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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Achondroplasia and severe sensorineural hearing loss: The role of active bone conduction implants.

Cochlear Implants International

The BONEBRIDGE is a partially implantable, transcutaneous bone conduction device that can be used to treat conductive or mixed mild-to-moderate hea...

MELUDIA - Online music training for cochlear implant users.

Cochlear Implants International

Music enjoyment is of importance for many cochlear implant (CI) users, and the interest in music training is high. But many CI users report that it is a challenge to find suitable training resources and that they stall because they don't know how to practice. Meludia is an online music training program that provides structured and guided music training for musically experienced and inexperienced children and adults.

The aim of the study was to evaluate the suitability of the Meludia music training software for CI recipients based on two research questions: (1) are the easiest exercises available easy enough for CI users, and (2) are there any gaps when progressing through levels and stars with increasing difficulty?

Thirty-eight adult MED-EL CI users completed fourteen exercises involving 5 different musical dimensions of the online music training program.

Our results show that the easiest exercises available in Meludia are easy enough for CI users to be able to use this training resource independent of age, indication, duration of CI use or musical background.

With Meludia we assessed and found a suitable and comprehensive training tool that allows CI recipients to work on individual goals regardless of their present abilities.

Speech perception abilities of adult cochlear implant listeners with single-sided deafness vs. bilateral hearing loss.

Cochlear Implants International

The purpose of this study was to compare the speech perception abilities in adult cochlear implant recipients implanted for bilateral sensorineural hearing loss (BSNHL) with those implanted for single-sided deafness (SSD).

A total of 12 adults with BSNHL and 12 adults with SSD participated. Each participant completed a battery of speech perception measures including monosyllabic words, sentences, and consonant recognition.

Cochlear implant users with BSNHL performed higher on word and sentence recognition. Consonant recognition scores showed higher performance for CI listeners with BSNHL for voicing and manner, but not for place or articulation.

Results of this study suggest that adults with SSD may have lower speech perception abilities with their cochlear implant when compared to adults implanted for BSNHL.

Detection accuracy of soft tissue complications during remote cochlear implant follow-up.

Cochlear Implants International

After cochlear implantation (CI), long-term follow-up is obligatory. Remote-care options which provide a standard of care comparable to in-person consultations, could be an attractive addition to a cochlear implant centre's portfolio. The aim of this study was to evaluate the accuracy of photographs of the skin covering the implant to reliably detect skin irritations or soft tissue complications.

During routine follow-up consultations, 109 CI patients were examined in person and asked to take a photograph of the skin covering the implant using their smartphones. Photographs were digitally and remotely evaluated by two CI physicians who were blinded to the findings during the in-person examination.

In nine cases, skin abnormalities were detected by the CI physician upon in-person examination, seven of which required immediate treatment. Both digital evaluators reliably detected all treatment-requiring conditions. Overall, more skin irritations were suspected digitally compared to in-person examination. Without additional information from the patients' medical record, sensitivity was 100% and specificity was 63%; with additional information provided, sensitivity was 100%, and specificity increased to 65.3%.

Digital photographic assessment of the skin covering the implant is a highly sensitive method to detect skin irritations and could reduce the number of necessary in-person consultations.

National study of hearing preservation rates and outcomes after cochlear implantation in Ireland.

Cochlear Implants International

To study the rate of hearing preservation and outcomes of hearing preservation candidates in a national cochlear implant centre. The HEARRING criteria was used.

All cochlear implant candidates with preserved low frequency pure tone average (PTA) were included. All patients underwent cochlear implantation using a standard 'soft-surgery' technique. PTA was assessed at switch-on, 3, 6, 9 and 12 months postoperatively. The primary outcome was hearing preservation at 12 months.

Sixty six patients were included in the study between 2015 and 2020. Seventy one ears were implanted including 33 adults and 33 children with 5 bilateral implantations. Mean preoperative PTA was 74.8 dB (range 52.3-92 dB), mean postoperative PTA was 95.3 dB corresponding to a mean shift of 20.5 dB. In the adult population, HP rates were as follows: complete HP in 13%, partial HP in 39.1%, minimal HP in 30.4%, loss of hearing in 17.4%. In the paediatric population: complete HP in 20.7%, partial HP in 51.7%, minimal HP in 13.8% and loss of hearing in 13.8%. After the initial postoperative shift, there was no significant worsening of residual hearing during follow-up between 3 and 12 months. There were no significant prognostic factors for hearing preservation.

