International Consensus Statements on Intraoperative Testing for Cochlear Implantation Surgery.

OBJECTIVES: A wide variety of intraoperative tests are available in cochlear implantation. However, no consensus exists on which tests constitute the minimum necessary battery. We assembled an international panel of clinical experts to develop, refine, and vote upon a set of core consensus statements. DESIGN: A literature review was used to identify intraoperative tests currently used in the field and draft a set of provisional statements. For statement evaluation and refinement, we used a modified Delphi consensus panel structure. Multiple interactive rounds of voting, evaluation, and feedback were conducted to achieve convergence. RESULTS: Twenty-nine provisional statements were included in the original draft. In the first voting round, consensus was reached on 15 statements. Of the 14 statements that did not reach consensus, 12 were revised based on feedback provided by the expert practitioners, and 2 were eliminated. In the second voting round, 10 of the 12 revised statements reached a consensus. The two statements which did not achieve consensus were further revised and subjected to a third voting round. However, both statements failed to achieve consensus in the third round. In addition, during the final revision, one more statement was decided to be deleted due to overlap with another modified statement. CONCLUSIONS: A final core set of 24 consensus statements was generated, covering wide areas of intraoperative testing during CI surgery. These statements may provide utility as evidence-based guidelines to improve quality and achieve uniformity of surgical practice.

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.

A novel coupling quality index to estimate the coupling efficiency in Vibrant Soundbridge.

BACKGROUND: The objective-based methods for intraoperative monitoring have been suggested to assess the coupling and the outcomes of Vibrant Soundbridge (VSB). Although several techniques were proposed, they have not been widely adopted due to their complexity and invasiveness. PURPOSE: This study aimed to investigate the accuracy of a new coupling quality index using an intraoperative ABR threshold via AcoustiAP and its correlation with the perioperative measures. METHODS: This is a prospective study conducted at a tertiary center. The medical records were retrieved for all patients who underwent VSB implantation and had an intraoperative objective assessment for the coupling efficiency. AcoustiAP was used to evaluate the intraoperative ABR thresholds, which were assessed directly after the floating mass transducer (FMT) placement using acoustic CE-Chirp signals. The Vibrogram was used for the postoperative audiological evaluation. A new coupling quality index was calculated based on the intraoperative ABR thresholds. RESULTS: Ten patients were eligible for the present study. The ABR thresholds for good coupling ranged from 35 to 60 dBnHL. The loose coupling thresholds ranged considerably from 40 to 100 dBnHL. Overall, the median intraoperative ABR threshold at good coupling was 42.5 (40-60) dBnHL and 60 (40-100) dBnHL at loose coupling. The analysis showed that there was a significant change in the coupling quality index at the good and loose coupling points (24.3 ± 14 vs 38.8 ± 18.2, respectively, p < 0.001). At a cut-off value of 22.6 dB, the coupling quality index had a sensitivity of 70%  and specificity of 90% for discriminating good and loose coupling. CONCLUSION: This study provides evidence for the utility of intraoperative ABR measurements in predicting the coupling efficiency in patients with VSB. Our results showed that the coupling quality index had an acceptable accuracy in discriminating between good and poor coupling, which can help clinicians optimize the fitting process for individuals and may ultimately lead to improved patient outcomes.

Cochlear implantation versus auditory brainstem implantation in children with auditory nerve deficiencies.

BACKGROUND: Cochlear nerve deficiency is one of the known causes of congenital sensorineural hearing loss. Management of hearing loss in children with cochlear nerve deficiency poses a multidimensional challenge. The absent or hypoplastic cochlear nerve may prevent electrical stimulation from reaching the brainstem and the auditory cortex. A deficient cochlear nerve can be associated with other inner ear malformations, which may diminish the success of cochlear implantation in those children. Promising results in adults after auditory brainstem implantation led to the expansion of candidacy to include the pediatric populations who were contraindicated for CIs. OBJECTIVE: To review the outcomes of cochlear implantation versus that of auditory brainstem implantation in children with various conditions of the auditory nerve. METHODS: This retrospective chart review study comprised two pediatric groups. The first group consisted of seven ABI recipients with cochlear nerve aplasia and the second group consisted of another seven children with cochlear nerve deficiencies who underwent CI surgery. The participants' auditory skills and speech outcomes were assessed using different tests selected from the Evaluation of Auditory Responses to Speech (EARS) test battery. RESULTS: There were some individual variations in outcomes depending on the status of the auditory nerve. The mean CAP score of the ABI group was 2.87, while the mean SIR score was 0.62. On the other hand, the mean CAP score of the CI group was 1.29, while the mean SIR score was 0.42. CONCLUSION: Our results are in good agreement with the reported auditory perception and speech and language development outcomes of pediatric auditory brainstem implantation. We added to the growing body of literature on the importance of verifying and identifying the status of the cochlear nerve in the decision-making process of the surgical management of those pediatric groups.

