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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The role of computed tomography and magnetic resonance imaging for preoperative pediatric cochlear implantation work-up in academic institutions.Cochlear Implants International
The goal of the study is to investigate the association of pertinent preoperative temporal bone computed tomography (CT) and brain magnetic resonance imaging (MRI) results and intraoperative surgical findings and complications of pediatric cochlear implantation reported in academic settings.
This is a retrospective review of cochlear implant patients who received a pre-operative temporal bone CT and MRI of the brain between 2005 and 2012 at academic pediatric otolaryngology practices within children's hospitals in the United States and France. Scans were reviewed in a double-blind fashion and compared to intraoperative findings.
91 children were analyzed (mean age 5.54 +/- 0.58 years). A small facial recess identified on CT was associated with difficult insertion of electrodes (P = 0.0003). A prominent sigmoid sinus noted on CT was associated of difficult insertion of electrodes (P = 0.01), iatrogenic tegmen dehiscence (P = 0.005), as well as difficult round window access (P = 0.025). No specific CT finding was found to be associated with external auditory canal injury, perilymphatic gusher, or iatrogenic facial nerve injury. MRI brain and internal auditory canal findings were not predictive of surgical outcomes.
Preoperative CT and MRI remain an important planning tool for pediatric cochlear implantation, particularly in academic institutions. The findings of our study demonstrate that a detailed assessment of both preoperative CT and MRI are valuable for teaching and surgical planning.
Facial nerve stimulation in a post-meningitic cochlear implant user: using computational modelling as a tool to probe mechanisms and progression of complications on a case-by-case basis.Cochlear Implants International
Facial nerve stimulation (FNS) is a side-effect of cochlear implantation that can result in severe discomfort for the user and essentially limits t...
Use of auditory evoked potentials with electrical stimulation at the round window niche pre-operatively on a brain-injured patient: A case study.Cochlear Implants International
To highlight the effectiveness of using PS testing in conjunction with electrically evoked auditory evoked potentials (eAEPs) to help guide treatment plans in patients with limited behavioural responses.
Case report on a 59-year-old male with traumatic brain injury. Electrophysiological measurements in conjunction with PS were performed.
eAEPs were obtained up to the thalamo-cortical region, supporting the viability of a CI in the non-implanted ear.
Use of PS in conjunction with electrically evoked auditory evoked potentials can provide valuable information to guide clinical decisions regarding implantation.
Hyrtl's fissures in cochlear implant surgery.Cochlear Implants International
This case study presents a rare anatomical anomaly complicating cochlear implantation in the form of patent periotic ducts and Hyrtl's (tympanomeni...
Effects of longstanding degraded auditory signal on visuospatial, visuomotor, and visual attention skills in adults with hearing loss.Cochlear Implants International
This study examined the consequences of long-term auditory deprivation on visuospatial functions, visuomotor functions, and visual attention skills in adults with early-onset hearing loss.
Fifteen adults with bilateral, early-onset (before age 3), severe-to-profound hearing loss who used spoken language participated in this study. Visuospatial (figure ground, form constancy, visual perception) and visuomotor functions (visuomotor integration, visual search) were examined using norm-referenced tests. Visual attention scales were examined using a computerized program, IVA plus continuous performance test.
As a group, participants performed in the average range on visuospatial and visuomotor functions when compared to normative data presented in the test instruments. However, participants demonstrated below average performance on sustained visual attention. Duration of cochlear implant use positively correlated with one of the visual attention scales, namely visual speed.
The findings of the current study suggest that adults with early-onset hearing loss may demonstrate difficulties in sustaining attention to visual information. Data also suggest that increased experience with cochlear implant may ameliorate deficits associated with visual attention. Future studies should explore challenges experienced by adults with early-onset hearing loss in their daily activities that may result from this deficit and intervention programs that may enhance visual attention skills.
Implications from cochlear implant insertion for cochlear mechanics.Cochlear Implants International
It is usually thought that the displacements of the two inner ear windows induced by sound stimuli lead to pressure differences across the basilar ...
Presence of the spiral ganglion cell bodies beyond the basal turn of the human cochlea.Cochlear Implants International
The purpose of this study was to obtain a better understanding of the number and distribution of spiral ganglion cell bodies (SGCB) in the central ...
Electrode impedance changes after implantation of a dexamethasone-eluting intracochlear array.Cochlear Implants International
Postoperative inflammation and the formation of fibrotic tissue around the intracochlear electrode array are often held responsible for negative ou...
Speech understanding and listening effort in cochlear implant users - microphone beamformers lead to significant improvements in noisy environments.Cochlear Implants International
To evaluate the effect of microphone directionality, i.e. beamforming, on speech understanding in noise with the SONNET audio processor.
Speech reception thresholds (SRTs) were tested in three different microphone settings (omnidirectional, adaptive, and fixed beamformer (natural)) and assessed via the Oldenburg Sentence Test and the Just Understanding Speech Test. Subjects rated the listening effort needed to understand speech in different signal-to-noise ratios (-10, -5, 0, 5, 10, 15 dB SNR) via a Visual Analogue Scale. For all test methods, speech was presented at 0° azimuth while fixed and uncorrelated masking noise was presented simultaneously from five loudspeakers positioned at ±70°, ±135°, and 180° azimuth.
