Challenging Times for Cochlear Implant Users - Effect of Face Masks on Audiovisual Speech Understanding during the COVID-19 Pandemic.

Unhindered auditory and visual signals are essential for a sufficient speech understanding of cochlear implant (CI) users. Face masks are an important hygiene measurement against the COVID-19 virus but disrupt these signals. This study determinates the extent and the mechanisms of speech intelligibility alteration in CI users caused by different face masks. The audiovisual German matrix sentence test was used to determine speech reception thresholds (SRT) in noise in different conditions (audiovisual, audio-only, speechreading and masked audiovisual using two different face masks). Thirty-seven CI users and ten normal-hearing listeners (NH) were included. CI users showed a reduction in speech reception threshold of 5.0 dB due to surgical mask and 6.5 dB due to FFP2 mask compared to the audiovisual condition without mask. The greater proportion of reduction in SRT by mask could be accounted for by the loss of the visual signal (up to 4.5 dB). The effect of each mask was significantly larger in CI users who exclusively hear with their CI (surgical: 7.8 dB, p = 0.005 and FFP2: 8.7 dB, p = 0.01) compared to NH (surgical: 3.8 dB and FFP2: 5.1 dB). This study confirms that CI users who exclusively rely on their CI for hearing are particularly susceptible. Therefore, visual signals should be made accessible for communication whenever possible, especially when communicating with CI users.

Expert validation of prediction models for a clinical decision-support system in audiology.

For supporting clinical decision-making in audiology, Common Audiological Functional Parameters (CAFPAs) were suggested as an interpretable intermediate representation of audiological information taken from various diagnostic sources within a clinical decision-support system (CDSS). Ten different CAFPAs were proposed to represent specific functional aspects of the human auditory system, namely hearing threshold, supra-threshold deficits, binaural hearing, neural processing, cognitive abilities, and a socio-economic component. CAFPAs were established as a viable basis for deriving audiological findings and treatment recommendations, and it has been demonstrated that model-predicted CAFPAs, with machine learning models trained on expert-labeled patient cases, are sufficiently accurate to be included in a CDSS, but it requires further validation by experts. The present study aimed to validate model-predicted CAFPAs based on previously unlabeled cases from the same data set. Here, we ask to which extent domain experts agree with the model-predicted CAFPAs and whether potential disagreement can be understood in terms of patient characteristics. To these aims, an expert survey was designed and applied to two highly-experienced audiology specialists. They were asked to evaluate model-predicted CAFPAs and estimate audiological findings of the given audiological information about the patients that they were presented with simultaneously. The results revealed strong relative agreement between the two experts and importantly between experts and the prediction for all CAFPAs, except for the neural processing and binaural hearing-related ones. It turned out, however, that experts tend to score CAFPAs in a larger value range, but, on average, across patients with smaller scores as compared with the machine learning models. For the hearing threshold-associated CAFPA in frequencies smaller than 0.75 kHz and the cognitive CAFPA, not only the relative agreement but also the absolute agreement between machine and experts was very high. For those CAFPAs with an average difference between the model- and expert-estimated values, patient characteristics were predictive of the disagreement. The findings are discussed in terms of how they can help toward further improvement of model-predicted CAFPAs to be incorporated in a CDSS for audiology.

The Otoprotective Effect of Ear Cryotherapy: Systematic Review and Future Perspectives.

This systematic review investigates ear cooling and cryotherapy in the prevention and treatment of inner ear damage and disease, within the context of animal models and clinical studies. A literature search was carried out in the databases Pubmed and Cochrane Library. Ten studies were identified concerning the otoprotective properties of cryotherapy. Nine of these were rodent in vivo studies (mice, rats, gerbils, guinea pigs). One study involved human subjects and investigated cryotherapy in idiopathic sensorineural hearing loss. The studies were heterogeneous in their goals, methods, and the models used. Disorder models included ischemia and noise damage, ototoxicity (cisplatin and aminoglycoside), and CI-electrode insertion. All ten studies demonstrated significant cryotherapeutic otoprotection for their respective endpoints. No study revealed or expressly investigated otodestructive effects. While limited in number, all of the studies within the scope of the review demonstrated some degree of cryotherapeutic, otoprotective effect. These promising results support the conducting of further work to explore and refine the clinical applicability and impact of cryotherpeutics in otolaryngology.

