Poznan's program of cochlear and brainstem implantation: a general review.

The cochlear implantation program in Poznan started in January 1994. Within 8 years, 151 patients were implanted (149 cochlear and 2 auditory brain-stem implants). The implanted group comprised 111 children and 40 adults. We have extended the lower age limit for cochlear implant candidates, and the youngest implanted patient was 18-months-old at the time of surgery. We have also implanted six multi-handicapped subjects. All patients were implanted with different nucleus devices (22, 24 M, 24 K, 24 Contour, 24 Double Array and 24 ABI). Insertion of the Nucleus 24 Contour electrode carrier requires a little larger cochleostomy in comparison with conventional straight array. After insertion, the intraoperative measurements are taken (impedance telemetry, electrically evoked stapedius reflex and NRT). The day after surgery, each patient undergoes an X-ray examination (the cochleogram or cochlear view). The calculated length of the electrode array insertion was 12.75-24.0 mm (mean: 22.05 mm) and the degree of electrode rotation was 180-540 degrees (mean: 292.82 degrees). After speech processor switch-on, we performed NRT measurements. Our results indicated that the NRT threshold was in 51.4% of the dynamic range within the group of examined patients. The adults' progress of rehabilitation was checked during individual sessions. The rehabilitation of children included two rehabilitation schedules: continuous ones and weekly rehabilitation camps. The progress of the recovery process of implanted children enabled them to change their school profile from hearing impaired to mainstream. Voice rehabilitation is often monitored by acoustic analysis using the Multi Dimensional Voice Program (MDVP).

[Cochlear implantation through the middle fossa approach]. / Implantacja wszczepu slimakowego z dojscia przez srodkowy dól czaszki.

The inner part of cochlear implant is inserted into inner ear during surgery through mastoid and middle ear. It is a classical method, used in the majority cochlear centers in the world. This is not a suitable method in case of chronic otitis media and middle ear malformation. In these cases Colletti proposed the middle fossa approach and cochlear implant insertion omitting middle ear structures. In patient with bilateral chronic otitis media underwent a few ears operations without obtaining dry postoperative cavity. Cochlear implantation through the middle fossa approach was performed in this patient. The bone fenster was cut, temporal lobe was bent and petrosus pyramid upper surface was exposed. When the superficial petrosal greater nerve, facial nerve and arcuate eminence were localised, the cochlear was open in the basal turn and electrode were inserted. The patient achieves good results in the postoperative speech rehabilitation. It confirmed Colletti tesis that deeper electrode insertion in the cochlear implantation through the middle fossa approach enable use of low and middle frequencies, which are very important in speech understanding.

Assessment of smell and taste in patients with allergic rhinitis.

We examined the senses of smell and taste in 240 patients with verified hypersensitivity reactions of the respiratory tract. Olfactometry was performed according to Elsberg and Levy's method and followed by electrogustometry. The examinations revealed that the incidence of smell and taste disorders in patients with allergic rhinitis is 21.4% and 31.2%, respectively. No significant relationships between smell and taste dysfunction were found. We evaluated statistically positive correlations between the olfactory and gustatory thresholds compared with 78 qualitative and quantitative factors assessed in the study. There was a statistically significant relationship between the olfactory thresholds and levels of eosinophils in blood and in nasal discharge. acid reaction of the nasal mucosa, coexisting nasal polyps and X-ray changes in the ethmoid sinuses. There was a positive influence of pharmacotherapy as well as specific desensitization and surgery on the impairment of the sense of smell in allergic rhinitis.

[Dysphagia and speech disorders]. / Dysfagia a zaburzenia mowy.

Swallowing disorders in oral and pharyngeal phase after surgery of mouth, pharynx or larynx are very often interrelated with speech and voice disorders. The results of diagnostic methods of dysphagia and voice/speech disorders based on own material of patients after total laryngectomy, partial tongue resection and cleft palate surgery were presented. Attention was also paid to other etiological factors of swallowing disorders observed in phoniatric practice.

[Phoniatric remarks on microsurgery of vocal cords]. / Uwagi foniatryczne do zabiegów mikrochirurgicznych na faldach glosowych.

Own experience in microsurgery of vocal folds are presented. The necessity and importance of photographic and acoustic documentation (MDVP) as well as phoniatric pre- and postoperative rehabilitation are stressed.

