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BACKGROUND: Prophylactic swallowing exercises (PSE) during radiotherapy can significantly reduce dysphagia after radiotherapy in head and neck cancer (HNC). However, its positive effects are hampered by low adherence rates during the burdensome therapy period. Hence, the main goal of this multicenter randomized controlled trial (RCT) was to investigate the effect of 3 different service-delivery modes on actual patients' adherence. METHODS: A total of 148 oropharyngeal cancer patients treated with primary (chemo)radiotherapy were randomly assigned to a 4 weeks PSE program, either diary-supported (paper group; n = 49), app-supported (app group; n = 49) or therapist-supported (therapist group; n = 50). Participants practiced 5 days/week, daily alternating tongue strengthening exercises with chin tuck against resistance exercises. Adherence was measured as the percentage of completed exercise repetitions per week (%reps). Statistical analysis was performed by means of SPSSv27, using Linear Mixed-effects Models with post hoc pairwise testing and Bonferroni-Holm correction. RESULTS: Adherence and evolution of adherence over time was significantly different between the three groups (p < .001). Adherence rates decreased in all three groups during the 4 training weeks (p < .001). During all 4 weeks, the therapist group achieved the highest adherence rates, whilst the app group showed the lowest adherence rates. CONCLUSIONS: PSE adherence decreased during the first 4 radiotherapy weeks regardless of group, but with a significant difference between groups. The therapist group achieved the highest adherence rates with a rather limited decline, therefore, increasing the face-to-face contact with a speech-language therapist can overcome the well-known problem of low adherence to PSE in this population. TRIAL REGISTRATION: Trial registration: ISRCTN, ISRCTN98243550. Registered December 21, 2018 - retrospectively registered, https://www.isrctn.com/ISRCTN98243550?q=gwen%20van%20nuffelen&filters=&sort=&offset=1&totalResults=2&page=1&pageSize=10&searchType=basic-search .
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Trastornos de Deglución , Neoplasias de Cabeza y Cuello , Neoplasias Orofaríngeas , Humanos , Trastornos de Deglución/etiología , Trastornos de Deglución/prevención & control , Deglución , Quimioradioterapia/efectos adversos , Neoplasias de Cabeza y Cuello/radioterapia , Neoplasias Orofaríngeas/radioterapia , Terapia por EjercicioRESUMEN
PURPOSE: Heavily T2-weighted 3D FLAIR (hT2w-3D-FLAIR) sequence with constant flip angle (CFA) has been reported as being more sensitive to low concentrations of gadolinium (Gd) enabling endolymphatic hydrops (EH) visualization. The purpose of this study was to compare signal-to-noise (SNR) ratio, detection rate of EH, and increased perilymphatic enhancement (PE) as well as diagnostic accuracy in diagnosing definite Menière's disease (MD), using 3D-SPACE FLAIR versus conventional 3D-TSE FLAIR. METHODS: This retrospective study included 29 definite MD patients who underwent a 4-h delayed intravenous (IV) Gd-enhanced 3D-TSE FLAIR and 3D-SPACE FLAIR MRI between February 2019 and February 2020. MR images were qualitatively and quantitatively analyzed twice by 2 experienced head and neck radiologists. Qualitative assessment included grading of cochlear and vestibular EH and visual comparison of PE. Quantitative assessment of PE was performed by placing a region of interest (ROI) and ratio calculation in the basal turn of the cochlea and the brainstem. RESULTS: The intra- and inter-reader reliability for grading of EH and PE was excellent (0.7 < kappa < 0.9) for 3D-SPACE FLAIR and exceeded the values for 3D-TSE FLAIR (0.5 < kappa < 0.9) The combination of EH and visual assessment of PE has the highest diagnostic accuracy in diagnosing definite MD on 3D-SPACE FLAIR with a sensitivity of 0.91 and a specificity of 0.98 resulting in a sensitivity raise of 6% compared to 3D-TSE FLAIR. CONCLUSION: Four-hour delayed IV Gd-enhanced 3D-SPACE FLAIR sequence has a higher sensitivity and reproducibility than 3D-TSE FLAIR for the visualization of EH and increased PE in definite MD patients.