Considerations for Fitting Cochlear Implants Bimodally and to the Single-Sided Deaf.

When listening with a cochlear implant through one ear and acoustically through the other, binaural benefits and spatial hearing abilities are generally poorer than in other bilaterally stimulated configurations. With the working hypothesis that binaural neurons require interaurally matched inputs, we review causes for mismatch, their perceptual consequences, and experimental methods for mismatch measurements. The focus is on the three primary interaural dimensions of latency, frequency, and level. Often, the mismatch is not constant, but rather highly stimulus-dependent. We report on mismatch compensation strategies, taking into consideration the specific needs of the respective patient groups. Practical challenges typically faced by audiologists in the proposed fitting procedure are discussed. While improvement in certain areas (e.g., speaker localization) is definitely achievable, a more comprehensive mismatch compensation is a very ambitious endeavor. Even in the hypothetical ideal fitting case, performance is not expected to exceed that of a good bilateral cochlear implant user.

Co-Occurrence of EBV-Positive Mucocutaneous Ulcer (EBV-MCU) and CLL/SLL in the Head and Neck Region.

EBV-positive mucocutaneous ulcer (EBV-MCU) was classified as a rare new entity of the lymphoproliferative B-cell diseases by the WHO in 2017 and must be distinguished from head and neck squamous cell carcinoma by early biopsy. The aim of the study is to raise awareness of the disease and to give a review of the current literature and a recommendation for EBV-MCU management. All EBV-MCU cases of the head and neck region published so far were included. We also report a case of a pharyngeal EBV-MCU in an 89-year-old patient who was immunosuppressed by chronic lymphatic leukaemia/small lymphocytic lymphoma (CLL/SLL). In contrast to all previously described cases, histopathology showed a co-infiltration of EBV-MCU and CLL/SLL. A total of 181 cases were identified on PubMed and summarised. EBV-MCU was predominantly caused by immunosuppressive drug therapy. Complete remission could be achieved in 68% of cases and was mainly attributed to a reduction of the immunosuppressive therapy alone (72%). However, some severe cases require more aggressive treatment. Regarding the various histopathologic similarities to other lymphoproliferative disorders, the diagnosis of EBV-MCU can be misleading, with a great impact on patient care and treatment. This diagnosis must be made with caution and requires a combination of clinical, morphological and immunophenotypic features.

Suitable Electrode Choice for Robotic-Assisted Cochlear Implant Surgery: A Systematic Literature Review of Manual Electrode Insertion Adverse Events.

Background and Objective: The cochlear implant (CI) electrode insertion process is a key step in CI surgery. One of the aims of advances in robotic-assisted CI surgery (RACIS) is to realize better cochlear structure preservation and to precisely control insertion. The aim of this literature review is to gain insight into electrode selection for RACIS by acquiring a thorough knowledge of electrode insertion and related complications from classic CI surgery involving a manual electrode insertion process. Methods: A systematic electronic search of the literature was carried out using PubMed, Scopus, Cochrane, and Web of Science to find relevant literature on electrode tip fold over (ETFO), electrode scalar deviation (ESD), and electrode migration (EM) from both pre-shaped and straight electrode types. Results: A total of 82 studies that include 8,603 ears implanted with a CI, i.e., pre-shaped (4,869) and straight electrodes (3,734), were evaluated. The rate of ETFO (25 studies, 2,335 ears), ESD (39 studies, 3,073 ears), and EM (18 studies, 3,195 ears) was determined. An incidence rate (±95% CI) of 5.38% (4.4-6.6%) of ETFO, 28.6% (26.6-30.6%) of ESD, and 0.53% (0.2-1.1%) of EM is associated with pre-shaped electrodes, whereas with straight electrodes it was 0.51% (0.1-1.3%), 11% (9.2-13.0%), and 3.2% (2.5-3.95%), respectively. The differences between the pre-shaped and straight electrode types are highly significant (p < 0.001). Laboratory experiments show evidence that robotic insertions of electrodes are less traumatic than manual insertions. The influence of round window (RW) vs. cochleostomy (Coch) was not assessed. Conclusion: Considering the current electrode designs available and the reported incidence of insertion complications, the use of straight electrodes in RACIS and conventional CI surgery (and manual insertion) appears to be less traumatic to intracochlear structures compared with pre-shaped electrodes. However, EM of straight electrodes should be anticipated. RACIS has the potential to reduce these complications.

