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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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.
The common cavity vs incomplete partition type I conundrum: Decision making and management with the cochlear implant form electrode.Cochlear Implants International
It has been seen that 20% of children with deafness have inner ear malformations. Studies demonstrate that Cerebrospinal Fluid (CSF) leakage occurs...
The speech perception gap in cochlear implant patients.Cochlear Implants International
To determine how commonly word recognition scores obtained using insert microphones (PB max) overestimate word recognition scores obtained through appropriately fit hearing aids (A-WRS).
Aided speech recognition tests may not be performed during routine hearing aid fittings; however, they are regularly performed for cochlear implant (CI) candidacy evaluation. Therefore, audiologic data from CI recipients were queried in a retrospective cohort study at a tertiary care center. PB max and A-WRS were obtained. The Speech Perception (SP) gap, defined as PB max minus A-WRS, was calculated for each patient and a high SP gap was defined as ≥20%.
Analyzing 78 patients with complete data, 30 patients had PB max ≥20%. Of these, 18 (60%) had a high SP gap. Eighteen of the 78 patients had PB max ≥40%, and of these patients, 15 (83%) had a high SP gap.
A Speech Perception Gap of ≥20% may exist in a sizable percentage of patients with hearing loss. Our pilot study suggests that over 80% of these patients could have Class D hearing (speech recognition <50%) using conventional hearing aids and may be better served using alternate rehabilitation strategies such as middle ear or cochlear implants. Therefore, aided speech testing should be performed as part of a verified hearing aid fit in all patients, especially those with PB Max ranging from 40% to 70%.
Introducing real-life listening features into the clinical test environment: Part I: Measuring the hearing performance and evaluating the listening effort of individuals with normal hearing.Cochlear Implants International
Controlled clinical test environments are very different from real-life listening situations in which speaker and background noise level variations can hinder a person's ability to hear and follow conversations. This study was performed to evaluate the ability of people with normal hearing to follow a single speaker in the presence of background noise, and to explore relations between those measures and the listeners' subjective assessments, listening effort, and sound quality judgements.
A group of adults with normal hearing were evaluated using the following battery of tests: (i) Roving Level Test, (ii) the Just Understanding Speech Test, (iii) Performance Perceptual Test, (iv) the Visual Analogue Scale to evaluate listening effort, and (iv) with a sound quality questionnaire.
The results show that people with normal hearing tend to accurately estimate their hearing abilities, and both the listening effort required and speech recognition thresholds tend to increase with increasing background noise.
The examination of both the self-estimated and verified performance measurements in simulated real-life listening situations can provide audiologists with a comprehensive and realistic profile of a person's hearing performance.
Cochlear implantation in a 10-year old boy with Pendred syndrome and extremely enlarged endolymphatic sacs.Cochlear Implants International
A 10-year-old boy with fluctuating sensorineural hearing loss (SNHL) and biallelic mutations in the SLC26A4 gene and with inner ear anomalies recei...
Duration of unilateral auditory deprivation is associated with reduced speech perception after cochlear implantation: A single-sided deafness study.Cochlear Implants International
Examine the relationship between duration of unilateral deafness and speech perception outcomes after cochlear implantation in adults with single-sided deafness.
A systematic review of PubMed articles containing individual speech perception and duration of deafness data from single-sided deaf adults. Studies were selected for detailed review and duration of deafness and speech perception outcomes were extracted, with speech scores reported as percent correct. A linear regression as a function of study and length of deafness was performed.
A statistically significant negative effect of duration of unilateral deafness on speech perception was found, but there was substantial uncertainty regarding the strength of the effect.
Speech perception scores in SSD patients are negatively correlated with duration of deafness, but the limited amount of data from cochlear implant users with long-term single-sided deafness leads to substantial uncertainly, which in turn precludes any strong clinical recommendations. Further study of SSD CI users with long-term deafness will be necessary to generate evidence-based guidelines for implantation criteria in this population.
An unusual case of post-cochlear implant performance degradation in a patient with suspected Cogan's syndrome.Cochlear Implants International
Cogan's Syndrome is an autoimmune disorder that can affect the ear, eye and other organs. Although rare, Cogan's Syndrome is particularly relevant ...
Use of MRI to determine cochlear duct length in patients undergoing cochlear implantation.Cochlear Implants International
It is recognised that CT can be used to determine the cochlear duct length (CDL) when selecting an electrode for cochlear implantation. It is the practice of our institution to routinely use MRI as the sole modality of pre-operative imaging in the assessment of children referred for consideration of cochlear implantation. We therefore wanted to determine whether MRI could be reliably used to determine cochlear duct length.
An analysis of 40 ears that had undergone MRI and CT of the temporal bones was undertaken. The diameter of the basal turn was independently measured for each ear using the two modalities, and CDL was then calculated.
The mean error of measurement was 0.26 mm (range 0-0.8 mm), leading to a difference in calculated CDL of 0.96 mm (range 0-2.92 mm). CDL did not predict full insertion of 28 mm cochlear implant electrodes in 30 ears.
MRI can be used to reliably determine cochlear duct length.