Cochlear implantation in common cavity deformity: a systematic review.

PURPOSE: Cochlear implantation became a valid hearing rehabilitation option in common cavity deformity. This study aimed to assess the audiological and speech outcomes of cochlear implantation in common cavity deformity patients and to address the surgical aspect used in this population. METHODS: A comprehensive systematic literature review based on preferred reporting items for systematic reviews and meta-analyses (PRISMA) guideline from database inception through April 2020. Eighteen published articles including 138 patients with common cavity deformity met the inclusion criteria. These articles studied the surgical techniques and the audiological outcomes of cochlear implantation in patients with common cavity deformity in English language. RESULTS: Trans-mastoid labyrinthotomy was the common surgical approach in these patients. The average speech intelligibility rating and categories of auditory performance scores in common cavity deformity were lower than in normal cochlea subjects (p < 0.05), and non-significant (p > 0.05) compared with other types of inner ear malformations. CONCLUSION: Patients with common cavity deformity who underwent cochlear implantation showed a beneficial audiological and speech outcome. However, their performance is highly variable. Therefore, pre-operative counseling of the parents is necessary. The surgical approaches should be individualized according to clinical, radiological, and surgical findings.

Auditory Performance and Subjective Satisfaction with the ADHEAR System.

BACKGROUND: The ADHEAR device, a new nonsurgical bone conduction hearing device, has been developed for patients with conductive hearing loss. OBJECTIVES: This study aims to assess the impact of the ADHEAR device on the audiological performance and satisfaction level in subjects with conductive hearing loss. METHODS: Twelve patients with conductive hearing loss were included. All patients received the device for 3 months. The audiological outcomes were determined using basic audiological assessments, including pure tone audiometry and sound field measurements of pure tone and speech audiometry with the contralateral ear occluded with a specific earplug. Additionally, the patients were subjectively evaluated using (1) the Speech, Spatial, and Qualities Questionnaire (SSQ), and (2) the custom-made ADHEAR questionnaire. RESULTS: Analysis of the measured audiological outcomes revealed an average improvement in pure tone thresholds (functional gain) of 23 (± 4.4) dB HL when the ADHEAR system was used compared to the unaided condition in the sound field. Moreover, speech reception thresholds improved by an average of 23 (± 15.3) dB SPL in the aided condition with plugged contralateral ear. Additionally, when using ADHEAR in the sound field, subjects' speech recognition scores improved by 32% (± 17.7) in quiet and 21% (± 15.1) in the presence of interfering noise. The average SSQ questionnaire scores improved from 3.9 at the study initiation to 6.6 after 3 months of device usage. ADHEAR custom questionnaire assessments revealed high satisfaction and acceptance of the device with no pain or skin irritation. CONCLUSION: During the study period, this new adhesive system yielded improved audiological outcomes with high patient satisfaction and acceptance and no reported skin irritation or pain.

Evaluation of computed tomography parameters in patients with facial nerve stimulation post-cochlear implantation.

PURPOSE: To compare the preoperative computed tomography (CT) parameters, including the thickness and density of the bone separating the upper basal turn of the cochlea (UBTC) and the labyrinthine segment of the facial nerve (LSFN), in patients with and without facial nerve stimulation (FNS) in post-cochlear implants (CI). METHODS: A retrospective case review of 1700 CI recipients in a tertiary referral center between January 2010 and January 2020 was performed; out of the 35 recipients who were found to have FNS, 29 were included in the study. The control group comprised the same number of randomly selected patients. CT parameters of the patients were measured independently by three fellowship-trained neuro-otologists blinded to the postoperative status of the patients. Thickness in axial and coronal views and density of the bone separating the UBTC and the LSFN were measured. RESULT: There was satisfactory agreement between the readings of the three reviewers. The distances (in mm) between the UBTC and LSFN obtained from the coronal (0.43 ± 0.24 vs. 0.63 ± 0.2) and axial (0.42 ± 0.25 vs. 0.6 ± 0.18) views were statistically lower in the FNS group (p = 0.001 and 0.005, respectively). The density (in HU) of the bony partition was also statistically lower in the FNS group (1038 ± 821 vs. 1409 ± 519; p = 0.029). CONCLUSION: Patients who experienced FNS postoperatively had significantly lower distance and bone density between the UBTC and the LSFN. This finding can help surgeons in preoperative planning in an attempt to decrease the occurrence of FNS.