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Hidropesía Endolinfática , Enfermedad de Meniere , Medios de Contraste , Hidropesía Endolinfática/diagnóstico por imagen , Gadolinio , Humanos , Imagenología Tridimensional , Imagen por Resonancia Magnética/métodos , Enfermedad de Meniere/diagnóstico por imagen , Reproducibilidad de los Resultados , Estudios RetrospectivosRESUMEN
OBJECTIVE: The MO-meatocanalplasty is the oblique modification of the M-meatoplasty. The MO-meatocanalplasty was designed to address the superior quadrants of the meatus and the bony canal without the need for a retro-auricular incision. This retrospective analysis was performed to evaluate the long-term results of the MO-meatocanalplasty in patients with a narrow external auditory canal (EAC) with recurrent otitis externa or in patients unable to wear a hearing aid. METHODS: Twenty-two ears in twenty consecutive patients who received a MO-meatocanalplasty for a narrow EAC with recurrent otitis externa or the inability to wear a hearing aid were analysed retrospectively. There were no patients included with any type of previous or planned second stage tympanoplasty procedures. A follow-up period of 3 years was analysed for postoperative recurrent narrowing, the self-cleaning capacity of the EAC, the recurrence of otitis externa, the inability to wear a hearing aid, change in hearing level and for all types of aesthetical complaints. RESULTS: The MO-meatocanalplasty procedure was effective in 82% (n = 18). Postoperative recurrent narrowing was detected in 9% (n = 2). Insufficient self-cleaning capacity of the EAC was 9.1% (n = 2). The ability to wear a hearing aid was restored in all patients with the need for a hearing aid. No aesthetical complaints were reported. CONCLUSION: The MO-meatocanalplasty is an effective, safe and aesthetical accepted procedure to address the narrow meatus and external auditory canal. With this procedure, there is no need for a retro-auricular incision in order to create a well aerated, dry and self-cleaning EAC in patients with a narrow EAC with recurrent otitis externa or in patient with the inability to wear a hearing aid.
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Audífonos , Otitis Externa , Conducto Auditivo Externo/cirugía , Humanos , Otitis Externa/cirugía , Estudios Retrospectivos , TimpanoplastiaRESUMEN
OBJECTIVE: To evaluate early results on hygiene, safety and functional outcome in a population undergoing a canal wall up technique with bony obliteration of the mastoid and epitympanic space (CWU-BOT) for extensive cholesteatoma, performed by a single surgeon. This study compares different techniques of tympanic membrane reconstruction, viz. allografts and autografts. PATIENTS: A consecutive series of 61 ears with acquired cholesteatoma treated with primary or revision CWU-BOT surgery from 2009 to 2014. INTERVENTION: Obliteration was performed by the use of cortical bone-chips and bone pâté. Patients were followed up with micro-otoscopy and MRI with diffusion-weighted imaging. Ossicular reconstruction was performed using a remodelled autologous or allogenic incus or malleus. MAIN OUTCOME MEASURES: Residual and recurrence rate and short- and mid-term hearing outcome prior to any revision tympanoplasty were analysed, the effect of type of tympanic membrane reconstruction was considered. RESULTS: 44 Ears were primary cholesteatoma cases, 17 cases were referred for revision surgery. Mean postoperative follow up was 45 months (SD 18.08) and mean follow-up until the last non-EP DW MRI 42 months (SD 17.72). Recurrent disease was present in 3%, no residual disease was present. An AC gain was seen in 75% of all ears undergoing ossicular reconstruction. CONCLUSION: Reproducible safety, hygiene and hearing results with limited recurrence and residual disease can be obtained by younger otologic surgeons performing the BOT-CWU for extensive cholesteatoma while using a variety of grafts for tympano-ossicular reconstruction. The tympano-ossicular allograft nevertheless shows superior hearing results when a mobile intact stapes is present. LEVEL OF EVIDENCE: Level 4.
