摘要:

ObjectiveTo investigate variations in gains in auditory performance in children with cochlear implants.Study DesignThe auditory performance of 98 children was measured with the Category of Auditory Performance survey instrument. All data were collected prospectively. Variables used to explain gain in Category of Auditory Performance were age at implantation, sex, the duration of “untreated” deafness, the year in which implantation occurred, health care inputs, and cause of hearing impairment. The data were analyzed by ordered probabilistic regression analysis.ResultsGain in Category of Auditory Performance was observed to be negatively related to age at implantation, the year in which implantation took place, and the number of medical consultations the child received. None of the other variables were significant determinants of gain in Category of Auditory Performance.ConclusionThis study demonstrates the value of examining incremental gain from implantation rather than simply examining outcome levels. It was found that pediatric implantation is subject to diminishing returns. This suggests that further relaxation of entry criteria to implant programs should be undertaken only after careful consideration. The study also confirmed that age at implantation is an important determinant of outcomes. Greater gain in Category of Auditory Performance was experienced by those who underwent implantation at a younger age. This finding has implications for screening, as well as for purchasers and providers of implant services, highlighting the importance of responding in a timely fashion to identified need.

ISSN:1531-7129    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

PurposeTo propose a nondestructive method for three-dimensional analysis of inner ear morphology after cochlear implantation for isolated petrous bones.Materials and MethodsAfter implantation of cochlear implant electrode arrays, fresh temporal bones were investigated on a new C-arm–based radiographic device permitting the generation of cross-sectional images and of three-dimensional models from multiple two-dimensional radiographic images taken under different projections (cone-beam computed tomography). Cross-sectional images and multiplanar reformations with a slice thickness of 0.15 mm were acquired. The relationship of the electrode to the modiolus was analyzed (distance between electrode and the modiolus; position of the electrode inside the tympanic or vestibular scale). Histologic preparation was used as a gold standard.ResultsIn all cases, cone-beam computed tomography gave similar information concerning the position of the electrode compared with histologic analysis (tympanic scale versus vestibular scale, proximity versus distance to the modiolus). Perforation of the electrode from the tympanic to the vestibular scale could be assessed three-dimensionally in the cross-sectional images. In contrast to histology, cross-sectional imaging based on radiography is performed in less than 10 minutes and needs no preparation of the object. Because it is nondestructive, it can be repeated and used as a control after position-correcting maneuvers.ConclusionCross-sectional imaging based on radiography is a valuable tool for the analysis of the electrode-modiolus relationship after cochlear implantation in isolated temporal bones, which may confirm histologic analysis.

ISSN:1531-7129    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectiveTo evaluate management options for cochlear implantation in patients with chronic suppurative otitis media.Study DesignRetrospective case review.SettingTertiary referral center with a large cochlear implant program.PatientsTen patients with chronic suppurative otitis media who received cochlear implants were identified. Case history, etiology of hearing loss, and management of the ear with the implant were evaluated.InterventionsCochlear implantation and subsequent rehabilitation.Main Outcome MeasuresEarly and late complications were evaluated.ResultsNo early or late complications were identified in this group of patients after an average follow-up period of about 4 years.ConclusionCochlear implantation can be safely achieved in patients with chronic suppurative otitis media. There are several options for the management of these patients, and the approach chosen should be individualized on the basis of clinical findings.

ISSN:1531-7129    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectiveTo assess the potential benefit of the MXM auditory brainstem implant for patients with neurofibromatosis type 2.Study DesignRetrospective case review.SettingTertiary referral centers.PatientsFourteen patients with neurofibromatosis type 2 and bilateral acoustic neuromas underwent implantation with the MXM auditory brainstem implant during surgery to remove the second-side tumor.ResultsThere were no complications related to the auditory brainstem implantation. Auditory sensations were present for 12 of 14 patients (86%). Global results indicated an improved quality of life for the patients receiving auditory sensations, in part because of their auditory orientation within the environment. Eighty-nine percent of patients tested with an open-set sentence test demonstrated enhancement of speech understanding as a result of lip-reading improvement when auditory brainstem implant sound was combined with lip-reading. A few patients (36%) had some speech understanding in sound-only mode. One patient was able to have limited phone conversations.ConclusionThese results indicate that significant auditory benefit can be derived from the MXM auditory brainstem implant.

