Cochlear implantation through the round window with a straight slotted electrode array: optimizing the surgical procedure.

The question addressed here is how optimizing the quality of insertion through the round window with the lower morbidity, when using a straight and slotted electrode array of regular length. This retrospective analysis includes all cases implanted with a cochlear implant Digisonic SP (Neurelec-Oticon Medical) since 2004. We checked the operative charts, the depth of insertion, and the follow-up. For comparisons, contingency tables were used and a Chi-square test was performed. A p value <0.05 was considered significant. 126 cases of patients with non-malformed cochleas were implanted through the round window. The mean age was 53.8 ± 16.2 for adults and 3.6 ± 2.6 for children (24 cases). The mean follow-up was 33 ± 22 months. The straight electrode array had either a square or a soft pointed tip (n = 84). Full insertion was achieved in 79 out of 84 cases with a soft tip vs. 18 out of 42 square tips (χ (2) = 41.41, DOF = 1, p < 0.0001). Two cases were stuck at the round window niche by a prominent crista fenestrae. In all cases but one, the chorda tympany was preserved. In one case, a misrouting to the vestibule required a revision surgery. Implantation through the round window with a straight and slotted electrode array with a soft tip (Digisonic SP, Neurelec-Oticon Medical) can lead to a full insertion in 94 % of cases. Drilling out a prominent crista fenestrae is recommended.

Abnormal fast fluctuations of electrocochleography and otoacoustic emissions in Menière's disease.

The responses of cochlear hair cells to sound stimuli depend on the resting position of their stereocilia bundles, which is sensitive to the chemical and mechanical environment. Cochlear hydrops, a hallmark of Menière's disease (MD), which is likely to come with disruption of this environment, results in hearing symptoms and electrophysiological signs, such as excessive changes in the cochlear summating potential (SP) and in the postural shifts of distortion-product otoacoustic emissions (DPOAEs). Here, SP from the basal part of the cochlea and DPOAEs from the apical part of the cochlea were recorded concomitantly in 73 patients with a definite MD, near an attack (n = 40) or between attacks with no clinical symptoms (n = 33), to compare their sensitivities to posture and evaluate their stability. The phase of the 2f1-f2 DPOAEs was monitored during body tilt, with stimuli f1 = 1 kHz and f2 = 1.2 kHz at 72 dB SPL. Extratympanic electrocochleography was performed in response to 95-dBnHL clicks. The normal limits of the DPOAE phase shift with body tilt, [-18°, +38°], and of the SP to action-potential (AP) ratio, <0.40, were exceeded in 75% and 60% of patients, respectively, near an attack. In these patients, but not in the asymptomatic ones, both tests reveal fluctuating cochlear responses from one data sample to the next. They emphasize how hydrops hinders normal hair-cell operation and may generate fast fluctuations in inner-ear functioning. If these fluctuations also occur on shorter time scales, it might explain the imperfect diagnostic sensitivity of SP and DPOAE tests, as averaging procedures would tend to level out transient fluctuations characteristic of hydrops.

Acute prediction of laryngeal outcome during thyroid surgery by electromyographic laryngeal monitoring.

BACKGROUND: The purpose of this study was to evaluate the contribution of laryngeal intraoperative nerve monitoring (IONM) during thyroidectomy in predicting postoperative laryngeal mobility. METHODS: Between 2009 and 2012, 127 patients underwent thyroidectomy, during which 216 recurrent laryngeal nerves were stimulated with suprathreshold stimulations. Laryngeal mobility was examined through direct laryngoscopy. Statistical analysis was performed to determine specificity, sensitivity, negative predictive value (NPV), positive predictive value (PPV), and a threshold value in order to define a intraoperative diagnostic test. RESULTS: Nine patients had a unilateral laryngeal palsy. No bilateral laryngeal palsy was observed. The threshold value to assure the postoperative laryngeal mobility is 280 µV. For this value, specificity was 94.06%, sensitivity 100%, NPV 100%, and PPV 47.83%. CONCLUSION: Laryngeal IONM can predict a favorable outcome of laryngeal mobility in cases in which the response exceeds 280 µV. Under this value, the risk of palsy is about 50% suggesting a staged surgery.

Suppressive therapy using azithromycin in 2 rare cases of recurrent staphylococcal infections.

Recurrent staphylococcal skin and soft tissue infections may recur despite decontamination and multiple courses of antibiotic therapy and may dramatically impair the patient's quality of life. We report successful use of long-term azithromycin prophylaxis in a recurrent laryngitis and a scalp folliculitis due to methicillin-susceptible Staphylococcus aureus.

Long-term benefit and sound localization in patients with single-sided deafness rehabilitated with an osseointegrated bone-conduction device.

OBJECTIVE: Investigation of long-term satisfaction and correlation with audiometric measurements after osseointegrated bone-conduction device (OBCD) surgery for patients with single-sided deafness (SSD). PATIENTS: Thirty-six patients implanted with an OBCD for SSD. STUDY DESIGN: Retrospective review in a university medical center. INTERVENTION: Rehabilitative. The patients were implanted after a test with an OBCD worn on a headband during 15 days in a daily use. The patients were implanted if the test gave us satisfaction. MAIN OUTCOME MEASURES: A series of audiometric tests, including speech perception in noise, prosthetic gain, and sound localization measurements, with and without OBCD on headband before surgery and on the transcutaneous implant remote from the surgery. Assessment of benefit and satisfaction using the modified Entific Medical System Questionnaire (EMSQ), the Abbreviated Profile of Hearing Aid Benefit (APHAB), and the Glasgow Benefit Index (GBI). RESULTS: The mean follow-up is 2.2 years. Approximately 64% of the patients use their OBCD more than 8 hours per day and 82% more than 4 hours per day. Mean satisfaction score is 7.3/10. The APHAB and GBI show a significant benefit (APHAB ease of communication before and after implantation, +21; GBI total score, +17). These results show an improvement in speech perception in noise with the OBCD, but no differences between the preoperative and postoperative tests. There is no improvement in sound localization. A high level of satisfaction is correlated with good results on the pre operative speech perception in noise. CONCLUSION: The OBCD is an effective way of rehabilitation for SSD. The BAHA improves the speech perception in noise but provided no significant improvement in sound localization as revealed in the postoperative test. With 3 questionnaires we noticed an improvement in the quality of life with the OBCD.