3D stereophotogrammetry for the assessment of tracheostoma anatomy

Conclusion. 3D stereophotogrammetry is a useful tool for quantitative assessment of tracheostoma anatomy, and thus in future could possibly play a role in solving current problems with peristomal and intratracheal fixation of stoma appliances. Objectives. Differences in tracheostoma anatomy between laryngectomized patients are held partly responsible for the differences in duration of attachment of standard peristomal adhesives for heat and moisture exchangers (HMEs) and automatic stoma valves (ASVs). Accurate information on a set of basic stoma anatomy parameters should be helpful to overcome fixation problems in individual patients and in the general laryngectomy population. Patients and methods. This was an exploratory observational pilot study in 20 laryngectomized patients. Three-dimensional (3D) images of the tracheostoma and surrounding tissue were captured with a 3D digital camera, which applies the advanced principles of stereophotogrammetry. Data were analysed by using a 3D editing program. The following tracheostoma parameters were measured for each patient: horizontal and vertical diameters, circumference, depth and surface. Results. Inter-observer outcomes show a mean stoma circumference of 58.2 mm (SD 11.6 mm). The mean surface was calculated at 186.6 mm² (SD 61 mm²). The mean size of the stoma's horizontal diameter and vertical diameter was 14.7 mm (SD 2.9 mm) and 19.0 mm (SD 3.4 mm), respectively. The mean depth of the stoma in relation to the right sternal head of the m. sternocleidomastoideus was 15.5 mm (SD 5.4 mm) and in relation to the left it was 16 mm (SD 5.6 mm).     

Three-dimensional stereophotogrammetrical analysis of peristomal fixation of adhesive base plates during hands-free speech among laryngectomised patients related to tracheostoma volumes

Clin. Otolaryngol. 2012, 37 , 124–129 Objectives:  This study evaluates the relation between stoma volumes by means of objective three‐dimensional measurements of laryngectomised individuals and peristomal fixation of adhesive baseplates during hands‐free speech. Design:  A three‐dimensional stereophotogrammetrical image was captured of the tracheostoma and its surrounding tissue for each participant. The placement of a baseplate adhesive was virtually simulated. Individual stoma volumes were calculated and related to the duration of lifetime of adhesive baseplates. Setting:  Prospective trial in a university hospital setting. Participants:  Twenty‐four laryngectomised patients. Main outcome measures:  Stoma volume in cm³ and adhesive baseplate adherence in minutes. Results:  For the 24 three‐dimensional images captured, the mean volume of the area under the adhesive (stoma volume) was 9.5 cm³ (range 3.5–22.5). After relating the different volumes of all patients to their individual fixation score, a significant decrease in duration of adhesive lifetime was found with increasing volumes of the stoma (P = 0.001). An increase of 1 cm³ in tracheostoma volume resulted in a decrease of 21% in median adhesive lifetime (95% confidence interval 10–31%). Conclusions:  Longer lifetime of the adhesive baseplate in patients with smaller volume outcomes suggests that a more accurate fit between baseplate and stoma leads to better fixation. This should be taken into account when shaping a stoma during laryngectomy. On the other hand, a more custom‐made patch that has a more accurate fit could increase the lifetime of fixation. We believe that our three‐dimensional volumetric data can contribute to the development of such an adhesive.     

Electrode estimation in the acoustic region of the human Cochlea

Abstract

Background: In this study, a method to estimate number of electrodes in the acoustic region of Electric Acoustic Stimulation (EAS) subjects was proposed. Aims/Objectives: To develop and validate an anatomy-based method for EAS subjects to estimate the number of electrodes within the acoustic region.

Material and methods: The postoperative CTs of adults with various degree of hearing implanted with lateral wall electrodes with mean insertion depth of 23.9?mm (18.0–28.2?mm) and mean insertion angle of 505° (355–695°) were evaluated.

Results: The difference between the estimated and measured angle varied between ?18 and 25°, with a mean of 0.9°. For the insertion angle of 230° and higher, the maximum difference was 24°. Taking this uncertainty into account, all electrodes in the acoustic region were predicted correctly.

