Skin flap complications after cochlear implantations.

The objective of the study was to analyse and present the surgical management strategy for major skin flap complications (MSFC) after cochlear implantations. Patients fitted with a titanium-silicone-coated implant of the same kind, operated on between 1994 and 2013 with a standardised procedure (1076 medical charts) were analysed. Analysis aimed to identify and study individuals with skin problems related to the cochlear implant treatment, i.e. requiring surgical treatment in hospital defined as MSFC and focused on incidence, risk factors and treatment of MSFC. MSFC were diagnosed in 1.76 % of patients: 2.06 % of children and 1.35 % of adults, 2.43 % after implantation with a long "C"-shaped incision and 1.28 % after short retroauricular incision. Registered risk factors included head trauma, acute otitis media, poor hygiene in children, and general comorbidities in adults. The primary intervention was dependent on skin complication severity and included revision surgery with wound closure over an implant (52.6 %) and revision surgery with explantation (47.4 %). Revision surgery without explantation was successful in 40 % and the most effective approach was debridement with a two-layer rotational flap. Explantation led to ultimate wound healing in all cases. Major skin flap complications after cochlear implantation are rare, but their treatment is complex and difficult. Revision surgery with resection of infected tissue, formation of a rotational two-layer flap preceded and supplemented by intensive targeted antibiotic therapy can be effective and should be the first treatment option. Spontaneous implant explantation, abscess formation or unsuccessful primary treatment necessitate implant removal as the ultimate solution.

Surgical, functional and audiological evaluation of new Baha(®) Attract system implantations.

Bone-anchored hearing aids are well-established solutions for treatment of hearing-impaired patients. However, classical systems with percutaneous abutments have disadvantages concerning aesthetics, hygiene and adverse soft tissue reactions. The study aimed to evaluate surgical, functional and audiological results of a new Baha(®) Attract system, in which the sound processor is attached by magnetic force. Twenty patients implanted with a Baha(®) Attract system were divided into two groups: A-bilateral mixed and conductive hearing loss, B-single-sided deafness, and evaluated during a 6-month follow-up. Parameters analysed comprised: (1) surgery and wound healing, (2) postoperative functional results (GBI, APHAB and BAHU questionnaires), (3) audiological results (free field speech in noise audiometry in two situations: with signal from implant side and from contralateral side). Obtained results revealed: mean time of surgery-44 min, soft tissue reduction-30 %, bone polishing-20 %, haematoma-10 %. Functional results showed: GBI total score-29.6 points, APHAB global score mean gain-23.5 %, BAHU 'good or very good' score for: aesthetic-85 %, hygiene-100 %, ease of placing the processor-100 %, stability of attraction-75 %. Audiological results-mean gain for the two analysed situations: 32.9 % (group A-36.5 %, group B-27.5 %). To conclude, the data obtained prove the safety and effectiveness of the Baha(®) Attract system in patients with conductive and mixed hearing loss as well as in patients with single-sided deafness. Cosmetic aspects are highly acceptable and the idea of Attract itself is important for patients with limited manual dexterity.

Observations on hearing preservation in patients with hybrid-L electrode implanted at Poznan University of Medical Sciences in Poland.

The objective of the paper is to evaluate the hearing preservation rate in patients with high frequency hearing loss, treated with Cochlear Nucleus Freedom Hybrid-L implant in the Otolaryngology Department, Poznan University of Medical Sciences in Poland. Study was designed as the retrospective analysis. Twenty-one patients were operated and implanted with Nucleus Freedom Hybrid-L implant. Pure tone thresholds were recorded prior to the surgery and at the time of speech processor switch-on. Patients were subdivided into two groups with respect to their PTA thresholds: group A-classic indications and group B-extended indications. Average PTA for three frequencies (250, 500, 1,000 Hz) were calculated for each patient pre- and postoperatively. In the group of 21 implanted patients in 17 cases we have observed preservation of hearing (12 patients from group A, 5 patients from group B) with a mean value of 13.1 dB. In 4 out of 21 patients deafness on the implanted ear was noted. Our results clearly indicate that with standard procedure hearing preservation can be obtained in majority of patients. Hearing preservation was not achieved in 19 %, but owing to design of the electrode of the Cochlear Nucleus Hybrid-L that enables to work as CI platform alone, in patients who lost their hearing after surgery re-implantations were not required. This proves that EAS is a safe and reliable method to help patients with specific type of hearing loss.

Can Assessment of Rheological Properties of Whole Blood and Plasma Be Useful in the Diagnosis of Tinnitus? A Pilot Study.

