Surgical and functional outcomes of two types of transcutaneous bone conduction implants.

OBJECTIVE: This study aimed to evaluate surgical and functional outcomes, in a tertiary referral centre, of two different types of semi-implantable transcutaneous bone conduction devices. METHOD: This study involved prospective data collection and review of patients implanted between November 2014 and December 2016. Glasgow Hearing Aid Inventory (Glasgow Hearing Aid Benefit Profile or Glasgow Hearing Aid Difference Profile) and Client Oriented Scale of Improvement were completed where appropriate. Surgical and audiological outcomes were recorded in the surgical notes. RESULTS: Glasgow Hearing Aid Difference Profile and Glasgow Hearing Aid Benefit Profile showed similar mean score in the active and the passive transcutaneous bone conduction devices. Client Oriented Scale of Improvement showed improvements in listening situations. Post-operative speech reception threshold showed better mean threshold in the active transcutaneous bone conduction devices group when compared with the passive transcutaneous bone conduction devices group. No device failures or surgical complications existed in either group, with the surgical time being less in the passive transcutaneous bone conduction devices group. CONCLUSION: Both devices are reliable semi-implantable transcutaneous bone conduction devices with excellent surgical and functional outcomes and patient satisfaction. Overall surgical time was much less in the passive transcutaneous bone conduction devices group with no necessity for pre-planning. This is much easier to remove with the possibility of conversion to other devices in the manufacturer's portfolio and wide-ranging wireless accessories. Further studies are needed to assess the longer-term results in a bigger population.

Soft-tissue outcomes following implantation of different types of bone conduction hearing devices in a single centre.

OBJECTIVE: To compare soft-tissue complications following implantation of different bone conduction hearing devices. METHODS: Adults who underwent implantation of different bone conduction hearing devices, between January 2008 and December 2016, were included in the study. Five groups were identified depending on the soft-tissue approach: (1) split-thickness skin flap with use of dermatome; (2) Sheffield 'S'-shaped incision with skin thinning; (3) linear incision without skin thinning (hydroxyapatite-coated abutment); (4) 'C'-shaped full-thickness incision for passive transcutaneous bone conduction hearing devices; and (5) post-aural incision for active transcutaneous bone conduction hearing devices. The main outcome measures were different soft-tissue complications. RESULTS: The study comprised 120 patients (group 1 = 20 patients, group 2 = 35, group 3 = 35, group 4 = 20, and group 5 = 10). Soft tissue related problems were encountered in 55 per cent of patients from group 1, 26 per cent in group 2, 3 per cent in group 3, and 0 per cent in groups 4 and 5. CONCLUSION: There was a reduction in soft tissue related complications with reduced soft-tissue handling. In addition, there was a shift from an initial skin-penetrating (percutaneous) approach to a non-skin-penetrating (transcutaneous) approach.

Paediatric epiglottitis: the influence of the Haemophilus influenzae b vaccine, a ten-year review in the Sheffield region.

Cases of acute epiglottitis in children have become very uncommon in recent years. This study set out to find whether the introduction of the Haemophilus influenzae b (Hib) vaccine in the UK in October 1992 has influenced the incidence of acute epiglottitis in the Sheffield region, and whether the pathogenesis has altered. A 10-year retrospective case note review was undertaken. A total of 30 children were treated for acute epiglottitis in Sheffield Children's Hospital over that time period. A sharp decline in the number of cases was found after the vaccine was introduced. Most children presenting with the disease after October 1992 had not been vaccinated. In addition, the pathogens isolated in those children who had received the vaccine were all Streptococci. This is the first study in the UK to examine the influence of the Hib vaccine on acute paediatric epiglottitis.

Effect of conductive hearing loss on the vestibulo-collic reflex.

