Efficacy of vibrant sound bridge in congenital aural atresia: an updated systematic review.

PURPOSE: The indications of Vibrant Soundbridge (VSB) have been expanded to include patients with conductive and mixed hearing loss due to congenital aural atresia (CAA). However, the current evidence supporting the auditory outcomes of VSB is based mainly on case reports and retrospective chart reviews. Therefore, the present systematic review aims to summarize and critically appraise the current evidence regarding the safety and effectiveness of VSB in children and adult patients with CAA. METHODS: A systematic literature search retrieved studies that evaluated the outcomes of unilateral or bilateral implantation of VSB in patients with CAA. The bibliographic search was conducted in PubMed, Scopus, EBSCO, and Cochrane Central Register of Controlled Trials (CENTRAL) databases from January 2000 to December 2022. RESULTS: Twenty-seven studies were included in the present systematic review. Overall, the speech perception after VSB was good, with a mean word recognition score (WRS) score ranging from 60 to 96.7%. The mean postoperative speech recognition threshold (SRT) after implantation ranged from 20.8 to 50 dB. The effective gain was reported in 15 studies, ranging from 31.3 to 45.5 dB. In terms of user satisfaction with VSB, the included studies showed significant improvements in the patient-reported outcomes, such as the Speech Spatial and Qualities of Hearing scale and Glasgow Hearing Aid Benefit Profile. The VSB implantation was generally safe with low incidence of postoperative complications. CONCLUSION: VSB provides significant benefits to individuals with hearing loss owing to CAA, with very good subjective outcomes and a low risk of complications.

Risk factors and management strategies of inadvertent facial nerve stimulation in cochlear implant recipients: A systematic review.

Objectives: To systematically review the prevalence and risk factors of inadvertent facial nerve stimulation (FNS) after cochlear implant (CI) surgery. And to report the different management strategies used for reducing and resolving FNS. Data Source: Web of Science, Scopus, PubMed, Cochrane Library, and Virtual Health Library (VHL) of the World Health Organization (WHO). Review Methods: A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) on studies that reported FNS as a complication after CI. A comprehensive electronic search strategy was used to identify the relevant articles. We extracted the data on the prevalence of FNS after CI activation, the reported grades, and the management strategies. The number of associated electrodes; cause of deafness; co-anomalies; and duration of hearing loss and their relationships with FNS were also studied. Results: Twenty-one relevant articles were included in this review. The prevalence of FNS among the CI populations was 5.29% (175/3306 patients). Among those whose ages were reported, 58.3% (95/163) were adults, and 41.7% (68/163) were pediatrics. Modifying the different fitting parameters was the most used strategy, as it successfully resolved FNS in 85.5% of the patients (142/166). The second commonly used management strategy was surgical intervention (reimplantation or explantation), which was reported in seven studies for 23 patients. Conclusion: FNS after CI activation could be controlled and resolved with many advances that range from readjusting the fitting parameters to surgical intervention. However, further studies are required to validate the efficacy of each management strategy and its impact on patients' performance. Our findings demonstrate that CI recipients with FNS could still benefit from the CI devices and their FNS could be controlled.

A Literature Review on Cochlear Implant Activation: From Weeks to Hours.

Objectives: The present literature review discusses the chronological evolution of Cochlear Implant (CI) activation and its definition among the relevant studies in the literature. In addition, the benefits of standardizing the early activation process in implantation centers worldwide are discussed. Methods: A comprehensive literature search was conducted in the major databases such as PubMed, Scopus, and Embase to retrieve all the relevant articles that reported early activation approaches following CI. Results: The evolution of the timing of early activation after CI has been remarkable in the past few years. Some studies reported the feasibility of early activation 1 day after the CI surgery in their users. Conclusions: Within the last decade, some studies have been published to report the feasibility and outcomes of its early activation. However, the process of early activation was not adequately defined, and no apparent guidelines could be found in the literature.

Early activation after cochlear implantation: a systematic review.

PURPOSE: To systematically review the outcomes of early activation following cochlear implantation (CI) based on the findings from different studies in the literature. METHODS: A comprehensive search strategy was conducted through different databases to identify relevant articles. Our outcomes included impedance levels, rates of complications, hearing and speech perception performance, and patients' satisfaction levels. RESULTS: The total number of included studies in this systematic review is 19, which recruited 1157 patients, including 857 who underwent early activation following CI. Seventeen studies investigated impedance levels or feasibility rates of early activation approaches. Most of these studies (n = 10) reported that mean impedance levels remarkably decreased within the first day-to-month (first measurement) post-activation. In addition, all 17 studies showed that impedance levels finally normalize and become comparable with intraoperative levels or the conventional activation group. Seventeen studies reported the occurrence of complications in their population. Ten of these studies indicated that none of their patients developed any post-operative complications after early activation. Seven studies reported the development of some minor complications, including pain 9.2% (28/304), infection 4.7% (13/275), swelling 8.2% (25/304), vertigo 15.1% (8/53), skin hyperemia 2.2% (5/228), and others 16.4% (9/55). Hearing and speech perception was assessed in six studies, which showed a remarkable improvement in their patients. Three studies investigated patients' satisfaction and showed high satisfaction levels. Only one report investigated the economic advantages of early activation. CONCLUSION: Early activation is safe and feasible and does not impact the hearing and speech outcomes of the patients undergoing CI procedures.