Tinnitus is a sensation of ringing in the ears in the absence of any physical source in the environment. Between 9-35% of adults experience some form of tinnitus. Common causes of tinnitus include noise, head injury, ototoxic substances, as well as disorders of blood and blood vessels. Vascular causes include: head-neck tumours, turbulent blood flow, problems with blood supply and inner ear cell damage. The aspect of rheology in terms of tinnitus has not been described yet. In the present study, which comprised 12 patients aged 30 to 74 years presenting with tinnitus, rheological properties of whole blood and plasma were assessed. All the subjects underwent audiological and neurological evaluation. The Quemada model was used to describe the variability of red blood cell shape, as well as their tendency to form aggregates. On the basis of the experimental study, statistically different results of haemorheological measurements were observed in the evaluated group in comparison to a reference group.

Simple technique for RNA purification from mouse inner ear hair cells.

Obtaining a good quality of RNA from small population of cells remain an issue. Isolation for a special anatomic location such as inner ear placed in the temporal bone become a challenge, especially in terms of time needed for isolation of living tissue from the bone, which is a key factor to preserve the RNA. Due to limited accessibility to the technologies such as laser dissection, we present a simplified procedure for isolation of good quality of RNA from the inner ear for further studies.

[Comparison of different deafening strategies based on ototoxic drugs on mouse animals model]. / Porównanie skutecznosci ogluszania mysiego modelu zwierzecego w oparciu o protokoly wykorzystujace leki ototoksyczne.

AIM OF THE STUDY: To compare safety, reliability and usefulness of two deafening protocols on animal mouse model, based on aminoglycosides exposure MATERIAL AND METHOD: Adults mice, Bulb/C, deafened with kanamycine 14 days treatment (group I), single kanamycin injection followed by etacrinic acid administration (group II) and control group. Hearing evaluation performed with ABR recordings on 6th day after drug exposure RESULTS: Both protocols were not able to guarantee complete ablation of the inner ear in tested animals. Although short deafening strategy was more effective (83.33% deaf mice) it was combined with high rate of mortality during general anesthesia for hearing evaluation. CONCLUSIONS: Variable outcomes in deafening mouse animal model implies the necessity of hearing evaluation every time prior to the pathophysiological as well as molecular studies. Mice exposed to severe oto- and nephrotoxic insult do not recover after anesthetic drug administration, thus harvesting inner ear tissues especially as the source of RNA should be performed immediately after ABR recordings.

Current indications for cochlear implantation in adults and children.

INTRODUCTION: Surgical treatment of deafness by cochlear implants is used for more than 40 years, and during this period permanently, gradual and significant expansion of indications for this surgery has been observed. MATERIAL AND METHODS: In our Department in the years 1994-2018 1480 cochlear implantations were performed, both in adults (647) and in children (883). In this study current indications and the rules for eligibility of patients based on 25 years of experience are presented. RESULTS: Indications for cochlear implantation in adults are: 1) bilateral postlingual deafness, 2) bilateral sensorineural hearing loss - in pure tone audiometry > 70 dB HL (average 500-4000 Hz) and in speech audiometry in hearing aids understanding < 50% of words for the intensity of the stimulus 65 dB, in the absence of the benefits of hearing aids, 3) bilateral profound hearing loss for high frequency with good hearing for low frequency, in the absence of the benefits of hearing aids, 4) some cases of asymmetric hearing loss with intensive tinnitus in the deaf ear. An indication in children is bilateral sensorineural hearing loss > 80dB HL confirmed by hearing tests, after about 6 months of rehabilitation with the use of hearing aids. DISCUSSION: Although cochlear implantation is used for more than 40 years, the indications for this treatment underlies constant modifications. They concern the age of eligible patients, implantation in patients with partially preserved hearing, as well as treatment for patients with difficult anatomical conditions. In many countries, bilateral implantations are commonly performed, and more and more centers recommend this treatment in the case of unilateral deafness or asymmetric hearing loss, especially with the accompanying tinnitus in the deaf ear.

Evaluation of quality of life in patients after cochlear implantation surgery in 2014-2017.

