Fixation of the electrode array with bone paté in cochlear implant surgery

The aims of this study are to report on our experiences using a bone paté (a mixture of bone dust and fibrin glue) fixation technique of the Combi 40/Combi 40+ electrode array during cochlear implant surgery. A retrospective study involving 57 patients implanted with Combi 40/Combi 40+ cochlear implants over 31 months fixated with bone paté was performed, utilizing our electrical fitting data as well as re-operation and X-ray findings. We found no signs of electrode retraction in any of the 57 patients. Electrical fitting data showed no reduction in the number of active channels between the first and last times patients were evaluated (a period of 4-31 months). Furthermore, a comparison of X-rays performed within the first week following cochlear implant surgery and again 7-27 months later showed no signs of electrode retraction in 10 patients. Three patients who required re-operations after implantation allowed us the opportunity to examine the effectiveness of the bone paté fixation and revealed new bone growth with the electrode fixed in place. Histological examinations of the newly built bone showed laminar and compact bone structures. The use of bone paté was thus found to be a suitable method of electrode fixation in cochlear implant surgery. Compared with other fixation methods, it is inexpensive and uses no foreign materials.     

Does size of the cochlear nerve affect postoperative auditory performance in pediatric cochlear implant patients with normal cochlear nerves?

IntroductionCochlear implantation is an effective treatment method for severe to profound hearing loss. Many factors that may influence cochlear implantation success have been explained in previous studies. Apart from those, minor differences in size of normal cochlear nerves may affect postoperative performance.ObjectiveTo investigate whether the minor differences in cochlear nerve size in normal cochlear nerves affect postoperative cochlear implant performance.Methods30 pediatric prelingually deaf patients who were treated with cochlear implantation were included in this study. From the reconstructed parasagittal magnetic resonance images, the diameter and cross-sectional area of the cochlear nerve on the ipsilateral and contralateral side were measured. Auditory evaluations were performed 1, 3, 6 and 12 months following the first fitting. All the analysis was performed by using EARS®, evaluation of auditory responses to speech tool. Correlation between cochlear nerve diameter, cross-sectional area and postoperative auditory perception was analyzed to determine whether variation in cochlear nerve size contributes to postoperative auditory performance.ResultsThe mean diameter of the cochlear nerve on the ipsilateral side was 718.4 μm (504.5 ? 904.3 μm) and mean cross sectional area was 0.015 cm² (0.012 ? 0.018 cm²). On the contralateral side the mean cochlear nerve diameter was 714.4 μm (502.6 ? 951.4 μm) and mean cross sectional area was 0.014 cm² (0.011 ? 0.019 cm²). The correlation between the diameter and cross-sectional area of the ipsilateral and contralateral cochlear nerve revealed no significance. Mean score at first month monosyllable-trochee-polysyllable test, MTP1, was 0.17 (0.08 ? 0.33), at 6th month with 6 words test, 6th month MTP6 was 0.72 (0.39 ? 1.0), at 6th month with 12 words, 6th month MTP 12 was 0.46 (0.17 ? 0.75) and at 12th month with 12 words, 12th month MTP12 was 0.73 (0.25 ? 1.0). There was no correlation between the monosyllable-trochee-polysyllable test, values at any time with the diameter of the ipsilateral cochlear nerve. However, the first month MTP, 6th month MTP6 and 12th month MTP12 correlated with the cross-sectional area of the ipsilateral cochlear nerve.ConclusionMeasuring the cross sectional area of the normal- appearing cochlear nerve may give important prognostic knowledge on cochlear implant outcomes. In patients with a larger cross sectional area the auditory performance was better and faster. Although normal appearing, slight differences on cross sectional area of the cochlear nerve may affect performance. Measuring the size of the cochlear nerve on parasagittal magnetic resonance images may provide beneficial information on the postoperative rehabilitation process.     

Measurement of cochlear length using the ‘A' value for cochlea basal diameter: A feasibility study†

Objectives: To determine whether the cochlea basal diameter (A value) measurement can be consistently and precisely obtained from high-resolution temporal bone imaging for use in cochlear length estimation.

Methods: A feasibility study at a tertiary referral center was performed using the temporal bone CTs of 40 consecutive patients. The distance from the round window to the lateral wall was measured for each cochlea by two independent reviewers, a neuroradiologist and an otolaryngologist. The interrater reliability was calculated using the intraclass correlation coefficient (ICC) and the Bland–Altman plot.