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Colesteatoma del Oído Medio , Timpanoplastia , Aloinjertos , Autoinjertos , Colesteatoma del Oído Medio/cirugía , Audición , Humanos , Higiene , Apófisis Mastoides , Recurrencia Local de Neoplasia , Estudios Retrospectivos , Resultado del Tratamiento , Membrana Timpánica/diagnóstico por imagen , Membrana Timpánica/cirugíaRESUMEN
PURPOSE: In this retrospective study the relationship between cochleovestibular function and a magnetic resonance imaging (MRI-) based classification system of endolymphatic hydrops was investigated. METHODS: Seventy-eight patients with unilateral definite Menière's disease who underwent MRI were included. The parameters of Pure Tone Audiometry (PTA), caloric irrigation test, cervical vestibular evoked myogenic potentials, and video Head Impulse Test were compared between the grades of endolymphatic hydrops (EH) and perilymphatic enhancement (PE) on MRI. RESULTS: The low-frequency PTA was significantly different between cochlear EH grades I and II (p = 0.036; Grade I: mean (Standard Deviation, SD) = 51 decibel Hearing Level (dB HL) (18 dB HL); Grade II: mean (SD) = 60 dB HL (16 dB HL)), and vestibular EH grades 0 and III (p = 0.018; Grade 0: mean (SD) = 43 dB HL (21 dB HL); Grade III: mean = 60 dB HL (10 dB HL)). The ipsilateral caloric sum of ears with vestibular EH grade I (n = 6) was increased with regards to vestibular EH grades 0 (p = 0.001), II (p < 0.001), and III (p < 0.001) (Grade 0: mean (SD) = 24°/s (15°/s); Grade I: mean (SD) = 47°/s (11°/s); Grade II: mean (SD) = 21°/s (13°/s); Grade III: mean (SD) = 16°/s (8°/s)). CONCLUSION: According to these results we can conclude that only the highest grades of cochlear and vestibular EH seem to be associated with decreased cochleovestibular functioning.
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Hidropesía Endolinfática , Enfermedad de Meniere , Potenciales Vestibulares Miogénicos Evocados , Hidropesía Endolinfática/diagnóstico por imagen , Humanos , Imagen por Resonancia Magnética , Enfermedad de Meniere/diagnóstico por imagen , Estudios RetrospectivosRESUMEN
PURPOSE: There is still a clinical-radiologic discrepancy in patients with Menière's disease (MD). Therefore, the purpose of this study was to investigate the reliability of current MRI endolymphatic hydrops (EH) criteria according to Baráth in a larger study population and the clinical utility of new imaging signs such as a supplementary fourth low-grade vestibular EH and the degree of perilymphatic enhancement (PE) in patients with Menière's disease (MD). METHODS: This retrospective study included 148 patients with probable or definite MD according to the 2015 American Academy of Otolaryngology, Head and Neck Surgery criteria who underwent a 4-h delayed intravenous Gd-enhanced 3D-FLAIR MRI between January 2015 and December 2016. Vestibular EH, vestibular PE, cochlear EH, and cochlear PE were reviewed twice by three experienced readers. Cohen's Kappa and multivariate logistic regression were used for analysis. RESULTS: The intra- and inter-reader reliability for the grading of vestibular-cochlear EH and PE was excellent (0.7 < kappa < 0.9). The two most distinctive characteristics to identify MD are cochlear PE and vestibular EH which combined gave a sensitivity and specificity of 79.5 and 93.6%. By addition of a lower grade vestibular EH, the sensitivity improved to 84.6% without losing specificity (92.3%). Cochlear EH nor vestibular PE showed added-value. CONCLUSIONS: MRI using vestibular-cochlear EH and PE grading system is a reliable technique. A four-stage vestibular EH grading system in combination with cochlear PE assessment gives the best diagnostic accuracy to detect MD.
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Imagen por Resonancia Magnética/métodos , Enfermedad de Meniere/diagnóstico por imagen , Adulto , Anciano , Anciano de 80 o más Años , Medios de Contraste , Diagnóstico Diferencial , Femenino , Humanos , Interpretación de Imagen Asistida por Computador , Imagenología Tridimensional , Masculino , Enfermedad de Meniere/clasificación , Persona de Mediana Edad , Compuestos Organometálicos , Perilinfa/diagnóstico por imagen , Reproducibilidad de los Resultados , Estudios RetrospectivosRESUMEN
The meatoplasty of the external auditory canal is a frequently performed otologic procedure in recurrent otitis externa, eczema or frequent accumulation of cerumen due to a narrow meatus of the external ear canal. Numerous surgical techniques have been described. The M-meatoplasty described by Mirck for addressing the external meatus is widely used. However, this technique does not sufficiently enlarge the external ear canal in all cases. Specifically in patients where the ear canal narrowing is most prominent in the postero- and/or anterosuperior quadrants of the lateral meatus the technique needs some modifications. In these cases, an oblique conversion of the M-meatoplasty, the MO-meatocanalplasty, is useful. In cases where the bony canal is also narrow this modification allows for a bony canalplasty while avoiding a retro-auricular approach. The MO-meatocanalplasty can be used in combination with myringoplasty and tympanoplasty.
