The latest medical research on Otolaryngology
The research magnet gathers the latest research from around the web, based on your specialty area. Below you will find a sample of some of the most recent articles from reputable medical journals about otolaryngology gathered by our medical AI research bot.
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Request AccessTransmuscular pocket: a modified technique to overcome thick musculocutaneous flap in cochlear implant surgery.
Cochlear Implants InternationalTo describe and evaluate a modified cochlear implant surgical procedure for patients with a thick musculocutaneous flap.
A prospective study for cochlear implant surgery in selected patients with a musculocutaneous flap thicker than 7 mm.
Fourteen patients with a thick scalp flap underwent cochlear implantation between July 2019 and December 2020. The patient age ranged between 17 and 53 years. The flap thickness was between 7 mm and 14 mm. The mean follow uptime post operatively was 16.5 months. The cochlear implant receiver coil was successfully implanted using the transmuscular technique without complications and with normal audiological function.
The transmuscular pocket modified technique is a safe and effective method to overcome a thick musculocutaneous flap in cochlear implant surgery.
Taste disturbance following cochlear implantation: a systematic review and meta-analysis.
Cochlear Implants InternationalThis systematic review and meta-analysis aimed to estimate the rate of taste disturbance following cochlear implantation.
The review was designed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Included studies psychophysically measured taste. DerSimonian and Laird random-effects models were used. An overall mean from studies reporting a single mean of taste strip performance was calculated using inverse variance method for pooling.
Of 380 studies identified, 9 were included across which 55 cases of postoperative taste disturbance were reported in 498 patients. Taste was tested at variable timepoints, from <1 week to ≥6 months postoperatively. The overall rate of postoperative taste disturbance was 13.5% (95% CI, 7.6-20.7%) with high heterogeneity between studies (I2 = 62%).
13.5% might indicate a higher prevalence of taste disturbance following cochlear implantation compared to the general population. However, the confidence we can assign to our calculated rate is limited by significant heterogeneity and potential publication bias. Studies reporting mean taste strip scores generally found reduced taste function on the side of the tongue ipsilateral to implantation, but this reduction wasn't statistically significant.
Further research, employing more robust and standardised methodologies, is necessary to accurately ascertain the rate and nature of taste disturbance following cochlear implantation.
Reading achievement and deaf students with cochlear implants.
Cochlear Implants InternationalThe purpose of this study was to investigate the reading outcomes of a Canadian cohort of school-aged deaf learners with cochlear implants (CIs). The goal was to investigate whether achievement approached that of hearing age peers and identify demographic factors influencing performance.
Participants represent a subset of 13 students with CIs from a larger sample of 70 deaf students in grades four through 12 educated in inclusive settings within a large school board in central Canada. Data sources included demographic information, teachers' ratings on the Categories of Auditory Performance (CAP), and scores from the Woodcock-Johnson III Diagnostic Reading Battery [WJ III-DRB].Results/Discussion: Participants performed within the low average range in all areas except for Phonological Awareness, which was in the low range; however, there was wide variability in scores across participants. None of the demographic variables (e.g. home language, additional disabilities) had a statistically significant association with performance, although older students had higher mean scores on the Phonological Awareness cluster.
These findings add to the body of research on literacy achievement and cochlear implantation, providing evidence that this technology has a significant positive effect on outcomes for a population that has heretofore underperformed in this area.
Long-term experience with biohybrid cochlear implants in human neurosensory restoration.
Cochlear Implants InternationalThe implantation of biohybrid electrodes was introduced a few years ago in our clinic. These electrodes coated with autologous mononuclear cells releasing anti-inflammatory and neuroprotective factors are thought to reduce insertion trauma and maintain the vitality of surviving spiral ganglion neurons. The clinical feasibility of this approach has already been demonstrated. In the present retrospective study, the four-year results of the two sides (classical electrode and biohybrid electrode) in the bilaterally implanted patients were compared in order to investigate possible adverse long-term effects.
All patients received a complete audiological diagnosis which also included a speech audiogram and impedance measurement. The measurements were carried out 1 month, 3 months, 6 months, 1 year, 2 years, 3 years and 4 years after implantation. The hearing results were assessed by pure tone audiometry.
All patients showed satisfactory speech understanding and similar impedances on both sides although they had a long-term deafness before implantation of the side provided with a biohybrid electrode array. The results of speech understanding and impedance measurements were stable for years. Cone beam computed tomography was performed in 4 patients three years after implantation and could rule out cochlear ossification. Other complications were also not registered in any of the patients.
Due to satisfactory outcomes and lack of complications, the biohybrid electrode is considered to be a safe option in cochlear implantation. The simplicity of application of autologous cells as a source of anti-inflammatory and neuroprotective factors via a biohybrid electrode array is a key step for cell-based, regenerative therapies for deafness.
Factors impacting outcomes of cochlear implantation in children at two University centres in China: Multi-year analysis from the Paediatric Implanted Recipient Observational Study (P-IROS).