INTRODUCTION: Profound hearing loss significantly affects the quality of life of deaf people as well as their families. Observation of the benefit from the use of cochlear implants in deaf patients allows to assess the success of treatment with this method and its impact on the quality of life of these patients. The aim of this study was to determine the quality of life in patient after the cochlear implantation in the material of Department of Phoniatrics and Audiology of the Medical University in Poznan. MATERIAL AND METHODS: The study involved implanted patients who voluntarily joined to the project entitled "Observational study of the implanted patient (Cochlear-IROS)". It has a prospective character, it is an international and long-term study, covering the observation of patients up to three years after implantation. Standardized HUI and SSQ questionnaires were used. 70 patients were included in the analysis, the mean age at the time of the cochlear implantation was 47.6 years. In the research group there were 33 men and 37 women. In the whole group, the patients' age at implantation was at least 18 years, max. 80 years. RESULTS: The results of the SSQ questionnaire, which deals with the self-assessment of hearing ability in everyday situations, indicate that in the subjective assessment of patients one year after surgery the speech hearing improved by 77%, spatial hearing by 84%, and the quality of hearing by 49%. The general quality of life before the first connection of the sound processor according to the HUI questionnaire, the patients rated at 0.49 (0-1 scale, where 0 - corresponds to the death condition and 1 - full health). After one year from the implantation, this rating increased to 0.56. CONCLUSIONS: The implantation of the cochlear implant significantly increases the patient's quality of life, its physical and emotional functioning. Statistically significant better self-assessment of patients mainly concerned hearing speech and spatial hearing - especially after 1 year of connecting the speech processor.

Polish universal neonatal hearing screening program-4-year experience (2003-2006).

OBJECTIVE: The aim of this paper is to share our experience and observations in running the Universal Neonatal Hearing Screening Program on a national level, present results and indicate some problems that have arisen during these 4 years. METHODS: Polish Universal Neonatal Hearing Screening Program started back in 2002 in all neonatal units in Poland. Implemented testing methods consisted of test of transient evoked otoacoustic emission (TEOAE) performed in all new born children in their first 2-3 days of life and auditory brainstem response testing (ABR) conducted on children, who did not meet the TEOAE pass criteria. Additional questionnaire registered information on ototoxic drugs and family history of hearing impairment in every newborn. Diagnosed children were further referred for treatment and rehabilitation. RESULTS: After 4 years of running the program (between 2003 and 2006) a total number of 1,392,427 children were screened for hearing impairment, what stands for 96.3% of all delivered babies, registered in Poland. The screening program enabled to identify and refer for further treatment 2485 children with various types of hearing loss, 312 with profound (0.02% of population) and 145 with severe sensorineural hearing loss (0.11% of population). CONCLUSIONS: Our results indicate the accuracy of newborn hearing screening which remain an issue. Although improvement is needed in both intervention systems and diagnostic follow-up of hospitals, the Polish Universal Neonatal Hearing Program fully has achieved the main goal, the identification and treatment of hearing impaired children.

Comparison of rehabilitation results in deaf patients with and without genetically related hearing loss.

The introduction of prognostic tools to evaluate rehabilitation progress in cochlear implant patients (CI patients) is of great importance. The authors attempted to verify whether the identified 35delG mutation in the GJB2 gene can serve as a valuable indicator for rehabilitation progress of CI patients. A group of 51 subjects was studied. Molecular analysis was based on the identification of 35delG in GJB2. Logopedic assessment was performed with a non-verbal test of seven sounds, evaluating detection, discrimination and identification of the sounds during the first, third and sixth months after implantation. Results indicated that patients with GJB2-related deafness (DFNB1)s achieve better results in rehabilitation, but only at the early stages of rehabilitation. Prolonged rehabilitation equalised differences, which, subsequently, excluded this marker as an indicator for rehabilitation evaluation.

Middle Fossa Approach for Cochlear Implantation.

OBJECTIVE: To present qualification criteria, surgery, and results of cochlear implantation via the middle fossa approach. STUDY DESIGN: A retrospective analysis of medical charts of patients. SETTING: Cochlear implant program in academic medical center. PATIENTS: Six adults after middle ear surgery due to chronic otitis media with bilateral deafness or profound hearing loss. INTERVENTION: Analysis aimed to identify patients qualified for cochlear implantation via middle fossa approach and to present surgery and result. MAIN OUTCOME MEASURE: Qualification criteria, details of surgery and surgical, functional and audiological results. RESULTS: Surgery was completed in four patients and in the remaining two it was stopped because of adhesions and bleeding from the dura. In three patients, there were no postoperative complications and in one individual intracranial hematoma occurred. Postoperative computed tomography showed the intracochlear position of the electrode in all the implanted patients. All of the patients use their implant for 14 to 16 hours daily. One year after the implantation, they had hearing thresholds in the sound-free field of between 25 and 45 dB sound pressure level, number recognition scores between 80 and 100% and monosyllabic words recognition between 30 and 90%. CONCLUSION: Successful cochlear implantation via middle fossa approach results in satisfactory hearing, bringing deaf people into a hearing environment. However, this approach is technically difficult and provides the risk of intracranial complications. In our opinion this approach should be used in special cases only (e.g., postmeningitis or otosclerotis patients with obliteration of basal turn of cochlea). In analysed group it should not be considered the primary solution.

