Combined posterior tympanotomy/endomeatal access in cochlear implantation.

Alternative techniques for cochlear implant surgery have been described, such as endomeatal- and suprameatal-alone approaches, without traditional posterior tympanotomy. A combined posterior tympanotomy/endomeatal approach is proposed as a way to enhance surgical safety and effectiveness. 64 patients, 34 men and 30 women, mean age 28 (range 1-81 years), 26 pre-verbal and 38 post-verbal, were submitted to cochlear implantation, 32 by means of the described combined posterior tympanotomy/endomeatal approach and 32 with traditional posterior tympanotomy-alone approach. Good anatomic and functional results were observed, with intraoperative improvements in visibility and accessibility of cochleostomy site in difficult cases without any complication, such as tympanic membrane perforation, external canal skin lesions, or extrusion at 12 months. No significant differences were found with traditional technique complication rates excepting for partial insertion data, with statistically significant better results with combined access. The combined posterior tympanotomy/endomeatal approach facilitates the array insertion in conditions of bad exposition/accessibility of promontory and round window. Moreover, this double-way access hinders an incomplete or incorrect positioning. It should be always considered as an alternative to the traditional posterior tympanotomy of one-way access.

Prevalence of abnormal electrocardiograms in a large, unselected population undergoing pre-participation cardiovascular screening.

AIMS: The implementation of 12-lead ECG in the pre-participation screening of young athletes is still controversial and number of issues are largely debated, including the prevalence and spectrum of ECG abnormalities found in individuals undergoing pre-participation screening. METHODS AND RESULTS: We assessed a large, unselected population of 32,652 subjects [26 050 (80%) males], prospectively examined in 19 clinics associated to Italian Sports Medicine Federation. Most were young amateur athletes, aged 8-78 years (median 17), predominantly students (68%), engaged predominantly in soccer (39%), volleyball or basketball (8% each), athletics (6%), cycling (5%), swimming (4%). The ECG patterns were evaluated according to commonly used clinical criteria. The 12-lead ECG patterns were considered normal in 28 799 of the 32 652 athletes (88.2%) and abnormal in 3853 (11.8%). The most frequent abnormalities included prolonged PR interval, incomplete right bundle branch block (RBBB) and early repolarization pattern (total 2280, 7.0%). Distinct ECG abnormalities included deeply inverted T-waves in > 2 precordial and/or standard leads (751, 2.3%), increased R/S wave voltages suggestive of LV hypertrophy (247, 0.8%), conduction disorders, i.e. RBBB (351, 1.0%), left anterior fascicular block (162, 0.5%), and left bundle branch block (19, 0.1%). Rarely, cardiac pre-excitation pattern (42, 0.1%) and prolonged QTc interval (1, 0.03%) were found. CONCLUSION: In a large, unselected population of young athletes undergoing pre-participation screening, the prevalence of markedly abnormal ECG patterns, suggestive for structural cardiac disease, is low (<5% of the overall population) and should not represent obstacle for implementation of 12-lead ECG in the pre-participation screening program.