Cochlear Implants InternationalTo identify factors affecting functional hearing performance and quality of life (QoL) outcomes in paediatric cochlear implantation (CI) recipients at two University centres in mainland China.
Two university centres in mainland China, part of the prospective longitudinal Paediatric Implanted Recipient Observational Study (P-IROS), contributed participant data. Participants were aged under 10 years at time of CI. Functional hearing performance and QoL measures were collected prior to device activation, and at 6-monthly intervals for 2 years post-implantation. Functional hearing endpoints including Categories of Auditory Performance-II (CAP-II) and QoL were evaluated and analysed using ordinal mixed-effects regression models.
Data were from 288 children with a mean age at implant of 2.74 years. Overall follow-up at 1 year was 59% and 51% at 2 years. Younger age at implantation (p<0.001) and hearing aid use preimplantation (p=0.026) were associated with significant benefit. Bilateral device users (both CI and bimodal) achieved significantly better functional hearing performance on the CAP-II than unilateral CI users (p<0.001). Slower functional hearing improvements were observed in those with lower parental expectations compared to higher expectations (p<0.001). QoL improved over time but followed a different initial trajectory between centres.
All participants demonstrated significant improvements in auditory performance and QoL over time. Younger age at CI, and bilateral/bimodal device fitting contributed to earlier improvements. Other potential factors that could help inform families, professionals, and health authorities about choice of hearing device and educational supports required included aetiology of hearing loss and level of maternal education.
Post-operative patient perception of decisional regret in cochlear implant recipients.
Cochlear Implants InternationalDecision regret post-surgery has has been linked to health outcomes for a number of elective procedures but is understudied in cochlear implantation satisfaction. Theunpredictability in outcomes may lead to unmet expectations by the recipient. This study is the first study to investigate the decision regret concept in cochlear implant recipients.
Tto investigate post-operative decision regret in (CI) recipients.
This was a prospective cohort study using the validated Ottawa Decision Regret Scale, and whether the CI met the patient's expectations. Variables potentially associated with decision regret including patient demographics, post-operative speech perception scores, duration of deafness, duration of CI use and age were analyzed using the logistic regression model.
This was a multi-center study. Participants were recruited and enrolled from the University of Miami and the University of Kansas in an outpatient setting.
Adult, English-speaking CI recipients with at least 6 months of listening experience with their implant.
Out of 173 58% reported no regret, 27% reported mild, and 15% reported moderate-to-strong regret. Expectations were met in 77% while not meeting expectations in 14%. The remaining 8% were neutral. Decisional regret was significantly associated (p = 0.02) with poor post-operative speech perception. No other variables were associated with regret.
Post-operative decision regret was reported by 42% of CI recipients. Poor speech perception abilities were associated with increased risk of regret. Further research is required to identify regret risks and provide resources to mitigate regret in CI recipients.
Communication breakdown repair skills: Comparison between deaf and hard-of-hearing, and normal-hearing adolescents.
Cochlear Implants InternationalCommunication breakdowns and their repair by deaf and hard-of-hearing (DHH) and hearing adolescents were examined in conversation with an unfamiliar communication partner.
This study compared the number and type of clarification requests and responses to those requests of 16 DHH and 16 normal-hearing adolescents aged 11-16 years, in a 10-minute conversation with an unfamiliar adult. It also analyzed the relationship between speech intelligibility, communication breakdowns, and clarification requests by an unfamiliar adult. the Children's Communication Checklist (CCC) was completed by parents.
DHH adolescents demonstrated significantly higher usage of nonverbal clarification requests and verbal and nonverbal responses to clarification requests compared to normal-hearing adolescents in conversations with an unfamiliar adult. Furthermore, the subscale scores of the CCC and the speech intelligibility of DHH adolescents were significantly lower than those of normal-hearing adolescents. There were correlations between speech intelligibility and the speech subscale score of the CCC, as well as correlations between the pragmatic composite score of the CCC, the number of communication breakdowns, and the number of clarification requests by an unfamiliar adult.
The adolescents with DHH experienced more communication breakdowns in conversation with an unfamiliar adult and the number of clarification requests made by adults was higher.
Delayed-onset facial paralysis following cochlear implantation: a case study and comprehensive analysis.
Cochlear Implants InternationalCochlear implantation (CI) is a surgical intervention used to rehabilitate hearing in individuals, both pediatric and adult, with severe hearing loss. It is generally a safe procedure with rare postoperative complications. Facial nerve paralysis following cochlear implant surgery poses challenges in diagnosis and treatment.
This case report details a 48-year-old male who experienced delayed facial paralysis after cochlear implantation, an uncommon occurrence with limited documentation.
The facial nerve palsy of the patient resolved by the third week with combined therapy.
The etiology of this complication is not fully understood, with latent virus reactivation, particularly HSV and VZV, hypothesized as a probable cause.
Successful management involves a combination of corticosteroids, antiviral therapy, and antibiotics, leading to a favorable outcome.
Utilization of SmartNav technology in cochlear implantation: optimizing efficiency in assessment of electrode placement.