Results: Forty patients (19 males, 21 females) for a total of 80 cochleae were included. Interrater reliability on the same ear had a high level of agreement by both the ICC and the Bland–Altman plot. ICCs were 0.90 (95% CI: 0.82, 0.94) for the left ear and 0.96 (95% CI: 0.92, 0.98) for the right ear. Bland–Altman plot confirmed interrater reliability with all 96% of measurements falling within the 95% limits of agreement.

Conclusions: Measurement between the round window and lateral cochlear wall can be consistently and reliably obtained from high-resolution temporal bone CT scans. Thus, it is feasible to utilize this method to estimate the cochlear length of patients undergoing cochlear implantation.     

Measuring the density of the fissula antefenestram and the section of the basal turn of the cochlea: Are they useful in the radiological diagnosis of otosclerosis?

IntroductionThe role of objective parameters in terms of improvement of the accuracy of high-resolution computed tomography (HRCT) of the temporal bone in the diagnosis of otosclerosis remains unclear.ObjectivesTo investigate the relationship between the density of the fissula antefenestram (FAF) and of the width of the transversal section of the basal turn of the cochlea (BTC), and the diagnosis of otosclerosis.MethodsThis is a retrospective study in which preoperative HRCT data from ears of patients submitted to stapedotomy due to otosclerosis (case group) were evaluated. For the control group, normal hearing ears having undergone HRCT for other purposes were included. Case and control HRCT images were objectively assessed by an experienced blinded radiologist. During this evaluation, measurements of the relative radiological density of the FAF and of the transversal section of the BTC were obtained. The results were compared between the groups. Also, a receiver operating characteristic curve was created and the area under the curve (AUC) was calculated for each variable. Significance level was set at .05.Results40 ears were included in each group. Case ears presented reduced values for the relative radiological density on the FAF (p-value<0.0001). Moreover, ears with otosclerosis (p-value: 0.022) presented lower transversal section of the BTC. The AUC for these variables reached 0.929 and 0.646, respectively.ConclusionsOtosclerotic ears present reduced radiological density on the FAF and narrower BTC. The relative density of the FAF also shows a great diagnostic power in the context of this disease.     

Outcomes for a clinically representative cohort of hearing-impaired adults using the Nucleus® CI532 cochlear implant

European Archives of Oto-Rhino-Laryngology - Hearing performance data was collected from a large heterogeneous group of subjects implanted with the Cochlear™ Nucleus® CI532 with Slim...     

Electrophysiological findings in two bilateral cochlear implant cases: does the duration of deafness affect electrically evoked auditory brain stem responses?

Bilateral cochlear implantation provides an interesting model for in vivo study of the effect of long-term profound deafness on neural transmission. We present electrophysiological observations on 2 patients implanted with the MXM Binaural Digisonic Convex system. This uncommon design consists of 2 electrode arrays placed bilaterally into the scala tympani and controlled by a single speech processor. In both patients, the duration of deafness before cochlear implantation clearly differed from one ear to the other. Electrically evoked auditory brain stem responses (EABRs) were measured and the EABRs from the ear with the longer deafness duration showed a lengthening of wave V latency. In I patient, recordings from this ear also showed a lack of reproducibility of wave III. The data suggest that neural responsiveness in the peripheral and intermediate auditory pathways is adversely affected by deafness duration. Poor EABRs on one ear possibly result from the total duration of deafness in this ear and/or compensation by the other ear.     

Basaloid squamous carcinoma of the nasal cavity — a case report

Basaloid squamous carcinoma is a rare variant of squamous carcinoma and is known for its aggressive behavior. Its presentation in the nasal cavity is uncommon . A case of this tumor arising from the nostril and showing good response to concomitant radiotherapy and cisplatinum is presented.     

Comparison of two cochlear implantation techniques and their effects on the preservation of residual hearing. Is the surgical approach of any importance?