Conclusions and significance: The method decides on non-overlapping acoustic and electric stimulation in terms of place in the cochlea. With the accuracy of 0.84?mm for the electrode arrays inserted for more than 230°, the method was sufficient to estimate the exact number of electrodes in the acoustic region of cochlear implantees. The benefit of this method may be in fitting of EAS subjects with some portion of the electrode array in the acoustic region.     

The Mi1000 CONCERTO PIN cochlear implant: An evaluation of its safety and stability in adults and children

Conclusion The study demonstrates the medium-term stability and safety of the CONCERTO PIN cochlear implant. The use of the CONCERTO PIN proved to be suitable for the use of a surgical technique without the need for suture fixation and resulted in short surgery duration and a low medium-term complication rate.

Objective The primary aim was to provide data on medium-term safety and stability of the CONCERTO PIN cochlear implant in adults and children, and to collect feedback on the surgical technique used, which involved no drilling and no suture fixation. The secondary aim was to analyze surgery duration.

Methods Implantation was performed using minimally invasive surgery. During surgery, data on the surgical procedure was collected by the attending surgeons or a designee. Safety and stability of the CONCERTO PIN were assessed at first fitting (1 month after implantation) and 6 months after first fitting.

Results Ninety-nine patients were implanted with a CONCERTO PIN implant and one patient with a CONCERTO implant. The CONCERTO PIN implants implanted during this study were immobilized by pins and a tight periosteal pocket. The mean (±?SD) surgery duration was 27:52 (±?9:19) min.     

Adverse effects of semicircular circle angles variation on Epley repositioning procedure: a study on reconstruction of Micro-CT images 3D

Abstract

Background: For patients with posterior semicircular canal (PSC) BPPV, Epley re-position maneuver and some improvement methods are the most efficient treatment methods. But there were still 9.43% patients who were not benefit from Epley re-position maneuver.

Objective: To measure the angles of semicircular canals and evaluate its effect on Epley maneuver.

Methods: Fifteen skull specimens, containing 30 temporal bone specimens were included. After Micro-CT scanning, 3D reconstruction was loaded with the CT image. The angles between each semicircular canal and each standard skull plane were measured. Furthermore, the angles’ effect on Epley maneuver was evaluated according to the three-dimension (3D) model.

Results: Angles of PSC plane: Frankfurt plane was 71.54?±?6.51, sagittal plane was 53.77?±?5.36°, and the coronal plane was 43.33?±?3.56°. Angles between PSC and the sagittal plane of skulls had an adverse effect on Epley maneuver, when it was less than 45°.

Conclusion: 1. Variation could be found in angles between the semicircular canals and the standard planes of skulls, which meant variation of semicircular canals’ location existing in skulls. 2. The variation of angles between PSC and sagittal plane could have an adverse effect on the Epley maneuver when the angle was less than 45°, which may cause the Epley maneuver to be invalid.     

Surgical technique affects the risk for tracheostoma-related complications in post-ICU patients

Conclusions. This study provides evidence that the surgical technique used for tracheotomy influences the risk of tracheostomy-related complications. Techniques resulting in an epithelialized tracheostoma seem to minimize the risk. Objective. Tracheotomies are frequently performed procedures in critically ill patients requiring long-term ventilation. Hence, we undertook a study to evaluate factors for tracheostomy-related complications among patients with a persisting stoma after critical care. Patients and methods. The patients underwent endoscopic examination of the tracheostoma, larynx, and trachea. The intensive care units (ICUs) were contacted with a questionnaire about the patient's diagnosis, the indication for the tracheotomy, the date of the tracheotomy, and the method of the tracheotomy procedure. Results. A total of 170 patients were included in this study. In all, 57.6% of the patients had unstable tracheostomas, a stenosis of the tracheal lumen above the stoma was encountered in 48.2% (G I, <50% of the lumen?=?27.6% and G II, >50% of the lumen?=?20.6%), and below the stoma in 3.5% of the patients. A significant association was found between severe suprastomal stenosis, tracheostoma instability and the use of dilatational tracheotomy (DT) (p<0.001). A malacia of the trachea was significantly more common among female patients (p?<?0.010).     