Cochlear Implants InternationalProper electrode placement is essential for favorable hearing outcomes following cochlear implantation. Though often used, traditional intraoperative X-ray imaging is time consuming, exposes patients and staff to radiation, and poses interpretational challenges. The Nucleus® SmartNav System, utilizes electrode voltage telemetry (EVT) to analyze the positioning of the electrode array intraoperatively. This study investigates the efficacy of SmartNav in optimizing the efficiency and accuracy of assessing electrode placement.
This prospective clinical study analyzed placement of 50 consecutive Cochlear Corporation cochlear implants conducted at a single institution between March of 2022 and June of 2023. Placement check of electrode array using SmartNav and X-ray was completed and individually assessed. A comparative analysis of SmartNav and X-ray completion times for electrode placement assessment was conducted.
Subjects included nine ears with abnormal anatomy and three reimplants. SmartNav placement check required a total time of 2.12 min compared to X-ray imaging at 14.23 min (p = 1.6E-16, CI 95%). Both SmartNav and X-ray had excellent sensitivity of 100% in identifying appropriate electrode position (p = 1.0). Tip fold-over was identified using both modalities in 3 cases with noted easier interpretation using SmartNav.
The Nucleus® SmartNav System significantly outperformed traditional X-ray imaging, offering a faster and more straightforward approach to assessing electrode positioning during cochlear implant surgery, thereby enhancing surgical efficiency and patient safety.
Worldwide differences in surgeon intraoperative practices for cochlear implantation.
Cochlear Implants InternationalTo characterize practice patterns of intraoperative imaging and/or functional confirmation of cochlear implant electrode location worldwide.
A cross-sectional survey of otolaryngologists performing cochlear implantation was conducted between March 1 and May 6, 2023. Participants were recruited worldwide using an international otologic society membership email list and at professional meetings. Ninety-seven of the 125 invited participants (78%) completed the survey. Participants were categorized by continent.
North American surgeons use intraoperative X-rays more frequently than surgeons in Europe and Asia (p < 0.001). Otolaryngologists in Europe and Asia more frequently use no intraoperative imaging (p = 0.02). There is no regional difference between the intraoperative use of electrophysiologic instruments. European and Asian surgeons implant MED-EL devices (p = 0.012) more frequently than North American surgeons, who more frequently use Cochlear Corporation devices (p = 0.003). MED-EL use is related to less frequent intraoperative X-ray use (p = 0.02). Advanced Bionics use is related to more frequent intraoperative CT use (p = 0.03). No significant association existed between years of practice, number of cochlear implantation surgeries performed yearly, volume of pediatric CI practice, and use of intraoperative tools.
Intraoperative practice for radiologic and functional verification of cochlear implant electrode positioning varies worldwide. Practice guidelines may help establish a standard of care for cochlear implantation.
Importance of preoperative HRCT temporal bone in the orientation of the cochlea and its relation to intra-operative difficulties in cochlear implantation - predicting the grades of difficulty.
Cochlear Implants InternationalThis study emphasizes the role of preoperative high-resolution computed tomography (HRCT) temporal bone in evaluating the variation in cochlear orientation and proposes a grading system to determine the level of intraoperative difficulties encountered.
Preoperative correlation of middle ear and inner ear structures along with the basal turn angle (BTA) was done to assess the orientation. Patients were divided into three groups depending on BTA and radiology findings.
Group A (BTA = 55°-60°) had statistically significant (p < 0.05) correlation between middle ear to inner ear structures on HRCT, whereas group B (BTA >60°) and C (BTA <55°) had variations in the alignment of middle ear structures to their corresponding inner ear structures.
The association of BTA to the correlation between middle ear and inner ear structures can determine the orientation of the cochlea. This evaluation makes the surgeon aware of intraoperative challenges and helps in surgical planning.
Health literacy of patients eligible for cochlear implants.
Cochlear Implants InternationalHearing loss is known to be an independent risk factor for inadequate health literacy. The objective of this study was to assess the level of health literacy among patients undergoing cochlear implantation to determine areas for improvement in delivery of patient information.
A cross-sectional survey was conducted at the otology-neurotology clinic at Sunnybrook Health Sciences Centre. Patients eligible for cochlear implantation completed two health literacy screening tools: The Short Test of Functional Health Literacy in Adults (S-TOFHLA) and Brief Health Literacy Screen (BHLS).
Thirty seven patients were included (41% female, 59% male, mean age: 55 years). Most patients had adequate health literacy through BHLS (76%) and S-TOFHLA (98%) scoring. Over 80% of patients were not able to correctly recount all the operative risks associated with cochlear implant surgery and one third of patients did not correctly recount any risks associated with a cochlear implant surgery. Female sex was associated with higher scores (p=0.03) and low income (<$35,000) was associated with lower scores (p=0.05).
Patients eligible for cochlear implants have adequate health literacy, but most are not able to recount operative risks. Educational tools are required to improve patient retention, understand, and perioperative health information delivery.