Epidemiological Characteristics, Pathogenesis and Clinical Implications of Sinusitis in the Era of COVID-19: A Narrative Review.

Sinusitis is a common condition with various forms and different etiologies. In the era of COVID-19, a large number of studies covered the association between sinusitis and COVID-19, while others reported the impact of COVID-19 on the development of acute invasive fungal rhinosinusitis (AIFR), together with the most commonly associated predisposing factors. Fungal sinusitis, particularly AIFR, can be life-threatening. It is important to dissect this association and improve current evidence and management. Therefore, we conducted this literature review to highlight the association between COVID-19 and sinusitis based on evidence from the available studies in the literature. Evidence shows that chronic sinusitis might have a negative impact on COVID-19 outcomes. However, current results are conflicting, and further studies are needed. On the other hand, COVID-19 can also cause olfactory dysfunction, which is usually temporary. In addition, we found several studies that indicated the association between COVID-19 and AIFR. The condition is usually associated with severe morbidities, as affected patients are usually immunocompromised, including those with uncontrolled diabetes, malignancy, immunosuppression, AIDS, the administration of chemotherapy and other immunosuppressive drugs, and COVID-19.

Capillary Hemangioma Involving the External Auditory Canal: Case Report and Review of the Literature.

Hemangioma is a frequently observed soft tissue tumor that can be classified into cavernous, capillary, and venous subtypes. It occurs frequently in the head and neck; however, with rare reports of hemangiomas in the external auditory canal (EAC). The present study describes the case of a 57-year-old male patient who presented to our center with a subsequent diagnosis of capillary hemangioma of the EAC. The entire lesion was surgically removed, with no evidence of recurrence on the subsequent follow-up.

Method to estimate the basal turn length in inner ear malformation types.

The mathematical equations to estimate cochlear duct length (CDL) using cochlear parameters such as basal turn diameter (A-value) and width (B-value) are currently applied for cochleae with two and a half turns of normal development. Most of the inner ear malformation (IEM) types have either less than two and a half cochlear turns or have a cystic apex, making the current available CDL equations unsuitable for cochleae with abnormal anatomies. Therefore, this study aimed to estimate the basal turn length (BTL) from the cochlear parameters of different anatomical types, including normal anatomy; enlarged vestibular aqueduct; incomplete partition types I, II, and III; and cochlear hypoplasia. The lateral wall was manually tracked for 360° of the angular depth, along with the A and B values in the oblique coronal view for all anatomical types. A strong positive linear correlation was observed between BTL and the A- (r2 = 0.74) and B-values (r2 = 0.84). The multiple linear regression model to predict the BTL from the A-and B-values resulted in the following equation (estimated BTL = [A × 1.04] + [B × 1.89] - 0.92). The manually measured and estimated BTL differed by 1.12%. The proposed equation could be beneficial in adequately selecting an electrode that covers the basal turn in deformed cochleae.

Brain MRI findings of prelingually deaf children and cochlear implant outcome: Preliminary results.

OBJECTIVE: To estimate the incidence of brain abnormalities in a cohort of prelingually deaf children and whether these abnormalities can impact the hearing outcomes of patients eligible for cochlear implantation (CI). METHODS: We performed a retrospective review of consecutive medical charts of prelingually deaf children under 12 years of age who underwent brain magnetic resonance imaging (MRI) during their preoperative workup for CI surgery. We used the category of auditory performance (CAP) test and the speech intelligibility rating (SIR) test to assess the hearing and speech performance of the children, respectively. RESULTS: The MRIs of 285 patients, 174 boys and 111 girls with a mean age of 36.4 (±16) months, were evaluated for this study. We identified 31 patients with abnormal findings (10.88%): (17/31) (54.8%) had MRI brain abnormalities, (9/31) (29%) had inner ear anomalies, and (5/31) (16.1%) had both inner ear and brain abnormalities. The most frequent inner ear anomaly was an enlarged vestibular aqueduct, while white matter lesions were the most common brain abnormality. The CAP and SIR mean score of patients with inner ear anomalies was slightly, but not significantly, higher than those of patients with brain abnormalities. CONCLUSION: CAP and SIR scores were not significantly different in children with brain abnormalities than inner ear anomalies. These patients can still benefit from CI to improve their overall hearing and speech performance.

