Cochlear Implants in Neurologically Impaired Children: A Survey of Health-Related Quality of Life.

OBJECTIVES: Evaluate health-related quality-of-life (HRQoL) measures in noncommunicative, neurologically impaired, developmentally delayed (NCNIDD) children compared to normally developing children (ND) who undergo cochlear implantation (CI). STUDY DESIGN: Cross-sectional survey of parents of NCNIDD and ND children who underwent CI. SETTING: Two tertiary care medical centers. METHODS: Questions comprising the Children With Cochlear Implants: Parental Perspectives survey were used in analysis. Average responses were calculated within 8 domains (communication, general functioning, self-reliance, well-being and happiness, social relationships, education, effects of implantation, and support the child). Groups were compared using Wilcoxon rank-sum test. Impact of individual and collective socioeconomic/family covariates was assessed using analysis of variance. RESULTS: Surveys were returned from 17 of 42 (40%) patients with NCNIDD and 35 of 131 (27%) patients with ND. There were no statistically significant differences between groups in survey response rate, age, sex, age at implantation, current age, or duration of implant use. Overall, parents of children with ND responded more favorably in all domains vs children with NCNIDD. Parents of children with NCNIDD answered neutrally or favorably in all domains, except "support the child" and "self-reliance" domains. Differences between groups in mean domain scores, univariably and almost universally when adjusting for socioeconomic and family variables individually and collectively, were statistically significant. CONCLUSIONS: This study suggests that HRQoL benefits of CI are perceived in most domains by parents of children with NCNIDD, albeit less strongly than children with ND. A survey sensitive to challenges of children with NCNIDD may better capture benefits that may not be apparent in this study.

Initial hearing preservation outcomes of cochlear implantation with a slim perimodiolar electrode array.

OBJECTIVE: To assess the slim modiolar array as a hearing preservation electrode. METHODS: Retrospective chart review of adult, post-lingual CI recipients implanted with slim modiolar array Sept 2016 to July 2017 in a tertiary referral center. Baseline audiograms were obtained within six months of initial CI evaluation. Patients with low frequency pure tone average (LFPTA) (125, 250, 500 Hz) <80 dB were considered HP candidates. Postoperative audiograms were obtained within 48 h before activation. Successful HP was considered as (1) retention of LFPTA threshold <80 dB and (2) change in threshold from pre- to post-operative. RESULTS: Sixty-three patients received the slim perimodiolar array and 42 were HP candidates. Post-operative audiograms were obtained for 39 of 42 patients an average of 28.92 days after surgery. 56.4% of HP candidates retainedLFPTA <80 dB. Mean ΔLFPTA was 24.15 dB (±16.14; p < 0.001). 56.4% of HP candidates experienced Δ LFPTA <20 dB; 69.2% <30 dB. Functional hearing preservation was more successful in lower frequencies where starting thresholds were better - 78% with LFPTA <50 dB retained serviceable hearing at activation. The postoperative change was similar in each low frequency (Δ125 Hz: mean 21.25 +/- 14.76 (N = 28); Δ250 Hz: 26.28 +/- 19.29 (N = 39); Δ500 Hz: 25.00 +/- 17.73 (N = 39)). CONCLUSIONS: The slim perimodiolar array is moderately effective at immediate hearing preservation. In subjects with preoperative audiometric profiles similar to those in prior EAS trials, immediate HP is comparable.

Slim Perimodiolar Arrays Are as Effective as Slim Lateral Wall Arrays for Functional Hearing Preservation After Cochlear Implantation.

OBJECTIVE: To compare functional hearing preservation (HP) with a slim perimodiolar array (SPA) and a slim lateral wall array (SLW) in cochlear implantation (CI). STUDY DESIGN: Retrospective chart review. SETTING: Tertiary referral center. PATIENTS: All adult, post-lingual CI recipients with serviceable preoperative hearing serially implanted with SPA or SLW electrodes from July 2015 through July 2018. INTERVENTIONS: Cochlear implantation. MAIN OUTCOME MEASURES: Hearing preservation (HP). Patients with a low frequency pure-tone average (LFPTA) (125, 250, 500 Hz) threshold less than 80 dB were considered HP candidates based on preoperative audiograms. Postoperative audiograms were obtained before activation. Successful HP was defined as retention of LFPTA less than 80 dB. The change in LFPTA (ΔLFPTA) was also calculated. RESULTS: One hundred twenty one patients were implanted with either the SPA or SLW electrodes, 82 (42,40) of whom were HP candidates with postoperative audiograms. Average (standard deviation, SD) preoperative LFPTA was 54.86 [19.38] and 54.38 [13.58] dB for SLW and SPA respectively, with a mean ΔLFPTA of 24.6 [15.94] and 24.92 [16.66] dB. Successful HP was achieved in 21 (50%) and 22 (55%). Preoperative LFTPA, ΔLFPTA, and postoperative LFPTA were not significantly different (p = 0.89, 0.75, 0.93) between electrodes. CONCLUSIONS: The SPA is as effective at immediate functional HP after CI as a SLW.

Fungal otitis externa as a cause of tympanic membrane perforation: a case series.

We describe a series of 11 patients--8 men and 3 women, aged 18 to 70 years (mean: 46.0)--who had fungal otitis externa that had been complicated by a tympanic membrane perforation. These patients had been referred to us for evaluation of chronic, mostly treatment-refractory otitis externa, which had manifested as otorrhea, otalgia, and/or pruritus. Seven of the 11 patients had no history of ear problems prior to their current condition. Five patients had been referred to us by a primary care physician and 4 by an otolaryngologist; the other 2 patients were self-referred. All patients were treated with a thorough debridement of the ear and one of two antifungal medication regimens. Eight of the 11 patients experienced a complete resolution of signs and symptoms, including closure of the tympanic membrane perforation. The other 3 patients underwent either a tympanoplasty (n = 2) or a fat-graft myringotomy (n = 1) because the perforation did not close within a reasonable amount of time. This series demonstrates that the nonspecific signs and symptoms of fungal otitis externa can make diagnosis difficult for both primary care physicians and general otolaryngologists. This study also demonstrates that most cases of tympanic membrane perforation secondary to fungal otitis externa will resolve with cleaning of the ear and proper medical treatment. Therefore, most patients with this condition will not require surgery.

Osseointegrated hearing implant surgery: outcomes using a minimal soft tissue removal technique.

OBJECTIVES: (1) To report on the results and complications arising from using a minimal tissue removal procedure for the placement of an osseointegrated hearing implant. (2) To comment on the advantages and disadvantages for this technique compared to current standard techniques. STUDY DESIGN: Case series with chart review; 2008-2010. SETTING: Tertiary care facility. SUBJECTS AND METHODS: All consecutive patients undergoing osseointegrated hearing implant surgery with a minimal tissue removal technique were reviewed. TECHNIQUE: A small incision (1.5 cm) with little to no soft tissue (fat only) removal with good skin to periosteum fixation after placement of implant and abutment. RESULTS: Thirty-one adults were assessed (aged 18-86, range of follow-up 3-45 months). No patients experienced hair loss, significant numbness, cosmetic defects, or intraoperative or audiologic complications. Eight patients required some combination of antibiotic ointment, steroid ointment, and/or oral antibiotic for mild erythema around the abutment, and 3 patients required soft tissue revision. Five children under the age of 18 were also assessed. One of these patients required soft tissue revision in the operating room and 1 required removal of the implant. CONCLUSIONS: We have demonstrated comparable outcomes to other surgical techniques with less cosmetic and other associated complaints. This study indicates that a less invasive approach for the surgical implantation of the osseointegrated auditory implant may have merit.