Performance of cochlear implant recipients fitted with triphasic pulse patterns.

PURPOSE: To assess the effect of triphasic pulse pattern stimulation strategy on the audiological performance of cochlear implant recipients with unintended facial nerve stimulation (FNS), and to compare the audiological and speech outcomes before and after switching to triphasic stimulation. METHODS: A retrospective study of patients who have changed their fitting maps from biphasic to triphasic pulse pattern stimulation because of FNS after cochlear implantation (CI). All identified patients with FNS after CI from 2017 to 2019 were included in this study. The medical records of 11 patients (16 ears) were queried for demographic and radiological data, pure tone audiometry, speech reception thresholds, speech discrimination score at 65 dB, maximum comfortable levels, thresholds, and dynamic range. Then, these parameters were compared in the two conditions, biphasic and triphasic. RESULTS: Using triphasic pulse stimulation only or combined with switch-off of few channels, complete resolution of FNS was achieved. Triphasic pulse pattern stimulation was associated with better speech discrimination scores (75.25 ± 26.13%) compared to the biphasic pulse (58.25 ± 26.13%). This triphasic strategy also showed higher maximum comfortable levels (36.62 ± 1.63 qu) than biphasic strategy (31.58 ± 2.5 qu). Moreover, the dynamic range was wider using triphasic pulse strategy. In general, the triphasic pulse pattern resulted in successful suppression of facial nerve stimulation with suitable maximum comfortable levels and better speech discrimination. CONCLUSION: Triphasic pulse pattern stimulation is an appropriate tool in controlling FNS following cochlear implantation with wider dynamic range. We recommend that all patients with facial nerve stimulation after CI surgery be switched to a triphasic pulse program prior to considering further surgery.

The outcome of cochlear implantation among children with genetic syndromes.

OBJECTIVE: To assess the outcome and efficacy of cochlear implantation in children with genetic syndromes. METHOD: Study design: case-control study. SETTING: A cochlear implantation tertiary referral center. PATIENTS: All pediatric cochlear implantation recipients with Waardenburg syndrome, Usher syndrome, Dandy-Walker syndrome, or albinism. A control group was appropriately matched to the syndromic group with regard to age at implantation and duration of device use. INTERVENTION: Cochlear implantation. MAIN OUTCOME MEASURES: Subjects' auditory abilities, speech intelligibility, and pure tone thresholds were compared between the syndromic and non-syndromic group. RESULTS: A total of 25 subjects (13 syndromic and 12 non-syndromic) participated in the study. Neither auditory ability nor speech intelligibility scores differed significantly by group. The final PTA of both the groups showed normal-to-mild hearing loss: 26 dB HL in the syndromic group and 23 dB HL for the control group. CONCLUSIONS: Cochlear implant recipients with genetic syndromes achieved similar levels auditory perception and speech intelligibility as their peers with a genetic syndrome. The presence of any of the genetic syndromes described herein should not be a contraindication to cochlear implant provision, as it would have a positive impact on the patients' sensory perception and lifestyle.

Facial palsy following cochlear implantation.

Owing to its anatomical location, the facial nerve (FN) is at risk of damage during cochlear implantation, especially during posterior tympanotomy. The aim of this study was, therefore, to evaluate the risk of FN palsy following cochlear implantation surgery via mastoidectomy and posterior tympanotomy approach (facial recess). This is a retrospective study. The data bank of patients who received a cochlear implant between 2000 and 2012 was analyzed. 3403 surgeries were done during this period. Records of the patients who had suffered from FN palsy were evaluated and the type of FN palsy, the severity, time of onset, and need for revision surgery were recorded. 0.76 % (26/3403) of the patients had FN palsy and were, therefore, included in the study. 76.9 % (20/26) subjects were 18 years or older. 0.15 % (5 subjects) suffered from immediate FN palsy and 0.62 % (21 subjects) from delayed FN palsy. Intraoperative FN injury was documented in only three subjects of the immediate FN palsy group. In two subjects with immediate FN palsy, the FN was intraoperatively exposed but not injured, despite these individuals' experiencing FN palsy. In 100 % of the immediate onset FN palsy group a part of the FN was exposed during surgery, whereas it was exposed only in 9.5 % of the delay onset FN palsy group. Although the FN was bone protected in 19 subjects, they had FN palsy. Most of the subjects presented House-Brackmann grade III or IV (69.2 %). All of the subjects were treated initially with a conservative therapy, only 42.3 % (11 subjects) underwent revision surgery. The recovery rate was 80.8 % (in immediate onset palsy 40 %, in delayed onset palsy 90.5 %). Cochlear implantation entails only a minimal risk of FN palsy and that FN palsy is chiefly a transient problem.