ISSN:1531-7129    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectivesTo study the benefit of the application of a bone-anchored hearing aid in patients with a unilateral air-bone gap.Study DesignProspective evaluation in eight patients.MethodsBinaural hearing was assessed in the sound field by comparing aided and unaided scores obtained with a sound localization test and a speech recognition in noise test with spatially separated sound and noise sources.SettingTertiary referral center.PatientsThe patients had subnormal hearing and unilateral conductive hearing loss.ResultsSound localization improved significantly in the six patients with acquired hearing loss. The binaural advantage, studied with speech-in-noise tests with spatially separated speech and noise sources, proved to be comparable with that in a control group of subjects with normal hearing when they were listening monaurally versus binaurally. For one of the two patients with unilateral congenital conductive hearing loss, the results were ambiguous. This patient's age at the time of surgery was high: 40 years (the other patient was 19 years old at the time of surgery). This might have played a role.ConclusionIf reconstructive surgery is not possible (e.g., in a patient with a chronically draining ear or a severe congenital malformation), a bone-anchored hearing aid is an option to reestablish binaural hearing. The results reported herein suggest that, at least for patients with acquired hearing loss, the bone-anchored hearing aid is an effective treatment of unilateral conductive hearing loss.

ISSN:1531-7129    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectiveTo determine the surgical efficacy of a simplified retrosigmoid approach for vestibular nerve sectioning.Study DesignA retrospective analysis.SettingTertiary academic referral center.PatientsTwenty-eight consecutive patients who underwent vestibular nerve sectioning for intractable peripheral vestibular disorders.InterventionAll patients had a simplified retrosigmoid approach for vestibular nerve sectioning.Main Outcome MeasuresFunctional outcome after vestibular nerve sectioning was analyzed with respect to improvement in patient disability from vertigo and reduction in the frequency of definitive vertigo attacks. Resolution of lightheadedness provided an additional outcome measure. The incidence of surgical complications, including postoperative headache, was determined, and the operative time was reviewed.ResultsTwenty-six patients (92.9%) had an improved functional level postoperatively, 21 (75.0%) had excellent improvement, 4 (14.3%) had significant improvement, 1 (3.6%) had limited improvement, and 2 (7.1%) had no change. No patient was worse postoperatively. Eighteen of 23 Ménière's patients (78.3%) had complete control of definitive vertigo attacks after vestibular nerve sectioning. Improvement in lightheadedness was seen in 23 patients (82.1%), 11 (39.3%) of whom reported complete resolution. Postoperative headache developed in 1 (3.6%) patient. No patients experienced infection, facial weakness, or leakage of cerebrospinal fluid. Mild hearing deterioration was seen in 2 patients (7.1%). The mean operative time was 76.3 minutes.ConclusionWith excellent efficacy, short operative time, and a low incidence of postoperative hearing loss or headache, this simplified retrosigmoid technique should be considered for vestibular nerve sectioning in patients with intractable peripheral vestibular disorders.

ISSN:1531-7129    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectivesTo assess the prevalence, presentation, treatment, and evolution of Menière's disease in elderly patients (≥65 yr old).Study DesignRetrospective clinical study and case report.SettingA neuro-otology referral center at the university hospital in Bern, Switzerland, and a neurotologic practice in Geneva, Switzerland.PatientsPatients were selected from the hospital clinic and otolaryngologic practice registers. Among 8423 neurotologic checkups performed between 1988 and 1998, 432 (5.1%) patients had definite Menière's disease and 66 (15.3%) of these patients were ≥65 years old.InterventionThe files of these 66 patients were analyzed.ResultsMenière's disease in the elderly had 2 modes of presentation: reactivation of longstanding Menière's disease (40.9%) and de novo Menière's disease (59.1%), where the first dizzy spells, tinnitus, and hearing loss appeared after 65 years of age. Drop attacks occurred in 11.1 and 25.6% of the cases, respectively, and could be responsible for misdiagnosis of strokes of the brainstem. The patients were treated by mild antivertiginous drugs (betahistine, cinnarizine). Twenty-seven patients (41%) underwent surgery: transtympanic ventilation tubes (19 patients), sacculotomy (4 patients), vestibular neurectomy (3 patients), surgical labyrinthectomy (1 patient). The vertigo spells disappeared in 73.3 to 100% of the cases according to the type of surgery performed.ConclusionOur study shows that Menière's disease in the elderly is not at all uncommon. It can appear as a de novo disease or as a reactivated longstanding disease. Drop attacks are more frequent than reported in general patient populations with Menière's disease and can mimic a stroke of the brainstem. Medical and surgical treatments have to be cautious because many of these elderly patients are fragile.

