Can Electrocochleography Help Preserve Hearing After Cochlear Implantation With Full Electrode Insertion?

OBJECTIVES: To evaluate the utility of intracochlear electrocochleography (ECochG) monitoring during cochlear implant (CI) surgery on postoperative hearing preservation. STUDY DESIGN: Prospective, randomized clinical trial. SETTING: Ten high-volume, tertiary care CI centers. PATIENTS: Adult patients with sensorineural hearing loss meeting the CI criteria who selected an Advanced Bionics CI. METHODS: Patients were randomized to CI surgery either with audible ECochG monitoring available to the surgeon during electrode insertion or without ECochG monitoring. Hearing preservation was determined by comparing preoperative unaided low-frequency (125-, 250-, and 500-Hz) pure-tone average (LF-PTA) to postoperative LF-PTA at CI activation. Pre- and post-CI computed tomography was used to determine electrode scalar location and electrode translocation. RESULTS: Eighty-five adult CI candidates were enrolled. The mean (standard deviation [SD]) unaided preoperative LF-PTA across the sample was 54 (17) dB HL. For the whole sample, hearing preservation was "good" (i.e., LF-PTA change 0-15 dB) in 34.5%, "fair" (i.e., LF-PTA change >15-29 dB) in 22.5%, and "poor" (i.e., LF-PTA change ≥30 dB) in 43%. For patients randomized to ECochG "on," mean (SD) LF-PTA change was 27 (20) dB compared with 27 (23) dB for patients randomized to ECochG "off" ( p = 0.89). Seven percent of patients, all of whom were randomized to ECochG off, showed electrode translocation from the scala tympani into the scala vestibuli. CONCLUSIONS: Although intracochlear ECochG during CI surgery has important prognostic utility, our data did not show significantly better hearing preservation in patients randomized to ECochG "on" compared with ECochG "off."

The relationship of inter-implant time and hearing outcomes for bilateral cochlear implants.

PURPOSE: Determine the relationship between time elapsed between sequential bilateral cochlear implantation (BiCI) and speech intelligibility scores in post-lingually deafened adults. MATERIALS AND METHODS: Retrospective review of post-lingually deafened adults who received bilateral cochlear implants from January 1, 2011 to January 1, 2018 at an ambulatory tertiary referral center. RESULTS: 113 patients (226 cochlear implants) were initially reviewed, with 56 patients (112 implants) being included in the final analysis. Median inter-implant interval was 187.5 days (IQ range 54.25-346.5). Maximum interval was 1787 days. Mean age at first implant was 60.66 ± 13.37. Bilateral AzBio score in quiet and inter-implant interval showed no significant correlation (r = 0.034, p = 0.815). There was no significant difference in mean bilateral AzBio scores in quiet between the simultaneous and sequential implantation groups (p = 0.22). Similar non-significant results were seen when examining the correlation between AzBio Difference and inter-implant interval (r = -0.07, p = 0.66). No significant result between mean AzBio Difference of simultaneous and sequential implant recipients was found (p = 0.06). CONCLUSIONS: For the inter-implant intervals examined, there seems to be no significant decline in speech intelligibility scores for patients receiving sequential bilateral cochlear implants compared to simultaneously implanted patients. There was no significant correlation noted between increasing inter-implant intervals and speech intelligibility scores.

Facial nerve paralysis.

Emotions are communicated through facial expression. Happiness, confusion, and frustration can be expressed with a slight smile, eyebrow shift, or wrinkled nose. Injury to the facial nerve and subsequent inability of perform volitional mimetic movement can provoke anxiety. This article explores the causes, treatment, and prevention of facial nerve paralysis.

The use of porous polyethylene implants to correct nasal valve collapse.

OBJECTIVE: To evaluate the long-term outcome of correction of nasal valve collapse with a porous polyethylene implant. STUDY DESIGN AND SETTING: Retrospective review from November 1999 to December 2005. Nasal valve collapse was corrected with a porous polyethylene implant in 12 adults. Main outcome measures included relief of nasal obstruction and complications. Independent variables included other causes of nasal obstruction and need for revision surgery. Simple statistical analysis was performed. RESULTS: Median follow-up was 5.6 years (58 months). 75% had complete resolution of nasal obstruction. 100% had complete resolution of nasal obstruction at 6 months and had coexisting causes of nasal obstruction. The implant extrusion rate was 21%. 42% went on to have revision surgery. CONCLUSION: Correction of nasal valve collapse with a porous polyethylene implant provided good long-term symptomatic relief of nasal obstruction, but with significant incidence of infection, implant extrusion, and need for revision surgery. The use of this implant should be reserved for cases in which autogenous graft material is not available.

Middle ear atelectasis: what causes it and how is it corrected?

Many options are available to manage a patient who has atelectatic ears. Establishing normal middle ear ventilation and aeration is the cornerstone to successful control of these ears. Often, medical management with nasal steroids and decongestants is all that is needed. If recurrent infections have weakened the tympanic membrane progressively, or the middle ear environment is so severe that medical management does not correct the problem, then surgical correction is often necessary. This article explores the pathogenesis of middle ear atelectasis and explains a classification system to help the clinician determine the best course of management.

Eustachian tube function and the middle ear.

Eustachian tube dysfunction has been linked to causing middle ear pathology. One of the sequelae seen is tympanic membrane retraction. Concern occurs when this physiological state becomes chronic, leading to adhesive otitis media followed by debris collection and fulminate cholesteatoma. This chapter explores the role the eustachian tube plays in regulating middle ear and mastoid aeration, the causes of eustachian tube dysfunction, and the treatment of this disorder.

Complications of chronic otitis media and cholesteatoma.

The incidence of complications of chronic otitis media and cholesteatoma has decreased since the proliferation of antibiotics early in the twentieth century. However, these complications continue to occur, and can be lethal if they are not identified and treated properly. Therapy for the complications associated with chronic otitis media, unlike that of acute otitis media, usually involves surgical intervention. As medical (antibiotic) therapy continues to improve, and new imaging techniques are introduced, less invasive treatment modalities may be shown to be as effective as the classic, time-tested, surgical options.

The effect of tablet moistening on labor induction with intravaginal misoprostol: a randomized trial.

OBJECTIVE: To estimate whether a dosage of 50 microg of misoprostol tablets moistened with 3% acetic acid and administered intravaginally is more efficacious for labor induction than a similar dosage regimen using dry tablets. METHODS: A total of 177 women who presented with an indication for cervical ripening and labor induction were randomly assigned to one of two treatment groups: 1) intravaginal misoprostol in dry tablet form, or 2) intravaginal misoprostol moistened with 1 mL of 3% acetic acid solution. The primary outcome assessed was the interval from start of induction to vaginal delivery. To detect at least a 3.5-hour difference in the primary outcome with 80% power, 87 subjects were required in each group. RESULTS: Among 162 patients evaluated, 80 were allocated to the misoprostol dry group and 82 to the misoprostol moistened group. No significant difference was noted for the mean +/- standard deviation interval to vaginal delivery: 1130 +/- 636 minutes for the group who received dry tablets and 1004 +/- 636 minutes for those who received moistened misoprostol tablets (P =.25). Additionally, no statistically significant differences were noted between the groups with respect to need for oxytocin, proportion of patients delivered after a single dose, intrapartum complications (including tachysystole and uterine hyperstimulation), mode of delivery, or perinatal outcomes. CONCLUSION: Tablet moistening with 3% acetic acid solution does not seem to improve the efficacy of intravaginally administered misoprostol for labor induction.