Bilateral simultaneous cochlear implantation is a safe method of hearing rehabilitation in adults.

PURPOSE: Bilateral cochlear implantation is an effective treatment for patients with bilateral profound hearing loss. In contrast to children, adults mostly choose a sequential surgery. This study addresses whether simultaneous bilateral CI is associated with higher rates of complications compared to sequential implantation. METHODS: 169 bilateral CI surgeries were analyzed retrospectively. 34 of the patients were implanted simultaneously (group 1), whereas 135 patients were implanted sequentially (group 2). The duration of surgery, the incidence of minor and major complications and the duration of hospitalization of both groups were compared. RESULTS: In group 1, the total operating room time was significantly shorter. The incidences of minor and major surgical complications showed no statistically significant differences. A fatal non-surgical complication in group 1 was particularly extensively reappraised without evidence of a causal relationship to the chosen mode of care. The duration of hospitalization was 0.7 days longer than in unilateral implantation but 2.8 days shorter than the combined two hospital stays in group 2. CONCLUSION: In the synopsis of all considered complications and complication-relevant factors, equivalence of simultaneous and sequential cochlear implantation in adults in terms of safety was found. However, potential side effects related to longer surgical time in simultaneous surgery must be considered individually. Careful patient selection with special consideration to existing comorbidities and preoperative anesthesiologic evaluation is essential.

Differences in mastoid and middle-ear cavity opacification in CT between intensive care patients and patients with acute mastoiditis requiring surgical treatment.

PURPOSE: To stratify differences in visual semantic and quantitative imaging features in intensive care patients with nonspecific mastoid effusions versus patients with acute mastoiditis (AM) requiring surgical treatment. METHODS: We included 48 patients (male, 28; female, 20; mean age, 59.5 ± 18.1 years) with mastoid opacification (AM, n = 24; control, n = 24) who underwent clinically indicated cerebral CT between 12/2007 and 07/2018 in this retrospective study. Semantic features described the extend and asymmetry of mastoid and middle-ear cavity opacification and complications like erosive changes. Minimum, maximum and mean Hounsfield unit (HU) values were obtained as quantitative features. We analyzed the features employing univariate testing. RESULTS: Compared to intensive care patients, AM patients revealed asymmetric mastoid or middle-ear cavity opacification (likelihood-ratio (LR) < 0.001). Applying a dedicated threshold of the extent of opacification, AM patients reached significance levels of LR = 0.042 and 0.002 for mastoid and middle-ear cavity opacification. AM cases showed higher maximum and mean HU values (p = 0.009, p = 0.024). CONCLUSIONS: We revealed that the extent and asymmetry of mastoid and middle-ear cavity opacification differs significantly between AM patients and intensive care patients. Multicenter research is needed to expand our cohort and possibly pave the way to build a non-invasive predictive model for AM in the future.

Cochlear implant magnet dislocation after MRI: surgical management and outcome.

PURPOSE: An increasing number of cochlear implant (CI) users is examined by magnetic resonance imaging which may cause the displacement of the implant magnet. This complication prevents the usage of the external processor and has to be treated surgically in most cases. The purpose of this study is to analyze the results of the surgical intervention and the consequences for the CI recipients. METHODS: The retrospective study was conducted at a tertiary referral center. From the patient care records between October 2014 and July 2018, 9 cases were reviewed that had undergone MRI after cochlear implantation and had experienced magnet displacement. RESULTS: Nine patients from 9 to 74 years of age were identified with MRI-induced magnet displacement. Implants of different manufacturers were affected (8 × Cochlear®, 1 Advanced Bionics®) but did not include the latest 3 T MR conditional product generation. The patients reported pain, swelling, redness above the implant and/or a noticeably dislocated magnet. One-third of the MRI examination were conducted in external radiological sites without any precautions such as a compression bandage. Surgical magnet repositioning was successful in all but one case with postoperative implant infection and consecutive explantation. In total, the patient was unable to use his CI for 420 days (1.2 years) after the MRI examination. The remaining eight patients averaged 29 days between MRI-related magnet dislocation and CI re-activation. CONCLUSIONS: The present study shows that in the majority of cases a surgical magnet reposition is possible without complications, and thus the time of nonuse of the CI is usually low. Nevertheless, there is a risk that in individual cases significant medical, functional, social and economic consequences for patients may occur. The presented data demonstrate that the indication to perform MRI scans in CI users needs to be further critically considered. An attentive, critical assessment of an MRI indication by both the initiating physician (usually not an ENT specialist) and the performing radiologist is mandatory.

Long-Term Results of Prophylactic Donor Lymphocyte Infusions for Patients with Multiple Myeloma after Allogeneic Stem Cell Transplantation.

The major reason for treatment failure after allografting in multiple myeloma (MM) is relapse. Donor lymphocyte infusions (DLIs) are considered a valuable post-transplant strategy mainly for relapsed patients but using them to prevent relapse in MM has been reported rarely. In the present study, we examined the efficacy of prophylactic DLIs after allogeneic hematopoietic stem cell transplantation (allo-HSCT) in myeloma patients with a long-term follow-up of more than 5 years. A total of 61 patients with MM who did not relapse or develop disease progression after allo-HSCT were treated with prophylactic DLI in an escalating fashion (overall 132 DLI procedures) to deepen remission status and prevent relapse. Overall response rate to DLI was 77%. Thirty-three patients (54%) upgraded their remission status, 41 patients (67%) achieved or maintained complete remission, and 26% achieved a molecular remission. Incidence of acute graft-versus-host disease (GVHD) grade II to IV was 33% and no DLI-related mortality was noted. After a median follow-up of 68.7 months from first DLI the estimated 8-year progression-free survival (PFS), and overall survival (OS) in a landmark analysis was 43% (95% confidence interval [CI], 28% to 57%) and 67% (95% CI, 53% to 82%), respectively, with best outcome for patients who acquired molecular remission (8-year PFS was 62% and 8-year OS was 83%). Prophylactic escalating DLI in a selected cohort of MM patients to prevent relapse after allograft resulted in a low incidence of severe GVHD and encouraging long-term results, especially if molecular remission is achieved.