Subtotal Petrosectomy and Cochlear Implantation in Children With Chronic Suppurative Otitis Media: A Single Institutional Experience.

BACKGROUND AND OBJECTIVES: Chronic suppurative otitis media (CSOM) with or without cholesteatoma is a frequent chronic inflammatory condition in children, which may lead to severe hearing loss that affects speech development. Treatment of recurrent CSOM associated with unserviceable hearing requires a specialized approach with regard to disease eradication and hearing rehabilitation. In this study, we investigated the advantages of subtotal petrosectomy (SP) combined with cochlear implantation (CI) in children with CSOM associated with unserviceable hearing and describe our experience with regard to the efficacy of this method, together with a literature review. SUBJECTS AND METHODS: SP with sequential or simultaneous CI was performed in three children (four ears), and postoperative audiometric data were recorded. RESULTS: The study included two male and one female patient. Mean age at the time of SP was 10.75 years (7-13 years). Sequential implantation was performed in three ears. Facial nerve palsy occurred after SP in one patient. The latest word recognition scores of Cases 1, 2, and 3 were 80% (at 60 dB), 75% (at 60 dB), and 70% (at 50 dB) and 90% (at 50 dB), respectively. CONCLUSIONS: SP with CI may be safe and reliable in children with CSOM associated with unserviceable hearing.

Staged surgical management of idiopathic sudden sensorineural hearing loss refractory to medical treatment / A gyógyszeres kezelésre nem javuló hirtelen halláscsökkenés lépcsozetes sebészi terápiája.

Összefoglaló. A hirtelen halláscsökkenés patofiziológiája még nagyrészt tisztázatlan, így oki terápia nem lehetséges. Az elsodleges kezelést a helyileg vagy szisztémásan adott kortikoszteroid jelenti, egységes protokoll azonban nem áll rendelkezésre. Nagy vagy súlyos fokú hirtelen halláscsökkenés esetén kóroki tényezoként felmerül a perilymphafistula lehetosége még azoknál a betegeknél is, akiknél nem szerepel trauma az anamnézisben. A kórkép mutéti kezelése a dobüreg feltárását követoen a belso fül ablakainak obliterálása. Amennyiben ez a megoldás nem eredményez megfelelo hallásjavulást, hagyományos vagy implantálható hallókészülékek alkalmazása javasolt. A közleményben részletezett esetünkben teljes siketséggel járó, jobb oldali hirtelen halláscsökkenés alakult ki, melynek hátterében egyértelmu okot azonosítani nem sikerült. Az eredménytelen kombinált, intratympanalis és szisztémás szteroidkezelést követoen exploratív tympanotomiát végeztünk, melynek során a belso fül ablakait obliteráltuk. Hallásjavulást ezt követoen sem sikerült kimutatni, így cochlearis implantáció elvégzése mellett döntöttünk. Az implantációt a kerek ablakon keresztül végeztük, mely alapján kijelenthetjük, hogy az elozetes kerekablak-obliteráció nem zárja ki a késobbi cochlearis implantációt. Orv Hetil. 2021; 162(51): 2055-2060. Summary. The pathophysiology of sudden sensorineural hearing loss is mainly unknown, therefore no causative treatment exists. Systemic and local administration of corticosteroids serves as first line therapy although protocols vary. In cases of severe or profound hearing loss with no improvement for medical therapy, perilymphatic fistulae can be assumed even without any history of trauma. Therefore, inner ear window obliteration as a primary surgical option in the early stage can be considered. For patients without complete recovery, conventional hearing aids or implantable hearing devices can be offered. In our case report, we present a patient with right sided idiopathic sudden deafness. After failure of conservative combined intratympanic and systemic steroid therapy, explorative tympanotomy and obliteration of the inner ear windows were performed. As no hearing improvement was witnessed, successful cochlear implantation via round window insertion was performed. Our case justifies that obliterating the round window membrane does not rule out further successful cochlear implantation. Orv Hetil. 2021; 162(51): 2055-2060.