How Face Masks Interfere With Speech Understanding of Normal-Hearing Individuals: Vision Makes the Difference.

OBJECTIVE: To investigate the effects of wearing a simulated mask on speech perception of normal-hearing subjects. STUDY DESIGN: Prospective cohort study. SETTING: University hospital. PATIENTS: Fifteen normal-hearing, native German speakers (8 female, 7 male). INTERVENTION: Different experimental conditions with and without simulated face masks using the audiovisual version of the female German Matrix test (Oldenburger Satztest, OLSA). MAIN OUTCOME MEASURES: Signal-to-noise ratio (SNR) at speech intelligibility of 80%. RESULTS: The SNR at which 80% speech intelligibility was achieved deteriorated by a mean of 4.1 dB SNR when simulating a medical mask and by 5.1 dB SNR when simulating a cloth mask in comparison to the audiovisual condition without mask. Interestingly, the contribution of the visual component alone was 2.6 dB SNR and thus had a larger effect than the acoustic component in the medical mask condition. CONCLUSIONS: As expected, speech understanding with face masks was significantly worse than under control conditions. Thus, the speaker's use of face masks leads to a significant deterioration of speech understanding by the normal-hearing listener. The data suggest that these effects may play a role in many everyday situations that typically involve noise.

Differentiation Behaviour of Adipose-Derived Stromal Cells (ASCs) Seeded on Polyurethane-Fibrin Scaffolds In Vitro and In Vivo.

Adipose-derived stromal cells (ASCs) are a promising cell source for tissue engineering and regenerative medicine approaches for cartilage replacement. For chondrogenic differentiation, human (h)ASCs were seeded on three-dimensional polyurethane (PU) fibrin composites and induced with a chondrogenic differentiation medium containing TGF-ß3, BMP-6, and IGF-1 in various combinations. In addition, in vitro predifferentiated cell-seeded constructs were implanted into auricular cartilage defects of New Zealand White Rabbits for 4 and 12 weeks. Histological, immunohistochemical, and RT-PCR analyses were performed on the constructs maintained in vitro to determine extracellular matrix (ECM) deposition and expression of specific cartilage markers. Chondrogenic differentiated constructs showed a uniform distribution of cells and ECM proteins. RT-PCR showed increased gene expression of collagen II, collagen X, and aggrecan and nearly stable expression of SOX-9 and collagen I. Rabbit (r)ASC-seeded PU-fibrin composites implanted in ear cartilage defects of New Zealand White Rabbits showed deposition of ECM with structures resembling cartilage lacunae by Alcian blue staining. However, extracellular calcium deposition became detectable over the course of 12 weeks. RT-PCR showed evidence of endochondral ossification during the time course with the expression of specific marker genes (collagen X and RUNX-2). In conclusion, hASCs show chondrogenic differentiation capacity in vitro with the expression of specific marker genes and deposition of cartilage-specific ECM proteins. After implantation of predifferentiated rASC-seeded PU-fibrin scaffolds into a cartilage defect, the constructs undergo the route of endochondral ossification.

Transplantation of adipose-derived stromal cells protects functional and morphological auditory nerve integrity in a model of cochlear implantation.

Cochlear implants are considered the gold standard therapy for subjects with severe hearing loss and deafness. Cochlear implants bypass the damaged hair cells and directly stimulate spiral ganglion neurons (SGNs) of the auditory nerve. Hence, the presence of functional SGNs is crucial for speech perception in electric hearing with a cochlear implant. In deaf individuals, SGNs progressively degenerate due to the lack of neurotrophic support, normally provided by sensory cells of the inner ear. Adipose-derived stromal cells (ASCs) are known to produce neurotrophic factors. In a guinea pig model of sensory hearing loss and cochlear implantation, ASCs were autologously transplanted into the scala tympani prior to insertion of a cochlear implant on one side. Electrically evoked auditory brain stem responses (eABR) were recorded 8 weeks after cochlear implantation. At conclusion of the experiment, the cochleae were histologically evaluated. Compared to untreated control animals, transplantation of ASCs resulted in an increased number of SGNs and their peripheral neurites. In ASC-transplanted animals, mean eABR thresholds were lower and suprathreshold amplitudes larger, suggesting a larger population of intact auditory nerve fibers. Moreover, when compared to controls, amplitude-level functions of eABRs in ASC transplanted animals demonstrated steeper slopes in response to increasing interphase gaps (IPGs), indicative of better functionality of the auditory nerve. In summary, results suggest that transplantation of autologous ASCs into the deaf inner ear may have protective effects on the survival of SGNs and their peripheral processes and may thus contribute to long-term benefits in speech discrimination performance in cochlear implant subjects.

