Surgery and functional outcomes in deaf children receiving cochlear implants before age 2 years.

OBJECTIVE: To examine the feasibility of cochlear implantation in children younger than 2 years regarding surgery and functional outcomes. DESIGN: Prospective study. SETTING: Tertiary pediatric cochlear implant center. PATIENTS: A consecutive sample of 12 children younger than 2 years at the time of cochlear implantation (8 boys and 4 girls). The cause of hearing loss was meningitis in 6 children and congenital in 6. INTERVENTIONS: Multichannel cochlear implantation using the Nucleus C124M (Cochlear Co, Sydney, Australia) device. Functional outcome was assessed using the Listening Progress Profile and the Categories of Auditory Performance. MAIN OUTCOME MEASURES: Perioperative and postoperative surgical complications and functional outcome. RESULTS: Eight children had a completely patent cochlea. Four children required a 3- to 5-mm drilling to reach the scala tympani because of ossification after meningitis. Full insertion was achieved in 11 patients; the other child received 18 electrodes. One patient had temporary facial nerve weakness; 2 others had wound edema and serous discharge that resolved with conservative management. In the longer term, 1 child experienced a single episode of acute otitis media; another had recurrent episodes of otitis media. Mean Listening Progress Profile scores increased from 1 to 42 and median Categories of Auditory Performance scores increased from 0 to 5 at 2 years postsurgery. Comparison with the scores in the 2- to 5-year group showed no significant differences. No significant tuning difficulties were experienced with all children. CONCLUSIONS: Cochlear implantation is feasible in children younger than 2 years without significant surgical complications or particular tuning difficulties. Functional results 2 years after implantation were as good as or better than those of children who underwent implantation between ages 2 and 5 years.

Fronto-ethmoid osteoma: the place of surgery.

Osteomas of the paranasal sinuses are common. Most are, however, asymptomatic and a chance radiographic finding. We describe four cases histories which help to illustrate the benefits and hazards of surgery, and highlight the importance of patient selection. A review of the literature is presented.

The changing faces of a parotid mass.

The development of a neurofibroma in the temporal and parotid regions of the facial nerve is rare. We report a case occurring in a 32-year-old male, where the initial presentation was a parotid mass. Cytologically this was initially thought to be a pleomorphic adenoma. However, the diagnosis was then changed to a schwannoma and finally a neurofibroma after complete excision of the lesion. The case illustrates how fine needle aspiration cytology under ultrasound guidance, and even histological examination of an incision biopsy can sometimes fail to give the correct diagnosis. In this case magnetic resonance imaging was used to help plan definitive surgery.

Measurement of small tissue volumes using Holden's apparatus.

A reproducible method for the estimation of volumes of small tissue samples was needed to allow comparison of the biological activity of tissue explants and to relate symptom improvement to procedures such as adenoidectomy or polypectomy. Holden's apparatus, which utilizes fluid displacement between two chambers, was compared to displacement in a 20 ml syringe. Two observers made four readings each on 20 tissue samples (range 0.37 to 4.70 ml) using both methods for comparison. A two-way analysis of variance for replicated data gave an F ratio of 0.6885 (df = 19; p > 0.8) for Holden's apparatus, and an F ratio of 1.4307 (df = 19; p > 0.1) for the 20 ml syringe. The standard error of the mean for repeated readings on the same sample by an observer was 0.001 ml for Holden's apparatus and 0.014 ml for the syringe method. For accurate estimation of small tissue volumes within 0.01 ml we recommend Holden's apparatus.

Glossal abscess presenting as unilateral tongue swelling.

Glossal abscesses are extremely rare, only 29 cases having been described in the last 28 years. Clinical and ultrasound examination should establish the diagnosis, and treatment should be by surgical incision and drainage. We report a case of glossal abscess presenting as a unilateral swelling of the tongue.

Endoscopic holmium:YAG laser dacryocystorhinostomy-safe and effective as a day-case procedure.

Endoscopic holmium laser dacryocystorhinostomy can be used safely and efficiently to relieve symptoms of distal nasolacrimal duct obstruction. It has great advantages over the conventional external approach as it can be done as a day-case procedure under local anaesthesia. The excellent ablation of bone and soft tissue using this type of laser contribute to the fact that the procedure can be performed in a mean time of 20 minutes. We report on the results of our first 50 patients and review the literature on the subject.

Twenty-four hour ambulatory nasal pH monitoring.

The nasal delivery of drugs, both for systemic and local use, is an expanding field with many drugs being delivered by this route. It is known that changes in pH can affect drug absorption but there is no data regarding intranasal pH over time. We present the results of 24-h ambulatory nasal pH monitoring in four subjects, each of whom had monitoring on two separate occasions. The apparatus consisted of a pH monitor with two electrodes, thus enabling us to take readings from 1 and 4 cm behind the anterior end of the inferior turbinate. Measurements were recorded every 6 s by the posterior electrode and every 30 s by the anterior electrode. The recording apparatus was worn around the subjects waist. Analysis of the results showed that there was no diurnal variation and no significant differences between the subjects. The mean pH from the anterior electrode was higher than that from the posterior (7.1 versus 6.6). The pH did not fluctuate with daily activities such as eating, drinking or sleeping. The results are interesting and may be of importance with regard to the design of formulations for nasal drug delivery systems.