[Universal neonatal hearing screening--parents view]. / Powszechne badanie przesiewowe noworodków w opinii rodziców.

UNLABELLED: The aim of the study was to determine the parents view and attitude to the universal neonatal hearing screening. MATERIAL AND METHODS: parents of randomly selected 200 infants, who underwent hearing rescreening, were surveyed using the authors questionnaire. RESULTS: the universal neonatal hearing screening and the way it is conducted is accepted by the vast majority of the parents in the region of Wielkopolska. The parents with higher social and economic status express their negative emotions associated with the organisation of hearing screening more often, their expectations towards the system of medical care are rising. CONCLUSION: the newborn hearing screening has been a good stimulus for parents intently observation of their child auditory reaction.

[Voice disorders in rheumatoid arthritis]. / Zaburzenia glosu w reumatoidalnym zapaleniu stawów.

UNLABELLED: The report presents three patients with coincidence of voice disorders and rheumatoid arthritis. Material consisted of 3 females aged 39, 48 and 74 years. Methods included phoniatric examination, videolaryngoscopy, stroboscopy and acoustic voice analysis MDVP). RESULTS: In the two youngest patients the laryngoscopic changes were located on vocal folds, mostly as yellow nodules. The appropriate mobility of both vocal folds was found. The MDVP analysis particularly revealed changes in parameters describing perturbation of amplitude in both cases. In the third case oedema in the region of the crico-arytenoid joints and vestibular folds were observed. MDVP analysis showed slight disturbances in the parameters describing frequency perturbation.

[Cochlear implantation in visually impaired patients--long-term rehabilitation results]. / Wyniki wieloletniej rehabilitacji osób zaimplantowanych wszczepem slimakowym z towarzyszacym uposledzeniem widzenia.

UNLABELLED: The aim of the study was to assess the rehabilitation results in visually impaired patients with cochlear implants. Material consisted of 9 patients (2 with prelingual deafness, 3 with perilingual deafness, 4 with postlingual deafness) from 244 implanted persons in Poznan. METHODS: In all the patients the rehabilitation results were evaluated using Test of Auditory Perception of Speech (TAPS) and screening test. RESULTS: In the group of patients with pre- and perilingual deafness a little bit slower progress of rehabilitation was found, according to 117 persons with prelingual deafness and 34 persons with perilingual deafness without vision disorders. Within the group of patients with postlingual deafness important progress of rehabilitation was observed. Two brothers with Usher syndrome 1-2 months after speech processor switch-on reached the highest level of test, they could communicate with family. One person after 5 months of rehabilitation could talk by phone without any problems. In all implanted visually impaired patients improvement of auditory perception of speech was observed.

The Knowledge of the Role of Papillomavirus-Related Head and Neck Pathologies among General Practitioners, Otolaryngologists and Trainees. A Survey-Based Study.

OBJECTIVES: The aim of the survey was to introduce knowledge of HPV's role in head and neck pathologies to general physicians (GPs), otorhinolaryngologists (ENTs) and newly graduated doctors, as well as to promote HPV-related diseases prevention. STUDY DESIGN: Cross-sectional study. METHODS: Self-designed questionnaire was sent to 2100 doctors. A total of 404 doctors, including 144 ENTs, 192 GPs and 68 trainees, responded. RESULTS: The majority of ENTs (86.8%) had contact with recurrent respiratory papillomatosis (RRP) and oropharyngeal cancers (OPCs) patients; in contrast, the majority of GPs (55.7%) did not (p = 0.00). The knowledge of HPV aetiology of cervical cancer versus OPCs and RRP was statistically higher. 7% of ENTs, 20% of GPs and 10% of trainees had not heard about HPV in oropharyngeal diseases. Women had greater knowledge than men. Both in the group of GPs and ENTs, 100% of respondents had heard about the impact of vaccination on the reduction of cervical cancer incidence. Only 39.11% of respondents had heard about the possibility of using vaccination against HPV in RRP-ENT doctors significantly more often than GPs and trainees (p = 0.00). Only 28.96% of physicians had heard about the potential value of HPV vaccination in preventing OPCs, including 44.44% of ENT doctors, 23.44% of GPs and 11.76% of trainees (p = 0.00). The doctors from district hospitals showed lower level of knowledge compared with clinicians (p = 0.04). CONCLUSIONS: The different levels of knowledge and awareness of HPV issues highlight the need for targeted awareness strategies in Poland with implementation of HPV testing and vaccination. The information should be accessible especially to those with lower education levels: ENTs from small, provincial wards, GPs from cities of < 200,000 inhabitants and older physicians. The incorporation of HPV issues into the studies curriculum would be fruitful in terms of improving the knowledge of trainees.