Long-Term, Multicenter Results With the First Transcutaneous Bone Conduction Implant.

OBJECTIVE: Investigation of long-term safety and performance of an active, transcutaneous bone conduction implant in adults and children up to 36 months post-implantation. STUDY DESIGN: Prospective, single-subject repeated-measures design. SETTING: Otolaryngology departments of eight German and Austrian hospitals.∗†‡§||¶#∗∗†† Affiliations listed above that did not participate in the study.‡‡§§||||¶¶. PATIENTS: Fifty seven German-speaking patients (49 adults and eight children) suffering from conductive or mixed hearing loss, with an upper bone conduction threshold limit of 45 dB HL at frequencies between 500 and 3000 Hz. INTERVENTION: Implantation of the Bonebridge transcutaneous bone conduction hearing implant (tBCI). MAIN OUTCOME MEASURES: Patients' audiometric pure tone averages (PTA4) (0.5, 1, 2, 4 kHz) thresholds (air conduction, bone conduction, and sound field) and speech perception (word recognition scores [WRS] and speech reception thresholds [SRT50%]) were tested preoperatively and up to 36 months postoperatively. Patients were also monitored for adverse events and administered quality-of-life questionnaires. RESULTS: Speech perception (WRS: pre-op: 17.60%, initial activation [IA]: 74.23%, 3M: 83.65%, 12M: 83.46%, 24M: 84.23%, 36M: 84.42%; SRT50%: pre-op: 65.56 dB SPL, IA: 47.67 dB SPL, 3M: 42.61 dB SPL, 12M: 41.11 dB SPL, 24M: 41.74 dB SPL, 36M: 42.43 dB SPL) and sound field thresholds (pre-op: 57.66 dB HL, IA: 33.82 dB HL, 3M: 29.86 dB HL, 12M: 28.40 dB HL, 24M: 28.22 dB HL, 36M: 28.52 dB HL) improved significantly at all aided postoperative visits. Air and bone conduction thresholds showed no significant changes, confirming preservation of patients' residual unaided hearing. All adverse events were resolved by the end of the study. CONCLUSIONS: Safety and performance of the tBCI was demonstrated in children and adults 36 months postoperatively.

Superparamagnetic Iron Oxide Particles (VSOPs) Show Genotoxic Effects but No Functional Impact on Human Adipose Tissue-Derived Stromal Cells (ASCs).

Adipose tissue-derived stromal cells (ASCs) represent a capable source for cell-based therapeutic approaches. For monitoring a cell-based application in vivo, magnetic resonance imaging (MRI) of cells labeled with iron oxide particles is a common method. It is the aim of the present study to analyze potential DNA damage, cytotoxicity and impairment of functional properties of human (h)ASCs after labeling with citrate-coated very small superparamagnetic iron oxide particles (VSOPs). Cytotoxic as well as genotoxic effects of the labeling procedure were measured in labeled and unlabeled hASCs using the MTT assay, comet assay and chromosomal aberration test. Trilineage differentiation was performed to evaluate an impairment of the differentiation potential due to the particles. Proliferation as well as migration capability were analyzed after the labeling procedure. Furthermore, the labeling of the hASCs was confirmed by Prussian blue staining, transmission electron microscopy (TEM) and high-resolution MRI. Below the concentration of 0.6 mM, which was used for the procedure, no evidence of genotoxic effects was found. At 0.6 mM, 1 mM as well as 1.5 mM, an increase in the number of chromosomal aberrations was determined. Cytotoxic effects were not observed at any concentration. Proliferation, migration capability and differentiation potential were also not affected by the procedure. Labeling with VSOPs is a useful labeling method for hASCs that does not affect their proliferation, migration and differentiation potential. Despite the absence of cytotoxicity, however, indications of genotoxic effects have been demonstrated.

