摘要:

BackgroundHistorically, vertigo after cochlear implantation has not been frequently documented. This differs from the authors' experience in reviewing all adults who underwent implantation at their center from 1995 through 1999.ObjectiveTo determine the incidence of vertigo after cochlear implantation and to describe appropriate intervention.Study DesignA retrospective case review.PatientsAll adults receiving cochlear implants at the Atlanta Cochlear Implant Group from 1995 through 1999.Intervention and Outcome MeasureVertigo was identified through subjective reports, provoked nystagmus, and static force plate evaluation. Vestibular therapy was initiated for each vertiginous patient after cochlear implant surgery. The outcome of treatment was resolution of vertigo and return to functional status.ResultsApproximately three-quarters of the adults with implants experienced vertigo or imbalance. Vestibular therapy was beneficial in alleviating these symptoms.ConclusionA significant number of patients experienced vertigo after cochlear implant surgery. Vestibular therapy is a successful treatment of condition.

ISSN:1531-7129    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveIn 1998, clinical trials were initiated to evaluate the CLARION Multi-Strategy Cochlear Implant (Advanced Bionics Corp., Sylmar, CA, U.S.A.), a precurved electrode with an electrode positioning system (EPS) in adults with severe to profound hearing impairments. In 1999, clinical trials were initiated to assess the CLARION HiFocus electrode with EPS in a similar group of adults. The purpose of this retrospective study was to evaluate and compare the preoperative and 1-, 3-, and 6-month postoperative speech perception scores obtained by the first 56 patients implanted with the precurved electrode with EPS and the first 56 patients implanted with the HiFocus electrode with EPS. Speech strategy preferences were additionally noted and compared at each test interval for each group.Study DesignAll subjects participated in preoperative testing with hearing aids and postoperative (1, 3 and 6 months) testing with either the precurved electrode with EPS or the HiFocus electrode with EPS. Demographic characteristics and preoperative and postoperative speech perception results were compared within and between the 2 groups.SettingData presented here were collected at cochlear implant programs affiliated with tertiary medical centers located in the United States and Canada that participated in the clinical trials.PatientsPatients were postlinguistically deafened adults who received a CLARION cochlear implant.Results and ConclusionWithin-group evaluations revealed that both groups demonstrated significant improvements on all speech perception measures when 1-month postoperative scores were compared with scores obtained preoperatively with hearing aids. Between-group comparison of demographic data showed that the HiFocus group had a significantly higher mean age at implant and a significantly longer mean duration of deafness than the precurved electrode with EPS group. Statistical comparison of mean speech perception scores showed no significant difference between subjects using the precurved electrode with EPS versus the HiFocus electrode with EPS at the preoperative, 1-, and 3-month test intervals. At the 6-month test interval, the mean CNC Monosyllabic Word Test score obtained by the HiFocus with EPS group was significantly better than the mean score obtained by the group with the precurved electrode with EPS (p < 0.05).

ISSN:1531-7129    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveA model is proposed for universal neonatal hearing screening.MethodsThe screening model is two-staged because it consists of a first test and, in case of failure (1.4% of the subjects), of a retest 3 weeks later. It is bipodal because it involves both the hospital audiologic department and a central Well Baby Organization. The idea is to have a maximal number of newborns tested at the maternity by trained audiologists and to have the Well Baby Organization trace and chase the missing subjects. The model has been evaluated during 1 calendar year (1999) in a maternity with 2,012 newborns.ResultThe result is a coverage of 99.3%. Most newborns (97.3%) were tested at the maternity ward with a total time investment of less than 15 minutes per child. The actual test time is 2 minutes, 12 seconds (median value). The Well Baby Organization keeps track of all the results and has to test no more than 2% of the newborns. Sensitivity and specificity were not the primary outcomes of this evaluation, but they were similar to those of a previous study evaluating the screen procedure on a larger scale, giving a sensitivity of approximately 100% and a false alarm rate of 1/1,000.ConclusionThese figures demonstrate that universal neonatal hearing screening is feasible within the existing health care structure, with unprecedented coverage, sensitivity, and specificity.

ISSN:1531-7129    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectivesTo report two cases of cleidocranial dysplasia in which hearing loss was the first presenting symptom.Study designRetrospective case review.PatientsTwo cases of cleidocranial dysplasia, a rare autosomal dominant skeletal dysplasia affecting both membranous and enchondral bone formation.SettingTertiary referral center.InterventionsClinical, audiometric, and imaging diagnostic procedures.ConclusionWith this report, we want to illustrate the possibility of a rare genetic disorder as the underlying cause of hearing loss. We also want to emphasize the need for a multidisciplinary approach and evaluation of unexplained hearing loss to obtain a correct diagnosis, which is important for genetic counseling and management of the patient and his or her family.