Cochlear Implantation: Long-Term Effect of Early Activation on Electrode Impedance.

Objectives: The growing adoption of cochlear implants (CIs) necessitates understanding the factors influencing long-term performance and improved outcomes. This work investigated the long-term effect of early activation of CIs on electrode impedance in a large sample of CI users at different time points. Methods: A retrospective study on 915 ears from CI patients who were implanted between 2015 and 2020. According to their CI audio processor activation time, the patients were categorized into early activation (activated 1 day after surgery, n = 481) and classical activation (activated 4 weeks after surgery, n = 434) groups. Then, the impact of the activation times on the electrode impedance values, along the electrode array contacts, at different time points up to two years was studied and analyzed. Results: The early activation group demonstrated lower impedance values across all the electrode array sections compared to the classical activation at 1 month, 1 year, and 2 years post-implantation. At 1 month, early activation was associated with a reduction of 0.34 kΩ, 0.46 kΩ, and 0.37 kΩ in the apical, middle, and basal sections, respectively. These differences persisted at subsequent intervals. Conclusions: Early activation leads to sustained reductions in the electrode impedance compared to classical activation (CA), suggesting that earlier activation might positively affect long-term CI outcomes.

Cochlear Implantation in Pediatrics: The Effect of Cochlear Coverage.

The effect of insertion depth and position of cochlear implant (CI) electrode arrays on speech perception remains unclear. This study aimed to determine the relationship between cochlear coverage and speech performance in children with prelingual hearing loss with CI. Pure tone audiometry (PTA) and speech audiometry, including speech reception threshold (SRT) using spondee words and speech discrimination score (SDS) using phonetically balanced monosyllabic words, were tested. The Categories of Auditory Performance (CAP) and Speech Intelligibility Rating (SIR) scales were also used. Thirty-one ears were implanted with the FLEX 28 electrode array, and 54 with the FORM 24 were included in the current study. For the studied ear, the mean cochlear duct length was 30.82 ± 2.24 mm; the mean cochlear coverage was 82.78 ± 7.49%. Cochlear coverage was a significant negative predictor for the mean pure tone threshold across frequecnies of 0.5, 1, 2, and 4 kHz (PTA4) (p = 0.019). Cochlear coverage was a significant positive predictor of SDS (p = 0.009). In children with cochlear coverage ≥ 82.78%, SDS was significantly better than in those with coverage < 82.78% (p = 0.04). Cochlear coverage was not a significant predictor of the SRT, CAP, or SIR. In conclusion, the cochlear coverage of the CI electrode array has an impact on the users' SDS. Further long-term studies with larger sample sizes should be conducted to address the most critical factors affecting CI recipients' outcomes.

Cochlear Implant Single-Unit Audio Processors in Young Children.

BACKGROUND: RONDO 2 is a lightweight, compact, wirelessly charged, and fully integrated single-unit speech processor. Single-unit processors provide an effective and convenient alternative to behind-the-ear processors for adults. Therefore, the aim of this study was to investigate if RONDO 2 is suitable for and did not compromise the hearing performance of young children in everyday life. METHODS: Thirteen children aged -lt;4 years were fitted with the RONDO 2 speech processor at the first activation of the cochlear implant. They were evaluated with the LittlEARS® Auditory Questionnaire, LittlEARS® Early Speech Production Questionnaire, and the Speech, Spatial, and Qualities of Hearing Scale 12 pre-implantation. In addition to these measures, they were evaluated with the Audio Processor Satisfaction Questionnaire post-implantation. Duration of daily use and troubleshooting data were acquired. Evaluation occurred at 4 time points: before implantation and 1, 3, and 12 months post-initial activation. RESULTS: Ten out of 13 children continued using RONDO 2 after the study. Twelve months after implantation, they used it on average 11.6 hours per day and had an average Audio Processor Satisfaction Questionnaire score of 9.1 out of 10. Average hearing performance scores continuously improved throughout the follow-up period across measures. Twelve months after implantation, the mean scores were 30.1 out of 35 for the LittlEARS® Auditory Questionnaire, 19.9 out of 27 for the LittlEARS® Early Speech Production Questionnaire, and 7.4 out of 10 for the Speech, Spatial, and Qualities of Hearing Scale 12. CONCLUSION: Participants demonstrated high levels of satisfaction and good hearing performance with RONDO 2, which indicates that this single-unit processor could be a viable and comfortable alternative to behind-the-ear processors in young children, although larger controlled experiments are warranted.