A retrospective European multicenter analysis of the functional outcomes after active middle ear implant surgery using the third generation vibroplasty couplers.

PURPOSE: To evaluate the safety and performance of three novel vibroplasty couplers that allow attachment of the floating mass transducer of a transcutaneous active middle ear implant (AMEI) to the round window (RW) membrane, the long process (LP), or the incus body and the short process (SP) of the incus. METHODS: Retrospective multicenter cohort study of 25 AMEI users with sensorineural or mixed hearing loss that were among the first implanted with an AMEI vibrating ossicular prosthesis in combination with the third generation of vibroplasty couplers between 2014 and 2016. Main Outcome Measures were bone-conduction pure-tone and vibroplasty thresholds, postoperative aided sound field thresholds and postoperative aided word recognition score (WRS). RESULTS: Bone conduction threshold changes of more than 10 dB in 4PTABC were observed in two subjects. A mean improvement of 57.8% in speech recognition was observed with a mean WRS at 65 dB SPL improving from 14.8% (SD 21.9%) preoperatively to a mean aided score of 72.6% (SD 18.6%). Sound field thresholds improved from an average 4PTASF of 64.1 dB HL (SD 9.8 dB HL) to 37.0 dB HL (SD 8.9 dB HL), resulting in a mean functional gain of 27.1 dB. There was no significant difference in WRS or functional gain between the coupler types. CONCLUSION: Initial experience shows that all three third generation vibroplasty couplers represent safe and efficient attachment options for the FMT allowing the surgeon to choose the coupling type based on the present pathology.

Toxicity and Functional Impairment in Human Adipose Tissue-Derived Stromal Cells (hASCs) Following Long-Term Exposure to Very Small Iron Oxide Particles (VSOPs).

Magnetic nanoparticles (NPs), such as very small iron oxide NPs (VSOPs) can be used for targeted drug delivery, cancer treatment or tissue engineering. Another important field of application is the labelling of mesenchymal stem cells to allow in vivo tracking and visualization of transplanted cells using magnetic resonance imaging (MRI). For these NPs, however, various toxic effects, as well as functional impairment of the exposed cells, are described. The present study evaluates the influence of VSOPs on the multilineage differentiation ability and cytokine secretion of human adipose tissue derived stromal cells (hASCs) after long-term exposure. Human ASCs were labelled with VSOPs, and the efficacy of the labelling was documented over 4 weeks in vitro cultivation of the labelled cells. Unlabelled hASCs served as negative controls. Four weeks after labelling, adipogenic and osteogenic differentiation was histologically evaluated and quantified by polymerase chain reaction (PCR). Changes in gene expression of IL-6, IL-8, VEGF and caspase 3 were determined over 4 weeks. Four weeks after the labelling procedure, labelled and unlabelled hASCs did not differ in the gene expression of IL-6, IL-8, VEGF and caspase 3. Furthermore, the labelling procedure had no influence on the multidifferentiation ability of hASC. The percentage of labelled cells decreased during in vitro expansion over 4 weeks. Labelling with VSOPs and long-term intracellular disposition probably have no influence on the physiological functions of hASCs. This could be important for the future in vivo use of iron oxide NPs.

Microphone directionality and wind noise reduction enhance speech perception in users of the MED-EL SONNET audio processor.

Objectives: Speech understanding in noise remains a challenge for many cochlear implant users. To improve this, the SONNET audio processor features three microphone directionality (MD) settings and three wind noise reduction (WNR) settings. The primary aim of this study was to assess if speech understanding in noise and hearing in real life was superior with the SONNET or with the OPUS 2, which does not feature MD or WNR.Methods: 31 of 33 participants completed the study. Speech understanding was assessed in two types of acoustic noise, in wind noise, and in quiet. A 4-speaker setup was used and speech was presented from 0° and noise from 90°, 180°, and 270°. Wind noise was simulated with a fan. Sound quality and hearing-related abilities were assessed via two subjective questionnaires.Results: Speech understanding in acoustic noise with the SONNET was significantly better or equal to than with the OPUS 2. Speech understanding in wind with the OPUS 2 was significantly better than with the SONNET in some settings. Sound quality and hearing-related abilities were both significantly better with the SONNET.Conclusions: The SONNET provides the same or significantly improved speech understanding than the OPUS 2 in quiet and in noise. While OPUS 2 was superior in wind than the SONNET in some settings, this was offset by SONNET's superiority in real-life listening situations. We therefore conclude that the front-end processing of the SONNET provides users with better hearing than does the OPUS 2.

