Outcome assessment alternatives for young children during the first 12 months after pediatric hearing-aid fittings

Abstract

Objective: Perform longitudinal evaluations of young children during the first 12 months after initial hearing-aid fitting. Document evidence of early prelingual auditory development (EPLAD), identify factors that affect EPLAD, and define performance milestones that can guide best practices. Design: Unblinded, prospective, within-subject, repeated-measures design. Audiological measures and measures of EPLAD were taken at baseline, 3, 6, and 12 months after hearing-aid fitting. Study sample: Subjects were 45 pediatric patients initially fitted with hearing aids between 1 and 5.5 years of age. Four groups were formed for analysis purposes based on severity of hearing loss (moderate-to-severe and profound) and initial fitting age (≤?30 months and >?30 months). Results: All groups exhibited statistically significant increases in EPLAD within six months of hearing-aid fitting, and those with profound losses exhibited further statistically significant improvement between six and 12 months. Similar EPLAD levels were reached at 12 months regardless of severity of hearing loss. The EPLAD trajectory is similar to that following early cochlear implantation. Conclusions: Measures of EPLAD provide a means of evaluating outcomes following early pediatric hearing-aid intervention, supplementing behavioral audiological measures.     

Longitudinal melanonychia: when to biopsy and is dermoscopy helpful?

Longitudinal melanonychia (LM) is a common presenting problem in general dermatology, and represents a diagnostic challenge to clinicians given its broad differential diagnosis that includes both benign and malignant entities. The decision of when a biopsy is required is incredibly challenging for dermatologists. Dermoscopy is a noninvasive technique that enhances the clinical evaluation of LM, and has demonstrated potential in improving the clinical decision making as to whether or not to biopsy LM. However, it is critical for clinicians to understand the limitations of dermoscopy, and that although it is able to add new criteria for the diagnosis of ungual pigmentation, it does not replace histopathologic diagnosis. Biopsy of the nail unit should be performed in any case where doubt based on the clinical evaluation exists.     

A Longitudinal Factor Analytic Study of Children’s Neurocognitive Abilities

The neurocognitive abilities of 503 Portuguese children aged 8–11.9 years at onset of the study were assessed annually for 8 years in 3 functional domains: memory, motor and visual motor functions, and attention. A series of exploratory principal axis factor analyses, with varimax rotation, revealed seven factors: Divided Attention, Selective Attention, Verbal Learning and Recall, Visual Learning and Recall, Motor Speed, Visual-Motor Speed, and Working Memory. The same factors emerged across the 8-year period, suggesting that children's neurocognitive structures are articulated and stable throughout this period of development. From these exploratory analyses a small set of cost-effective neuropsychological tests were found to characterize children's functioning consistently throughout the 8-year period.     

How to address cerebrospinal fluid leakage following ossification of the posterior longitudinal ligament surgery

BackgroundPrimary dural repair in ossification of posterior longitudinal ligament (OPLL) surgery via anterior is challenging because of limited space. Based on several years of our experiences, we present our concept for addressing cerebrospinal fluid (CSF) leakage following dural tear during anterior OPLL surgery.MethodsWe reviewed the medical records of 65 patients who underwent anterior OPLL surgery from 2003 to 2014. We included 7 patients whose operation records described dural tear followed by CSF leakage. Primary dural repair could not be performed in 6 patients because of ragged tear and limited space. We managed them with our own strategy: simple cover with an artificial dura, collagen sponge and/or fibrin glue on defect site; anatomical layer-by-layer repair without either subfascial or CSF drain, and early ambulation.ResultsOf 7 patients, wound problems developed in 2 patients. Wound aspiration and antibiotic treatment was done without wound compression in one patient, and simple irrigation followed by anatomical layer-by-layer re-closure was done in the other patient without either bed rest or lumbar drainage.Pseudomeningoceles were detected in 4 patients, including 2 patients who had wound problems. However, all pseudomeningoceles were absorbed spontaneously or stabilized on follow-up images without interventions such as bed rest, lumbar drain or wound compression.ConclusionsWithout interference of pressure equilibrium between intradural and extradural space, the defect site would heal and close. After that, the isolated pseudomeningocele would be spontaneously absorbed after certain period of time.