ISSN:1531-7129    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

HypothesisThe purpose of this study was to elucidate whetherGJB2mutations are responsible for childhood deafness in Southeast Asia.BackgroundGJB2mutations are responsible for a large part of childhood deafness in many countries. In Whites, there is a common mutation (35delG) that accounts for about 70 to 80% of theGJB2mutations. Previously, we and others reported a commonGJB2mutation (235delC) in Japanese patients with prelingual deafness. The association of the 235delC mutation with a single haplotype suggested a founder effect of the mutation.MethodsWe analyzed theGJB2gene in 17 deaf patients from 12 unrelated families in Thailand. Genomic DNA was extracted from peripheral lymphocytes of each patient and the entire coding region of theGJB2gene was sequenced.ResultsGJB2mutations were found in 4 patients in 3 families. Patient 1 was a homozygote of 235delC. Patient 2 was a compound heterozygote of 235delC and W24X (71G → A). Patient 3A and 3B (in 1 family) were heterozygotes of a novel mutation M34L (100A → T).ConclusionThe 235delC mutation may be widely distributed in Asian countries outside of Japan.

ISSN:1531-7129    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveThis study describes the application of a new radiographic imaging modality, phase-contrast radiography, to in vitro human temporal bone imaging and investigates its use in the development of new electrode arrays for cochlear implants.BackgroundThe development of perimodiolar electrode arrays for cochlear implants requires detailed information from postoperative radiologic assessment on the position of the array in relation to the cochlear structures. Current standard radiographic techniques provide only limited details.Materials and MethodsNucleus standard electrode arrays and perimodiolar Contour electrode arrays were implanted into the scala tympani of 11 human temporal bones. Both conventional and phase-contrast radiographs were taken of each temporal bone for comparative purposes.ResultsPhase-contrast imaging provides better visualization of anatomic details of the inner ear and of the structure of the intracochlear electrode array, and better definition of electrode location in relation to cochlear walls.ConclusionPhase-contrast radiography offers significant improvement over conventional radiography in images of in vitro human temporal bones. It seems to be a valuable tool in the development of intracochlear electrode arrays and cochlear implant research. However, this new radiographic technique still requires certain computational and physics challenges to be addressed before its clinical use can be established.

ISSN:1531-7129    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveEndoscope-guided round window membrane repair was performed to evaluate whether the approach is feasible in the treatment of a round window fistula.Study DesignRetrospective case review.SettingTertiary care academic center.PatientA 27-year-old man had been scuba diving 6 days previously in the Australian Great Barrier Reefs. He had poor hearing with tinnitus in the left ear and a vertiginous sensation.InterventionA myringotomy was incised, and a tympanoscope was introduced into the middle ear cavity. With the patient under general anesthesia, the middle ear and the oval and round window areas were examined with a tympanoscope. In endoscopic visualization, a round perforation could be seen in the round window membrane. After detection of the round window perforation, a small piece of temporal fascia was obtained to seal the membrane perforation.ResultsOne month after the operation, the patient's hearing was significantly better. The myringotomy had healed.ConclusionA transmyringeal endoscopic procedure for round window fistula repair is feasible and combines the best features of minimally invasive surgery and aural endoscopy.

ISSN:1531-7129    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveTo report the clinical, auditory, and vestibular characteristics of a nonsyndromic otovestibular dysfunction in a large Belgian family caused by a missense mutation of the DFNA9 gene: COCH.Study DesignRetrospective study of the clinical, audiologic, and vestibular data of 60 genetically affected cases.SettingTertiary referral center.PatientsAll members of a Belgian kindred who carry the genetic (P51S) defect linked to the inherited hearing and vestibular impairment.InterventionsDiagnostic otologic, audiometric, and vestibular analysis and imaging.Main Outcome MeasuresPure tone audiometry, supraliminary audiometry. and vestibular investigation.ResultsThe autosomal dominant inherited impairment was characterized by peripheral degeneration of the inner ear, leading to total deafness and bilateral vestibular areflexia.ConclusionsThe genetically affected persons of a Belgian family shared a progressive sensorineural hearing loss starting between the third and sixth decade. Vestibular symptoms started at about the same age as the hearing loss. The vestibular symptoms consisted of instability in darkness, a tendency to fall sideways, light-headiness, a drunken feeling, and attacks of vertigo. Most of the patients reported tinnitus, and half of them reported pressure in the ears. Clinically, 9 of the 60 patients met the criteria for definite Ménière's disease, and another 13 and 17 patients met the criteria for probable or possible Ménière's disease, respectively. All 9 were older than the age of 35, but only 1 was older than 55 years, so more than 30% of the patients were between 35 and 55 years old.A specific pattern could be recognized in the evolution of the otovestibular impairment. Under the age of 35 years, almost all the affected family members had normal hearing, whereas above the age of 55 years, the hearing loss was at least moderate, and vestibular hypofunction occurred. In between, there was a transition period of two to three decades, when deterioration of the cochleovestibular function occurred, with a temporary audiometric and vestibular asymmetry.