Compared to the omnidirectional mode, significant improvements (p<0.001) were shown in mean SRTs for both the natural (3.3 dB SNR) and adaptive (5.2 dB SNR) settings. Using the natural or the adaptive setting required significantly less listening effort than using the omnidirectional setting for the SNR conditions -5 dB SNR (p=0.002) and 0 dB SNR (p<0.001).
The beamformer settings significantly improved speech understanding in noise over the omnidirectional setting. Due our multi-speaker test setup, we conclude that beamforming should yield significantly better and less stressful speech understanding in demanding real-life listening situations.
Iatrogenic facial nerve exposure in cochlear implant surgery: incidence and clinical significance in the absence of intra-operative nerve monitoring.Cochlear Implants International
Iatrogenic facial nerve injury is one of the most feared complications of cochlear implantation. Intraoperative facial nerve monitoring is used as an adjunctive modality in a variety of neurotologic surgeries including cochlear implantation. With the lack of nerve monitoring, there is a theoretically higher risk of iatrogenic fallopian canal dehiscence with facial nerve exposure, particularly the mastoid portion, during cochlear implant surgery. The purpose of this study is to determine the incidence of iatrogenic exposure of the facial nerve and its relation to the incidence of post-operative facial paralysis in the absence of facial nerve monitoring.
This was a retrospective study. Medical charts of 307 patients who underwent cochlear implantation without facial nerve monitoring, from 2012 to 2017 were reviewed to identify cases with a reported iatrogenic defect over the mastoid facial nerve. The incidence of post-operative facial palsy was determined and compared to the incidence with the use of intra-operative monitoring which has been reported in the literature.
The incidence of iatrogenic dehiscence with facial nerve exposure was 46.58%. However, the incidence of post-operative facial palsy was only 2.1% which decreased to 0.72% in cases without injury of the facial neural sheath. This was not significantly different from the 0.73% rate reported in the literature with the use of intra-operative facial monitoring (P = 0.99).
The incidence of iatrogenic facial nerve exposure during cochlear implantation may be relatively high. However, no additional risk of post-operative facial nerve paralysis was found, provided that the integrity of the neural sheath was preserved, even with the lack of intra-operative monitoring.
Initial surgical and clinical experience with the Nucleus CI532 slim modiolar electrode in the UK.Cochlear Implants International
The goal of this work is to describe the first experience in the UK with the slim pre-curved perimodiolar electrode Nucleus CI532 in a continuous series of patients in terms of surgical and clinical reliability and early performance outcomes.
In this retrospective review we describe the complication rate (including electrode array tip fold-over), NRT thresholds, hearing preservation, power efficiency and CI performance outcomes in a continuous series of 40 cochlear implants CI532 performed between October 2016 and November 2017 in 17 adults and 13 children with severe to profound hearing loss.
Preliminary data from these groups reveals some low-frequency hearing preservation in the CI532 group although none of the patients were conventional hearing preservation candidates. NRT thresholds, power efficiency, and BKB sentences in quiet were measured at 3 and 6 months post activation. There were no significant differences in these results. The average BKB score in quiet increases from 22% pre-operatively to 58% at 3 months and 70% at 6 months. In addition, although hearing preservation was not an objective, low-frequency thresholds were preserved in 20% of cases at 3 and 6 months post-operatively. Complications were observed in 5 cases, one case with non-device related aerocoele and four related to the device array: two cases of tip roll over, one case of the electrode array being placed extra-cochlea, and one case with the electrode buckling into the middle ear. The last 2 cases were dealt with per-operatively.
CI532 is a reliable device offering good initial results and could be an option for hearing preservation although further studies are required.
Evaluation of a wireless contralateral routing of signal (CROS) device with the Advanced Bionics Naída CI Q90 sound processor.Cochlear Implants International
Cochlear implants (CIs) usually provide severe to profoundly deaf recipients with speech intelligibility in quiet. In difficult listening situations such as background noise however, communication often remains challenging. For unilateral CI recipients with a bilateral hearing loss, speech intelligibility for speech sources on the non-implanted side is further impaired by the head-shadow effect. One possibility to overcome this impairment is the use of Contralateral Routing of Signal (CROS) systems, which capture sounds from the non-implanted side and (wirelessly) transmit them to the implant processor, therefore increasing audibility. Such a CROS system was evaluated in this study.
Speech intelligibility in noise was measured in several spatial listening setups using the Oldenburg matrix sentence test in ten cochlear implant users. Performance was compared between listening with the CI alone and listening with the CI in combination with a wireless CROS device. Following an extended trial phase, subjective feedback regarding the device benefit in everyday life was collected via the Bern Benefit in Single Sided Deafness (BBSS) questionnaire.
The addition of the wireless CROS device significantly improved speech intelligibility by 7.2 dB (median) in spatial noise. Using advanced directional microphones, a statistically significant benefit of 4.4 dB (median) could be shown in a diffuse noise field. Responses to the BBSS questionnaire revealed that subjects perceived benefit in their everyday lives when using the CROS device with their CI.
The investigated CROS system presents a valuable addition to a unilateral CI in cases where bilateral implantation is not an option.