ABSTRACT
BACKGROUND: Funding for paediatric bilateral cochlear implantation became available in Ireland in 2014. Prior to this, children eligible for cochlear implantation received a unilateral implant. OBJECTIVE: To examine the cohort of children who received a unilateral cochlear implant in the 4 year period following bilateral cochlear implantation funding becoming available. METHODS: A clinical audit of all children implanted for the first time between July 2014 and July 2018. The unilaterally implanted children (n = 105) were divided into 3 groups according to whether they met the audiometric thresholds for implantation in neither ear (Group 1), one ear (Group 2) or both ears (Group 3). One year post operative functional outcomes were examined for all 3 groups. RESULTS: All 3 groups showed significant improvements in functional outcomes at 1 year post op. To date, 20% of the unilaterally implanted children have proceeded to get a sequential CI, often where there was no change in audiological status. CONCLUSIONS: The number of children in Groups 1 and 2 highlighted how our decision making around cochlear implantation has changed in recent years. Unilateral cochlear implantation in certain circumstances is good practice, independent of the audiological profile when an experienced multi-disciplinary team (MDT) is involved in the decision making process. Decision making using a holistic model approach is key, including involving the parent/carer and, where appropriate, the child/teenager themselves. A staged bilateral cochlear implant is also a good option, where careful monitoring and support for the first implant has resulted in positive outcomes.
Subject(s)
Audiology , Cochlear Implantation , Cochlear Implants , Speech Perception , Adolescent , Child , Humans , Cochlear Implantation/methods , Ireland , Treatment OutcomeABSTRACT
OBJECTIVE: To study the rate of hearing preservation and outcomes of hearing preservation candidates in a national cochlear implant centre. The HEARRING criteria was used. METHODS: All cochlear implant candidates with preserved low frequency pure tone average (PTA) were included. All patients underwent cochlear implantation using a standard 'soft-surgery' technique. PTA was assessed at switch-on, 3, 6, 9 and 12 months postoperatively. The primary outcome was hearing preservation at 12 months. RESULTS: Sixty six patients were included in the study between 2015 and 2020. Seventy one ears were implanted including 33 adults and 33 children with 5 bilateral implantations. Mean preoperative PTA was 74.8â dB (range 52.3-92â dB), mean postoperative PTA was 95.3â dB corresponding to a mean shift of 20.5â dB. In the adult population, HP rates were as follows: complete HP in 13%, partial HP in 39.1%, minimal HP in 30.4%, loss of hearing in 17.4%. In the paediatric population: complete HP in 20.7%, partial HP in 51.7%, minimal HP in 13.8% and loss of hearing in 13.8%. After the initial postoperative shift, there was no significant worsening of residual hearing during follow-up between 3 and 12 months. There were no significant prognostic factors for hearing preservation. CONCLUSION: Hearing preservation rates using the HEARRING criteria are described. This study will help counselling and decision making in patients eligible for cochlear implantation with hearing preservation. Further studies are required to assess the performances and outcomes of electronatural and electroacoustic stimulation.
Subject(s)
Cochlear Implantation , Cochlear Implants , Adult , Audiometry, Pure-Tone , Auditory Threshold/physiology , Child , Cochlear Implantation/methods , Hearing/physiology , Humans , Ireland , Retrospective Studies , Treatment OutcomeABSTRACT
There is a tendency for children undergoing sequential cochlear implant after a long period of unilateral implant use to have a smaller dynamic range in their second implant compared to their first implant. This study aimed to investigate if balancing the dynamic ranges between the two implants influenced functional outcomes in sequentially implanted children. Nineteen participants with long inter-implant time delays were randomly assigned to a study group or a control group. Children in the study group received progressive minimal changes to both first and second implants over a period of nine months to achieve balanced dynamic ranges, while the children in the control group received only changes to their sequential implant. Functional outcomes were collected 24-months after sequential implantation and consisted of speech discrimination scores, spatial localisation, device use and quality of life measures. Results show that spatial discrimination skills improved over time for both groups of children; however children in the study group had smaller localisation errors compared with the children in the control group. No other differences between the two groups were observed. Balanced dynamic ranges in sequentially implanted children can contribute to better performance, particularly in spatial discrimination tasks that rely in inter-aural level differences.