The acoustic analysis of voice in patients with multi-channel cochlear implant.

The acoustic analysis of the voice was performed in 5 implanted patients (2 children and 3 adults). This analysis was made twice in each patient one week before the implantation and the second time at least three months later. The examination was carried out using the KAY Electronics 4300 instruments and the MDVP program. The comparison of the results showed: decreased F0 value of phonation tone after the surgery in all patients; mean values of jitter and shimmer were increased in relation to norm before and after the surgery in adults and children; the gap between harmonic signal and noise (NHR) was within norm in 2 adults, and in 1 child with prelingual deafness significantly decreased after the surgery. The acoustic analysis of voice of cochlear implant patients, especially children, may be the objective evaluation of progress in speech and hearing rehabilitation. In the process of rehabilitation tendencies pointing out to the normalization of voice especially in patients with prelingual deafness was observed.

[Voice and spirometric examinations in patients after laser arytenoidectomy]. / Ocena funckcj oddechowej i glosowej u pacjentów po arytenoidektomii laserowej.

Spirometric, phoniatric and acoustic investigations were performed in 13 patients after laser arytenoidectomy due to bilateral vocal cord paresis. Phoniatric examination included voice recording, average level and voice range, time of phonation, laryngoscopy and stroboscopy. Acoustic analysis covered harmonic structure of the voice, jitter, shimmer, noise component, basic frequency.

[CT examination of the temporal bones for cochlear implantation]. / Badanie CT kosci skroniowych u osób przygotowanych do operacji wszczepu slimakowego.

CT examinations of temporal bones were performed in 31 deaf patients from qualify diagnostic stage prepared for cochlear implants. Essential for surgical treatment anatomic details were estimated, especially canalis spiralis cochleae was paid to attention. In our group, 8 patients had some CT changes (abnormal findings) which corresponded to different stages of obliteration the cochlea. The majority of patients lost the hearing because of meningitis. In 6 implanted patients CT scan was compared with surgical findings. During the operation 1 patient with patent cochlea on CT scan had partially ossified basal turn.

[Results of palatal, linguographic and phoniatric studies in patients with pseudoprogeny after cleft palate surgery]. / Wyniki badan palato-i lingwograficznych oraz foniatrycznych u chorych z pseudoprogenia po rozszczepach podniebienia.

In 27 patients with cleft palate and pseudoprogeny the osteotomy according to Le Fort I and in 7 patients the accessory oblique osteotomy were performed. The phoniatric evaluations as well as the palatal and linguographic examinations proved the amelioration of the articulation in the second zone. The dental occlusions were also better as well as the speech intelligibility.

[Rehabilitation in esophageal speech and its perceptive-acoustic features after total laryngectomy without pharyngo-esophageal plastic surgery]. / Rehabilitacja mowy przelykowej i jej cech percepcyjno-akustycznych po laryngektomii calkowitej z i bez plastyki zwieracza gardlowo-przelykowego.

The experiences with the plastic surgery of pharyngo-oesophageal sphincter during the laryngectomy were presented. The sphincteric forces were studied accordingly to the rehabilitation successes and also the acoustic and perceptive data of the oesophageal speech. The results were compared with these after the classical laryngestomy. It was pointed out that the sphincteroplasty lowered its tension and made the rehabilitation more easier. The oesophageal voice produced in this occasion is better than after the classical laryngectomy. The fundamental frequency is two times higher, the prosody and speech tempo more normal. These positive results were encountered in 76% of cases. However, in some cases the psychological and social difficulties were so great that we preferred the surgical rehabilitation with shunt formation.

[The value of stapedius reflex examinations in patients with myasthenia gravis (author's transl)]. / Dav Vehalten des Stapediusreflexes bei Patienten mit Myasthenia gravis.

The behavior of the stapedius reflex was examined by means of the Z0-70 Madsen electroacoustic bridge in 41 patients (aged 9-73) with myasthenia gravis. A higher stapedius reflex threshold (90-130 db) at normal hearing was found in 66% of the cases. In 46.3% of the cases, an increased fatigue of the stapedius muscle was observed, as characterized by the lowering of the amplitude or the disappearance of the reflex after several successively repeated recordings. The examination of stapedius muscle fatigqu may be helpful indiagnosing early forms of myasthenia, in following the results of therapy for the disease, as well as in assessing the efficiency of antimyasthenic drugs.