The first direct acoustic middle-ear implantation in Hungary / Az elso hazai direkt akusztikus középfül-implantáció

Due to the remarkable development in the field of hearing implantation, almost all kinds of hearing loss can be successfully rehabilitated. The first Hungarian Codacs™ (Cochlear's direct acoustic cochlear stimulator; Cochlear, Sydney, Australia) implantation was performed at the Department of Otorhinolaryngology and Head-Neck Surgery, Clinical Centre, University of Pécs. This electromechanical middle-ear implant can be offered for patients with bilateral, severe to profound, mixed-type hearing loss. In our case, a 67-year-old male patient with bilateral advanced otosclerosis was implanted, which led to significant improvement of the hearing threshold and speech reception. Orv Hetil. 2020; 161(24): 1015-1019.

[First experiences with Cochlear Implant Function Index (CIFI) in Hungary]. / A Cochlearis Implantáltak Funkcionális Indexe (CIFI) magyarországi bevezetésével szerzett kezdeti tapasztalatok.

Introduction: The success of cochlear implantation can be evaluated with audiological measurements and quality of life questionnaires. Aim: Our aim was to translate and introduce the Cochlear Implant Function Index (CIFI) test to analyze the physical, psychological and social state of our cochlear implant patients. Method: Between 01. 11. 2016 and 31. 05. 2018, 30 patients filled the questionnaire before and 6 and 12 months after the implantation. Results and conclusion: Results showed a remarkable improvement in the quality of life in several patients even after 6 months. Further improvements could be measured after 12 months. Orv Hetil. 2019; 160(33): 1296-1303.

[Analysis of prognostic factors influencing the effectiveness of treatment in sudden sensorineural hearing loss]. / A hirtelen halláscsökkenés javulásában szerepet játszó prognosztikai faktorok vizsgálata.

Sudden sensorineural hearing loss is defined as a greater than 30 dB deterioration in at least 3 consecutive frequencies occurring within 72 hours. The disease is mostly idiopathic and needs an urgent treatment. Between 01. 01. 2015 and 31. 12. 2016, 149 patients with sudden hearing loss were admitted to the Department of Otorhinolaryngology, University of Pécs. The epidemiological data, the prognostic factors and the outcome of the treatment were retrospectively analyzed. Isolated high frequency (p = 0.012) and less severe hearing loss (p<0.001), older age (p = 0.005), comorbodities like cardiovascular disease (p = 0.009) and diabetes (p = 0.029) were found as negative prognostic factors. Time of introduction of the treatment, gender, and side of the affected ear did not influence the outcome. Our finding was mainly congruent to the literature. Orv Hetil. 2019; 160(18): 687-693.

Perinatal positive and negative influences on the early neurobehavioral reflex and motor development.

Early life events are critical in the development of the central nervous system. Injuries in this period can cause severe damage with permanent disabilities. The early changes following a perinatal lesion have prognostic significance. The nervous system in young age has a potential for plasticity and regeneration, which can prevent the negative effects of neuronal damage, and the most important objective of rehabilitation is to enhance this inner potential of the developing brain. Experimental examination of the environmental factors affecting this regeneration and remodeling process is very important. Endogenous factors, such as neurotrophic factors, which play a role in neurogenesis, migration, and differentiation of neurons, and development of neuronal circuits, are also in the center of interest. Most studies concerning the effect of positive or negative perinatal treatments focus mainly on long-term effects, and most examinations are carried out on adult animals following perinatal injuries. Less data are available on short-term effects and early neurobehavioral changes. In the past several years, we have shown how different (positive or negative) perinatal events affect the early neuronal development. Applying different tests widely used for behavioral testing, we have established a standardized testing method. This includes measuring parameters of somatic growth and facial development, appearance of basic neurological reflexes and also reflex performance, more complex motor coordination tests, and open-field and novelty-seeking tests. In the present chapter, we summarize data on early neurobehavioral development of newborn rats subjected to negative (perinatal asphyxia, hypoxia, excitotoxic injury, stress) and positive (enriched environment, neurotrophic factor treatment) stimuli during early postnatal life.