Subject(s)
Cochlear Implantation , Cochlear Implants , Deafness , Speech Perception , Child , Cochlear Implantation/methods , Deafness/surgery , Humans , Quality of Life , Treatment OutcomeABSTRACT
OBJECTIVES: Persistent stapedial artery (PSA) is a rare congenital anomaly that can complicate middle ear surgery. METHODS: We present the case of a 25-year-old male who underwent right-sided cochlear implantation. A PSA was encountered lying over the middle promontory intraoperatively. RESULTS: The PSA was carefully lifted off the middle ear promontory using a Hughes elevator to divide adhesions and delineate the artery. The implant electrode was placed through the round window niche in the usual fashion. Tragal cartilage and fibrin glue were used to control the trajectory of the electrode. CONCLUSION: Cochlear implantation can be performed safely in patients with PSA.
ABSTRACT
AIM: To compare listening and spoken language outcomes after cochlear implantation for children born preterm and at term, and to examine patterns associated with additional disabilities or gestational age. METHOD: Children were included if they underwent cochlear implantation in 2013 or 2014 and had complete 5-year follow-up data available. An analysis of assessment data recorded annually was conducted, including outcomes as measured by the Category of Auditory Performance (CAP), the Speech Intelligibility Rating, Second Edition (SIR 2) scale, and the British Picture Vocabulary Scales, Third Edition (BPVS-3). Analyses were conducted to measure the impact of preterm birth and of additional causes of disability on these outcomes. RESULTS: Eighty-two children (39 males, 43 females; median corrected age at first cochlear implantation 28.5mo [interquartile range 16.3-48.5]) were included in the study. Children who underwent cochlear implantation experienced significant improvements as measured by the CAP, SIR 2, and BPVS-3. Comparable improvements were seen in the groups born at term and preterm. Children with additional disabilities experienced significant improvement in all measures but performed less well than children without additional disabilities. INTERPRETATION: Infants born preterm benefit from cochlear implantation to a degree comparable to their peers born at term. Additional disabilities may limit improvements in speech intelligibility, listening performance, and receptive vocabulary. Children with additional disabilities, nonetheless, derived significant benefit from cochlear implantation; additional benefits of cochlear implantation for this subgroup may go unmeasured by the outcome tools used in this study.
Subject(s)
Cochlear Implantation , Cochlear Implants , Deafness , Premature Birth , Speech Perception , Child , Deafness/surgery , Female , Humans , Infant , Infant, Newborn , Language , Language Development , Male , Pregnancy , Speech Intelligibility , Treatment OutcomeABSTRACT
OBJECTIVE: To evaluate the impact of simultaneous and sequential bilateral cochlear implantation on deaf children's quality of life (QoL) and to investigate the impact of inter-implant time delay for the sequentially implanted children. METHODS: All completed questionnaires of the Brief Assessment of Parental Perception (BAPP), which had been routinely filled out by parents at annual review, were analysed for children with at least 12 months of bilateral implant experience. The responses for the simultaneous implanted group were compared to those who received sequential implants. Within the sequential group, the impact of shorter (<7 years) and longer (>7 years) inter-implant delays on QoL were compared. RESULTS: There were a total of 176 children in the sequential group and 97 in the simultaneous group. Results indicated that most children wore their devices regularly and significant improvements in QoL were reported for all children particularly in communication and learning. QoL scores were higher for the children with simultaneous implants, followed by children with a shorter time delay between implants. CONCLUSION: Both simultaneous and sequential bilateral cochlear implants significantly improved the functioning and QoL of deaf children.
Subject(s)
Cochlear Implantation , Cochlear Implants , Deafness , Speech Perception , Child , Deafness/surgery , Humans , Parents , Quality of Life , Retrospective StudiesABSTRACT
BACKGROUND: The current COVID-19 pandemic has placed enormous strain on healthcare systems worldwide. Understanding of COVID-19 is rapidly evolving. Pneumonia associated with COVID-19 may lead to respiratory failure requiring mechanical ventilation. The rise in patients requiring mechanical ventilation may lead to an increase in tracheostomies being performed in patients with COVID-19. Performing tracheostomy in patients with active SARS-CoV-2 infection poses a number of challenges. METHODS: These guidelines were written following multidisciplinary agreement between Otolaryngology, Head and Neck Surgery, Respiratory Medicine and the Department of Anaesthetics and Critical Care Medicine in the Royal College of Surgeons in Ireland. A literature review was performed and a guideline for elective tracheostomy insertion in patients with COVID-19 proposed. CONCLUSION: The decision to perform tracheostomy in patients with COVID-19 should be undertaken by senior members of the multidisciplinary team. Steps should be taken to minimise risks to healthcare workers.
