Bone conduction hearing: device auditory capability to aid in device selection.

OBJECTIVE: To obtain identical laboratory measures of 8 (surgical and nonsurgical) bone conduction devices and relate them to clinical function. STUDY DESIGN: Each device was measured with a single laboratory system and characterized with descriptive statistics. SETTING: Laboratory. SUBJECTS AND METHODS: Seven surgical devices (Intenso, BP110, BP100, and Cordelle [Cochlear, Denver, Colorado]; Ponto Pro and Ponto Pro Power [Oticon Medical, Somerset, New Jersey]; and Alpha 2 [Sophono, Inc, Boulder, Colorado]) and 1 nonsurgical dental device (SoundBite; Sonitus Medical, Inc, San Mateo, California) constituted the independent variables. Measured maximum output and gain parameters were the dependent variables. RESULTS: Maximum output varied across devices in the pure-tone average (PTA; 500-3000 Hz) frequency range (mean, 109.7 dB re 1 µN; range, 98.8-119.2 dB) and in the above-PTA (4000-8000 Hz) frequency range (mean, 102.6 dB re 1 µN; range, 88.99-119.6 dB). Maximum gain varied in the PTA frequency range (mean, 40 dB; range, 29.1-49.1 dB) and was higher in the frequency range above the PTA (mean, 32.0 dB; range, 20.8-46.0 dB). CONCLUSION: All devices have sufficient maximum output and gain for the PTA frequency range for single-sided deafness (SSD). The devices differed in maximum output and gain for the frequency range above the PTA, a consideration for accommodating presbycusis and optimizing auditory function for SSD. The surgical devices have less maximum output and gain in the above-PTA range than in the PTA range. The nonsurgical dental device had the highest output (up to 30 dB higher) and gain (up to 26 dB higher) in the above-PTA range.

Teleaudiology.

Teleaudiology has become a more viable approach to delivering care. Asynchronous and synchronous delivery can be used to deliver Teleaudiology. Hybrid delivery involves using both synchronous and asynchronous modes of delivery. Teleaudiology has been used for otoscopy, audiometry, immitance, cochlear implant programming and newborn screening. Teleaudiology is a viable technology, although reimbursement remains unclear.

Oral carcinoma associated with betel nut chewing in the Pacific: an impending crisis?

In Western populations, tobacco and alcohol use are the major etiologic factors associated with oral cavity cancers. In developing countries of Asia and the South Pacific, however, oral cancer is increasingly associated with the chewing of betel nut. As the population of Asia and the South Pacific immigrates, Head and Neck surgeons in North America are likely to see more patients with oral carcinoma induced by betel nut chewing. Tumor Registry records from 1977-2003 from a tertiary care, referral medical center were reviewed. All patient charts (27) demonstrating betel quid use of greater than 20 years and carcinoma of the upper aerodigestive tract were entered into the study. Five-year disease-free rates by stage were as follows: Stage 1: 100% (2/2); Stage 11: 50% (2/4); Stage III: 36% (4/9): Stage IV: 25% (3/12). Despite the prevalent misperception in the Pacific region that betel nut chewing is a harmless habit, betel nut-induced oral carcinomas are aggressive malignancies requiring aggressive treatment and long-term follow-up.

Telehealth: voice therapy using telecommunications technology.

Telehealth offers the potential to meet the needs of underserved populations in remote regions. The purpose of this study was a proof-of-concept to determine whether voice therapy can be delivered effectively remotely. Treatment outcomes were evaluated for a vocal rehabilitation protocol delivered under 2 conditions: with the patient and clinician interacting within the same room (conventional group) and with the patient and clinician in separate rooms, interacting in real time via a hard-wired video camera and monitor (video teleconference group). Seventy-two patients with voice disorders served as participants. Based on evaluation by otolaryngologists, 31 participants were diagnosed with vocal nodules, 29 were diagnosed with edema, 9 were diagnosed with unilateral vocal fold paralysis, and 3 presented with vocal hyperfunction with no laryngeal pathology. Fifty-one participants (71%) completed the vocal rehabilitation protocol. Outcome measures included perceptual judgments of voice quality, acoustic analyses of voice, patient satisfaction ratings, and fiber-optic laryngoscopy. There were no differences in outcome measures between the conventional group and the remote video teleconference group. Participants in both groups showed positive changes on all outcome measures after completing the vocal rehabilitation protocol. Reasons for participants discontinuing therapy prematurely provided support for the telehealth model of service delivery.

Management of cholesteatoma: status of the canal wall.

OBJECTIVE/HYPOTHESIS: Management of chronic otitis media with cholesteatoma remains controversial. The purpose of the study is to examine factors associated with the surgical approach to manage cholesteatoma. STUDY DESIGN: A retrospective review. METHODS: A retrospective review was made of all primary cases of mastoid surgery for cholesteatoma performed at an otological center between 1995 and 2000. During the study period, 486 ears underwent surgery for cholesteatoma. Data included procedures performed, location and extent of the disease, residual and recurrent disease, complications, reasons for staging the surgery, and duration of follow-up. RESULTS: The canal wall remained intact in 68.5% of ears. The majority of the remainder of the patients underwent a canal wall down technique with mastoid obliteration. Residual cholesteatoma was found in 26.9% of second procedures and in 2.7% of third procedures. CONCLUSIONS: The majority of patients with cholesteatoma can be adequately managed with a canal intact tympanomastoidectomy with staging. Otolaryngologists should consider a two-staged procedure as a viable management approach for chronic otitis media with cholesteatoma.

Telemedicine: teleproctored endoscopic sinus surgery.

OBJECTIVE/HYPOTHESIS: Teleproctored surgery projects a surgeon's expertise to remote locations. The objective of the present study was to evaluate the safety and feasibility of this technique as compared with the current standard of care. STUDY DESIGN: Prospective. METHODS: A study was conducted in a residency training program comparing conventionally proctored endoscopic sinus surgery cases with teleproctored cases, with the faculty surgeon supervising through audiovisual teleconferencing (VTC) in a control room 15 seconds from the operating room. RESULTS: Forty-two control patients (83 sides) and 45 teleproctored patients (83 sides) were evaluated. There were no internal differences between groups regarding extent of polypoid disease, revision status, procedures per case, degree of difficulty, general or local anesthesia, or microdebrider use. There were no cases of visual disturbance, orbital ecchymosis or hematoma, or cerebrospinal fluid leak. Orbital fat herniation and blood loss were equal between groups. Three teleproctored cases required faculty intervention: two for surgical difficulty, one for VTC problems. Teleproctored cases took 3.87 minutes longer per side (28.54 vs. 24.67 min, P <.024), a 16% increase. This was thought to be a result of nuances of VTC proctoring. Residents had a positive learning experience, with nearly full control of the operating suite combined with remote supervision through telepresence. Faculty thought such supervision was safe but had concerns regarding personal skills maintenance. CONCLUSIONS: Teleproctored endoscopic sinus surgery can be safely performed on selected cases with an acceptable increase in time. Teleproctored surgery with remote sites may continue to be safely investigated. Incorporating remote supervision through telepresence into the curriculum of surgical residency training requires further study.