The Dynamic Tracheoesophageal Prosthesis Length.

OBJECTIVE: In a postlaryngectomy patient, tracheoesophageal (TE) speech is considered to be the most effective and preferred method of communication. Previous research has demonstrated that despite an appropriately sized TE prosthesis placement at the time of puncture, there are a portion of patients that require resizing postoperatively. The purpose of this study was to report on the variability of the tracheoesophageal prosthesis length. STUDY DESIGN: Retrospective chart review. SETTING: Tertiary care academic medical center. METHODS: This was a retrospective chart review of 62 patients who underwent secondary tracheoesophageal puncture (TEP) at a tertiary care academic medical center from January 2008 to November 2019. Patient demographic information, average changes in prosthesis length, number of prosthesis adjustments, and timing of prosthesis exchanges were collected. RESULTS: 62 patients met criteria for study inclusion. Mean age was 61.96 years old with 49 being male (79%) and 13 (21%) females. Overall change in prosthesis length was - 3.85 mm ± 3.58 with time to first prosthesis change at 2.29 months ± 2.73. There was an average of 4.37 changes ± 3.43 before reaching a stable length. Twenty-six patients (41.9%) had increases in their prosthesis length resulting in closure of the tracheoesophageal fistula requiring seven patients (11.3%) to return to the operating room for repuncturing. History of smoking (P = 0.02), Blom-Singer prosthesis type (P = 0.03), and larger diameter (P = 0.01) appeared to be predisposing factors for a fluctuating prosthesis length. CONCLUSION: Tracheoesophageal prosthesis length decreases over time for secondary punctures, requiring adjustments with a speech language pathologist. There are a clinically significant portion that have fluctuations in prosthesis length resulting in an increased risk for requiring re-puncturing.

Are eye-care practitioners fitting scleral contact lenses?

BACKGROUND: To determine the extent of scleral lens fitting worldwide and to characterise the associated patient demographics. METHODS: Survey forms were sent to contact lens fitters around the world, every year for 20 consecutive years (2000 to 2019). Practitioners were asked to record data relating to the first 10 contact lens fits or refits performed after receiving the survey. Data were analysed for those countries reporting ≥ 1,000 contact lens fits during this period. RESULTS: A total of 369,209 contact lens fits were recorded from 40 eligible countries, comprising 2,309 scleral lens fits and 366,900 other (non-scleral) lens fits. Overall scleral lenses represented 0.76 per cent of all contact lens fits with significant differences between countries (p < 0.0001), ranging from no fits in six countries: Hungary, Indonesia, Iran, Korea, Malaysia and Singapore, to 5.9 per cent in Switzerland. There has been an increase in scleral lens fitting over the survey period (p < 0.0001), with the rate of fits increasing from negligible (< 0.50 per cent) before 2006 and then increasing from 2011 onward (p < 0.0001). Scleral lenses were fit to older patients (38.5 ± 15.0 years) compared to other lenses (31.4 ± 13.7 years) (p < 0.0001), this age disparity increasing over the survey period (p < 0.0001) and were more likely to be males (scleral lens fits 53 per cent, non-scleral lenses 33 per cent, p < 0.0001). The increase in scleral lens fits is commensurate with the increase in related publications in the peer-reviewed literature over the same period (p < 0.05, r2 = 0.82). CONCLUSION: Scleral lens use has increased since 2011 with these specialised lenses more likely to be fitted to males and older patients than non-scleral lenses.

Ocular Drug Delivery Systems Using Contact Lenses.

The use of contact lenses as ocular drug delivery systems has been considered intuitive for decades. However, at this time, there are no approved products using such systems. In this article, we review the challenges with current therapies, pharmacokinetics, and pharmacodynamics of different drug classes and the patient population. In addition, we note the relative lack of clinical studies, and list potential products in active development at this time. In particular, we address the alignment of time course of the therapeutic need, the pharmacokinetics of the molecule, and the delivery characteristics of the systems (e.g., pulsatile vs. zero-order). We also discuss the needs of various populations including the elderly (who may have motor and cognitive issues as well as presbyopia) and the young. While a contact lens delivery system may also provide refractive correction, to date, most of the studies have used noncorrective (plano) lenses. We also considered nanotechnology-based carrier systems. We generalize the development of contact lens delivery systems to all ocular delivery systems in which there are relatively few product approvals and long development times.