Subject(s)
COVID-19/therapy , Critical Care , Respiration, Artificial , Tracheostomy , COVID-19/complications , Clinical Protocols , Elective Surgical Procedures , Humans , Infection Control , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Ireland , Patient Selection , Personal Protective EquipmentABSTRACT
OBJECTIVES: Cochlear Implant (CI) is an established treatment for severe to profound hearing loss (HL). Early diagnosis and intervention in HL are crucial in order to provide access to sound and increase the likelihood of spoken language development in pre-lingually deaf children. In April 2011, the Health Service Executive (HSE) implemented the Universal Newborn Hearing Screening (UNHS) in a phased regional basis in Ireland. This study aimed to investigate the general clinical pathway for UNHS referrals to the CI service and to evaluate the impact of earlier referrals via UNHS on functional outcomes in children. METHODS: The first part of this study constituted a retrospective review of 100 children referred to the National Hearing Implant and Research Centre (NHIRC) via UNHS from November 2011 to December 2016. Implanted children referred via UNHS were categorised into three groups according to their medical status. Their clinical pathway to cochlear implantation was evaluated. Functional outcomes were investigated based on medical and developmental status, respectively. In the second part of this study, developmentally healthy implanted children referred post-UNHS were compared with medically healthy children referred pre-UNHS under the age of four, from January 2005 to June 2011. Current implant status of children, age at referral and functional outcomes were investigated. RESULTS: Medically healthy children were referred to the NHIRC at an earlier age than the medically complex children (2.8 months vs 5.2 months, p < 0.01) and the children presenting with auditory neuropathy spectrum disorder (ANSD) (2.8 months vs 5.3 months, p < 0.01). On average they attended their first appointment and were implanted at a younger age than the ANSD group (6.1 months vs 10.1 months, p < 0.01; 16.3 months vs 29.4 months, p < 0.001, respectively). Developmentally healthy children had significantly better functional outcomes than children with developmental delays. Children referred via UNHS were referred and implanted at a younger age than those referred pre-UNHS. The former group achieved better Categories of Auditory Performance (CAP) and Speech Intelligibility Rating (SIR) scores 2 years post-implantation. CONCLUSION: UNHS in Ireland is an important platform for earlier diagnosis and management of congenital HL and our results show that early intervention has a positive impact on functional outcomes in children.
Subject(s)
Cochlear Implantation , Cochlear Implants , Hearing Loss/diagnosis , Hearing Loss/etiology , Age Factors , Child , Child, Preschool , Early Intervention, Educational , Female , Hearing Loss/therapy , Hearing Tests , Humans , Infant , Infant, Newborn , Ireland , Male , Neonatal Screening , Retrospective Studies , Speech IntelligibilityABSTRACT
OBJECTIVES: It is well established that sequential bilateral implantation offers functional benefits in speech in noise and sound localisation, although it can be challenging to get long-term unilateral users to adapt to the second implant. The aim of this study was to investigate programming differences between the two cochlear implants that can impact on performance outcomes. DESIGN: Cohort Study. PARTICIPANTS: Sixteen older children who received sequential implants in Ireland and with at least one-year experience with their sequential implant were included in this study. Children were categorised into two groups according to the time interval between the two implants: short if the time between the two implants was less than eight years and long if more than eight years. MAIN OUTCOME MEASURES: Dynamic ranges and current levels were compared for both implants. Functional outcome measures included sentence discrimination in quiet and in noise and sound localisation. RESULTS: Results show that for the children with long inter-implant delays, the dynamic range of their second implant was on average 34% less than the dynamic range of their first implant. This difference was driven by smaller comfort levels in the second implant compared to the first. Children with longer inter-implant delays also show lower speech discrimination scores with their second implant compared to children with shorter delays, in addition to no bilateral advantage in speech in noise, that is their performance in unilateral mode does not differ from the performance in bilateral mode. Finally, children with longer delays demonstrate poor performance in sound localisation compared to the children with shorter delays. CONCLUSION: Sequentially implanted older children show limited functional benefits from the second implant. The observed functional benefits are determined both by a short inter-implant delay and by having balanced dynamic ranges between the two implants.