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Conducto Auditivo Externo/cirugía , Procedimientos de Cirugía Plástica/métodos , Conducto Auditivo Externo/patología , HumanosRESUMEN
BACKGROUND: An isolated malleus handle fracture is rare and presents with vague otological symptoms. Diagnosis depends on careful history taking and otoscopic examination. Different treatment options are available. Reconstruction with hydroxyapatite bone cement is a relatively new technique. OBJECTIVE: The aim of this article is to review the current diagnostic work-up and treatment options and to demonstrate our method of treatment with hydroxyapatite bone cement. METHODS: Three cases, repaired with hydroxyapatite bone cement in a tertiary referral otologic center, were retrospectively analyzed. A review of the literature on diagnosis and treatment procedures was performed. RESULTS: One fracture occurred by withdrawing a finger from the external auditory canal and 2 occurred without clear prior trauma. Our 3 cases were successfully repaired with hydroxyapatite bone cement. CONCLUSION: Diagnosis of an isolated malleus handle fracture still depends on careful clinical examination. In addition to pure tone audiometry, both low and higher frequency tympanometry may be useful. High resolution computed tomography with reformatting through the malleus handle is the most accurate imaging modality. Reconstruction with hydroxyapatite bone cement is reliable by restoring the original situation with only minimal manipulation and without additional ossicular interruption.
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Fracturas Óseas/cirugía , Pérdida Auditiva Conductiva/cirugía , Martillo/lesiones , Pruebas de Impedancia Acústica , Adulto , Audiometría de Tonos Puros , Tomografía Computarizada de Haz Cónico , Femenino , Fracturas Óseas/complicaciones , Fracturas Óseas/diagnóstico , Pérdida Auditiva Conductiva/diagnóstico , Pérdida Auditiva Conductiva/etiología , Humanos , Masculino , Martillo/cirugía , Persona de Mediana Edad , OtoscopíaRESUMEN
Congenital cholesteatoma (CC) is a non-neoplastic lesion of keratin debris lined by epithelium found in the temporal bone. It is the lesser-known sibling of the acquired cholesteatoma and may be classified as congenital middle ear cholesteatoma and congenital petrous bone cholesteatoma. The incidence is rising, probably owing to increased recognition and advances in imaging modalities. Cone beam CT provides detailed anatomical information, highlighting quadrant location, ossicular involvement, and mastoid extension. MRI aids in lesion characterization and detection of complications. The classification systems for congenital middle ear and petrous bone cholesteatoma are helpful in the preoperative workup and have a role in predicting postoperative recurrence rates. Management almost invariably involves surgical intervention aimed at preserving middle and inner ear function. Follow-up of CC is mainly based on MRI together with otoscopic examination. Non-echo planar diffusion-weighted imaging, especially, has proven essential for detecting residual disease. This review article emphasizes the significance of imaging in the timely diagnosis and management of CCs. CLINICAL RELEVANCE STATEMENT: This article underscores the crucial role of imaging for prompt detection, preoperative assessment, and postoperative follow-up of CCs, a condition with rising incidence associated with potentially severe complications. KEY POINTS: Timely diagnosis of CCs is imperative for avoiding complications. Imaging is key in detection, preoperative evaluation, and postoperative management. Cone Beam CT and non-echo planar DWI represent state-of-the-art imaging techniques.
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OBJECTIVES: With the introduction of more flexible and thinner electrodes, such as Cochlear's Slim Modiolar Electrode, there is a higher risk of electrode insertion problems, in particular the tip foldover. Timely intraoperative detection of the problem would allow for direct intraoperative correction. This paper describes a non-radiological method for intraoperative tip foldover detection that is applicable in all surgical centers and can quickly deliver accurate results. METHODS: Postoperative radiographs of 118 CI-recipients implanted with Nucleus devices were retrospectively analyzed on the presence of a tip foldover. Electrode Voltage Telemetry (EVT), also called Electric Field Imaging, was performed by means of Cochlear's EVT software tool, which is now integrated into Custom Sound-EP as the Trans-Impedance-Matrix measurement option. Tip foldover detection was automated by using the linear Hough transform for extracting straight-line patterns in the Trans-Impedance Matrix's heatmap. RESULTS: The six cases of electrode tip foldover were accurately identified by the EVT measurements, including two cases with folding location very close to the electrode tip (contact 20). CONCLUSION: Electrode Voltage Telemetry measures the Trans-Impedance Matrix, which can accurately detect tip foldovers of the cochlear implant electrodes within 1â min. This method can be reliably applied in all patients with normal cochlear anatomy and is able to intraoperatively detect foldovers localized even very close to the electrode tip. Application of the linear Hough transform allows for automatic detection of electrode tip foldovers that shows excellent agreement with visual evaluation of the radiological images and the transimpedance matrix's heatmap.