Difficulties in the fixation of prostheses for voice rehabilitation after laryngectomy

In most patients with advanced or recurrent laryngeal or hypopharyngeal cancer, total laryngectomy is indicated. This means the loss of three main functions: phonation; respiration; and the prevention of aspiration during deglutition. Laryngectomy patients have various options to restore phonation: an oesophageal voice; an electrolaryngeal voice; or a tracheo-oesophageal voice. In the last case a silicone rubber shunt valve is placed in the tracheo-oesophageal wall and phonation is generated when exhaled air is forced through the oesophagus and neopharynx. This method is widely applied in Western Europe. In this paper we review the literature on fixation problems with shunt valves, tracheostoma valves and heat and moisture exchange (HME) filters. Tracheo-oesophageal speech without a valve is not considered. Despite 22 years of experience with the implantation of tracheo-esophageal shunt valves and many improvements in the design, problems still remain, such as biofilm formation with subsequent leakage through the valve, the need for frequent and inconvenient replacements, fistula enlargement leading to leakage around the device and reduced fixation, and infections. The high cost of shunt valves is a drawback to their use worldwide. To enable hands-free speech, different types of tracheostoma valve have been developed. These valves are fixed to the skin or to the tracheostoma by means of an intra-tracheal device. An HME filter is used to protect the airway and maintain physiological balance. Such devices are only suitable for a selected group of patients as fixation to the skin or trachea can be a major problem. Speaking and coughing cause pressure increases, which often result in mucous leakage and disconnection of the valve and/or HME filter. Recommendations are made for future improvements in fixation techniques.     

Diagnostic role of cone beam computed tomography for the position of straight array

Objective: To assess the usefulness of cone beam computed tomography (CBCT) for characterizing electrode insertion and evaluate the influence of electrode insertion status on post-cochlear implantation (CI) outcomes.

Design: Twenty-six ears with post-CI CBCT scans were included. The devices were MED-EL Flex28 (n?=?21) and Nucleus slim straight (n?=?5). The parameters including cochlear duct length (CDL), insertion depth angle (IDA), insertion length of electrode (IL), and cochlear coverage (CC) were analyzed and compared with aided pure-tone threshold (PTA) with implant in free field, and open-set sentence score.

Results: The mean CDL was 36.8?±?1.4?mm. Electrode array was dislocated into scala tympani in two ears. The mean IL and IDA were 26.5?±?1.9?mm and 541.4?±?70.2°. The mean linear CC (IL/CDL, 0.73?±?0.06) was larger than the mean angular CC (IDA/900, 0.60?±?0.08). The CBCT parameters showed correlation one another. While the aided pure-tone threshold was correlated with IL and IDA, there were no significant correlations in the open-set sentence score. For the postlingually deaf patients with single electrode (Flex 28), the sentence score had no significant correlation and the aided PTA was positively correlated with IL (R?=?0.517, p?=?.028).

Conclusions: This study validated the CBCT evaluating the electrode array position. The CBCT could be helpful for the preoperative selection of the optimal array and prediction of the CC.     

Surgical technique affects the risk for tracheostoma-related complications in post-ICU patients

CONCLUSIONS: This study provides evidence that the surgical technique used for tracheotomy influences the risk of tracheostomy-related complications. techniques resulting in an epithelialized tracheostoma seem to minimize the risk. OBJECTIVE: Tracheotomies are frequently performed procedures in critically ill patients requiring long-term ventilation. Hence, we undertook a study to evaluate factors for tracheostomy-related complications among patients with a persisting stoma after critical care. PATIENTS AND METHODS: The patients underwent endoscopic examination of the tracheostoma, larynx, and trachea. The intensive care units (ICUs) were contacted with a questionnaire about the patient's diagnosis, the indication for the tracheotomy, the date of the tracheotomy, and the method of the tracheotomy procedure. RESULTS: A total of 170 patients were included in this study. In all, 57.6% of the patients had unstable tracheostomas, a stenosis of the tracheal lumen above the stoma was encountered in 48.2% (G I, <50% of the lumen = 27.6% and G II, >50% of the lumen = 20.6%), and below the stoma in 3.5% of the patients. A significant association was found between severe suprastomal stenosis, tracheostoma instability and the use of dilatational tracheotomy (DT) (p<0.001). A malacia of the trachea was significantly more common among female patients (p < 0.010).     