Subject(s)
Cochlear Implantation/methods , Cochlear Implants , Deafness/surgery , Reoperation/statistics & numerical data , Adolescent , Age Factors , Child , Child, Preschool , Female , Hearing Tests , Humans , Infant , Ireland , Male , Sound Localization , Speech Perception , Young AdultABSTRACT
OBJECTIVES/HYPOTHESIS: Complications during or after cochlear implantation are relatively rare. They occur more frequently in patients who partake in activities that can potentially lead to local trauma. No formal recommendations exist for participation in self-contained underwater breathing apparatus (SCUBA) activities. We describe three patients with a combined five cochlear implants and extensive diving experience, the largest case series to date, and highlight some of the difficulties faced. We also review the literature on previously described SCUBA-diving patients with cochlear implants. STUDY DESIGN: Retrospective case series and literature review. METHODS: A review of the known SCUBA divers in the National Hearing Implant and Research Centre in Ireland was conducted, and a review of the literature was carried out using PubMed and Google Scholar. RESULTS: Of the three SCUBA divers with cochlear implants, two required reimplantation, the first due to nonauditory stimulation, and the second due to extrusion of the electrode through the tympanic membrane following repetitive SCUBA dives. The third patient remains without complications after 80 dives. CONCLUSIONS: Patients with cochlear implants can have complications relating to the implant itself, with device failure a theoretical risk. The cochleostomy can lead to perilymphatic extravasation, as well as inner ear barotrauma, decompression sickness, and formation of air bubbles along the electrode. A combination of deafness, vestibulopathy with abrupt perilymph leak, and loss of proprioception can lead to disorientation and blue dome syndrome. Based on our experience with cochlear implants in SCUBA divers, along with those reported in the literature, we recommend caution in patients with cochlear implants who SCUBA dive regularly and strict adherence to the recommended safety limits. LEVEL OF EVIDENCE: 4 129:2760-2764, 2019.
Subject(s)
Barotrauma/complications , Cochlear Implants , Diving/adverse effects , Hearing/physiology , Postoperative Complications/etiology , Adult , Female , Humans , Male , Middle Aged , Postoperative Complications/physiopathology , Retrospective StudiesABSTRACT
OBJECTIVES: Cochlear implantation (CI) is considered an effective and relatively safe procedure for patients with severe-profound hearing loss. However, severe complications are reported in several studies. The purpose of this study was to report the frequency and management of major complications following CI surgery at the National CI Programme (NCIP) in Ireland. METHODS: Major complications were defined according to the classification of Hansen et al. 2010. The medical records of 1017 patients undergoing CI between 1995 and 2016 were analyzed retrospectively for major complications. In addition, radiological and intraoperative findings as well as therapeutic management of all patients with a major complication were reviewed. RESULTS: Altogether, 1017 patients underwent 1266 CI surgeries. The median follow-up of all CI surgeries was 44 months. The total number of major complications identified was 21 which corresponds to an overall rate of 1.7%. The majority of major complication (71%) occurred at least one week after surgery. The most common major complications were internal receiver/stimulator protrusion and migration (6/21), followed by migration of the electrode array (4/21) and recurrent otitis media requiring re-implantation (4/21). All patients with major complications required additional surgery, with reimplantation necessary in 19 patients (90%). DISCUSSION: CI surgery is a safe surgical procedure for hearing rehabilitation associated with a low rate of severe complications. However, major complications can occur many years after surgery, making revision surgery necessary. CONCLUSION: Long-term follow-up is necessary for the early identification of complications to facilitate appropriate care.
