INTRODUCTION:
The cochlear implant is considered to be a very effective and safe surgical procedure that provides a world of sound to patients who are rendered deaf or hard of hearing. Unfortunately, infections happen years after implantation with dreaded cases of device exposure and poor prognosis. One of the reasons for limited effectiveness of antibiotics is the presence of biofilm on the device.1 Thus, the knowledge of complications is essential to facilitate the best possible early management and treatment especially flap related complications such as hematoma, necrosis and infections. The percentage of infections in cochlear implant patients range from 1.7% to 4.1%,2, 3 the severity of infections is difficult to predict at that stage and can lead to device removal despite rigorous medical and surgical efforts to eradicate the infection.
Biofilms are heterogeneous communities that are continuously changing. The microorganisms synthesize and secrete a protective matrix that attaches the biofilm firmly to a living surface. Any attempt at conservative management would fail unless the eradication of biofilm from the implant surface takes place. Recent literature supports the role of tea tree oil and Hydrogen peroxide in eradicating biofilm.4
Underlying bacterial infections and chronic inflammation leads to the formation of biofilm. Because biofilms are found on the surface of many medical devices, 5, 6 and also in infections in other parts of body, we aimed at using new agents having antimicrobial activity along with surgical debridement, double layer vascularised soft tissue cover and using oral rifampicin post operatively.