Cochlear Implantation: Small Cochlear Diameter May Indicate Degree of Abnormality.

Cochlear size variation was first reported in 1884, and since then, there have been various reports confirming the same. Yet, there is no single report that has displayed the wide variations in the cochlear size in a single layout capturing the cochlea in the oblique coronal view/ cochlear view. Basal turn diameter (A-value) was measured in the oblique coronal plane using the OTOPLAN® otological preplanning tool in 104 computed tomography (CT) scans of the temporal bones of cochlear implant (CI) recipients in a tertiary CI center. All CT scans with an image resolution of at least 0.5 mm and identified as having cochleae with normal anatomy were included in this study. A 3-dimensional (3D) segmentation was performed using the 3D slicer and visualized to evaluate the impact of cochlear size on the number of turns studied. The A-value was found to vary between 7.3 mm and 10.4 mm among the studied patients. Three-dimensional segmentation of the inner ear revealed only 2 turns of the cochlea in 4 ears, with A-values of 7.3, 8.8, 7.8, and 7.7 mm. One ear had only 11 /2 turns of the cochlea, with an A-value of 7.9 mm. As a further advancement in the assessment of cochlear size as determined by the A-value, 3D segmentation of the complete inner ear provides a full picture of the number of cochlear turns. Three-dimensional segmentation of the entire inner ear could help improve the preoperative planning of CI surgery and have implications for electrode array selection. Cochlear size could be a predictor of the number of cochlear turns, even in cases that look normal from the radiological findings. The findings of this study could help in improving the preoperative planning for a more successful CI surgery by differentiating between the normal and abnormal cochlea.

Evaluation of Intraoperative Testing During Cochlear Implantation From a Time and Cost Perspective: A Single-Center Experience in the United States.

OBJECTIVE: To measure the time spent performing intraoperative testing during cochlear implantation (CI) and determine the impact on hospital charges. STUDY DESIGN: Prospective study. SETTING: Tertiary referral hospital. PATIENTS: Twenty-two children (7 mo-18 yr) who underwent a total of 22 consecutive primary and/or revision CIs by a single surgeon from December 2016 to July 2017. INTERVENTION: The time spent performing intraoperative testing, including evoked compound action potentials (ECAP) and electrical impedances (EI), was recorded for each case. The audiologist performing the testing was unaware of the time measurement and subsequent evaluations with regard to cost data. Billing information was used to determine if the testing contributed to increased operative charges to the patient. OUTCOME MEASURES: Whether intraoperative testing had an impact on operative charges to the patient. RESULTS: The average time spent in testing (ECAPs/EIs in all cases) was 6.7 minutes (range, 2-26 min). No correlation was found between testing time and preoperative computed tomography findings, the audiologist performing testing, or the electrode type used (p > 0.05). Based on billing data, including time spent in the operating room (OR), 5/22 (23%) cases incurred greater charges than if intraoperative testing had not been performed. CONCLUSION: Our data suggest that intraoperative testing increases time in the OR and can contribute to increased hospital charges for CI patients. By using testing selectively, costs incurred by patients and hospitals may be reduced. This is of interest in a healthcare environment that is increasingly focused on cost, quality, and outcomes.

Early prediction of oral calcium and vitamin D requirements in post-thyroidectomy hypocalcaemia.

OBJECTIVE: To optimize and individualize post-thyroidectomy hypocalcemia management. STUDY DESIGN: A multicenter prospective cohort study. SETTING: Two tertiary care hospitals. SUBJECTS AND METHODS: parathyroid hormone (PTH) was measured preoperatively, then at 1 and 6 hours after surgery. The required doses of calcium and vitamin D were defined as those maintaining the patients asymptomatic and their cCa ≥ 2 mmol/L. They were used as an endpoint in a generalized linear mixed effect model (GLIMMEX) aiming to identify the best predictors of these optimal required doses. Models were evaluated by goodness of fit and Receiver Operating Characteristic (ROC) curves. RESULTS: One hundred and sixty-eight patients were analyzed; 85.1% were female, 49.3% had BMI > 30, and 64% had vitamin D deficiency. Post-thyroidectomy hypocalcemia was found in 25.6%, of whom 18 (41.9%) were symptomatic and received intravenous calcium. First hour percentage of drop in PTH correlated positively with the severity of hypocalcemia (P < .0001). The GLIMMIX prediction model for oral calcium requirement was based on first-hour percentage change from preoperative PTH level, preoperative actual PTH, BMI, and thyroid function. The same predictors were identified for vitamin D, except that thyroid function was replaced with vitamin D status. These factors were used to build predictive equations for calcium and vitamin D doses. CONCLUSION: Our findings help to optimize management of post-thyroidectomy hypocalcemia by assisting in the early identification of those who are not at risk of hypocalcaemia and by guiding early effective management of those at risk. This may reduce complications and medical cost.