Natural History After Below-knee Amputation: Analysis of Survival and Prosthetic Fitting Over 2 Decades. / Historia natural del paciente sometido a una amputación infracondílea: análisis de la supervivencia y protetización durante 2 décadas.

INTRODUCTION: This study sought to evaluate the natural history of patients undergoing below-knee amputation (BKA) and compare their evolution over 2 decades, as well as survival predictors, prosthetic fitting, and contralateral amputation. METHODS: Retrospective study of 209 consecutive patients (mean age 72.9 years; 68% males) who underwent BKA in 2 periods: 1996-2005 and 2006-2015. The fitting of prostheses, risk of contralateral amputation and survival, as well as their predictive factors, were assessed by survival analysis. RESULTS: 133 BKA were performed from 1996-2005 and 106 from 2006-2015. The etiology that motivated the BKA was acute ischemia (4.3%), chronic ischemia (34.0%), infection (9.1%) or mixed (chronic+infection, 52.6%), with no differences found between periods. Survival: mortality within one month=9.2%, one year=31.9%, 2 years=43.8% and 5 years=63.9%, with no significant differences between the 2 periods. Prosthetic: the fitting rate was 44.5% throughout the follow-up, with no significant differences between the two periods. 41.1% patients managed to walk. Contralateral amputation: 20.1% of the patients later required a major contralateral amputation, with no significant differences between the two periods. CONCLUSIONS: In the last decade, fewer BKA have been performed probably, due to higher previous interventional revascularization. Despite this, the results of fitting, contralateral amputation or survival were not modified. In any case, the number of patients who are able to achieve ambulation is modest, so it emphasizes the need for an optimal selection of patients with BKA with the goal of prosthetic fitting.

Retention Rates in New Contact Lens Wearers.

PURPOSE: To determine the retention rate (RR) for neophyte patients fitted with contact lenses (CLs) and to identify factors associated with retention and dropout. METHOD: This multisite, sponsor-masked registry study evaluated the 1-year status of neophyte CL wearers fitted in a representative range of UK practices. A total of 26 UK investigational sites each recruited up to 89 neophyte patients. The participants were requested to complete surveys at 1 month (±1 week from date of fitting), 3 months (±2 weeks), and 12 months (±3 weeks) online or through phone. Participants were contacted by email (or phone) and invited to complete an online survey that asked a range of questions regarding their CL wearing experience. RESULTS: Of the 531 participants recruited, 65.3% (347/531) responded to at least one follow-up survey and 42.3% (225/531) responded to all three surveys. One in four patients showed discontinued CL wear by 12 months. Based on evaluable subjects at 12 months, the RR was 77.6% (194/250, 95% confidence interval: 72.0-82.3). The most common reason for discontinuation was problems with vision (41%), followed by discomfort (36%) and handling problems (25%). The factors affecting first-year RRs: sex, spherical refraction, lens usage (full time or part time), and supply method (collected or posted). CONCLUSIONS: In this prospective study, the first-year RR for neophyte CL wearers was 77.6%. This was consistent with that noted in a retrospective study: 74.0%. As with the previous study, the commonly cited reason for discontinuation was visual problems.

Can Perceval sutureless valve reduce the rate of patient-prosthesis mismatch?†.

