Inadvertent insertion of hearing aid impression material into the middle ear: Case report and implications for future community hearing services

INTRODUCTIONThe creation of ear moulds for hearing aids is generally considered a safe and routine procedure for trained professionals. In the literature there are reports of otological complications caused by hearing aid mould impression material in the middle ear cavity but such complications are considered rare.PRESENTATION OF CASEWe present the case of a patient in whom impression material entered the middle ear through a perforation of the tympanic membrane during the process of making a hearing aid mould and review how this was managed.DISCUSSIONWe discuss how many aspects of the British Society of Audiology guidelines were not followed during this procedure and make recommendations as to how independent community practitioners need to be closely supervised with regular review to minimise the risks of such complications.CONCLUSIONOur report demonstrates how a serious otological complication from the creation of a hearing aid impression in a community based private hearing clinic was managed. The reporting of such complications is rare but the incidence is likely to be much higher than the literature would suggest. We recommend and advise how these adverse incidents may be minimised and managed through competency reviews and formal referral links from community centres to hospital otolaryngology/audiology departments.     

耳内科专病门诊建立的必要性及建设体会

2000年国内王秋菊教授提出发展耳内科学,使我国耳内科学的发展和建设有了目标,并形成了相对独立于耳外科学的专门学科。我院于2010年开设耳内科专病门诊,经过数年运转,已成为我科门诊的特色。在耳内科专病门诊的诊疗过程中,我科以耳内科疾病特点为基础,开展专门针对耳内科疾病的治疗,得到广大患者与同行的认可。现分享我科在专病门诊建设方面的经验,以期有助于耳内科学的建设与发展。     

Novel use of the Cochlear® Hybrid CI24REH cochlear implant

Cochlear implantation is becoming more widespread. From its early days to date, huge strides have been made in the technology and surgical technique. However, one challenge remains: implanting malformed or abnormal cochleae. Even more challenging is a cochlea that appears normal at first glance, but is not. We present a case of a child with chondrodysplasia punctata, who had apparently morphologically normal inner ears, but with one major obstacle: the cochlea was smaller than normal in all dimensions. To the best of our knowledge, this is the first case described, and the solution is a novel one as well.     

Dermoid cyst in the facial nerve--a unique diagnosis

Facial nerve paralysis in children may occur as a complication of infections, trauma, or rarely from benign or malignant tumors of the facial nerve. We present the first reported case of a dermoid tumor in the facial nerve causing facial paralysis in a child. Case report at a tertiary Children's Hospital. A 9-month-old was referred to our institution for evaluation of persistent, complete right sided facial paralysis three months after receiving a diagnosis of Bell's palsy. A workup at our institution including MRI and CT revealed marked widening of the facial canal in the mastoid segment consistent with facial nerve schwannoma or hemangioma. Surgical exploration via mastoidectomy and facial nerve decompression revealed keratinous material containing hair that had fully eroded the facial nerve, disrupting it completely. The entire tumor was removed along with the involved segment of facial nerve, and the missing facial nerve segment was cable grafted. Histological examination of the tumor confirmed a ruptured dermoid cyst in the facial nerve. Facial nerve tumors are rare causes of facial paralysis in children, accounting for fewer than 10% of cases of facial paralysis in the pediatric population. Dermoid cyst can occur throughout the head and neck region in children, but a dermoid tumor in the facial nerve has not been described in the literature prior to this report. This represents a new and uncommon diagnostic entity in the evaluation of facial nerve paralysis in children. Appropriate imaging studies and pathology slides will be reviewed.     

Holmium-YAG Laser ablation characteristics in calvarial lamellar and cortical bone: The role of water and tissue micro-architecture

The effect of tissue micro-architecture and water content on ablation rates in bone is examined. Precisely machined and prepared porcine calvarial lamellar and cortical bone were ablated with a Holmium-YAG laser (=2.1m). Lamellar and cortical bone differ substantially in their tissue micro-architecture. Both are porous hard tissues, which differ predominantly in size and distribution of pores within the bone matrix. These hard tissues were ablated under physiological (wet) and chemically dehydrated conditions. The ablation rates over the range of energy densities examined assumes many linear characteristics. Ablation rate (as a function of fluence) is considerably higher for dehydrated cortical bone (4.7m cm² J^–1) compared to fresh cortical bone (1.49m cm² J^–1). This trend is also observed in lamellar bone (2.31m cm² J^–1 for wet and 0.37m cm² J^–1 for dry). Under both physiological and dehydrated conditions, cortical bone was ablated faster. Mechanisms accounting for these observations are discussed.     

Day-surgery in otology: Impact study of a dedicated organizational model

AimDay surgery (DS) in otology in France is insufficiently implemented compared to other countries of comparable socio-economic level. The aim of the present study was to evaluate changes in surgical practice in “major otology” cases in a hospital center after launching a dedicated ENT DS unit.Material and methodsThis new unit, designed in collaboration with the surgeons, was inaugurated in 2014. Number of procedures, patient demographics, surgery durations, and rates of crossover from DS to conventional management were recorded prospectively for the year before and the year after the launch. All otologic surgery procedures with at least tympanomeatal flap elevation were included; minor surgeries such as grommet insertion were excluded.ResultsBetween the two time periods, major otology day cases increased from 106 to 153 procedures (+43%). In 2013, the DS rate was 27%, versus 56% in 2015. Otosclerosis surgeries represented 7% in 2013 and 15% in 2015, and type II and III tympanoplasties 3% and 24% respectively. Difference in patient age between DS and conventional surgery was lower in 2015. Crossover rates were 10% in 2013 and 21% in 2015, mainly due to nausea/vertigo (56%) and surgery ending too late in the day (33%).ConclusionMajor otologic cases are suitable for DS. Launching this dedicated unit with its specific organization enabled a very significant increase in DS rates, probably due to greater patient satisfaction and surgeons’ growing confidence. The main pitfall was in scheduling, with surgery ending too late in the day for discharge home; this has since been corrected.     

Clinical and scientific innovations in auditory brainstem implants

The auditory brainstem implant (ABI) was originally developed to provide rehabilitation of retrocochlear deafness caused by neurofibromatosis type 2 (NF2). Recent studies of the ABI have investigated outcomes in non-NF2 cohorts, such as patients with cochlear nerve aplasia or cochlear ossification and more recently, intractable tinnitus. New technologies that improve the ABI-neural tissue interface are being explored as means to improve performance and decrease side effects. Innovative discoveries in optogenetics and bioengineering present opportunities to continually evolve this technology into the future, enhancing spatial selectivity of neuronal activation in the cochlear nucleus and preventing side effects through reduction in activation of non-target neuronal circuitry. These advances will improve surgical planning and ultimately improve patients’ audiological capabilities. ABI research has rapidly increased in the 21st century and applications of this technology are likely to continually evolve. Herein, we aim to characterize ongoing clinical, basic science, and bioengineering advances in ABIs and discuss future directions of this technology.