The goal of this work was to review the pre-and postsurgical auditory thresholds of two surgical implantation techniques, namely the mastoidectomy with posterior tympanotomy approach (MPTA) and suprameatal approach (SMA), to determine whether there is a difference in the degree of preservation of residual hearing. In a series of 430 consecutive implanted patients 227 patients had measurable pre-operative hearing thresholds at 250, 500, and 1,000 Hz. These patients were divided into two groups according to the surgical technique that was used for implantation. The SMA approach was followed for 84 patients in Amsterdam, whereas the MPTA technique was adhered to 143 patients in Maastricht. The outcome variables of interest were alteration of pre-and postoperative auditory thresholds after cochlear implantation. Complete or partial preservation of residual hearing was obtained in 21.4 and 21.7 % in the SMA and MPTA group, respectively. No statistical differences could be found between the SMA and MPTA group (p = 0.96; Chi-square test). The SMA technique is correlated with a similar degree of hearing loss after cochlear implantation compared to the MPTA technique. However, both techniques were not able to conserve a measurable amount of hearing in patients with a substantial degree of residual hearing. Therefore, both surgical techniques need to be refined for patients in which residual acoustical hearing is pursued.     

Tinnitus in cochlear implant patients—a comparison with other hearing-impaired patients: Acufeno en pacientes con implante coclear-una comparación con otros pacientes hipoacusicos

As part of a quality of life study, 84 patients who received multichannel intra-cochlear cochlear implants (CIs) were evaluated regarding tinnitus problems by a questionnaire. As controls, 60 hearing aid (HA) users and 35 non-operated CI candidates were used. The prevalence of tinnitus in the CI group was 70%, and that of troublesome tinnitus was 35%. In the two other groups, the prevalences of tinnitus were 40% (HA) and 74% (non-CI). Twenty-three per cent of HA users and 51% of non-operated CI candidates had troublesome tinnitus. CIs were found to be superior to HAs in reducing tinnitus, 54%) of the CI patients with tinnitus experiencing a reduction in tinnitus when using a CI. In the other two groups, 4% of HA users and 23%) of non-operated CI candidates experienced a reduction in tinnitus when using an HA. Eight per cent of the CI patients with tinnitus experienced an increase in tinnitus when using their implant. Not having paid employment was independently associated with troublesome tinnitus in all three groups.

Sumario: Como parte de un estudio de calidad de vida, se evaluó por medio de un cuestionario a un grupo de 84 pacientes, a quienes se les había colocado un implante coclear multicanal (IC), investigando sus problemas de acúfeno (tinnitus). Se integró un grupo control de 60 usuarios de auxiliares auditivos (HA) y a 35 candidatos para IC, aún no operados. La prevalencia del acúfeno en el grupo de IC fue del 70%) y la del acúfeno molesto fue del 35%. En los otros dos grupos, la prevalencia del acúfeno fue del 40%> (HA) y de 74%, (no-lC). El 23%. de los usuarios de auxiliar auditivo y el 51%) de los candidatos a IC no operados sufrian de un acúfeno molesto. Se encontró que los IC eran más eficientes para reducir el acúfeno que los auxiliares auditivos. El 54%o de los pacientes con IC y con acúfeno experimentaron una reducción del mismo cuando usaban su IC. En los otros dos grupos, el 41% de los usuarios de auxiliar auditivo, y el 23%) de los candidatos a IC no operados experimentaron una reducción de su acúfeno cuando usaban su auxiliar auditivo. El 8% de los pacientes con IC y acúfeno experimentaron un incremento de su acúfeno cuando usaban el implante. El no tener empleo con remuneración tuvo una asociación independiente con el acúfeno molesto en los tres grupos.     

Solitary fibrous tumor of the orbit—two cases and a review of the literature

Solitary fibrous tumors of the orbit (SFT) are mesenchymal lesions that can develop either as malignant or benign neoplasias. We describe the histological features leading to the diagnosis in two females and review the current literature. Diagnosis of SFT only can be performed by histological examination, since clinical signs and radiological features are not specific enough. Even a malignant or benign course cannot be predicted, since clinical and radiological features do not correlate with histological signs of malignancy and vice versa. Radical resection is the treatment of choice, since no other treatment option has been proven to be efficient.     

Leiomyoma of the external auditory canal—a case report and brief review of the literature

Leiomyoma usually originates from the uterus and alimentary tract, but rarely from the soft tissue of the head and neck. It is extremely rare that leiomyoma appears in the external auditory canal. A 47-year-old male with left external auditory canal leiomyoma presented with conductive hearing impairment and post-auricular swelling. Tumor excision was successful via a retroauricular approach. The pathological examination demonstrated a vascular leiomyoma without malignant change. To date, including our case, only three cases of external auditory canal leiomyoma have been reported. The tumor occurs mainly in adult males aged around 50 and should be included in the differential diagnoses for external auditory canal tumor. The proper treatment of choice is complete excision. In case of an external auditory canal tumor, even if it is believed to be benign before surgery, precise pathologic examination is required to exclude the possibility of malignancy.     