OBJECTIVES: The aim of this study is to compare the theoretical incidence of patient-prosthesis mismatch (PPM) in patients undergoing a sutureless or a sutured aortic valve replacement using an exact statistical matching. METHODS: Between May 2012 and March 2016, 65 patients with severe symptomatic aortic stenosis underwent a sutureless aortic valve replacement with the Perceval bioprosthesis in 2 centres. Moreover, 177 aortic valve replacements with conventional sutured bioprosthesis were performed between August 2003 and September 2015. Perceval and sutured patients were 1:1 exactly matched for sex and body surface area (BSA), resulting in 62 couples (sutureless: BSA 1.77 ± 0.16 m 2 , female 62.9% vs sutured: BSA 1.77 ± 0.15 m 2 , female 62.9%). RESULTS: After matching, the indexed effective orifice area was 1.50 ± 0.18 cm 2 /m 2 and 0.81 ± 0.19 cm 2 /m 2 in the sutureless and the sutured group, respectively ( P < 0.001). No PPM occurred in patients who received a Perceval bioprosthesis ( n = 62). In the sutured group ( n = 62), 38 patients (61.3%) developed a PPM, which was moderate in 41.9% ( n = 26) and severe in 19.4% ( n = 12) ( P < 0.001). CONCLUSIONS: The indexed effective orifice area of the sutureless group was significantly larger than in the sutured one. The incidence of PPM with the conventional sutured biprosthesis was 61.3%, while it decreases to 0% in the sutureless group. No PPM was reported in the sutureless valve group. Therefore, the Perceval sutureless valve provides larger effective orifice areas compared to the sutured conventional bioprosthesis and could be considered as a good option to reduce the risk of a PPM.

The Role of Conventional and Right-Sided ECG Screening for Subcutaneous ICD in a Tetralogy of Fallot Population.

BACKGROUND: Information regarding suitability for subcutaneous implantable cardioverter-defibrillator (S-ICD) implant in tetralogy of Fallot (ToF) population is scarce and needs to be further explored. THE AIMS OF OUR STUDY WERE: (1) to determine the proportion of patients with ToF eligible for S-ICD, (2) to identify the optimal sensing vector in ToF patients, (3) to test specifically the eligibility for S-ICD with right-sided screening, and (4) to compare with the proportion of eligible patients in a nonselected ICD population. METHODS: We recruited 60 consecutive patients with ToF and 40 consecutive nonselected patients. Conventional electrocardiographic screening was performed as usual. Right-sided alternative screening was studied by positioning the left arm and right arm electrodes 1 cm right lateral to the xiphoid midline. The Boston Scientific electrocardiogram (ECG) screening tool was utilized. RESULTS: We found a higher proportion of patients with right-sided positive screening in comparison with standard screening (77 ± 0.4% vs. 67 ± 0.4%; P < 0.0001) and a trend to higher number of appropriate leads in right-sided screening (1.3 ± 1 vs. 1.1 ± 1 ms; P = 0.07). Patients who failed the screening had a longer QRS duration and longer QT interval. Standard and right-sided screening showed a higher percent of positive patients in the control group compared to ToF patients (P < 0.001). CONCLUSION: Right-sided screening was associated with a significant 10% increase in S-ICD eligibility in ToF patients. When comparing with an acquired cardiomyopathies group, ToF showed a lower eligibility for S-ICD. The most appropriate ECG vector was the alternate vector in contrast to what is observed in the general population.

Factors in the success of new contact lens wearers.

PURPOSE: To determine the first-year retention rate for patients fitted with contact lenses (CLs) and identify factors associated with retention and dropout. METHODS: This multi-site study was a retrospective chart review of the status of neophyte CL wearers fitted in representative UK eye care practices. RESULTS: Consecutive records for 524 patients at 29 sites were reviewed. Mean age at dispensing was 34 years (range 8-79), 68% were under 45 years and 61% female. Soft CLs were fitted to 98% of patients. After 12 months, 388 were still CL wearers, a retention rate of 74% (95% CI: 70.1-77.6). Of the 136 lapsed, 25% discontinued during the first month and 47% within 60 days. The main reasons cited for discontinuation included poor distance vision (26%; of whom, 37% were toric and 51% multifocal), poor near vision (16%), discomfort (14%) and handling problems (15%). In 32% of cases, the reasons for discontinuation were unknown. For 71% of dropouts, no alternative lens or management strategy had been tried. Significant factors associated with retention in univariate analysis were: age (younger), sphere power (higher), lens type (sphere vs multifocal) and purchase frequency (regular). Multivariate analysis showed lens sphere power, purchase frequency and lens material to be significant factors. There was a wide variation in retention rates between sites (40-100%). CONCLUSIONS: During the first year of CL wear, the overall retention rate for neophyte CL wearers was 74% (spherical CLs 79%, torics 73%, multifocals 57%), with many lapsing during the first 2 months. Factors associated with retention and dropout in these patients include: lens power, material and type, and purchase frequency. While handling and comfort are the most commonly cited performance-related reasons for discontinuing in new spherical lens wearers, visual problems are the most common among new wearers of toric and, in particular, multifocal CLs.

