Delayed-onset facial nerve paresis following cochlear implantation: case report and literature review.

OBJECTIVE: Facial nerve paresis is rare following cochlear implantation. Mechanisms underlying delayed-onset facial paresis are poorly understood. This paper describes the case of a patient who developed facial nerve paresis three years after implantation. A literature review was performed with the aim of identifying any similar cases. METHODS: The patient case is reported, and the literature reviewed using PubMed, Embase and Ovid databases. RESULTS: The literature review revealed that the vast majority of delayed-onset facial nerve paresis cases occur within the first month of implantation. Only two other cases occurring years after device implantation were identified. Although potential causative factors have been suggested, as in our case this phenomenon may be idiopathic. CONCLUSION: Prognosis for recovery of late-onset facial nerve paresis seems promising, despite the unfortunate requirement for device explantation in all previous cases including our own.

The prevalence of lymphoedema in women who attended an information and exercise class to reduce the risk of breast cancer-related upper limb lymphoedema.

Breast cancer-related upper limb lymphoedema (BCRL) affects approximately 20 % of women undergoing axillary intervention. Women who attended a "reducing your risk of lymphoedema" class, including exercise instruction, anecdotally reported positive BCRL outcomes. The aim of this study was to examine BCRL outcomes and perceived benefit for attendees at a "reducing your risk of lymphoedema" class between 2000 and 2005. A cross-sectional study was conducted in two parts: (1) self-report questionnaire regarding lymphoedema status and benefit received from class and exercise programme; (2) clinical evaluation and objective measurement to confirm BCRL. 46 women completed questionnaires; 40 continued to clinical evaluation and objective measurement. BCRL prevalence defined as ≥10 % excess limb volume was only 5 %, although clinician judgement identified 23 % with arm lymphoedema and 8 % with lymphoedema limited to the hand. Clinician judgement correlated highly with patient self-report (Kappa = 0.833, p = 0.000). All women found the class beneficial, reporting increased confidence to return to normal life and a wide range of activities/exercise. We conclude that prevalence of BCRL should be determined by both clinical judgement and objective measurement to avoid underestimation. The benefit of group education with a lymphoedema expert and of exercise instruction should be further explored, and the potential for exercise to reduce BCRL prevalence should be examined.

A pilot study to explore the experiences of congenitally or early profoundly deafened candidates who receive cochlear implants as adults.

OBJECTIVES: To explore the experiences of congenitally or early profoundly deafened candidates who receive cochlear implants as adults. METHODS: Eight congenitally or early profoundly deafened implantees who had received their implants as adults were interviewed using a semi-structured interview technique. Interviews were conducted in the participant's preferred communication mode (oral/aural, Sign Supported English, or British Sign Language). RESULTS: All participants reported benefit from implantation. Areas of benefit identified correspond with results from similar studies conducted with post-lingually deafened adult implantees. DISCUSSION: Congenitally or early profoundly deafened adults implanted as adults report benefit from cochlear implantation in the following areas: identity, hearing the world, and emotional wellbeing. They also commented on their motivation for wanting an implant and the advice they would give to others considering implantation.

Lymphoedema: an underestimated health problem.

BACKGROUND: Lymphoedema/chronic oedema is an important cause of morbidity in the population, but little is known of its epidemiology and impact on patients or health services. AIM: To determine the magnitude of the problem of chronic oedema in the community, and the likely impact of oedema on use of health resources, employment and patient's quality of life. DESIGN: Questionnaire-based survey. METHODS: Health professionals from dedicated lymphoedema services, specific out-patient clinics, hospital wards and community services (GP clinics and district nurses) were contacted to provide information on patients from within South West London Community Trust. A subset of the identified patients was interviewed. RESULTS: Within the catchment area, 823 patients had chronic oedema (crude prevalence 1.33/1000). Prevalence increased with age (5.4/1000 in those aged > 65 years), and was higher in women (2.15 vs. 0.47/1000). Only 529 (64%) were receiving treatment, despite two specialist lymphoedema clinics within the catchment area. Of 228 patients interviewed, 78% had oedema lasting > 1 year. Over the previous year, 64/218 (29%) had had an acute infection in the affected area, 17/64 (27%) being admitted for intravenous antibiotics. Mean length of stay for this condition was 12 days, estimated mean cost pound 2300. Oedema caused time off work in > 80%, and affected employment status in 9%. Quality of life was below normal, with 50% experiencing pain or discomfort from their oedema. DISCUSSION: Chronic oedema is a common problem in the community with at least 100 000 patients suffering in the UK alone, a problem poorly recognized by health professionals. Lymphoedema arising for reasons other than cancer treatment is much more prevalent than generally perceived, yet resources for treatment are mainly cancer-based, leading to inequalities of care.

Management of chronic oedema.

Lymphoedema is a treatable, although incurable, chronic condition that is usually attributed to insufficient drainage¹. However, many tissue swellings maybe considered mixed forms of lymphoedema; for example, oedema will occur when the load of capillary filtrate is increased (as in the case of infection or chronic venous insufficiency) and the lymphatics fail to keep up with the demand on the drainage system².