Neurovascular compression syndrome with Meniere's disease—a report of the treatment of a patient with microvascular decompression

Neurovascular compression syndrome(NVCS) is currently regarded as one of the causes of disabling positional vertigo (DPV). A 59-year-old man visited our hospital on December 15, 1993. The neuro-otological examination suggested that the patient had Meniere's disease and he was treated with conservative medication. However, the patient continued to suffer definite vertigo attacks, as well as a fluctuation in his hearing. A consultation and discussion lead us to believe the patient was also suffering from NVCS. We planned the microvascular decompression surgery. After surgery, the patient stopped suffering from vertigo attacks but his audiogram showed severe fluctuation in sensorineural hearing levels. It was concluded that the present patient had been suffering from NVCS combined with Meniere’s disease.     

Is age at implant the only factor that counts? The influence of working memory on lexical and grammatical development in children with cochlear implants

In this study, we explored the influence of time factors (age at implant, time with cochlear implant and age), complex working memory and phonological short-term memory on lexical and grammatical development in congenitally deaf children with cochlear implants. Fifteen children (aged 5 years 4 months to 11 years 5 months) were examined with the use of several linguistic and cognitive measures after a minimum of 18 months of implant use. Phonological short-term memory was assessed with non-word repetition, where the percentage of correctly repeated consonants and vowels was counted. For the assessment of lexical acquisition. a novel word learning task was administered. Receptive and expressive grammar was tested. Our results corroborate earlier findings on the influence of phonological short-term memory on novel word learning. The percentage of vowels correctly produced in non-word repetition was more important in this group than age at implant, not only for novel word learning. but also for receptive and expressive grammar.     

Is age at implant the only factor that counts? The influence of working memory on lexical and grammatical development in children with cochlear implants

In this study, we explored the influence of time factors (age at implant, time with cochlear implant and age), complex working memory and phonological short-term memory on lexical and grammatical development in congenitally deaf children with cochlear implants. Fifteen children (aged 5 years 4 months to 11 years 5 months) were examined with the use of several linguistic and cognitive measures after a minimum of 18 months of implant use. Phonological short-term memory was assessed with non-word repetition, where the percentage of correctly repeated consonants and vowels was counted. For the assessment of lexical acquisition, a novel word learning task was administered. Receptive and expressive grammar was tested. Our results corroborate earlier findings on the influence of phonological short-term memory on novel word learning. The percentage of vowels correctly produced in non-word repetition was more important in this group than age at implant, not only for novel word learning, but also for receptive and expressive grammar.     

Sparfloxacin in the treatment of purulent sinusitis—a multicentric study in Indian patients

Sparfloxacin, a new quinolone antibacterial was used to treat one hundred and thirty two patients with acute purulent sinusitis, at a dosage of 400 mg on the first day followed by 200 mg once daily for a further four days. A clinically successful outcome (defined as disappearance of nasal discharge, fever, pain, tenderness over the sinuses and headache) was recorded in 122 ( 95.3%) patients. Sparfloxacin was well tolerated. Fourteen adverse experiences were reported in 7 patients ( 5.3%); they were mainly gastrointestinal and mild. No phototoxic or cardiological adverse events occurred. An unusual feature was that Staphylococcus aureus and Pseudomonas spp. were the most common bacterial species isolated from middle meatal was of patients in this study.     

Safety aspects of subcutaneous immunotherapy with multiple allergens—a retrospective analysis on polysensitized patients

Polysensitization against a multitude of different allergens is a common problem in the treatment of allergies with specific immunotherapy (SIT). The aim of this retrospective study was to investigate the risk of simultaneous administration of two allergen extracts during SIT with a conventional or Cluster regimen. Local (LR) and systemic reactions (SR) in 147 patients receiving different forms of SIT were compared. Patients received a total number of 2,758 injections during dose-increase phase and 3,412 injections during maintenance phase. During dose-increase phase, a higher rate of LR (for 1A 0.7% and for 2A 1.5%) was found with parallel injections of two allergen extracts (2A). The increase of SR was, however, not significant with conventional (for 1A 0% and for 2A 0.3%) or Cluster therapy (for 1A 0.3% and for 2A 0.5%). No increment of SR with injections of two allergen extracts did occur during maintenance phase (for 1A 0.3% and for 2A 0.1%). In conclusion, the results of the present study indicate that a higher rate of LR and SR must be considered during dose-increase phase independent of the kind of induction regime used. The rate of adverse events (AE) with two different allergen extracts, however, seems tolerable. After reaching maintenance phase, a higher rate of AE with parallel allergen injections did not occur.     