Hearing preservation rates using the HEARRING criteria are described. This study will help counselling and decision making in patients eligible for cochlear implantation with hearing preservation. Further studies are required to assess the performances and outcomes of electronatural and electroacoustic stimulation.

Maximum acceptable level for the determination of ECAP and ESRT in a paediatric population.

Cochlear Implants International

Two of the most used objective measures are electrically evoked action potentials (ECAPs) and electrically evoked stapedius reflex thresholds (ESRTs). Although stimuli used for these measures differ considerably, both measures are influenced by subjective loudness percept. We focus on the subjective maximum acceptable loudness (MAL) to investigate if loudness sensitivity varied along the electrode array during ECAP recordings. In addition, we explored how the MAL reached during an ECAP recording related to the postoperative ESRT.

Uni- and bilaterally implanted young CI users (n = 15, average age = 9 y, age range 3-18 y) underwent ECAP and ESR recordings using the clinical software MAESTRO (MED-EL, Innsbruck, Austria) and a commercially available immittance instrument (PATH MEDICAL GmbH, Germering, Germany).

Loudness tolerance during ECAP recordings was lowest at the two apical-most electrode contacts (number 1 and 2). There was a moderate correlation between the MAL achieved during ECAP recordings and ESR maximum stimulation amplitudes. (r: 0.44344).

ECAP recordings should commence at basal or medial contacts to increase the users' comfort and loudness tolerance, especially in young CI users. A higher maximum stimulation appears to increase the chance of the automatic determination of ECAP thresholds for all electrode contacts.

Neural recovery function of the auditory nerve in cochlear implant surgery: Comparison between different regions of the cochlea.

Cochlear Implants International

Cochlear implants allow measures of neural function, through Neural response telemetry (NRT) and Auditory nerve recovery function (REC). These help in programming the speech processor and understanding the auditory system. However, not many studies have evaluated and compared these in different regions of the cochlea.

Comparing NRT and REC in different regions of the cochlea.

Cross-sectional, descriptive and prospective. NRT and REC (through the function of T0 - absolute refractory period, A - amplitude and TAU - time constant of the relative refractory period parameters) were evaluated, in three groups according to the stimulated electrode of the cochlea: apical, medial and basal.

26 adult patients were evaluated, 2 bilateral, totalling 28 ears. Data analysis showed no statistically significant difference between NRT between medial and basal but showed between apical and medial and apical and basal. For T0, there was a significant difference between medial and basal; for A, there was a significant difference between apical and basal and also medial and basal; and for TAU, there was no significant difference.

There was a statistically significant difference in NRT and REC when compared between different regions of the cochlea.

New approach in programming sequentially implanted children: Towards balanced dynamic ranges (DR).

Cochlear Implants International

There is a tendency for children undergoing sequential cochlear implant after a long period of unilateral implant use to have a smaller dynamic ran...

Variability in surgical techniques for cochlear implantation: an international survey study.

Cochlear Implants International

This study aimed to gain insight into current practices regarding the surgical techniques used for positioning and fixation of internal components of the cochlear implant.

A questionnaire focused on surgical techniques used for cochlear implantation was distributed among 441 cochlear implant surgeons. Descriptive statistics were reported.

The questionnaire was completed by 59 surgeons working in 13 different countries. The most preferred incision shapes were the S-shape (41%) and the C-shape (36%). The preferred implantation angle for the receiver/stimulator device was either 45° (64%) or 60° (30%), relative to the Frankfurter Horizontal Plane. Most respondents used a drilled bony well with (42%) or without a subperiosteal pocket (31%) to fixate the receiver/stimulator device. All respondents used the facial recess approach. Most used the round window insertion technique to enter the scala tympani (73%). Approximately half of the respondents preferred the lateral wall electrode array, whereas the other half preferred the perimodiolar electrode array. During their career, most (86%) changed their technique towards structure preservation and minimizing trauma.

