-lymphocyte ratio in peritonsillar abscesses. Braz J Otorhinolaryngol. 2016 Nov-Dec;82(6):662-667. doi: 10.1016/j.bjorl.2015.11.018. Epub 2016 Mar 28.

Study record dates

Study Major Dates

• Study Start (Actual): May 1, 2014
• Primary Completion (Actual): October 1, 2018
• Study Completion (Actual): October 1, 2018

Study Registration Dates

• First Submitted: October 7, 2019
• First Submitted That Met QC Criteria: October 7, 2019
• First Posted (Actual): October 9, 2019

Study Record Updates

• Last Update Posted (Actual): October 10, 2019
• Last Update Submitted That Met QC Criteria: October 8, 2019
• Last Verified: October 1, 2019

More Information

Terms related to this study

• Keywords: infection; cochlear implant; Neutrophil-to-lymphocyte ratio; Platelet-to-lymphocyte ratio; artificial implant
• Additional Relevant MeSH Terms: Pathologic Processes; Nervous System Diseases; Neurologic Manifestations; Disease Attributes; Otorhinolaryngologic Diseases; Ear Diseases; Sensation Disorders; Hearing Disorders; Infections; Communicable Diseases; Hearing Loss; Hearing Loss, Sensorineural
• Other Study ID Numbers: 2019/01

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: Undecided

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No