A sixteen year survey of Canadian contact lens prescribing.

PURPOSE: To understand long-term contact lens prescribing habits of Canadian optometrists. METHODS: One thousand optometrists were surveyed annually from 2000 to 2015. Information was requested on the first ten patients examined after receiving the survey. RESULTS: Over the 16-year survey period, 1987 optometrists provided information on 19,143 patients. Mean age of the patients was 32.7±14.4years. Ratio of females to males was 2:1, the ratio of new fits to refits was 2:3. Soft contact lenses represented 94.5% of all fits. Rigid lenses were more often used as a refit compared to a new fit. Over the 16 years, market share for silicone hydrogel materials grew from 0% to 69.6%, mid-water content materials declined from 75.7% to 14.1%. The multifocal market share grew at the expense of spherical designs, with no change in toric lens fitting. Monthly soft lens replacement remained the preferred option at 48.2%, followed by daily disposable at 40.8%; two-weekly replacement declined to less than10% of patients by 2015. Extended wear was likely used to refit and only to a small proportion of wearers, representing 2.6% of SCL by 2015. The lens care system of choice throughout the period was multipurpose solutions, although the proportion for peroxide systems more than doubled by 2015 from 9.6%, to 21.1%. CONCLUSIONS: Over the 16-year period, SCL material preference changed to silicone hydrogels with monthly replacement being preferred; daily disposables replacing 2-weekly as the alternate. Lens care preference continued to be multipurpose solutions. Rigid lenses appear to be sustained for specialist fitting.

Clinical Experience With PROSE Fitting: Significance of Diagnosis and Age.

OBJECTIVE: To compare ease of adoption of the BostonSight Prosthetic Replacement of the Ocular Surface Ecosystem device, a custom-fit scleral lens, by patients in different age and diagnosis groups. METHODS: In this prospective study, patients were categorized by age as younger than 60 or 60 years and older and by diagnosis as corneal irregularity (CI) or ocular surface disease (OSD). Ease of adoption of the scleral device was assessed by (1) number of devices and visits required to complete the fitting process, (2) time needed for device insertion and removal, (3) adaptation to the device, as assessed by daily wear time and by time needed to achieve full-time wear (defined as 8 hours per day), and (4) patients' subjective rating of ease of device insertion and removal. The length of the fitting process was also assessed. RESULTS: There was no significant difference in the number of devices and visits needed between age group younger than 60 and age group of 60 and older or between CI and OSD groups. Patients in all groups achieved full-time wear in less than 2 weeks. Average wear time per week did not differ significantly between age or diagnosis groups. Similarly, the time needed for daily insertion and removal during the fitting period, as well as patients' subjective rating of ease of device insertion and removal, did not differ between age or diagnosis categories. The length of the fitting process was significantly longer in the OSD group compared with the CI group (P<0.001); however, factors not related to ease of adoption of the scleral device may be responsible for this difference. CONCLUSIONS: Patients in both younger and older patient groups adopted the use of a scleral device with equal ease, as did patients in the CI and OSD diagnosis groups.

[Orthotic Supply after Complex Trauma of the Foot]. / Orthopädische Schuhversorgung nach komplexer Fußverletzung.

BACKGROUND: After complex trauma of the foot, patients frequently need orthotic care. There have been no systematic studies on the quality of care or patient satisfaction. Therefore the goal of this study was to evaluate patient satisfaction and the quality of orthotic care. PATIENT AND METHODS: In a prospective non-randomized, cross-sectional intervention study, the quality of care and patient satisfaction with orthotic devices were evaluated clinically and pedographically. This was followed by a lengthy discussion and recommendation to improve the insoles or shoes. These improvements were followed up by a written/telephone survey. 39 of the 50 recruited patients with complex trauma of the foot (78 %) were supplied with orthotic devices (insoles, modifications of the sole and orthopaedic shoes). RESULTS AND CONCLUSION: Most patients (76 %) were content with their orthotic care. However, shortcomings were noted in 20 patients. These were: insufficient arch support/stabilization, inadequate support of roll-off and unsatisfactory unloading of the forefoot. 23 % of the patients did not use their orthotic devices. Compliance increased after counseling. However, half of the patients had problems in obtaining reimbursement for the modifications recommended. In conclusion, orthotic treatment of patients after complex trauma of the foot is demanding. Modifications of the devices are frequently needed. Interprofessional collaboration plays an important role.