A new technique to find the facial nerve and recess by using the short process of the incus and the spine of Henle as landmarks: incus-spine angle

Abstract

Background: Precise techniques to find the facial nerve (FN) and recess are lacking.

Objectives: We aimed to define incus-spine and incus-FN angles which can be used to localize the FN and recess during mastoidectomy.

Material and methods: Thirty adult cadaveric temporal bones were studied. Canal-wall up mastoidectomy with a facial recess approach was performed. The temporal bones and microscope were positioned differently to change the visual angle. The following distances were measured: (1) Short process of the incus (SPI)-FN; (2) Body of the incus-FN. Photographs were taken. Three lines were drawn on the photographs between the SPI, FN, and the spine of Henle. The angles were created and measured.

Results: Three of the temporal bones were excluded due to the absence of the spine of Henle and two of them due to the displacement of the SPI. The mean of the incus-spine angle in 25 temporal bones was 90.12° and the mean of the Incus-FN angle was 135.96°. The mean distances of the SPI-FN and body of incus-FN were 4.85 and 9.26?mm, respectively.

Conclusions and significance: The incus-spine and the incus-FN angles along with the distances can help localize the FN and recess.     

Evaluation and interpretation of the bucket test in healthy individuals*

Objective: To determine and interpret the range of normal deviation of the bucket test in healthy subjects

Subjects and methods: Study design: Cross-sectional study in a secondary care center. Inclusion criteria: subjects ≥18 years old with no otologic or neurologic symptoms and normal complete neuro-otological examination. The subjective visual vertical was evaluated binocularly using the bucket test. Five measurements were made on the clockwise direction and five on the counterclockwise direction. The examiner selected the starting point, the patient then manipulated the bucket and it stopped when the volunteer considered the line reached the vertical position.

Results: Fifty healthy volunteers were included, 16 (32%) were men, and 34 (68%) women with a mean age of 34 years. The mean value found clockwise was 1.93°?±?2.26° and counterclockwise sense was of 0.86°?±?2.44°. Mean normal values ranged from 1.4°?±?1.9°.

Conclusions: The bucket test is easy and quick to perform; we recommend to use a range of ?1.0° to +3.0° as normal values in the healthy population.     

Treatment of posttraumatic olfactory dysfunction with corticosteroids and olfactory training

Abstract

Background: Few have investigated long-term effect of treatment of posttraumatic olfactory dysfunction (OD).

Aims/objectives: To explore if sequential treatment with corticosteroids and olfactory training (OT) improved smell in patients with OD after moderate and severe traumatic brain injury (TBI).

Material and methods: Twenty-two patients with persistent OD, mean 62 months after trauma, completed an open uncontrolled intervention study of treatment for 10 d with oral corticosteroids and thereafter for 3 months with OT twice daily. Olfaction was assessed by Sniffin’ Sticks. They were tested at four-time points, with the last assessment 12 months after baseline measurements.

Results: Mean age at trauma was 45 (SD 14) years. Mean threshold, discrimination and identification (TDI) score at baseline was 14.4 (SD 7.3) and increased to mean 20.8 (SD 7.4) after 1 year (minimum ?3.0; maximum 19.5, p value <.001). Analysed separately, each TDI component increased significantly after 1 year. Half of the patients (11/22) experienced a clinically significant improvement of ≥6.0 TDI points. Improvement was not associated with any sociodemographic or trauma-related characteristics or with olfactory function at baseline.

Conclusions and significance: Treatment with corticosteroids and OT was promising in persistent OD after TBI and should be further studied.     