The vestibulo-collic reflex represents a promising test for evaluating the integrity of otolith function. We have investigated the threshold of this response in a group of normal subjects, and the effect of a conductive hearing loss. A positive response was recorded in 31 of 32 normal subjects. The threshold of the vestibulo-collic reflex varied from 80 to 97 dBHL in these subjects with a 95% response rate at a threshold at 96 dBHL. A total of 23 ears with a conductive hearing loss in 17 patients were also investigated. The average conductive hearing loss (at 0.5, 1, 2 and 4 kHz) ranged from 8.75 to 40 dBHL (average 24.46 dBHL). A positive response was recorded in only two ears. Therefore, the vestibulo-collic reflex has a high stimulus threshold which is dependant on reliable transmission of the click stimulus to the inner ear thus limiting is clinical use.

Early post-operative morbidity following tonsillectomy in children: implications for day surgery.

Adenotonsillectomy and tonsillectomy are amongst the most commonly performed surgical procedures. In our prospective study we looked at early post-operative morbidity (haemorrhage, vomiting and pyrexia) in 521 consecutive children following tonsillectomy, adenotonsillectomy and adenoidectomy. While the incidence of reactionary haemorrhage is low, pyrexia and vomiting are common. The implications of this high early post-operative morbidity for day surgery are discussed.

Use of transient evoked otoacoustic emissions to detect and monitor cochlear damage caused by platinum-containing drugs.

Transient evoked otoacoustic emissions (TEOAE) have been evaluated as a means of monitoring cochlear function in patients receiving the chemotherapeutic agents cisplatin and carboplatin (-cis-diammine, 1,1-cyclobutane dicarboxylate (2) -0,0-platinum). Patients receiving these drugs were monitored prospectively with pure tone audiometry (PTA), tympanometry and TEOAE. Data was collected on 22 subjects receiving cisplatin and nine subjects receiving carboplatin. Significant deterioration in both PTA thresholds and TEOAE energy levels (with no change in tympanometry) were detected in the cisplatin group. No significant deterioration in audiological parameters occurred in the carboplatin group. It is indicated that cisplatin has a significant ototoxic effect in the majority of patients, whereas any ototoxic effect of carboplatin was undetectable. Our findings were different from previous studies in that the measurable changes in TEOAE occurred later than changes in the pure tone audiogram for the cisplatin group.

The vestibulo-collic reflex.

Until now there has no been no simple, reliable clinical test that assesses the function of the otolith organs. However, recent work has suggested the occurrence of an easily identifiable electromyographic (EMG) waveform in isometrically contracting sternomastoid muscles in response to loud clicks. This is thought to represent an otolith evoked disynaptic reflex. Equipment routinely used for evoked response audiometry (ERA) has been adapted to investigate this response. A short latency (8 ms) positive-negative EMG waveform has been recorded in 31 of 32 normal subjects. The latency of the positive peak (P1) is 11.7 ms (SD = 0.89), and the negative peak (N1) is 20.5 ms (SD = 1.89). It is predominantly ipsilateral, although a contralateral response was present in 35.5%. The response has also been recorded in three patients with a severe unilateral sensorineural hearing loss and normal caloric responses, and in a patient undergoing cochlear implantation for profound bilateral sensorineural hearing loss. Further work is required to delineate the value of this technique in investigating vestibular lesions.

Palatoplasty for snoring: a randomized controlled trial of three surgical methods.

In a randomized, controlled trial, 62 patients (47 men and 15 women) with severe antisocial snoring, but no sleep apnea, were allocated to one of three surgical treatments. These were uvulopalatopharyngoplasty, laser palatoplasty, and diathermy palatoplasty. Postoperative morbidity was measured on a visual analogue scale of severity of pain, dysphagia, and nasal regurgitation at 1, 2, and 7 days after the operation. Efficacy of each procedure was measured by asking the sleeping partner to record the severity of snoring before and after the operation, again on a visual analogue scale. Measurements were taken at 1, 3, and 6 months. There were no significant differences in early postoperative morbidity among the treatment groups. Diathermy palatoplasty is a new technique for the relief of snoring that is associated with low morbidity and requires little in the way of expensive equipment.

Troy, Mycenae, and the otologic demise of Herr Heinrich Schliemann.