Spatial Speech-in-Noise Performance in Bimodal and Single-Sided Deaf Cochlear Implant Users.

This study compared spatial speech-in-noise performance in two cochlear implant (CI) patient groups: bimodal listeners, who use a hearing aid contralaterally to support their impaired acoustic hearing, and listeners with contralateral normal hearing, i.e., who were single-sided deaf before implantation. Using a laboratory setting that controls for head movements and that simulates spatial acoustic scenes, speech reception thresholds were measured for frontal speech-in-stationary noise from the front, the left, or the right side. Spatial release from masking (SRM) was then extracted from speech reception thresholds for monaural and binaural listening. SRM was found to be significantly lower in bimodal CI than in CI single-sided deaf listeners. Within each listener group, the SRM extracted from monaural listening did not differ from the SRM extracted from binaural listening. In contrast, a normal-hearing control group showed a significant improvement in SRM when using two ears in comparison to one. Neither CI group showed a binaural summation effect; that is, their performance was not improved by using two devices instead of the best monaural device in each spatial scenario. The results confirm a "listening with the better ear" strategy in the two CI patient groups, where patients benefited from using two ears/devices instead of one by selectively attending to the better one. Which one is the better ear, however, depends on the spatial scenario and on the individual configuration of hearing loss.

Intraoperative Estimation of the Coupling Efficiency and Clinical Outcomes of the Vibrant Soundbridge Active Middle Ear Implant Using Auditory Brainstem Response Measurements.

Purpose This study intraoperatively measured the coupling efficiency of the Vibrant Soundbridge (VSB), with the aim of avoiding revision surgery due to insufficient outcome. This method can also be used to test the integrity of the implant at the end of the implantation surgery and to evaluate aided thresholds. In addition, this method makes it possible to objectively test how well the VSB has been fitted, provide assistance in fitting handicapped patients or children, evaluate hearing degradation, or test for a drop in coupling efficiency before revision surgeries. In order to analyze the feasibility of these new VSB-aided auditory brainstem response (ABR) thresholds, they were compared to behavioral thresholds from the Vibrogram and the preoperative bone conduction thresholds. Method The study included 30 patients with mild-to-severe hearing loss implanted with a VSB (VORP503). Intraoperative ABR thresholds during the VSB implantation were recorded using a VSB-optimized chirp stimulus. The new method is compared to the bone conduction threshold of the study sample and the aided Vibrogram thresholds. Speech intelligibility results up to 24 months after surgery are also presented. Results A reliable correlation between the bone conduction thresholds and the intraoperative ABRs was found and was higher in comparison to the Vibrogram. Furthermore, speech intelligibility outcomes were stable over time. Conclusion ABR measurements can be used intraoperatively to estimate the coupling efficiency of the VSB and test the integrity of the implant at the end of surgery.

Long-Term Impact of Zinc Oxide Nanoparticles on Differentiation and Cytokine Secretion of Human Adipose-Derived Stromal Cells.

Zinc oxide nanoparticles (ZnO-NPs) are widely utilized, for example in manufacturing paints and in the cosmetic industry. In addition, there is raising interest in the application of NPs in stem cell research. However, cytotoxic, genotoxic and pro-inflammatory effects were shown for NPs. The aim of this study was to evaluate the impact of ZnO-NPs on cytokine secretion and differentiation properties of human adipose tissue-derived stromal cells (ASCs). Human ASCs were exposed to the subtoxic concentration of 0.2 µg/mL ZnO-NPs for 24 h. After four weeks of cultivation, adipogenic and osteogenic differentiation procedures were performed. The multi-differentiation potential was confirmed histologically and using polymerase chain reaction (PCR). In addition, the gene expression of IL-6, IL-8, vascular endothelial growth factor (VEGF) and caspase 3 was analyzed. Over the course of four weeks after ZnO-NPs exposure, no significant differences were detected in the gene expression of IL-6, IL-8, VEGF and caspase 3 compared to non-exposed cells. The differentiation was also not affected by the ZnO-NPs. These findings underline the fact, that functionality of ASCs is likely to be unaffected by ZnO-NPs, despite a long-term disposition of NPs in the cells, supposing that the starting concentration was safely in the non-toxic range. This might provide important information for single-use nanomedical applications of ZnO-NPs.