Subject(s)
Cochlear Implantation/adverse effects , Cochlear Implants/adverse effects , Deafness/surgery , Postoperative Complications/epidemiology , Adult , Child , Cochlear Implantation/methods , Female , Humans , Incidence , Ireland/epidemiology , Male , Otitis Media/epidemiology , Otitis Media/etiology , Postoperative Complications/etiology , Prosthesis Failure , Reoperation/statistics & numerical data , Retrospective Studies , Treatment OutcomeABSTRACT
This study was performed to investigate the effect of cochlear implantation on the Quality of Life (QoL) of children with profound and multiple learning disability (PMLD). This cohort of children has been viewed historically as poor candidates for cochlear implantation as they generally have poor speech and hearing outcomes. The Irish National Cochlear Implant Program's prospectively maintained database was examined for all children implanted from July 1996 to July 2015. All charts of the 381 children implanted during this time were reviewed retrospectively; 16 children met criteria for being PMLD. For this cohort of patients, speech and hearing performance and the Glasgow Children's Benefit Inventory scores were retrospectively analyzed. Speech and hearing outcomes, as measured by Categories of Auditory Performance (CAP) and Speech Intelligibility Rating (SIR) scores, demonstrated little or no improvement from pre-implantation to an interval 3 years post-op; however, 11 out of 16 parents reported an improvement in their child's quality of life after implantation with 3 out of 16 reporting no improvement. This study suggests that despite children with PMLD performing poorly on traditional outcome measures such as CAP and SIR they may have improvement to their QoL after cochlear implantation. Further study is warranted to characterize the impact of CI on these children.
Subject(s)
Cochlear Implantation/adverse effects , Hearing Loss/psychology , Learning Disabilities/etiology , Postoperative Complications/etiology , Quality of Life , Adolescent , Child , Child, Preschool , Databases, Factual , Female , Hearing Loss/surgery , Hearing Tests , Humans , Infant , Ireland , Language Development , Male , Postoperative Period , Retrospective Studies , Speech Intelligibility , Treatment OutcomeABSTRACT
OBJECTIVES/HYPOTHESIS: Vocal fold paralysis is the second most common congenital laryngeal anomaly in newborns. Bilateral paralysis is a severe condition and often remains of unknown etiology. We report our experience of congenital idiopathic bilateral vocal fold paralysis in newborns and infants, and discuss the therapeutic options. STUDY DESIGN: Retrospective review. METHODS: A retrospective review was carried out at a single tertiary referral center over a 15-year period of children presenting with congenital idiopathic bilateral laryngeal paralysis (CIBP). RESULTS: Twenty-six patients were identified and managed over period of the study (mean follow-up, 6.7 years). A tracheostomy was eventually performed in 14 patients, 12 during the neonatal period. Endoscopic treatment was performed in 16 patients and an external approach in five patients after endoscopic failure. Three patients were managed by watchful waiting. Spontaneous recovery occurred in 16 patients (median age, 14.5 months), including nine with a tracheostomy. Decannulation was achieved in 12 patients (median age, 42 months), and noninvasive positive pressure ventilation (NPPV) was applied in six patients. CONCLUSIONS: Only inhomogeneous series of pediatric bilateral laryngeal palsies have been published so far, making it difficult to identify prognostic and predictive markers, as well as therapeutic guidelines. Focusing on CIBP, our data suggest that the management strategy must take into account the possibility of a delayed spontaneous recovery. NPPV is an interesting therapeutic tool in this situation. A systematic somatic assessment is mandatory to look for associated conditions.
Subject(s)
Disease Management , Vocal Cord Paralysis/congenital , Vocal Cord Paralysis/therapy , Humans , InfantABSTRACT
OBJECTIVE: This study aimed to report pediatric cochlear reimplantation data focusing on failure of the device and to assess surgical challenges and functional outcomes. METHODS: Retrospective case review from 1990 to 2012. Tertiary referral academic center. A retrospective review of medical and surgical records, audiologic results, and report of the manufacturer's analysis was performed. The causes of revision cochlear implantation were divided into hard failure and soft failure. Results compared speech perception in open set or closed set words before and after revision surgery with cochlear implant only. RESULTS: During the study period, 877 cochlear implantations were performed. Our reimplantation rate for failure of the device is 5.7% (50 of 877). The main reasons for hard failure were loss of hermeticity and cracked casing following head trauma. Surgical difficulties might be due to neo-osteogenesis related to the use of bone dust. Initial atraumatic insertion is important to ensure that revision surgeries are less problematic. In postmeningitis deafness, initial choice of electrode array is of utmost importance. We would suggest a plain shape and a larger diameter array, to ensure sufficient subsequent insertion. Post-reimplantation audiologic results were the same or better than preoperative levels in 86% of cases. CONCLUSION: Failure might be difficult to diagnose in children with limited language skills. The surgical team and patients should be aware of the surgical difficulties that can be encountered, especially in cases of meningitis or initial traumatic insertion. Auditory performances after reimplantation are the same or better in most cases.