History and symptom taking in contact lens fitting and aftercare.

AIM: To appraise history and symptom taking for contact lens consultations, to determine current practice and to make recommendations for best practice. METHOD: The peer reviewed academic literature was reviewed and the results informed a survey completed by 256 eye care practitioners (ECPs) on their current practice and influences. RESULTS: The last eye-test date, last contact lens aftercare (for existing wearers) and reason for visit are key questions for most ECPs. Detailed use of contact lens questions are more commonly applied in aftercares than when refitting patients who have previously discontinued wear (87% vs 56% use), whereas questions on ocular and general history, medication and lifestyle were generally more commonly utilised for new patients than in aftercares (72% vs 50%). 75% of ECPs requested patients bring a list of their medication to appointments. Differential diagnosis questioning was thorough in most ECPs (87% of relevant questions asked). Attempts to optimise compliance included oral instruction (95% always) and written patient instructions (95% at least sometimes). Abbreviations were used by 39% of respondents (26% used ones provided by a professional body). CONCLUSION: There is scope for more consistency in history and symptom taking for contact lens consultations and recommendations are made.

The use of daily disposable lenses in problematic reusable contact lens wearers.

PURPOSE: Replacing soft contact lenses (CLs) on a daily basis brings a number of advantages, most notably, reduced exposure to deposits, disinfectants, allergens, and other contaminants. This retrospective study estimated the prevalence of problems in current wearers of reusable soft CLs and tested the effect of refitting "problem" patients with daily disposable (DD) hydrogel lenses. METHODS: Prevalence was estimated from 398 current reusable CL wearers for: frequent/constant discomfort or dryness, ≥2 h of uncomfortable wear, ≥grade 2 conjunctival hyperaemia (0-4), or ≥grade 3 corneal staining (0-15). In the second part of the study, 217 reusable CL wearers classified as problem patients were randomly refitted with DD lenses manufactured from one of two materials: etafilcon A (n=96) or nelfilcon A (n=121) and reassessed 1 week later. RESULTS: Thirty-nine percent (154/398) had some qualifying criterion: reduced comfortable wearing time (CWT), 20%; dryness, 20%; irritation, 5%; corneal staining, 8%; and hyperaemia, 7%. After refitting with DDs, the prevalence of reduced CWT was decreased from 65% to 51% (P=0.0039), dryness from 60% to 41% (P < 0.0001) and corneal staining from 28% to 21% (P=0.04). There was no significant change in the prevalence of irritation, or hyperaemia. Some differences were noted between the two lens materials. CONCLUSIONS: A high proportion of reusable soft lens wearers encounter clinically relevant signs or symptoms with their current CLs. This study provides evidence that refitting with DD lenses is a useful strategy for alleviating some of the common problems of CL wear.

Adaptation to prostheses among patients with major lower-limb amputations and its association with sociodemographic and clinical data.

CONTEXT AND OBJECTIVE: Lower-limb amputation compromises patients' independence and autonomy, and therefore they should be referred for rehabilitation in order to adapt to prostheses and regain autonomy. The aim here was to assess adaptation to prostheses among patients with major lower-limb amputations and its association with sociodemographic and clinical data. DESIGN AND SETTING: This was a cross-sectional study in the city of Aracaju, Brazil. METHODS: The patients were identified by primary healthcare teams. The inclusion criterion was that these should be patients who underwent major lower-limb amputations of any etiology. Associations between sociodemographic and clinical variables and the adaptation to lower-limb prostheses were assessed. RESULTS: 149 patients were examined. Adaptation to the prosthesis occurred in 40% (60/149) of them, but only 62% (37/60) were using it. Adaptation occurred more often among male patients (P = 0.017) and among those who had a higher educational level (P = 0.013), with a longer time since amputation (P = 0.049) and when the etiology was trauma (P = 0.003). The result from logistic regression analysis showed that only patients with low education (P = 0.031) were significantly associated with a lower frequency of adaptation to prostheses. CONCLUSION: It was found that patients with a low educational level became adapted to the prosthesis less frequently.