ISSN:1531-7129    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectiveWe compared the treatment outcome of patients with benign paroxysmal positional vertigo unassociated with additional objective evidence of vestibular pathology (BPPV) with that in patients who did demonstrate additional vestibular pathology on standard neurotologic testing (BPPV+).Study DesignAn open, retrospective, record-based study.SettingSpecialized outpatient dizziness clinic.Patients and MethodsWe reviewed 58 unselected patients with a Dix-Hallpike test demonstrating positioning nystagmus characteristic of BPPV, who were treated during the past 4 years with the particle repositioning maneuver. Before treatment, all patients underwent detailed clinical and laboratory neurotological testing.Main Outcome MeasuresThe treatment outcome was assessed with regard to persistence of symptoms and the presence of positioning nystagmus on Dix-Hallpike testing.ResultsSeventy-eight percent of patients with BPPV no longer demonstrated characteristic positional nystagmus after 1 particle repositioning maneuver compared with 71% of patients with BPPV+ (p = 0.56) who did, whereas 13% of the BPPV and 14% of the BPPV+ group required more than 1 treatment to be rendered nystagmus negative on Dix-Hallpike testing (p = 0.89). However, 14% of patients with BPPV remained dizzy, compared with 63% patients from the BPPV+ group, despite a negative Dix-Hallpike test after treatment (p = 0.0018). Patients with horizontal canal paresis (n = 15) had a better outcome than patients with central vestibular dysfunction (n = 7, p = 0.006). Etiologic factors seemed to affect outcome—patients with idiopathic BPPV and those with a preceding acute vestibular neuronitis had a tendency for a better outcome than BPPV patients with any other etiology (p = 0.058).ConclusionOur study demonstrates that patients with BPPV+ do not have a worse prognosis with respect to resolution of positional nystagmus, on performing the particle repositioning procedure, compared with patients with uncomplicated BPPV. However, they do suffer incomplete resolution of symptoms because of a coincidental anterior or horizontal canal dysfunction and otolithic or central vestibular dysfunction. It appears that the majority of patients with BPPV+ need further vestibular rehabilitation after the particle repositioning maneuver.

ISSN:1531-7129    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectiveIntracranial epidermoids (cholesteatomas) mimic arachnoid cysts in their radiologic characteristics, especially in the cerebellopontine angle. It is essential to differentiate the two conditions because they warrant different therapeutic interventions. The objective of this study is to elucidate the different radiologic characteristics of the conditions.Study Design and SettingThis was a retrospective study of 4 patients referred for a differential diagnosis and management of intracranial cystic lesions to the Departments of Neurotology/Neurosurgery and Neuroradiology in a tertiary referral university hospital.PatientsFour patients of different age groups with cystic intracranial lesions, diagnosed epidermoid or arachnoid cysts, were chosen. A retrospective analysis of their case charts, radiologic and surgical interventions, and follow-up records was undertaken.MethodsThe imaging techniques used included computerized tomographic scans, magnetic resonance imaging (MRI) with T1, T2, proton-density, and gadolinium-enhanced T1 images. In addition, special MRI sequences were used that included fluid-attenuated inversion recovery and echo planar diffusion scanning. All the patients underwent an audiovestibular evaluation.ResultsBoth lesions are characteristically well demarcated and have a homogeneous low density, similar to cerebrospinal fluid on computerized tomographic scan, showing no contrast enhancement. On MRI, epidermoids and arachnoid cysts usually appear hypointense on T1-weighted images and hyperintense on T2-weighted images. On fluid-attenuated inversion recovery, an arachnoid cyst tends to follow cerebrospinal fluid intensity, whereas an epidermoid becomes hyperintense. There are occasions when an epidermoid may appear as a low-intensity lesion on fluid-attenuated inversion recovery. This dilemma is resolved with the use of echo planar diffusion scanning, on which an epidermoid remains bright.ConclusionThe authors recommend the use of fluid-attenuated inversion recovery and diffusion sequence MRI when definitive radiologic diagnosis of cystic intracranial lesions becomes difficult with routine computerized tomographic scanning and MRI.

ISSN:1531-7129    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectiveTo determine whether early and late postoperative facial nerve function can be predicted on the basis of electromyographic responses in acoustic neuroma surgery.SettingProspective blinded study.DesignTertiary referral center.Patients and MethodsBurst and train electromyographic responses were recorded intraoperatively during the last step of vestibular schwannoma removal. The responses were classified and compared with early and late postoperative facial function in 49 patients who underwent enlarged translabyrinthine acoustic neuroma surgery.ResultsIn the early postoperative period, 20 of 22 patients with an irritable pattern and 10 of 13 patients with an ordinary pattern had Grade III or better facial nerve function, whereas all 3 patients with a stray pattern and 9 of 11 patients with a silent pattern had Grade V or VI. In the late postoperative period, on the other hand, Grade III or better facial nerve function was achieved in 37 of 38 patients with an irritable, stray, or ordinary pattern, but the facial nerve function remained at Grade V or VI in 2 patients with the silent pattern.ConclusionPatients with mechanically evoked facial electromyographic responses to the last step of tumor dissection may not experience severe facial nerve dysfunction or show a remarkable improvement. However, patients with silent electromyographic responses during this step tend to experience severe facial nerve dysfunction early in the postoperative course, and some patients may not show any functional improvement.

ISSN:1531-7129    

出版商:OVID    

年代:2002

数据来源: OVID