Subject(s)
Cochlear Implants , Hearing Loss/surgery , Prosthesis Failure , Speech Perception/physiology , Audiometry , Child , Child, Preschool , Female , Follow-Up Studies , Hearing Loss/physiopathology , Humans , Infant , Male , Reoperation , Retrospective Studies , Treatment OutcomeABSTRACT
OBJECTIVE: To determine the indications for, and auditory outcomes following, cochlear reimplantation in adults and investigate factors influencing outcome. STUDY DESIGN: Retrospective case series. SETTING: Cochlear implant program in a tertiary care hospital. PATIENTS: Thirty adults (32 ears) who have undergone cochlear reimplantation in the ipsilateral ear. INTERVENTION(S): Explantation and reimplantation of cochlear implant. MAIN OUTCOME MEASURE(S): Speech discrimination as measured using Bamford-Kowal Bench sentence testing in quiet (BKBq) and noisy (BKBn) environments. RESULTS: Best BKBq improved from 58.5% to 71.4% (p = 0.0242), and BKBn improved from 60.9% to 67.2% (p = 0.826) after reimplantation. Device failure was the most common indication for reimplantation. There was no significant difference in failure rate or outcome between implant manufacturers. The mean time to reimplantation was 4.7 years, and this was not related to auditory outcome. Otosclerosis and Ménière's disease may predispose to a worse auditory outcome after reimplantation. CONCLUSION: Cochlear reimplantation does not have a detrimental effect on auditory outcomes and in some cases results in improved speech perception.
Subject(s)
Cochlea , Cochlear Implantation/methods , Equipment Failure , Hearing Loss/surgery , Speech Perception , Adult , Aged , Cochlea/surgery , Cochlear Implants , Female , Humans , Male , Meniere Disease , Middle Aged , Noise , Reoperation , Retrospective Studies , Treatment OutcomeABSTRACT
OBJECTIVE: To investigate the outcomes from ipsilateral simultaneous or sequential cochlear implantation in patients with neurofibromatosis type 2 (NF2) after vestibular schwannoma removal with cochlear nerve preservation. STUDY DESIGN: Retrospective case series. SETTING: Single tertiary referral NF2 center. PATIENTS: Six patients with NF2. INTERVENTION: Removal of vestibular schwannoma (VS) with preservation of the cochlear nerve and cochlear implantation. Four patients had their surgery via a translabyrinthine approach. Two patients had a retrosigmoid approach. A cochlear implant was inserted at the same time as tumor removal in 4 cases and sequentially in 2 cases. MAIN OUTCOME MEASURES: Surgical and audiometric outcomes using Bamford-Kowal-Bench (BKB) and City of New York University (CUNY) sentence scores. RESULTS: The average age at implantation was 24 years (range, 15-36 yr). Follow-up ranged from 5 to 93 months, with an average of 38 months. All patients had useful hearing in the contralateral ear before surgery. One patient gained no benefit from cochlear implantation and proceeded to have an auditory brainstem implant. Of those that had functional cochlear nerves, the average BKB score in quiet was 64%, BKB score in noise was 42%, and CUNY score with lipreading was 97%. Results varied within the group, but all patients gained significant benefit and continue to use their CI at least intermittantly. CONCLUSION: The present series demonstrates that in selected cases, cochlear implantation can be successful after a translabyrinthine approach for VS removal and for restoring hearing after failed retrosigmoid hearing preservation surgery. All patients found the cochlear implant offered useful hearing even in the presence of contralateral hearing.