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Implantación Coclear , Implantes Cocleares , Humanos , Implantación Coclear/métodos , Estudios Retrospectivos , Cóclea/cirugía , Electrodos Implantados , Telemetría/métodosRESUMEN
Introduction: In a previous manuscript from our research group, the concept of vestibular co-stimulation was investigated in adult subjects who received a cochlear implant (CI). Despite what literature reports state, no signs of vestibular co-stimulation could be observed. Results: In this case report, it was described how a woman, who previously underwent a neurectomy of the left vestibular nerve and suffers from bilateral vestibulopathy (BVP), reported improved balance whenever her CI on the left was stimulating. Unexpectedly, the sway analyses during posturography indeed showed a clinically relevant improvement when the CI was activated. Discussion: Vestibular co-stimulation as a side effect of CI stimulation could not be the explanation in this case due to the ipsilateral vestibular neurectomy. It is more likely that the results can be attributed to the electrically restored auditory input, which serves as an external reference for maintaining balance and spatial orientation. In addition, this patient experienced disturbing tinnitus whenever her CI was deactivated. It is thus plausible that the tinnitus increased her cognitive load, which was already increased because of the BVP, leading to an increased imbalance in the absence of CI stimulation.
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INTRODUCTION AND AIM: Atraumatic laryngeal fractures are extremely rare and are most commonly provoked by sneezing or coughing. Only seven cases have been described in medical literature, and only one case described a fracture after swallowing. We present two cases of atraumatic laryngeal fracture after swallowing. CASE REPORT: A 37-year-old male presented to the outpatient ENT clinic with severe dysphonia and odynophagia. He reported feeling a crack in the throat after swallowing with a flexed head. The patient's physical examination showed diffuse swelling and tenderness over the thyroid cartilage without subcutaneous emphysema. Flexible nasolaryngoscopy showed a large right true vocal fold hematoma with normal vocal fold movement. Computed tomography (CT) showed a fracture of the thyroid. Treatment consisted of corticosteroids and pantoprazole. Two years later he presented again at the emergency department with extreme odynophagia after suffering a knee punch on the larynx. CT showed a new fracture line, slightly off midline to the left in the thyroid cartilage. A 42-year-old male presented at the emergency department with odynophagia, dysphonia, and fever after feeling a crack in the throat during forceful swallowing in an extended neck position. Physical examination demonstrated a painful thyroid cartilage with subcutaneous emphysema. Flexible nasolaryngoscopy was normal but CT scan showed a slightly displaced fracture line of the median thyroid cartilage. Complaints gradually disappeared with conservative treatment with corticosteroids and antibiotics. CONCLUSION: Congenital anomalies by abnormal mineralization and ossification could lead to focal weakness of the thyroid cartilage and thus predispose to non-traumatic fractures. The double triad of odynophagia, dysphagia, and dysphonia after sneezing, coughing or swallowing should raise the physician's attention to the possibility of thyroid cartilage fracture, especially after feeling or hearing a crack. Further investigation is obligatory with high-resolution CT of the neck and examination by an ENT specialist.