This study indicates variability in the surgical techniques used to position and fixate the internal components of the cochlear implant. Additionally, surgical preference transits towards structure preservation and minimal invasiveness.

Cochlear implant explantation: An in vitro model to evaluate electrode explant force and trauma.

Cochlear Implants International

Removal of a cochlear implant and its intracochlear electrode array is sometimes necessary, potentially causing cochlear explant trauma. Explantation typically occurs years post-implantation by which time reactive tissue has formed around the electrode. We aimed to create an in-vitro electrode explant model to examine explant forces and intracochlear trauma across multiple electrode types and insertion depths.

An in-vitro model using gel to represent tissue surrounding the electrode was developed. Pre-curved electrodes and straight electrodes at different insertion depths (20mm, 25mm, 28mm) were explanted from the model. During explantation, explant force was measured, and high-definition videos were recorded to capture electrode exit path and gel disruption.

Explant force patterns varied based on electrode position in the scala tympani. Explant forces did not correlate with gel disruption, which represented explant trauma. The least gel disruption occurred with pre-curved electrodes and the under-inserted straight electrode. The greatest disruption occurred with the overly inserted straight electrode.

An in-vitro model using gel to mimic tissue surrounding the electrode may provide insights into potential electrode explant trauma. Explant force did not correlate with explant trauma in our model. Pre-curved electrodes and shallower insertion depth of a straight electrode resulted in the least amount of explant trauma.

A comparison of imaging techniques to measure skin flap thickness in cochlear implant patients to enable pre-operative device selection.

Cochlear Implants International

Magnetic resonance imaging (MRI)-compatible cochlear implants have weaker internal magnets than non-MRI-compatible devices. Their suitability for individual patients is limited by skin flap thickness, traditionally measured with a needle in the operating theatre. We aimed to establish the accuracy of imaging modalities to measure skin flap thickness pre-operatively, with the goal of streamlining device selection and simplifying the consent process.

Skin flap measurements were taken using ultrasound (US), computed tomography (CT) and MRI and compared for agreement with intra-operative needle measurement.

Twenty-seven skin flaps were included. Absolute agreement between needle and imaging methods was low: needle/US: 44.4% (95% confidence interval [CI]: 27.7-62.7), needle/CT: 39.1% (95% CI: 22.2-59.2), needle/MRI: 20.8% (95% CI: 9.2-40.5). However, US and CT showed 95.7% agreement (95% CI: 76.0-99.8) with intraclass correlation of 0.996 (95% CI: 0.991-0.998) and narrow Bland-Altman limits of agreement (-0.37, 0.45 mm). BMI and skin flap thickness showed a significant positive correlation (rs = 0.664, P = 0.002) but no significant correlation was observed for age (P = 0.659).

The high level of agreement between US and CT suggests that there are more accurate measurements of skin flap thickness compared with needle or MRI. Needle measurements are consistently smaller.

The use of CT or US should be considered when making pre-operative device choices.

Effect of adaptive beamforming and noise reduction algorithms on speech intelligibility and noise tolerance in bimodal cochlear implant users.

Cochlear Implants International

To evaluate the effect of a directional microphone (beamformer) and continuous noise reduction algorithms (CNRs) in bimodally aided cochlear implant (CI) users and to find the optimum hearing aid (HA) and CI settings of the beamformer and CNRs.

Speech reception threshold (SRT) and acceptable noise level (ANL) were assessed in twelve adult CI users for unilateral CI, unilateral HA and bimodal listening. To assess the effect of the UltraZoom beamformer and the ClearVoice™ and NoiseBlock CNRs on SRT and ANL, speech was presented from the front in multi-source speech-shaped noise.

With unilateral CI, application of UltraZoom resulted in a significant improvement of the median SRT and ANL by 3.8 and 4.3 dB, respectively. For bimodal listening with UltraZoom, a significant improvement of 3.5 dB in median SRT was found. There was no significant effect of using the CNRs on speech intelligibility in noise or noise tolerance in either listening condition.

UltraZoom should be applied on the CI to improve speech intelligibility in face to face conversations with multi-source background noise. However, due to the heterogeneous data, no recommendations for the settings of UltraZoom on the HA or of ClearVoice/NoiseBlock on either device can be given.

German Clinical Trials Register identifier: DRKS00010807.