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 Good Practice Guide for Organizing the Scientific Program of International Conferences.

This paper provides a step-by-step guide for organizing the scientific program (OSP) of international conferences. Through informal discussions, a panel of experts organizing international conferences came up with this guide, which includes a flowchart, checklist, and detailed discussions of each step. Subsequently, additional specialists were invited to evaluate this synopsis and provide their input. All of the participants approved the final version after the outline was improved. This guide proposes the following six steps: 1) preparation, 2) recruitment, 3) building the agenda, 4) cross-checking the program, 5) reviewing and finalizing, and 6) in-conference refining. Thirteen items are specified across the six main steps in a detailed checklist. This OSP guide includes a flowchart and a checklist for providing a comprehensive manual for establishing, conducting, and organizing international scientific conferences. Understanding the procedures that are expected to be followed when holding a scientific conference enables the involved parties to organize and assign tasks to one another as well as create a schedule that allows them to finish their work on time. This guide can be used at any kind of scientific conference to describe an organized process, resulting in a professional and distinguished scientific program.

Speech performance and subjective satisfaction of middle ear implant in congenital aural atresia.

Objectives: To evaluate the safety, speech performance in noise and subjective satisfaction of patients with congenital aural atresia (CAA) implanted with the active middle ear implant. Methods: This retrospective study included 13 patients (15 ears) implanted with middle ear implants with different methods of floating mass transducer attachment. In 6 ears, the floating mass transducer (FMT) was coupled with the short process of incus; in 8 ears, a clip coupler was used; and in one ear, a round window coupler was used. Patients were assessed preoperatively, and at one, three, and six months postoperatively. The assessment included Pure Tone Average (PTA4), Speech Reception Threshold (SRT) and Speech Discrimination Score (SDS). The Speech Spatial and Qualities of Hearing scale (SSQ12) was also used to evaluate levels of satisfaction. Results: The mean aided PTA4 using Vibrant Sound Bridge (VSB) was 26.44 4.03 dB HL compared to 61.88 ±1.53 dB HL unaided. The SDS improved significantly (p = 0.002) from 51% (± 9.17%) to 94.60% (± 4.43%). Furthermore, there was a significant improvement in SDS in noise (p = 0.008) and SSQ12 responses (p < 0.0001). Conclusions: Patients with hearing loss due to CAA can substantially benefit from VSB, with highly satisfactory subjective results and a negligible rate of complications.

Osseointegrated device placement with minimally invasive surgery: Experience and audiological outcome.

OBJECTIVES: To evaluate the clinical and audiological outcomes of percutaneous bone conduction device placement by minimally invasive Ponto surgery (MIPS). METHODS: This was a retrospective descriptive study of patients who underwent MIPS from March-November 2019 at King Abdullah Ear Specialist Center, Collage of Medicine, King Saud University, Riyadh, Saudi Arabia. We reviewed all the clinical data of patients, including preoperative data, postoperative surgical results, and audiological performance (aided and unaided pure tone audiometry and aided and unaided speech tests). RESULTS: A total of 9 patients with 10 implants were enrolled in this study. One patient underwent revision surgery because of infection and loss of the abutment. We followed the patients from 1-2 years, with a mean of 16.8 months. A significant difference was found between the unaided air conduction pure tone average, with a mean of 72.6±28.4 decibel (dB), and the postoperative aided threshold, with a mean of 20.8±12.2 dB/hectoliter (p=0.008), indicating a functional gain of 51.8 dB. The mean unaided speech discrimination at 65 dB sound pressure level was 34.7±24.8, which was significantly improved to 88.4±11.7 after implantation (p=0.007). CONCLUSION: minimally invasive Ponto surgery is a suitable minimally invasive surgical method for bone-anchored implant placement. This technique has an advantage in terms of skin sensitivity, cosmetic outcomes, and operative duration.