Bilateral cochlear implantation is regarded as very beneficial: results from a worldwide survey by online questionnaire.

PURPOSE: Bilateral cochlear implant (CI) provision is now widely regarded as the most beneficial hearing intervention for acceptable candidates. This study sought to determine if a number of well-regarded hearing professionals at highly reputable clinics shared similar practices and beliefs regarding bilateral CI provision, use, and rehabilitation in children and adults. METHODS: An 11-question online questionnaire was created and distributed to all 27 clinics in the HEARRING group. Questions 1-5 asked for facts; questions 6-11 asked for opinions. RESULTS: 20 completed questionnaires were returned. All 20 respondents reported that their clinics perform bilateral cochlear implantation in children; 18 do so in adults. Regarding the fact-based questions, bilateral CI provision is more commonly performed and more likely to be reimbursed in children than in adults. Children are also much more likely to be implanted simultaneously than are adults. Regarding the opinion-based questions, respondents gave broadly similar answers. Communication between the CIs and speech coding strategies specifically developed for bilateral CI users were regarded as the two future technologies that would most enhance the benefit of bilateral CI use. CONCLUSIONS: Most clinics in the HEARRING group are very familiar with bilateral CI provision and hold similar opinions on its results and benefits. Hopefully the results described herein will lead to a greater acceptance and regular reimbursement of bilateral CI provision, especially in adults.

Cochlear Implantation in Chronic Otitis Media: Investigation of Long-term Speech Comprehension and Rate of Complications.

OBJECTIVE: To analyze the long-term speech comprehension and rate of complications of cochlear implantation in chronic otitis media. STUDY DESIGN: Retrospective data analysis. SETTING: Tertiary referral center with a large cochlear implant program. MAIN OUTCOME MEASURE: Speech perception scores in quiet and background noise and rate of complications. PATIENTS: Forty ears from a total of 38 patients with a mean age of 63.28 ±â€Š2.16 years at the time of implantation were included. RESULTS: Patients with a history of multiple ear surgeries, with no alternative option for hearing restoration than a cochlear implant, were implanted with satisfactory results in regard to speech comprehension. Preoperative bone conduction PTA4 correlated to postoperative speech comprehension scores in background noise. The rate of complications was low, but higher than in cases of cochlear implantation in normal middle ears. CONCLUSION: Cochlear implantation in chronic otitis media can be a satisfactory and safe procedure, if the surgery technique and aftercare is appropriate to the altered anatomy.

Surgical Impact of Coupling an Active Middle Ear Implant to Short Incus Process.

INTRODUCTION: Since 1996 the active middle-ear implant Vibrant Soundbridge (VSB) is used to treat mild-to-severe sensorineural hearing losses. The former standard surgical approach for incus vibroplasty included a mastoidectomy and a posterior tympanotomy, crimping the Floating-Mass Transducer (FMT) to the long incus process. The introduction of the short process (SP) coupler allows the attachment of the FMT to the incus body making the procedure of a posterior tympanotomy unnecessary. The aim of this study was to evaluate the duration of surgery (surgical case length) and to compare the audiological results of SP coupling with the former standard surgical approach to the long incus process. MATERIALS AND METHODS: Patients undergoing an incus vibroplasty between October 2009 and February 2016 were included in this cohort study. The patients received an incus vibroplasty with crimping the FMT to the long incus process (former standard application) (n = 25) and with the SP coupler (n = 17) respectively. The surgical case length as well as the functional audiological outcome was assessed 12 months postoperatively using pure-tone audiometry and speech audiometry. RESULTS: The surgical case length was significantly shorter in the SP coupler group compared to the standard application incus vibroplasty (85 ±â€Š29 min vs. 114 ±â€Š50 min). Additionally, patients receiving the SP coupler had an increased speech perception if compared to the standard application (Freiburger monosyllables at 65 dB SPL: 76.1 ±â€Š16.1% vs. 66.2 ±â€Š23.5%). CONCLUSION: The SP coupler leads to a shortened time of surgery and by the less invasive surgery to reduced risks for facial nerve and chorda tympani. Speech perception is significantly improved by SP coupling compared to classic long incus coupling.