ISSN:1531-7129    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveTo review characteristics of and outcome in patients undergoing microvascular decompression of the vestibulocochlear nerve. Patients studied had a diagnosis of disabling positional vertigo caused by a vascular loop compressing the VIIIth cranial nerve.Study DesignRetrospective chart review and telephone interview.SettingPrivate practice tertiary neurotologic referral center.PatientsTwenty patients with disabling positional vertigo underwent 25 retrosigmoid craniotomies for microvascular decompression between November 1990 and June 1999. The 4 men and 16 women ranged in age from 30 to 71 years (mean age, 46 yr).Main Outcome MeasuresCharts were reviewed and patients were contacted by telephone and asked to rate severity of symptoms (tinnitus and dizziness) on a 4-point scale (none = 1, mild = 2, moderate = 3, and severe = 4) before and after surgery. They were also asked to rate their overall disability from their symptoms on the six-point scale established by the American Academy of Otolaryngology–Head and Neck Surgery. Preoperative and postoperative four-frequency (500 Hz, 1 kHz, 2 kHz, and 4 kHz) pure-tone average and speech discrimination scores were calculated and compared. Complications of surgery are also reported.ResultsPostoperative tinnitus score and dizziness score showed significant improvement from preoperative scores (p ≤ 0.047 and p ≤ 0.001, respectively), with 80% of patients improved in dizziness rating; 85% improved in their overall disability rating, and the difference from preoperative to postoperative was significant (p ≤ 0.001). The mean postoperative pure-tone averages (15.4 dB) and speech discrimination scores (99%) did not differ from preoperative scores (11.9 dB and 98%). One patient lost all vestibular function in the operated ear (hearing remained intact) as the only complication of surgery. When asked, 83% of patients responded that they would have the surgery again.ConclusionsDiagnosing disabling positional vertigo secondary to vascular compression of the VIIIth cranial nerve remains the clinical challenge; a clear history plus air-contrast computed tomographic or magnetic resonance imaging make the diagnosis. Microvascular decompression of the vestibulocochlear nerve is a safe and effective operation for these carefully selected patients.

ISSN:1531-7129    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveTo describe health-related quality of life among patients with Ménière's disease in whom conventional therapy failed and who requested further medical intervention.Study DesignPretreatment interviews to establish baseline quality of life characteristics before medical intervention.SettingTertiary referral center.Patients19 adult patients, 12 women and 7 men, whose ages ranged from 32 to 83 years.InterventionsPretreatment baseline interviews.Main Outcome MeasuresQuality of Well-being Scale, SF-12 Physical and SF-12 Mental scores, Center for Epidemiologic Studies–Depression Scale.ResultsThe Quality of Well-being score (0.561) indicated a loss of well-being from 1 to 0.561 = 43.9% in patients with Ménière's disease as compared with people with no symptoms and full functional status. The hypothesis that Quality of Well-being scores on days on which patients had symptoms characteristic of acute Ménière's disease episodes were lower than Quality of Well-being scores on days on which they did not report such symptoms was supported (p = 0.000). The reported SF-12 Physical mean score (38.9) was greater than 1 standard deviation below the general mean of 50, and the SF-12 Mental score (44.2) was 0.5 standard deviation below the general mean of 50. The Center for Epidemiologic Studies–Depression Scale score was 23, with a score 16 or greater indicating clinically significant depression.ConclusionsThe results suggest that the condition of patients with Ménière's disease may be measured by these instruments, that the instruments are in substantial agreement about the serious impairment in patients' quality of life, and that the days with acute episodes of Ménière's disease symptoms are significantly worse than the days without such symptoms. Treating physicians indicated surprise at the breadth and the level of debilitation characteristic of these patients with Ménière's disease.

ISSN:1531-7129    

出版商:OVID    

年代:2001

数据来源: OVID