Mucosal melanocytic lesion in the middle ear extending to the inner ear and nasopharynx.

Benign dendritic melanocytic proliferation is usually observed in the skin. We report an extremely rare case of a melanocytic lesion in the middle ear mucosa. Only 3 cases of melanocytic lesions in the middle ear have been reported. Our report is the only one that describes an adult with a melanocytic lesion in the middle ear that extended to the inner ear and nasopharyngeal mucosa. A 23-year-old female presented with profound sensory neural hearing loss and recurrent discharge from the right ear. Examination revealed a blue right tympanic membrane with a small perforation. Computed tomography scans and magnetic resonance imaging were performed. After surgical exploration and histopathological examination, the patient was found to have a benign melanocytic lesion in the right middle ear. Melanocytic lesions are commonly found in the skin. There are no previous reports have described adult patients with melanocytic lesions in the middle ear that extend to the inner ear and nasopharynx, which cause profound hearing loss with recurrent ear discharge. These patients require regular follow-up to assess the progression of the lesion and to watch for any malignant behavior.

Mastoid Growth and the Configuration of Cochlear Implant Electrode Lead.

OBJECTIVES: To study the changes in the coiled configuration of electrode excess lead in the mastoid cavity in the cochlear implant recipients over time. METHODS: Post-operative CT scans at two different appointments of fourteen patients with cochlear implants (CI) were retrospectively analyzed using a DICOM viewer software (3D-slicer). Mastoid thickness (MT) was measured in the oblique coronal plane from the round window (RW) entrance to the mastoid edge and inter-cochlear distance (ICD) was measured in the axial plane at the fundus level between two ears. 3D segmentation of the entire inner ear of both sides and coiled electrode excess lead was performed to visually compare the changes in coiled configuration between the two CT scan time points. RESULT: MT and ICD increased logarithmically with the patient's age, as has been measured from both the 1st and the 2nd CT scans and a weak linear correlation between MT and ICD was observed. Growth in MT and ICT measured between the time of 1st and 2nd CT scans showed a strong linear correlation. In eight cases, changes in the electrode excess lead have been observed in the 2nd CT scan, either a change in the coiling configuration of electrode excess lead or shifted laterally toward the mastoid edge. The ICD growth between the 1st and the 2nd CT scans was >2 mm in only seven cases and all of them were children. All other six cases had no observed changes in the coiled electrode lead. In addition, the mastoid growth between the 1st and the 2nd CT scan was >2.5 mm in only 4 cases. CONCLUSION: Coiled configuration of electrode excess lead could change when the MT and ICD increased over time.

Can Electrocochleography Help Preserve Hearing After Cochlear Implantation With Full Electrode Insertion?

OBJECTIVES: To evaluate the utility of intracochlear electrocochleography (ECochG) monitoring during cochlear implant (CI) surgery on postoperative hearing preservation. STUDY DESIGN: Prospective, randomized clinical trial. SETTING: Ten high-volume, tertiary care CI centers. PATIENTS: Adult patients with sensorineural hearing loss meeting the CI criteria who selected an Advanced Bionics CI. METHODS: Patients were randomized to CI surgery either with audible ECochG monitoring available to the surgeon during electrode insertion or without ECochG monitoring. Hearing preservation was determined by comparing preoperative unaided low-frequency (125-, 250-, and 500-Hz) pure-tone average (LF-PTA) to postoperative LF-PTA at CI activation. Pre- and post-CI computed tomography was used to determine electrode scalar location and electrode translocation. RESULTS: Eighty-five adult CI candidates were enrolled. The mean (standard deviation [SD]) unaided preoperative LF-PTA across the sample was 54 (17) dB HL. For the whole sample, hearing preservation was "good" (i.e., LF-PTA change 0-15 dB) in 34.5%, "fair" (i.e., LF-PTA change >15-29 dB) in 22.5%, and "poor" (i.e., LF-PTA change ≥30 dB) in 43%. For patients randomized to ECochG "on," mean (SD) LF-PTA change was 27 (20) dB compared with 27 (23) dB for patients randomized to ECochG "off" ( p = 0.89). Seven percent of patients, all of whom were randomized to ECochG off, showed electrode translocation from the scala tympani into the scala vestibuli. CONCLUSIONS: Although intracochlear ECochG during CI surgery has important prognostic utility, our data did not show significantly better hearing preservation in patients randomized to ECochG "on" compared with ECochG "off."