The latest medical research on Otolaryngology

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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.

Objective, audiological and quality of life measures with the CI532 slim modiolar electrode.

Cochlear Implants International

To report on electrode array measurements for the Nucleus® CI532 Slim Modiolar Electrode device including: ECAP thresholds, electrode impedances, and psychophysical comfort levels, as well as speech perception results pre- and post-operatively and standardized evaluations of quality of life.

Forty-four subjects were implanted with the CI532. Electrically evoked compound action potential (ECAP) thresholds and impedances were measured using automatic Neural Response Telemetry intra-operatively, at activation and at six months post implant. Pre- and post-operative measures of words in quiet and sentences in noise were made in multiple languages. Quality of life was assessed using The Speech Spatial Qualities questionnaire (SSQ) and Glasgow Benefit Inventory (GBI).

Intra-operative ECAP thresholds were recorded successfully from 90% of electrodes tested. ECAP thresholds varied across the array and a post-hoc Dunn's test showed that median thresholds for electrodes E1-E13 were significantly greater than those for E17-E22 (all P < 0.001). Impedances increased significantly between surgery and activation. Speech recognition scores for words in quiet and sentences in noise showed a significant improvement for the group at six months, when using the cochlear implant, compared with pre-operative performance (P < 0.001). There was a significant increase compared to pre-operative ratings for all sections of the SSQ at six months post activation (P < 0.001). The GBI gave scores significantly above zero for the 'general' subscale and total score.

Objective ECAP and impedance measures for this new electrode array were as expected and similar to results reported for other array types. Speech perception and quality of life improved significantly following implantation. (Registered as NCT02392403 on ClinicalTrials.gov PRS).

Knowledge about cochlear implantation: A parental perspective.

Cochlear Implants International

Cochlear implantation (CI) is used for children with severe to profound hearing loss who show little or no improvement using hearing aids. This study explored parental knowledge of their children's CI.

A cross-sectional study involving the parents of 115 pediatric CI patients was conducted at King Abdullah Specialized Children's Hospital in Riyadh, Saudi Arabia. Parents were interviewed by telephone using a 50-question validated questionnaire.

Most parents of children with CI reported being comfortable in using the internet (68.7%) and social media (40.9%) to obtain information regarding CI. Although most parents of children with CI relied on health professionals and websites as their main sources of information, they were also able to obtain necessary information at meetings for CI patients and health professionals. Parents of children with CI felt they had sufficient information regarding the impact of hearing loss (78%) and CI (71%) on speech understanding and language development; however, they had insufficient information regarding criteria for CI candidacy, available brands of CI devices, and the advantages and disadvantages of each.

Parents reported that health professionals were the ideal source of information regarding hearing loss and CI. Moreover, our study showed that parents should learn more about cochlear implant devices, the post-implantation process, and candidacy criteria.