Cochlear implantation among patients with otosclerosis: a systematic review of clinical characteristics and outcomes.

PURPOSE: There have been considerable advancements in cochlear implants in different clinical scenarios; however, their use in patients with otosclerosis remains challenging. This review aimed to investigate the surgical and clinical outcomes of cochlear implantation in patients with otosclerosis. METHODS: An electronic literature search was performed using four main databases through February 2021 to identify original studies of cochlear implantation in patients with otosclerosis for inclusion in this systematic review. The study protocol was registered with the Prospectively Registered Systematic Reviews and Meta-analyses (reference number: CRD42021234753). RESULTS: A total of 23 studies including 3162 patients were enrolled. Of these patients, only 392 had otosclerosis and underwent cochlear implantation. The duration of deafness was reported in only eight studies, extending up to 50 years. Far-advanced otosclerosis was observed in 153 patients. A total of 56 patients used hearing aids. Stapedectomy and stapedotomy were performed in 118 and 63 patients, respectively. In three studies, the temporary success of stapedectomy and stapedotomy was 6 (43%) and 5 (71%) patients, respectively. Computed tomography was used as a preoperative assessment tool in most studies (n = 14, 60.9%). Incomplete implant insertion occurred in 17 patients, while facial nerve stimulation occurred in 36 patients after implantation. CONCLUSION: Cochlear implantation is a relatively safe modality that can provide promising audiological outcomes in patients with otosclerosis. However, several factors, including cochlear ossification, duration of deafness, and previous operations, can affect its outcomes. Further studies with a larger sample population are recommended.

Clinical Approaches To External Auditory Canal Hemangiomas: A Systematic Review.

OBJECTIVES: Hemangioma is a common soft tissue tumor that can be categorized mainly into cavernous, capillary, and venous subtypes. It usually develops in the head and neck and rarely in the external auditory canal (EAC). METHODS: A systematic review of patients with capillary hemangioma of the EAC was performed. A computerized systematic search was conducted in PubMed, Scopus, and Web of Science to extract relevant studies for a qualitative review. RESULTS: A total of 38 patients were included in the systematic review, and half of them were men. Hearing loss was the most common presenting feature (n = 19; 50%), followed by aural fullness (n = 15; 39.4%). Cavernous hemangioma was the predominant type (n = 22, 57.8%). Endaural and transcanal surgical approaches were the most frequent, with ten (26.3%) and nine (23.6%) cases, respectively. Most of the patients (n = 31; 81.5%) had no recurrence. CONCLUSIONS: Hemangioma of the EAC may not be uncommon as healthcare professionals may expect. Hearing loss, aural fullness, and tinnitus are possible symptoms, but many patients remain asymptomatic. Surgical excision is the main effective management option, and complete resolution is the most prevalent outcome. Computed tomography assists in the diagnosis, but histopathological examination after resection is mandatory for the definitive diagnosis.

Systematic Review of Postcochlear Implant Electrode Migration: What Is Known?

BACKGROUND AND OBJECTIVES: Electrode migration after cochlear implantation (CI) is a rare complication that accounts for 1to 15% of all revision surgery. This study is a systematic review of the literature for investigating the knowledge and approaches to the incidence of electrode migration after CI. METHODS: A systematic electronic search of the literature was carried out using PubMed, Cochrane, Virtual Health Library, Scopus and Web of Science (ISI). All original articles that reported electrode migration after CI surgery were included. The Newcastle-Ottawa Scale and CARE checklist were utilized for the assessment of the risk of bias. Descriptive data analysis was performed using SPSS software. RESULTS: A total of 26 studies including 4,316 patients were included. Out of them, 289 patients had electrode migration following CI. To diagnose electrode migration, traditional computed tomography scan was used in 13 studies, while cone-beam computed tomography was applied in three studies. In addition, electrode migration was detected during intraoperative exploration in eight studies. The most common presenting symptom was change in sound/poor performance (n = 43) followed by pain sensation (n = 15) and facial nerve stimulation (n = 10). Cholesteatoma was the most common associated pathology (n = 10) followed by infection (n = 9) and ossification of the basal turn of the cochlea (n = 8). CONCLUSION: Electrode migration is a major complication of CI and could be more common than previously thought. As it may occur with or without clinical complaints, long-term follow-up through routine radiological scanning is recommended. Further studies are warranted to identify the underlying mechanism of electrode extrusion and the appropriate fixation method.