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Disfonía , Enfermedades de la Laringe , Enfisema Subcutáneo , Masculino , Humanos , Adulto , Estornudo , Disfonía/diagnóstico , Disfonía/etiología , Enfermedades de la Laringe/diagnóstico , Cartílago Tiroides , CorticoesteroidesRESUMEN
The objective of this study was to compare the hearing outcome using hydroxyapatite (HA) bone cement to bridge the incudostapedial gap versus incus remodelling for ossiculoplasty in case of incudostapedial discontinuity. A non-randomized retrospective study was conducted at a tertiary referral otologic centre. The intervention in 24 primary cases of conductive hearing loss was subsequent middle ear inspection where incudostapedial discontinuity was observed. HA bone cement was used in 10 consecutive cases, and incus remodelling was performed in 14 consecutive cases. Air-bone gap (ABG), bone-conduction (BC) thresholds, and air-conduction (AC) thresholds were evaluated preoperatively and at 3, 6 and 12 months postoperatively. No patients were lost to follow-up. Pure-tone averages were calculated according to the guidelines of the Committee on Hearing and Equilibrium for the evaluation of conductive hearing loss. The Amsterdam Hearing Evaluation Plots are presented. The postoperative ABG closure to within 20 and 10 dB at 12 months was, respectively, 80 and 40% in the HA bone cement group and 57.1 and 28.6% in the standard ossiculoplasty group (no statistically significant difference). However, we observed a statistically significant difference in ABG gain at 6 and 12 months favoring the HA bone cement cases. No short-term or intermediate-term adverse reactions were observed. Hydroxyapatite bone cement bridging ossiculoplasty offers a better intermediate-term ABG gain than standard ossiculoplasty. This new technique is a valuable alternative to conventional ossiculoplasty and presents the practical advantage of being easier and faster.
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Pérdida Auditiva Conductiva/cirugía , Hidroxiapatitas , Yunque/cirugía , Prótesis Osicular , Reemplazo Osicular/métodos , Procedimientos de Cirugía Plástica/métodos , Cirugía del Estribo/métodos , Adolescente , Adulto , Anciano , Audiometría de Tonos Puros , Conducción Ósea , Niño , Femenino , Estudios de Seguimiento , Audición/fisiología , Pérdida Auditiva Conductiva/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento , Adulto JovenRESUMEN
Measurement of the complex electrical impedance of the electrode contacts can provide new insights into the factors playing a role in the preservation of residual hearing with cochlear implants (CIs). However, unraveling the contributions related to the different phenomena from impedance data necessitates more advanced measurement and analysis techniques. The present study explores a new impedance measurement option recently included into the cochlear-implant programming software and aims to contribute to a more solid basis for the clinical use of impedance measures as a biomarker for fibrous tissue formation. Twenty adult CI-recipients were followed from surgery until 1 year after implantation by means of Electrode Voltage Telemetry (EVT), also called Electric Field Imaging or TransImpedance-Matrix measurement, and a 4-point technique for probing the voltage between adjacent electrode contacts. The data were compared to the electrode location derived from computed tomography, and to the device usage log. Using our impedance model for electrical stimulation of the cochlea, the polarization impedance related the electrode-tissue interface was determined, and the bulk impedance (access resistance) was split into a near-field and a far-field component. On average, the polarization impedance increased abruptly after surgery, indicating a strong passivation of the electrode contacts before cochlear-implant initiation. Its initial rise resolved almost completely soon after device switchon (2-4 weeks). The gradual increase of the access resistance mainly happened during the first 40 days on a time scale very similar to that observed in a guinea-pig study correlating impedance changes to fibrous tissue growth. The higher increase towards the round window is consistent with the higher amount of tissue observed in histological animal studies close to the electrode entry point. While the initial changes were due to the near-field resistance, the far-field resistance began to rise only after one month for half of the study group, once the near-field component had reached its critical value. This suggests indeed fibrosis initiating near the electrode contacts and spreading thereafter farther away. The near-field resistance positively correlated to device usage. EVT data allow for a further decomposition of the impedance at a cochlear-implant electrode, yielding a more detailed description of the postoperative intracochlear phenomena, such as fibrosis.
