Long Term Impact of Age at Implantation on Quality-of-Life Outcomes in Cochlear Implant Recipient Children.

Cochlear implantation (CI) is used in management of children with bilateral severe to profound sensorineural hearing loss (SNHL). Recently, due to technological advancements, more and more infants and toddlers are undertaking the CI. The age at implantation may have an impact on CI outcomes. The primary aim of this study was to determine the long-term impact of 'age at implantation' on Health Related Quality of Life (HRQoL) outcome post-CI. In this prospective study at a tertiary care centre, we evaluated 50 CI recipient children from 2011 to 2018. Group A consisted of 35 (70%) children who received CI at less than or equal to 5 years of age and Group B with 15 (30%) children who underwent CI at more than 5 years of age. Following CI, all children received auditory-verbal therapy and thereafter we evaluated their long-term HRQoL outcomes at 5 years post-CI. Children were assessed by Nijmegen Cochlear Implant Questionnaire (NCIQ) and Children with cochlear implants: parental perspectives-questionnaire (CCIPPQ). There were significantly improved HRQoL outcomes (with an increase of 11.7% in mean NCIQ and 11.4% in mean CCIPPQ scores) at 5 years post-CI in CI recipients of age group '5 years or less' as compared to those who underwent CI at 'more than 5 years' age [P value < 0.05 for both the mean NCIQ scores and mean CCIPPQ scores respectively]. However, for children with 'more than 5 years' age at implantation, mean NCIQ and CCIPPQ scores were still more than 80% of maximum achievable NCIQ and CCIPPQ scores. In this study, CI recipient children who were implanted at less than or equal to 5 years of age were found to have significantly improved HRQoL outcomes at 5 years post-CI. Hence, it seems desirable to provide CI at an early age. However, even in children who received CI at more than 5 years of age, there was a substantial enhancement in HRQoL outcomes and CI was still effective in these children. Hence, knowledge of 'age at implantation' may provide reasonable assistance in predicting the HRQoL outcomes and optimal counseling of parents and families of CI candidates.

Giant paravertebral myxoma.

The study design includes case report and clinical discussion. The objective was to describe a rare case of a giant intramuscular myxoma (IMM) presenting as a mass in the paravertebral muscles. Myxoma is a rare benign soft tissue tumour of mesenchymal origin. Although intramuscular presentation is common, they are rare in the paravertebral muscles and are characteristically <5 cm in length. We report the clinical and imaging features in a 70-year-old woman presenting with back pain, asymmetry of the waist and a mass in right paravertebral region. This was originally misdiagnosed as a juxtafacet synovial cyst after CT-guided biopsy. The mass was excised en bloc and sent for histology. This revealed a low-grade myxoid neoplasm with features of an IMM. The patient went on to make a complete recovery. To our knowledge, this is only the fifth case of paravertebral IMM reported in the literature and at approximately 15 cm in length may be the largest encountered in clinical practice.

Congenital lumbar hernias: A case report.

Congenital lumbar hernias are rare and associated with other malformations. There have been 42 cases reported to date. The authors report the first case in the literature of isolated bilateral congenital lumbar hernias.