Tracheostoma valve with integrated cough lid for improvement of hands-free speech in laryngectomees - long term results

BACKGROUND: Tracheostoma valves for laryngectomized patients were introduced to enable the laryngectomee after successful surgical voice restoration either by a voice prosthesis, a surgical shunt or microvascular laryngoplasty, to speak without using his fingers to close the tracheostoma. The basic principle of these aids is a mobile valve, which closes automatically at a certain air flow, directing the expired air of the lungs into the pharynx. In spite of the clear advantage of enabling a hands-free speech, the long term acceptance rate is still rather low, which is mainly caused by problems of an airtight fixation within or at the tracheostoma. Another important disadvantage of these tracheostoma valves is the necessity of removing the valve during coughing. The new tracheostoma valve "Window" (ADEVA Company, Lübeck, Germany) offers a clear improvement regarding this point. It is constructed with an additional coughing lid, which opens at a certain airflow and closes automatically after the coughing attack. After successful development and clinical testing of the new aid in 1999 and 2000, it was now the question, if the previously low acceptance rate of tracheostoma valves could be improved in the long term use by this new type of valve. PATIENTS: Within the last 4 years 70 patients were provided with the "Window" tracheostoma valve. Patients were followed up at regular intervals in order to evaluate the function, the acceptance and the durability of the new device. Additional to the clinical examination patients had to fill in a questionnaire in order to investigate the subjective estimation by each patient himself. 15 patients did not send back their questionnaire or did not fill it in correctly, 5 patients refused clinical supervision after adjustment of the device, so finally the long term use in 50 patients could be analysed. RESULTS: 82 % of the patients reported, that the coughing lid worked safely and opened immediately during the coughing attack. Most of the patients were satisfied with their device, but had nevertheless some proposals for a further improvement: although they cover the tracheostoma either with their clothes or a protection scarf, most of the patients would prefer a device which is smaller than the current model. Some patients reported on an insufficient stability of the plastic material, which led to a defect at the sliding mechanism of the coughing lid. The greatest problem regarding the regular use of the valve was - comparable to conventional tracheostoma valves - the occurrence of an air leakage around the tracheostoma. Although there are three different models of the "Window" tracheostoma valve available, only patients being fitted with the "standard-T-type" version could wear the device 10 hours a day or longer without any problems of air leakage. CONCLUSIONS: The "Window" tracheostoma valve with an integrated coughing lid provides further improvement in speech rehabilitation of laryngectomees. The actual rate of acceptance of 62 % for all "Window" patients (1 month daily use for at least 2 hours) is superior to other reports on the use of tracheostoma valves and probably caused by the additional comfort provided by the coughing lid. Another important factor for the long term use of tracheostoma valves is however the safe fixation of the device in or around the tracheostoma. In this point further improvement is necessary, as only the model with the fixation within the trachea (T-type) led to a satisfactory long term airtight fixation.     

Evaluation of cochlear nerve diameter and cross-sectional area in ANSD patients by 3.0-Tesla MRI

Conclusions: The size of cochlear nerve (CN) is atrophic in adult auditory neuropathy spectrum disorder (ANSD) patients compared with non-ANSD sensorineural hearing loss (SNHL) patients and normal hearing subjects, and CN deficiency is one of the lesions for ANSD patients. Objectives: To evaluate the dimensions of CN in adult ANSD patients on magnetic resonance imaging (MRI) and confirm the hypothesis that CN deficiency is one of the lesions for ANSD patients. Methods: Medical records and MRI of 24 adult ANSD patients reviewed retrospectively and 20 non-ANSD SNHL and 24 volunteers with normal hearing were recruited as control groups. The long diameter (LD), short diameter (SD), and cross-sectional area (CSA) of CN and facial nerve (FN) were measured. Results: Among the 24 ANSD patients, this study was able to reconstruct and measure the CN of 91.7% (22/24, total 43 ears) of patients and FN of 83.3% (20/24, total 38 ears) of patients. The mean values and standard deviations of LD, SD, and CSA of CN in ANSD patients were 0.65?±?0.20?mm, 0.44?±?0.15?mm, and 0.30?±?0.19?mm², respectively. They were significantly smaller in ANSD patients than in control groups (p?相似文献   

Development of a murine model of traumatic benign paroxysmal positional vertigo: a preliminary study

Conclusion: The results showed a gradual detachment of otoconia in the utricle after a single event of head vibration, possibly explaining the frequent recurrence of BPPV attacks and persistent dizziness after trauma.