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Implantación Coclear , Implantes Cocleares , Cobayas , Animales , Impedancia Eléctrica , Cóclea/fisiología , Fibrosis , BiomarcadoresRESUMEN
BACKGROUND: Vestibular co-stimulation is a side effect of cochlear implant stimulation. The electrical currents delivered by the cochlear implant can spread toward the vestibular system and thus stimulate it. The aim of the study is to evaluate whether it is feasible to functionally restore the balance by modifying the vestibular co-stimulation. METHODS: Four adult patients, who had received a commercially available cochlear implant previously, were enrolled. Counterbalanced biphasic pulses were presented as bursts or as an amplitude-modulated biphasic pulse train (modulation frequencies ranging from 1 to 500 Hz) at the participant's upper comfortable level for electrical stimulation. Subjective sensations and vestibular-mediated eye movements were used for evaluating the possible effects of vestibular co-stimulation. RESULTS: One participant experienced a cyclic tilting of his head in response to an amplitude-modulated biphasic pulse train with a modulation frequency of 2 and 400 Hz. However, during a follow-up visit, the sensation could not be replicated. CONCLUSION: Subjective vestibular sensations or vestibular-mediated eye movements could not be electrically evoked with a commercially available cochlear implant in 4 adult patients with almost normal vestibular function. Therefore, customized design of the hard-, firm-, and/or software of the commercially available cochlear implant might be necessary in order to electrically restore vestibular performance.
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Implantación Coclear , Implantes Cocleares , Vestíbulo del Laberinto , Adulto , Estimulación Eléctrica , Humanos , SensaciónRESUMEN
INTRODUCTION AND AIM: There is no consensus in literature on the most optimal follow-up imaging protocol for non-echoplanar diffusion-weighted magnetic resonance imaging (non-EP DW MRI) after the canal wall-up bony obliteration tympanoplasty. Clearly, no residual cholesteatoma should be missed but on the other hand, unnecessary MR controls should be avoided. The aim of this study is to evaluate the postoperative results of non-EP DW MRI after canal wall-up bony obliteration tympanoplasty surgery at our Institute and to propose an optimal postoperative MR imaging scheme based on our data. MATERIAL AND METHODS: Retrospective cohort study; all 271 patients who underwent the bony obliteration tympanoplasty between January 2010 and January 2016 with follow-up at our Institute were included. A postoperative MR imaging was systematically performed at 1âyear after surgery and repeated at either 5 or both 3 and 5âyears after surgery, based on the preferences of the surgeon. Variables of interest were retrieved from electronic patient records. RESULTS: The median follow-up time was 60âmonths (inter-quartile range 56-62âmo). Two hundred seventy-one patients (100%) received a 1-year MRI, 107 (39%) a 3-year MRI, and 216 (79.7%%) a 5-year MRI. Residual cholesteatoma was found in nine cases (3.3%), corresponding with an estimated residual rate at 5âyears follow-up of 3.7% when using Kaplan-Meier analysis. Of these nine cases, six cases of residual cholesteatoma (66.7%) were detected at the 1-year MRI (12-14âmo postsurgery), two cases (22.2%) at the 3-year MRI (35-39âmo postsurgery), and one case (11.1%) at the 5-year MRI (51âmo postsurgery, in this patient no 3-year MRI was performed). An uncertain MRI result was found in 15 cases, presenting as relatively hyperintense lesions. However, subsequent follow-up scans did not show persistent evidence for residual disease in 14 of these 15 cases. CONCLUSIONS: A postoperative MRI scan after 1 and 5âyears is essential to detect early and late residual cholesteatoma. In our cohort, 22.2% of residual cases were detected at the 3-year MRI. However, this percentage could potentially have been higher when all patients would have received a 3-year MRI. Therefore, in order to detect residual disease as soon as possible, we propose to perform an MRI scan at 1, 3, and 5âyears after the bony obliteration tympanoplasty. In cases with an unclear MR result, we suggest a repeat MRI after 12âmonths.
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Colesteatoma del Oído Medio , Timpanoplastia , Colesteatoma del Oído Medio/diagnóstico por imagen , Colesteatoma del Oído Medio/cirugía , Progresión de la Enfermedad , Estudios de Seguimiento , Humanos , Imagen por Resonancia Magnética/métodos , Apófisis Mastoides/cirugía , Recurrencia Local de Neoplasia/cirugía , Neoplasia Residual/patología , Estudios Retrospectivos , Timpanoplastia/métodosRESUMEN
The objectives of the study were to determine the incidence of skin reactions and complications associated with bone-anchored hearing aid (BAHA) implantation. The study is a retrospective case review done in a tertiary referral center. One hundred thirty-eight consecutive patients between 1998 and 2008 underwent implantation of a BAHA and were regularly seen for follow-up. Indications included conductive or mixed hearing loss where a hearing aid cannot be used and since 2000 also had contralateral single-sided perceptive hearing loss. BAHA implantation was done by creating a pedicled flap using the skin flap dermatome technique. Postoperative incidence of skin reactions and complications were measured. Significant postoperative complications requiring revision surgery occurred 37 times in 30 patients. Normal skin healing was seen in 52 patients (63.4%), while abnormal skin healing occurred in 30 patients (36.6%). This study showed that skin problems occur more often than expected. Because of the skin problems with the skin flap technique, the authors have switched to the linear incision technique, hoping to decrease the incidence of skin problems.
