Advantages of binaural hearing provided through bimodal stimulation via a cochlear implant and a conventional hearing aid: a 6-month comparative study.

CONCLUSIONS: Our study data demonstrate the additional benefit derived from continued use of a contralateral hearing aid (HA) post-cochlear implantation for speech recognition ability in quiet and in noise. Postoperative bimodal stimulation is recommended for all subjects who show some speech recognition ability in the contralateral ear as it may offer binaural listening advantages in various listening situations encountered in everyday life. OBJECTIVES: To assess the benefits derived from bimodal stimulation for experienced HA users implanted with a cochlear implant (CI) (score=20% in disyllabic test). The correlation between pre- and postoperative performance on speech perception measures was examined to determine additional criteria for recommending bimodal stimulation postoperatively. MATERIAL AND METHODS: A within-subject repeated-measures design was used, with each subject acting as their own control. Assessments were carried out preoperatively in aided monaural and best-aided conditions and at 6 months postoperatively in CI-alone, contralateral HA-alone and bimodal listening conditions. Speech recognition using Spanish words and sentences materials was assessed at conversational level and for soft speech in quiet. Speech comprehension in noise was assessed using word materials at a signal:noise ratio of +10, for coincident speech in noise and for spatially separated speech in noise. Twelve adult native Spanish subjects with a severe-to-profound hearing impairment who were experienced with optimally fitted conventional amplification and who displayed suboptimal speech understanding preoperatively were enrolled in the study. Preoperatively, conventional amplification was worn by five subjects binaurally and by seven monaurally. RESULTS: Postoperatively, superior speech recognition ability in quiet and in noise for disyllabic words was achieved using bimodal stimulation in comparison to performance for either monaural aided condition. Mean improvement in speech recognition in the bimodal condition was significant over performance in the CI-alone condition for disyllabic words in quiet at 70 (p=0.006) and 55 dB SPL (p=0.028), for disyllabic words in noise at +10 dB with speech and noise spatially separated with the noise source closest to the contralateral HA (S0NHA) (p=0.0005) and when the noise source was closest to the CI ear (S0NCI) (p=0.002). When testing word recognition in noise with speech and noise sources coincident in space, word scores were superior in the bimodal condition relative to the CI-alone condition but this improvement was not significant (p=0.07). The advantages of bimodal stimulation included significant effects of binaural summation in quiet and significant binaural squelch effects in both the S0NHA and S0NCI test conditions. All subjects showed superior performance in the binaural situation postoperatively relative to the best-aided condition preoperatively for one or more test situations.

[Speech understanding in post-lingual adults with cochlear implants]. / Comprensión del habla en adultos postlinguales con implante coclear.

It is well recognised that multi-channel cochlear implants are highly effective in gaining or regaining auditory perceptual skills of severe to profound hearing-impaired people. Research shows that adults rapidly improve in speech understanding after cochlear implantation. This study reports on speech understanding from two Spanish Clinics. 32 post-lingually deafened adults were fitted with either a MED-EL COMBI 40 or COMBI 40+ cochlear implant at the Hospital Universitario San Cecilio, at the Granada or Hospital Universitario La Fe, Valencia Clinic, Spain. Subjects were assessed at 1, 3, 6 and 12 months post-fitting on a number of speech perception tests. Results showed a highly significant improvement on all speech perception tests over the time. These ratify other studies in saying that cochlear implantation is a viable and successful treatment in post-lingually deafened adults.

[Surgery of the cochlear implant: complications]. / Cirugía del implante coclear: complicaciones.

From 1991 to 1994 13 patients underwent cochlear implant in our Department. The surgical results and complications in this group of patients are reviewed. In all cases the cochlear implant was successful and no major complications were recorded. The most common problems was transient dizziness or imbalance. Other complications were minor facial nerve stimulation during the programming of the device, dehiscence of the suture in the tragal region, problems in the insertion of the electrodes in the scala tympani and a case that needed reimplantation due to technical problems with the device. We consider that a proper selection of cases and a precise surgical technique are essential in order to achieve the adaptation of the cochlear implant and avoid pitfalls.

[Posttraumatic retropharyngeal hematoma of delayed onset]. / Hematoma retrofaríngeo postraumático de aparición tardía.

Retropharyngeal hematoma (RE) is a rare occurrence. A case of RE in a 48-year-old man who suffered a whiplash trauma in a motor vehicle accident is reported. He had been receiving long-term aspirin therapy for ischemic heart disease. Management consisted on tracheostomy and medical treatment and the patient evolved satisfactorily. Whiplash injuries that take place in predisposed subjects can originate RE. Diagnosis is made by X-ray and CT. If acute airway obstruction occurs it is safer to perform tracheostomy than endotracheal intubation. If the lesion is non-expanding, medical treatment is preferred by most authors, so do we.

[46 XY gonadal dysgenesis and dysgerminoma (author's transl)]. / Disgenesia gonadal 46 XY y disgerminoma.

A patient with gonadal dysgenesis, cariotype 46 XY and female biotype is presented. The histological study confirmed the presence of a dysgerminoma in the left gonad. The features of the cases are discussed.