[Two cases of rare unilateral sensorineural hearing loss]. / Dwa przypadki rzadkiej przyczyny jednostronnego niedosluchu odbiorczego.

We report a case of unilateral sensorineural hearing loss due to Borrelia burgdorferi infection and in a patient with haemophilia B and hepatitis C treated with alpha-interferon. An audiological check-up of that kind of patients is indicated in order to exclude hearing loss.

[Olfaction in congenital hypothyroidism]. / Stan narzadu powonienia we wrodzonej niedoczynnosci tarczycy.

The aim of the study is to present results of the olfactory testing in congenital hypothyroidism in the group of 20 subjects. The etiology of hypothyroidism included: Pendred's syndrome in 2 cases, hypoplasia in 2 cases, athyreosis in 5 cases and ectopy of thyroid gland in 11 cases. Olfactory testing involved olfactometry by Elsberg-Levy modified by Pruszewicz for 4 odorants: coffee, lemon, mint and anise; smell fatigability test by Pruszewicz et al. for lemon. Level of plasma TSH was determined in each subject. Age of the subjects, at which hormonal replacement therapy was started and regularity of the treatment were taken into consideration. Obtained results: impaired odorant identification and shortened smell fatigability period prove a significant impact of thyroid status on central nervous system development most probably already prior to birth and on cognition processes.

[Poznan's program of cochlear implantation: 10 years experience]. / Poznanski Program Leczenia Gluchoty Metoda Wszczepów Slimakowych--10 lat doswiadczen.

The first cochlear implant in the ENT Department in Poznan was introduced in adult patient in January 1994. One year later the first deaf child was implanted. During 10 years over 200 deaf people were operated on. Modifications of diagnostics, surgery and rehabilitation were presented. Lowering the age of the implantation, changes of audiological criteria, genetic diagnostic and possibility of implantation in multi-handicapped patients were emphasized. Almost all surgeries were performed through the posterior tympanotomy and in one cases through the middle fossa approach. In one child with total ossification in CT scans Nucleus Double Array was used. Speech rehabilitation bases on auditory-verbal therapy. Rehabilitation consists of individual sessions with speech therapist and group therapy. Logorytmics exercises were introduced.

[Quality of life in children with cochlear implants and their families (Program Schwarzenberg)--initial report]. / Ocena jakosci zycia u dzieci zaimplantowanych wszczepem slimakowym oraz ich rodzin (Program Schwarzenberg)--doniesienie wstepne.

The aim of the study was to present the results of international evaluation program "Quality of Life in children and their families--Schwarzenberg Initiative". The parents of children under 15 years old was asked to fill out specially prepared questionnaires. 1240 children from 9 countries participated in the study. In Poland 60 families filled out the questionnaires. 80 questions concerned several topics, including reaction of parents to the first information about impaired hearing of their child, using hearing aids before and after implantation, evaluation of behaviour in kindergarten and in school. This initial report describes only a few important topics. In 27.7% of Polish families the impaired hearing of their child was a cause to stop the work of one of the parents, to decrease time of work or to change the place of work in 9.1%. In most of the children the perception of sound was noticed. Only a few families from Austria, Slovenia, Swiss and Italy reported unsatisfactory results after implantation. Implantation increases quality of life of implanted children and their families.

[Enlarged vestibular aqueduct syndrome in patients with hypoacusis and deafness]. / Zespól poszerzonego wodociagu przedsionka u chorych z niedosluchem i gluchota.

UNLABELLED: In 1978 Valvassori and Clemis have reported that enlarged vestibular aqueduct can cause progressive perceptive hearing loss and finally deafness. AIM: Analysis of CT scans of patients with cochlear implants. Analysis of radiological data of 120 implanted patients was performed. CT examinations were performed during qualification to cochlear implantation. Most of the CT scans were performed using high resolution computed tomography (HRCT). A special attention was paid to patients with progressive perceptive hearing loss and CT of two patients with "gusher" during CI surgery. In one case (6-years old girl with bilateral profound perceptive hearing loss diagnosed in 2nd year of age) an enlarged vestibular aqueduct was found radiologically. In the second case (16 years old girl with progressive perceptive hearing loss since 1st year of age) no enlarged vestibular aqueduct was detected. Diagnostics and treatment of enlarged vestibular aqueduct syndrome are presented.