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Audífonos/efectos adversos , Pérdida Auditiva Conductiva/cirugía , Perdida Auditiva Conductiva-Sensorineural Mixta/cirugía , Enfermedades de la Piel/etiología , Trasplante de Piel/efectos adversos , Colgajos Quirúrgicos , Anclas para Sutura , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Enfermedades de la Piel/patología , Adulto JovenRESUMEN
Electrical stimulation with cochlear implants is able to significantly suppress the tinnitus sensations in 25-72% of implanted patients. Up to this point, no clear predictors for the effectiveness of tinnitus suppression with cochlear implants have been found and this substantially limits the possibility of the application of cochlear implants for this purpose. The objective of the study was to investigate if a trial electrical round window stimulation (RWS) could be used as a diagnostic tool for identifying candidates in whom electrical stimulation would be successful as treatment for tinnitus. Thirty-four patients with unilateral severe tinnitus and ipsilateral moderate to severe sensorineural hearing loss underwent a trial RWS under local anesthesia. Thirteen patients received a cochlear implant. All patients qualified for cochlear implantation on the basis of the trial RWS showed tinnitus suppression with the implant switched on. Complete or almost complete tinnitus suppression was obtained in 77% and partial in 23%. The mean tinnitus loudness reduction was 68% (VAS score reduction from 7.7 to 2.5). False negative results are estimated not to exceed 10-15%. We conclude that significant tinnitus suppression achieved during trial RWS under local anesthesia is a simple procedure allowing the efficient identification of candidates in whom electrical stimulation with a cochlear implant would be successful as treatment for intractable tinnitus.
RESUMEN
Clinical and audiological examination was done in 2 Belgian families with autosomal dominant sensorineural hearing loss (SNHL) linked to DFNA22. Nineteen subjects in family 1 had mild to moderate SNHL starting in the third decade. The hearing loss was characterized by a flat audiogram affecting all tested frequencies with statistically significant progression. In family 2 eleven subjects were affected with mild to moderate SNHL starting in the second decade. Most of them showed a flat audiogram, but some had mid-frequency hearing loss. Significant progression of thresholds was present at 4 and 8 kHz. For all hitherto known DFNA22 families the audiological and clinical characteristics were correlated with the molecular data. This study describes the phenotype of 2 Belgian families with SNHL linked to DFNA22, both with a pathogenic change in the deafness gene MYO6. The phenotypes of all hitherto reported DFNA22 families with mutations in the MYO6 gene have been studied and compared. It seems that genetic defects that spare the motor domain of the myosin VI protein have a milder phenotype.
Asunto(s)
Aberraciones Cromosómicas , Análisis Mutacional de ADN , Sordera/genética , Genes Dominantes/genética , Genotipo , Pérdida Auditiva Sensorineural/genética , Fenotipo , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Umbral Auditivo , Bélgica , Niño , Femenino , Tamización de Portadores Genéticos , Haplotipos/genética , Humanos , Lactante , Masculino , Persona de Mediana Edad , Miosina Tipo IV/genética , Linaje , Adulto JovenRESUMEN
Congenital cholesteatomas of the petrosal apex account for 1% to 3% of all cholesteatomas and often present an important surgical challenge. This report describes an exceptional case of a "nondestructive" translabyrinthine surgical approach to a large congenital petrosal cholesteatoma that threatened the vestibulum, superior semicircular canal, facial nerve, and internal auditory canal. We applied a nonconventional transmastoid subarcuate supralabyrinthine approach in a 20-year-old patient by accessing the lesion through the center of the superior semicircular arch without damaging the integrity of the canal. This led to a complete removal of the petrosal cholesteatoma with preservation of hearing and vestibular function. Follow-up imaging performed 1 and 2 years after operation by means of non-echo-planar diffusion-weighted imaging did not show residual cholesteatoma. This report describes the first successful use of a subarcuate supralabyrinthine approach through the arches of the superior semicircular canal in a case of petrosal cholesteatoma.