Objectives: This study developed a murine model of traumatic BPPV and observed the changes in otoconia detachment over time.

Methods: Six-week-old CBA mice were used in this study. Otoconia detachment was induced by vibrating the head for 2?min. Utricles of mice were harvested from different groups: before the head vibration and 1?day, 1 week, 1 month, and 3 months after vibration application. Using scanning electron microscopy and ImageJ software, the percentage of the intact area of otoconia in the utricle was calculated. Hearing thresholds were compared among the groups.

Results: The mean (±?SD) percentages of the intact area of otoconia in the utricle were 98.1%?±?1.7% before the vibration and 93.6%?±?1.7%, 88.9%?±?5.3%, 78.2%?±?20.9%, and 38.9%?±?24.1% at 1?day, 1 week, 1 month, and 3 months after the vibration, respectively. The percentage decreased significantly over time after the vibration (p?相似文献   

Factors affecting hearing deterioration in vestibular schwannoma patients treated with gamma knife radiosurgery: the Asan Medical Center experience

Objectives: To investigate the changes in hearing and to determine factors predicting hearing deterioration in patients with vestibular schwannoma (VS) who undergo gamma knife radiosurgery (GKRS).

Design: A retrospective review of medical records in patients diagnosed with VS and initially treated with GKRS at a tertiary care medical center between 1995 and 2015 was performed. Tumor factors (location, volume), parameters related to irradiation to the tumor and cochlea, and distance between the tumor and cochlea were reviewed.

Results: Fifty-six patients were included in the final analysis with a mean observation period following GKRS as 24.4?±?27.8 months. Prior to GKRS, the average pure tone threshold at 500, 1k, 2k, and 4k?Hz (PTA₄) was 51.0?±?29.7?dB HL. After GKRS, the mean PTA₄ was 71.6?±?33.3?dB HL. Significant independent odds ratios for hearing deterioration were 8.5 for extracanalicular tumors, 18.8 for more than 10 shots in GKRS, and 12.2 for a distance between the tumor center and cochlea modiolus less than 20?mm.

Conclusions: A significant hearing deterioration was shown in 2 years after GKRS. Tumor location, number of radiation shots, and distance between the tumor and cochlea affected hearing level after GKRS.     

Electrophysiological and behavioural study of localisation in presence of noise

Objective: The ability to determine the location of the sound source is often important for effective communication. However, it is not clear how the localisation is affected by background noise. In the current study, localisation in quiet versus noise was evaluated in adults both behaviourally, and using MMN and P3b.

Design: The speech token/da/was presented in a multi-deviant oddball paradigm in quiet and in presence of speech babble at +5?dB SNR. The deviants were presented at locations that differed from the standard by 30°, 60° and 90°.

Study sample: Sixteen normal hearing adults between the age range of 18–35?years participated in the study.

Results: The results showed that participants were significantly faster and more accurate at identifying deviants presented at 60° and 90° as compared to 30°. Neither reaction times nor electrophysiological measures (MMN/P3b) were affected by the background noise. The deviance magnitude (30°, 60° and 90°) did not affect the MMN amplitude, but the smaller deviant (30°) generated P3b with smaller amplitude.

Conclusions: Under the stimulus paradigm and measures employed in this study, localisation ability as effectively sampled appeared resistant to speech babble interference.     

The diagnostic value of measurement of cochlear length and height in temporal bone CT multiplanar reconstruction of inner ear malformation

Conclusion: The cochlear length (CL) and cochlear height (CH) measured through MPR will provide for more accurate quantitative diagnosis of inner ear malformation, and are subsequently convenient for calculating cochlear duct length (CDL) before cochear implant.

Objectives: Qualitative and quantitative diagnosis of inner ear malformation in deaf patients through multiplanar reconstruction (MPR) was performed to provide a reference for cochlear implants.