[Complications in hearing aid fitting without otolaryngologist expertise]. / Komplikationen bei der Hörgeräteversorgung ohne HNO-Arzt.

BACKGROUND: Hearing loss is a symptom. The underlying disease must be investigated by an otolaryngologist, in order to ensure timely identification of alterations in disease course, complications and newly occurring secondary disease. METHODS: During the course of 1 year, 484 case studies in which treatment errors had arisen due to lack of otolaryngologist involvement during hearing aid fitting were collected from 115 practices and 7 ENT clinics, as well as from the patient representatives of the Federal Joint Committee. Depending on the type and cause of the individual complications, these were classified into five groups and described cumulatively. RESULTS: A total of 484 cases in which results had been incorrectly interpreted or charged to the wrong payer organization were presented in the form of a systematic overview. Furthermore, serious technical deficits, as well as unnecessary temporary and inappropriate fittings were observed. CONCLUSION: The aforementioned cases are interpreted on the basis of regulations governing hearing aid fitting and current legal practices. These case reports clearly demonstrate that otolaryngologist expertise are required not only at the first hearing aid fitting, but also for subsequent fittings, in order to appropriately treat the underlying disease. Only so can the patient be protected from damage to their health and financial complications, and health insurance providers avoid wasting resources.

Adaptation to prostheses among patients with major lower-limb amputations and its association with sociodemographic and clinical data / Adaptação a prótese em pacientes com amputações maiores de membros inferiores e sua associação com os dados sociodemográficos e clínicos

CONTEXT AND OBJECTIVE: Lower-limb amputation compromises patients' independence and autonomy, and therefore they should be referred for rehabilitation in order to adapt to prostheses and regain autonomy. The aim here was to assess adaptation to prostheses among patients with major lower-limb amputations and its association with sociodemographic and clinical data. DESIGN AND SETTING: This was a cross-sectional study in the city of Aracaju, Brazil. METHODS: The patients were identified by primary healthcare teams. The inclusion criterion was that these should be patients who underwent major lower-limb amputations of any etiology. Associations between sociodemographic and clinical variables and the adaptation to lower-limb prostheses were assessed. RESULTS: 149 patients were examined. Adaptation to the prosthesis occurred in 40% (60/149) of them, but only 62% (37/60) were using it. Adaptation occurred more often among male patients (P = 0.017) and among those who had a higher educational level (P = 0.013), with a longer time since amputation (P = 0.049) and when the etiology was trauma (P = 0.003). The result from logistic regression analysis showed that only patients with low education (P = 0.031) were significantly associated with a lower frequency of adaptation to prostheses. CONCLUSION: It was found that patients with a low educational level became adapted to the prosthesis less frequently. CONTEXTO E OBJETIVO: A amputação de membros inferiores compromete a independência e a autonomia dos pacientes, por isso, eles devem ser encaminhados para a reabilitação para a adaptação das próteses e assim viabilizar a recuperação da autonomia. O objetivo foi avaliar a adaptação de prótese em pacientes com amputações maiores de membros inferiores e sua associação com dados sócio-demográficos e clínicos. .

TIPO DE ESTUDO E LOCAL: Estudo transversal realizado na cidade de Aracaju, Brasil. MÉTODO: Os pacientes foram identificados pelas equipes de atenção primária à saúde. O critério de inclusão foi pacientes submetidos a amputações de membros inferiores principais de todas as etiologias. Foram avaliadas as associações entre variáveis sociodemográficas e clínicas e a adaptação de próteses de membros inferiores. RESULTADOS: Foram examinados 149 pacientes. A adaptação da prótese ocorreu em 40% (60/149) deles, mas apenas 62% (37/60) a utilizavam. Adaptação ocorreu mais frequentemente em pacientes do sexo masculino (P = 0,017) e naqueles que tinham maior nível de escolaridade (P = 0,013), com maior tempo de amputação (P = 0,049) e quando a etiologia (P = 0,003) foi o trauma. O resultado da análise de regressão logística mostrou que apenas a com baixa escolaridade (P = 0,031) foi significativamente associada com uma menor frequência na adaptação de próteses. CONCLUSÃO: Verificou-se que pacientes com baixa escolaridade tiveram menor frequência de ajuste para a prótese. .