Positive findings on barium swallow in patients presenting with a “sensation of a lump in the throat”

Our objective is to evaluate the pickup rate of a significant pathology, on barium swallow, in patients who present to our clinic with a feeling of a lump in the throat (globus symptoms). Hospital—secondary referral centre. This is a retrospective study of 192 patients who had barium swallow in our department between August 2009 and August 2010. We revised 500 case notes to rule in 192 who presented with only a feeling of a lump in their throat. All patients with positive clinical findings, such as dysphagia, odynophagia, referred otalgia, hoarseness of voice, weight loss, neck swelling or vocal cord palsy, were ruled out. Eight patients were diagnosed on barium swallow as having significant pathology: five with diverticulae and three patients with oesophageal web. The percentage of significant pathology in our study is 4.17% (eight patients). Out of those eight cases, there was no malignant pathology identified on further panendoscopy. Our conclusion is that barium swallow adds very little to the diagnosis of Globus Pharyngeus, but it plays a role in the reassurance particularly from the patients’ perspective.     

Efficacy of two calcium phosphate pastes on the remineralization of artificial caries： a randomized controlled double-blind in situ study

To test the efficacy of two calcium phosphate pastes compared to that of fluoride toothpaste on remineralizing artificial caries in situ, this study had a double-blind crossover in situ design, involving three experimental phases of 14 days each, with an 8-day washout period between phases. Nine healthy subjects participated in the study. The subjects wore removable palatal appliances mounted with six human enamel slabs with artificial caries lesions, and in each of the experimental phases, used one of the following methods two times/day： group A, brushing with 1.0 g of Colgate Regular Flavor, followed by applying 0.25 g of Tooth Mousse Plus; group B, brushing with 0.25 g of Clinpro Tooth Crbme; and group C, brushing with 1.0 g of Colgate Regular Flavor. After 14 days, the enamel slabs （54 slabs/ group） were embedded in resin, sectioned and examined with a polarized-light microscope, and the lesion areas were quantified using Image-Pro Plus. All experimental groups showed a significant reduction in lesion area compared to the initial lesion area （paired t-test, P〈O.O01）. The mean reduction in lesion area of Groups A, B and C were （0.029__.0.010）, （0.030_＋0.009） and （0.027_＋0.009） mm2, respectively. There were no statistical differences between groups （KruskaI-Wallis test, P〉0.05）. All three groups remineralized the enamel slab lesions, indicating model sensitivity to fluoride. Given the differences in usage amounts and treated regimens, Clinpro Tooth Crbme provided similar benefits to the fluoride toothpaste; however, no additional benefit of Tooth Mousse Plus was observed when used in conjunction with the fluoride toothpaste.     

Basal cell adenoma of the parotid gland: a clinicopathological study of nine cases—basal cell adenoma versus pleomorphic adenoma and Warthin’s tumor

The aim of this study is to investigate the clinical and pathological characteristics of basal cell adenoma (BCA) and to compare the diagnosis/treatment of BCA with those of Warthin’s tumor (WT) and pleomorphic adenoma (PA). Among 192 patients with benign tumors of the parotid gland who underwent surgery, 9 had BCA. All of these tumors showed a benign pattern on computed tomography and magnetic resonance imaging. The accuracy of fine needle aspiration biopsy (FNAB) for diagnosis of BCA was slightly lower than for PA and WT. Most PA and BCA lesions developed in the upper part of the parotid gland. Considering the gender difference, tumor site, and age, it is necessary to differentiate BCA from PA rather than from WT. There were no significant differences in the duration of surgery, the blood loss, and the incidence of transient facial paralysis between surgical resection of BCA and surgery for PA or WT. BCA is the third most common of the benign parotid tumors, following WT and PA, although its incidence is low. When PA and WT are ruled out by FNAB after a tentative diagnosis of benign tumor has been based on imaging findings, BCA should be considered.