Comparison of outcomes in a case of bilateral cochlear implantation using devices manufactured by two different implant companies (Cochlear Corporation and Med-El).

OBJECTIVE: This paper reports a case of a patient who has had bilateral cochlear implants that have been manufactured by different cochlear implant companies (Cochlear Corporation and Med-El). METHOD: Comparison of speech perception tests following single implant insertion and bilateral insertion (3 and 12 months). The patient was also interviewed to obtain a subjective opinion on their quality of hearing. RESULTS: The patient reported that their Med-El implant had better sound quality than their Cochlear Corporation implant. The speech perception tests however failed to show any difference. CONCLUSION: Despite no difference found with the objective tests hearing is very subjective and therefore the patient's opinion on the quality of sound is important. It is only a matter of time before other patients are fitted with bilateral cochlear implants from different companies and this information should be collated to allow comparison between manufacturers.

Multiple sites of impingement of a tracheal tube as it is advanced over a fibreoptic bronchoscope or tracheal tube introducer in anaesthetized, paralysed patients.

Impingement of the tracheal tube on upper airway structures occurs commonly during advancement over a fibreoptic bronchoscope or introducer. In this descriptive study a fibrescope was used to assess the site and mechanism of tracheal tube impingement during advancement over a variety of fibreoptic bronchoscopes and introducers during orotracheal intubation in anaesthetized adults. The effect of the 90 degree counterclockwise rotation manoeuvre in overcoming impingement was also assessed. We recorded impingement at the right arytenoid, left arytenoid, epiglottis, interarytenoid tissue and the left pyriform fossa. Our study found a wider range of sites at which impingement may occur than in previous studies. We also found that when 90 degree counterclockwise rotation of the tip of the tracheal tube was achieved, the impingement was reliably overcome.

Fractured clavicle is an unavoidable event.

OBJECTIVES: The three purposes of this study were to determine the incidence of fractured clavicle in newborns delivered at our hospital, to identify preventable risk factors associated with these fractured clavicles, and to identify the acute sequelae of fractured clavicle in these infants. STUDY DESIGN: We performed a retrospective chart review of all women delivered during an 8-month period. Newborns with radiologically proved fractured clavicles were compared with a control group of infants delivered immediately before and immediately after the study patient. Maternal, labor, delivery, and newborn factors were analyzed statistically. RESULTS: A fractured clavicle occurred in 0.9% (34/3880) of vaginally delivered newborns; none occurred with an abdominal delivery. The only statistically significant risk factors were gestational age, shoulder dystocia, and newborn weight. No infant with fractured clavicle had a 5-minute Apgar score < 7, an abnormal cord blood pH, or an abnormal neurologic examination. CONCLUSIONS: We did not identify a specific perinatal factor that can be changed to avoid clavicle fracture. The injury appears to be an unavoidable event without permanent sequelae. Thus it is not an indicator for quality improvement.