Test-retest reliability of probe-microphone verification in children fitted with open and closed hearing aid tips.

PURPOSE: To investigate the test-retest reliability of real-ear aided response (REAR) measures in open and closed hearing aid fittings in children using appropriate probe-microphone calibration techniques (stored equalization for open fittings and concurrent equalization for closed fittings). RESEARCH DESIGN: Probe-microphone measurements were completed for two mini-behind-the-ear (BTE) hearing aids which were coupled to the ear using open and closed eartips via thin (0.9 mm) tubing. Before probe-microphone testing, the gain of each of the test hearing aids was programmed using an artificial ear simulator (IEC 711) and a Knowles Electronic Manikin for Acoustic Research to match the National Acoustic Laboratories-Non-Linear, version 1 targets for one of two separate hearing loss configurations using an Audioscan Verifit. No further adjustments were made, and the same amplifier gain was used within each hearing aid across both eartip configurations and all participants. Probe-microphone testing included real-ear occluded response (REOR) and REAR measures using the Verifit's standard speech signal (the carrot passage) presented at 65 dB sound pressure level (SPL). Two repeated probe-microphone measures were made for each participant with the probe-tube and hearing aid removed and repositioned between each trial in order to assess intrasubject measurement variability. These procedures were repeated using both open and closed domes. STUDY SAMPLE: Thirty-two children, ages ranging from 4 to 14 yr. RESULTS: The test-retest standard deviations for open and closed measures did not exceed 4 dB at any frequency. There was also no significant difference between the open (stored equalization) and closed (concurrent equalization) methods. Reliability was particularly similar in the high frequencies and was also quite similar to that reported in previous research. There was no correlation between reliability and age, suggesting high reliability across all ages evaluated. CONCLUSIONS: The findings from this study suggest that reliable probe-microphone measurements are obtainable on children 4 yr and older for both traditional unvented and open-canal hearing aid fittings. These data suggest that clinicians should not avoid fitting open technology to children as young as 4 y because of concerns regarding the reliability of verification techniques.

A multimodal approach in total hip arthroplasty preoperative templating.

OBJECTIVES: Accurate preoperative planning is mandatory for a successful total hip arthroplasty (THA). Templating helps to achieve multiple technical goals, including offset restoration, leg-length equality, and components positioning. This study aims to measure how successful a new stepwise method for preoperative radiographic templating is in achieving postoperative restoration of anatomy. METHODS: We measured the relationship of several radiographic landmarks on the affected limb in comparison to the unaffected limb to define the appropriate position of the components. One hundred consecutive patients with unilateral disease undergoing THA were retrospectively analyzed. The preoperative templates were compared with the postoperative radiographs. RESULTS: Accuracy in achieving the desired offset, leg-length discrepancy within 5 mm, was 93 % and 100 % respectively. Acetabular component positioning within 2° was replicated in 92 %. CONCLUSION: We conclude that this technique can help the surgeon to accurately reproduce the anatomy of the contralateral unaffected hip.

Subsidence of SB Charité total disc replacement and the role of undersizing.

PURPOSE: A possible complication after total disc replacement (TDR) is subsidence, presumably caused by asymmetric implantation, implant undersizing or reduced bone quality. This study aims to quantify the degree of subsidence of an SB Charité TDR, and investigate whether undersizing is related to subsidence. METHODS: A custom developed software package (Mathworks) reconstructed 3D bone-implant geometry. A threshold for subsidence was determined by comparing penetrated bone volume (PBV) and rotation angles. Inter- and intra-observer reproducibilities were calculated. Subsidence was correlated to undersizing. RESULTS: High inter- and intra-observer correlation coefficients were found for the method (R > 0.92). Subsidence was quantified as PBV 700 mm(3) combined with a rotation angle >7.5°. A reduced risk of subsidence was correlated to >60 and >62 % of the bony endplate covered by the TDR endplate for L4 and L5, respectively. CONCLUSIONS: A reproducible method to determine undersizing was developed. Thresholds were determined related to a reduced risk of subsidence.