Heinrich Schliemann (1822-1890) was a self-made man with a remarkable aptitude for language and an excellent business mind. He was also the founder of Aegean archeology, providing a factual base for the writings of Homer, which until then had been considered merely a collection of mythologic poems. During his life, Schliemann suffered from ear trouble, ultimately dying from an otogenic temporal lobe brain abscess. He consulted many of the most famous 19th century otologists and was eventually operated on by the famous Professor Schwartze. We present the life and death of arguably the most famous man of his day as drawn from a number of biographic sources and speculate on the ear pathology that ultimately lead to his demise.

Rescued from the sands of time: interesting otologic and rhinologic findings in two ancient Egyptian mummies from the Royal Ontario Museum.

OBJECTIVE: Two mummified specimens from the Royal Ontario Museum both approximately 3500 years old were recently examined in the Ear Pathology Research Laboratory (EPRL) of the University of Toronto. High-resolution computed tomography (CT) scanning of the ancient Egyptian mummified heads was undertaken with special reference to the nasal cavities, paranasal sinuses, anterior cranial fossae, and temporal bones. The elaborate ritual for the dead that was required to prepare for the after life and our knowledge concerning the status of ear and nasal pathology in ancient Egypt is reviewed. CONCLUSION: As a result of this preliminary study, we believe we may have discovered a hitherto unrecognized step in the formal process of mummificiation.

Long-term results of trimming of the inferior turbinates.

The long-term benefit of trimming of the inferior turbinates for nasal obstruction is unclear and our aim was to assess this. Fourteen patients who had had pre-operative nasal symptom scores and anterior rhinomanometry prior to inferior turbinate resection were reassessed at least 7 years post-operatively. Both nasal symptom scores for obstruction and nasal resistance had increased significantly in the intervening time period. Nasal crusting and hypertrophy of the cut inferior turbinate are considered to be responsible for this. Patients should be warned some degree of nasal obstruction may recur postoperatively.

Trends in voice rehabilitation in the United Kingdom.

Three main basic forms of vocal rehabilitation are available for post-laryngectomy patients in this country: oesophageal, mechanical vibrator and valved speech. In Sheffield, we advocate the use of valved speech, and insertion of the prosthesis preferably at the time of laryngectomy. We studied current vocal rehabilitation trends in the United Kingdom by a random survey of 100 consultant otolaryngologists and present our findings here. While all forms of vocal rehabilitation are provided in the majority of centres, 20% of units involved in head and neck surgery do not have optimum levels of speech therapy involvement.

Day case tonsil and adenoid surgery: how many are eligible?

We wished to estimate the percentage of children undergoing tonsil and adenoid surgery who would make suitable day cases. To achieve this a prospective study of 100 consecutive children admitted for the above surgery was undertaken. A medical and social history was obtained along with the parents' attitude to the possibility of day case tonsil and adenoid surgery. We found that 59% of our population would be eligible for day case surgery on the strict criteria we used. Reasons for failure were social in 26%, medical in 6% and both in 9%.

The Sheffield Nasal Pressure Probe: the development of a new device to measure intranasal pain thresholds.

We present the development of a mechanical pressure probe which was constructed from items readily available to most university departments. The device is simple to operate and gives repeatable determinations. Its main use has been to measure the pressure thresholds for pain in the nasal mucosa.

Plexiform neurofibroma: an unusual cause of neck lump in a child.

Although relatively rare, neurofibromas have been described in many different sites. We present the unusual case of an 8-year-old girl with a plexiform neurofibroma situated deep to the sternomastoid muscle, and review the current literature with particular regard to the pathology and site of neurofibromas.

Dental prostheses and the impacted swallowed foreign body.

A common belief exists that patients who wear false teeth are more likely to present with an impacted swallowed foreign body than those with a normal dentition. This study reviewed a series of 65 patients (with data available from 45) who presented with a swallowed impacted foreign body which required endoscopic removal under general anaesthesia. With the aid of a questionnaire the incidence of dental prostheses in these patients was determined. The number of patients in our study who had either false teeth or natural dentition was compared with the expected age-related incidence of wearing dental prostheses in the general population of the United Kingdom. There were no statistically significant differences between these groups. Patients presenting with an impacted swallowed foreign body are no more likely to be wearing false teeth than any other member of the population.