Methods: One hundred and two cases without sensorineural deafness and 560 patients with sensorineural deafness had MPR of temporal bone computed tomography performed to obtain the standardized cochlear-view and oblique coronal-view images. The inner ear radial lines were measured to formulate normal values for inner ear malformation diagnosing, and the CDL was estimated based on CL.

Results: The normal range values of inner ear radial lines were measured and formulated, of which CL was 8.1–9.59?mm and CH was 3.28–3.90?mm. According to inner ear morphology and the normal values measured above, 61 cases of incomplete partition-type II (IP-II) and a high percentage (27/110, 24.5%) of hypoplasia of cochlea (HC) were diagnosed. The HC group was further divided into 1-turn, 1.5-turn, and 2-turn sub-groups, which had CDL of 15.98?±?1.48?mm, 21.36?±?0.96?mm, and 26.56?±?0.60?mm, respectively.     

Compliance,quality of life and quantitative voice quality aspects of hands-free speech

Conclusions

With the use of a new automatic stoma valve (ASV) it appears possible to rehabilitate patients who have previously been unsuccessful in acquiring hands-free speech. As well as making daily ASV use possible for an additional group of patients, this new device was also appreciated by many patients as an additional rehabilitation tool for specific occasions. Despite statistically significant improvements in aspects of voice and breathing using this novel ASV, improvement of peristomal adhesion is probably the main factor needed to further increase success rates. Nevertheless, our results show that it makes sense to keep trying to achieve hands-free speech, even if previous attempts have failed.

Objective

To make a long-term (6 months) assessment of compliance and aspects of voice, breathing and quality of life using a new ASV: the Provox FreeHands heat and moisture exchanger (HME).

Material and methods

This was a prospective clinical multicentre trial in 79 laryngectomized patients (8 regular ASV users, 58 previously unsuccessful users and 13 new users). Data were collected at baseline and after 1 and 6 months by means of European Organization for Research and Treatment of Cancer Quality of Life questionnaires and specific structured questionnaires concerning compliance, skin adhesion, voicing and pulmonary aspects. An objective assessment of voice parameters (maximum phonation time, maximum phonation time while counting, dynamic loudness range and number of pauses in a standard read-aloud text) was made for comparison of different stoma occlusion methods (digital occlusion via an HME and two different ASVs). A subjective assessment of overall voice quality was made.

Results

After 6 months, 19% of patients used the new ASV on a daily basis (mean 5?h/day), while 57% used it on an irregular basis as an additional rehabilitation tool for special occasions. Two-thirds of the study group indicated that they would continue to use the new ASV after the study period. With respect to the objective parameters, statistically significantly better maximum phonation times and dynamic loudness ranges were observed with the new ASV compared to the Blom–Singer ASV. However, the best results for all the objective parameters were obtained with digital occlusion via the Provox HME.     

Outcomes of the Baha Attract System combined with auricle reconstruction in mandarin speaking patients with bilateral microtia-atresia

Background: A transcutaneous bone-conduction hearing device (tBCHD), the Baha Attract System has been recently introduced to China, and very few studies have assessed the efficacy of this system in speakers of mandarin.

Objectives: This study aims to analyze the functional and cosmetic outcomes of this system.

Materials and Methods: This prospective study included 11 patients (nine males, two females), of mean age 16 years (range 9–32 years). Seven patients were conducted the implantation simultaneously with auricle reconstruction, and the other four were before it. Auditory results were compared between unaided patients and implanted patients. Subjective satisfaction was analyzed using three questionnaires.

Results: The mean sound field thresholds were 65.9?±?5.1?dB SPL unaided and 30.9?±?4.7?dB SPL with an implanted Baha Attract System, resulting in a mean hearing gain of 35.0?±?6.7?dB. The mean WRS scores were 47.8?±?8.7% unaided and 92.1?±?2.0% with the Baha Attract System, resulting in a mean improvement of 47.8?±?8.7%. No adverse events were reported and questionnaires showed good patients satisfaction.

Conclusions: The transcutaneous Baha Attract System is effective in mandarin speaking patients, and the combination of hearing rehabilitation and auricle reconstruction surgery is promising for patients with bilateral microtia-atresia.