Subject(s)
Cochlear Implantation/methods , Neurofibromatosis 2/surgery , Neuroma, Acoustic/surgery , Speech Perception/physiology , Adult , Audiometry, Pure-Tone , Cochlear Implants , Cochlear Nerve/physiopathology , Cochlear Nerve/surgery , Female , Hearing/physiology , Humans , Male , Neurofibromatosis 2/physiopathology , Retrospective Studies , Treatment OutcomeABSTRACT
OBJECTIVES/HYPOTHESIS: This study aimed to report our experience in the management of congenital laryngeal stenosis and to compare our series and results to published data in the literature. STUDY DESIGN: Retrospective case series. Tertiary referral center for rare pediatric head and neck malformations. METHODS: Medical charts of patients diagnosed with congenital laryngeal stenosis in our institution were reviewed over a 15-year period, from 1996 to 2011. Surgical treatment consisted of an endoscopic procedure, open laryngeal surgery (OLS), or a combination of both. RESULTS: Sixteen patients met the inclusion criteria for the study and were divided in two groups: the endoscopic laryngoplasty (EL) group, with patients who underwent the endoscopic procedure as first-line treatment, and the OLS group, whose patients underwent open laryngoplasty with cartilage graft as first-line treatment. Each group contained eight patients with grade II to IV congenital stenosis. All patients, except one in the EL group, achieved a good result (<50% residual stenosis) at the end of the follow-up. CONCLUSIONS: This case series suggests that EL, with incision of the subglottic laryngeal cartilages with cold steel instruments and balloon dilation, is a safe and effective treatment for congenital laryngeal stenosis grade II to IV. This procedure could be considered as an alternative option to OLS, even as a first-line procedure. An endoscopic procedure does not preclude the possibility for an open laryngeal procedure in case of failure. A prolonged follow-up is mandatory. LEVEL OF EVIDENCE: 4.
Subject(s)
Laryngoplasty/methods , Laryngoscopy/methods , Laryngostenosis/therapy , Larynx/abnormalities , Child, Preschool , Female , Follow-Up Studies , Humans , Infant , Infant, Newborn , Laryngostenosis/congenital , Laryngostenosis/diagnosis , Larynx/surgery , Male , Retrospective Studies , Treatment OutcomeABSTRACT
BACKGROUND: Congenital facial paralysis is a rare disorder with an incidence of less than 1 in 1000 live births. Several surgical rehabilitation techniques have been described, such as free flaps or transpositions of the temporalis muscle. We report our experience of transposition of the temporalis muscle in this indication. MATERIALS AND METHODS: Retrospective monocentric study between January 2005 and December 2009. RESULTS: Five children (mean age at the surgery: 7.3 years, range 6-13) presenting with a congenital facial paralysis were treated by a temporalis muscle transposition during the considered period. An etiological assessment was achieved by carrying out a petrous bone CT, a cerebral and petrous MRI, and audiometric evaluation. Four patients out of 5 (80%) showed a satisfactory and stable functional outcome over time (average follow-up: 26 months). CONCLUSION: Temporalis muscle transposition is a single-stage procedure, easily adapted for the pediatric condition of congenital facial paralysis. It is our opinion that this procedure needs to be carried out at the end of the pre-school period.
Subject(s)
Facial Paralysis/congenital , Surgical Flaps , Temporal Muscle/transplantation , Adolescent , Child , Facial Paralysis/surgery , Female , Humans , Male , Retrospective Studies , Treatment OutcomeABSTRACT
The authors present a case of nasal chondromesenchymal hamartoma (NCMH) in an 8-year-old boy with a 4-month history of frontal headache and no symptoms of nasal obstruction, rhinorrhoea or postnasal drip. An ENT examination as well as ophthalmology assessment presented normal results. CT scan showed a lesion involving the sphenoid and ethmoid sinuses. The patient had an endoscopic resection of the lesion that was confirmed histologically to be a NCMH. Though NCMH is known to present usually in infants with obstructing nasal mass, an unusual presentation of a patient with throbbing headache without any nasal symptoms is reported here.
Subject(s)
Cartilage Diseases/complications , Hamartoma/complications , Nasal Obstruction/etiology , Cartilage Diseases/diagnosis , Child , Diagnosis, Differential , Hamartoma/diagnosis , Humans , Male , Nasal Obstruction/diagnosis , Nose Diseases/complications , Nose Diseases/diagnosis , Tomography, X-Ray ComputedABSTRACT
Neurotrophin-BDNF can be effectively encapsulated in nanoporous poly(L-glutamic acid) particles prepared via mesoporous silica templating. The loaded BDNF can be released in a sustained manner with retained biological activity. Animal experiments demonstrate the released BDNF can efficiently rescue the auditory neurons (as indicated by the arrows) in the cochlea of guinea pigs with sensorineural hearing loss.