Corrigendum to "The Effect of Cochlear Size on Cochlear Implantation Outcomes".

[This corrects the article DOI: 10.1155/2019/5849871.].

The Effect of Cochlear Size on Cochlear Implantation Outcomes.

OBJECTIVES: To determine if cochlear duct length and cochlear basal diameter, measured using routinely available radiology software, affect hearing outcomes after cochlear implantation with two different length electrodes. METHODS: 55 patients who received a Med-El Flex electrode were retrospectively reviewed. 34 patients received the Flex 31 electrode (31mm) and 21 patients received the Flex 28 electrode (28mm). Preoperative high-resolution CT scans of the temporal bone were reformatted in the axial and coronal plane. The basal diameter of the cochlear (A-value) and the outer-wall lengths of the cochlear duct were measured using readily available imaging software. Postoperative plane X-rays were used to determine the degree of electrode insertion and the number of electrodes within the cochlea and speech discrimination scores at 6 months were evaluated. RESULTS: The cochlear metrics obtained were comparable with those previously published in the literature. There was no significant difference in the degree of insertion or speech outcomes between the two electrode lengths. However, when the group who had received the shorter electrode were analysed, there was an association seen between both cochlear duct length and cochlear diameter and speech outcomes. CONCLUSIONS: Cochlear size may be a factor in determining speech outcomes that cannot be explained solely by insertion depth or degrees of insertion. Further studies are required to determine if cochlear duct length is an independent predictor of speech outcomes.

Preassessment Interview Improves the Efficacy and Safety of Bowel Preparation for Colonoscopy.

Aim. To determine whether preassessment improves bowel preparation quality and prevents renal deterioration for chronic kidney disease (CKD) patients. Methods. Data was collected prospectively starting in January 2011 for 12 months. Patients were divided according to the presence or absence of preassessment and stratified to one of three risk groups based on patient's comorbidities and identified risk factors for poor bowel preparation; group 1 had no risk factors, group 2 had 1 risk factor, and group 3 patients had 2 or more risk factors. The association between preassessment and bowel preparation quality was analyzed using binary logistic regression. Results. 1840 colonoscopies were carried out during the period. Total number analyzed was 1704. 404 patients were preassessed. Preassessment patients had significantly better bowel preparation across all groups (OR 1.605; p = 0.002). Group 3 patients were 52% more likely to have good bowel preparation (p = 0.04) if they had been preassessed. Eighty-eight patients were identified with an eGFR < 60 mL/min. There was a significant difference in the eGFR percentage change between patients with preassessment and those without (p = 0.006). Conclusions. Face-to-face preassessment appears to improve the quality of bowel preparation and aids in minimizing the risk of renal injury in patients with CKD.

Nasal nitric oxide as a marker of sinus mucosal health in patients with nasal polyposis.

BACKGROUND: Reduced nasal nitric oxide (nNO) has been shown in patients with chronic rhinosinusitis (CRS) but its clinical significance remains uncertain. The objective of this study was to measure nNO changes in patients undergoing endoscopic sinus surgery (ESS) for CRS and to explore its relationship to clinical measures of sinus mucosal health postoperatively. METHODS: This was a prospective study of CRS patients undergoing ESS. Patients had the following measurements at baseline and at 1 and 6 months post-ESS: nNO levels, Lund-Kennedy Endoscopy Score (LKES), and 22-item Sino-Nasal Outcome Test (SNOT-22) score. Statistical analysis was performed using GraphPad Prism 6. RESULTS: Thirty-nine patients were enrolled, of these 84.6% had CRS with nasal polyps. Baseline Lund-Mackay computed tomography (CT) score was 16.9 ± 5.1. There was a statistically significant increase in nNO levels from baseline to 1 month and 6 months postoperatively (p < 0.0001). The SNOT-22 and LKES followed a similar trend with a significant and sustained improvement at 1 month and 6 months post-ESS (p < 0.0001). Subgroup analysis revealed that changes in nNO were driven by the polyp cohort because nonpolyp patients had no significant changes in their nNO postoperatively. No correlation was found between nNO levels and SNOT-22. However, a significant negative correlation was found between nNO and LKES (p < 0.0001), suggesting healthier sinus mucosa was associated with higher nNO levels. CONCLUSION: This is the first study to show that nNO levels may be a marker of sinus mucosal health following ESS in patients with polyps. This has important implications for nNO in its potential etiologic role in mediating ongoing sinus inflammation.

The role of a new contralateral routing of signal microphone in established unilateral cochlear implant recipients.

OBJECTIVES/HYPOTHESIS: To investigate whether a contralateral routing of signal (CROS) microphone combined with a unilateral cochlear implant (CI) results in hearing improvement after a prolonged trial period. STUDY DESIGN: A prospective experimental trial was undertaken on a group of 10 postlingually deafened adults who are experienced CI users. METHODS: Participants completed audiometric testing and validated questionnaires with their unilateral CI alone, followed by addition of a CROS microphone (CI-CROS). This was worn daily for the 2-week trial, after which hearing performance was reevaluated using the same measures. Objective tests included AzBio sentences in quiet and noise and consonant-vowel nucleus-consonant (CNC) words. Subjective measures included the Abbreviated Profile of Hearing Aid Benefit (APHAB); Speech, Spatial, Qualities of Hearing Index (SSQ); Hearing Implant Sound Quality Index; an institutional questionnaire; and a daily log sheet. RESULTS: There is statistically significant enhanced speech discrimination with the CI-CROS when speech is presented on the CROS side. However, scores are markedly diminished when background noise is introduced, particularly to the CROS side. Subjective results indicate lower satisfaction scores for the global and ease of communication subdomains of the APHAB with the CI-CROS, but increased scores on the spatial hearing subdomain of the SSQ (P < 0.05). CONCLUSION: The CI-CROS provides significant benefit in certain situations, particularly speech recognition in quiet. CI-CROS performance with background noise is poor, leading to low satisfaction scores. Further refinement of the device may yield a useful tool for unilateral CI users in the future.

Dexamethasone uptake in the murine organ of Corti with transtympanic versus systemic administration.

OBJECTIVE: To investigate glucocorticoid uptake in auditory hair cells following transtympanic versus systemic administration of dexamethasone. STUDY DESIGN: Controlled experimental study. SETTING: Translational science experimental laboratory. METHODS: Swiss-Webster mice were injected with dexamethasone via transtympanic or systemic administration. At 1, 6, or 12 hours post-injection the temporal bones were harvested. After cryosectioning, immunohistochemical staining was performed using an antibody for dexamethasone. RESULTS: Dexamethasone labelling was greatest at 1 hour. Inner hair cells demonstrated much higher steroid uptake than outer hair cells. Both transtympanic injection and high-dose systemic administration resulted in strong dexamethasone labelling of hair cells, and a decreasing basal-to-apical gradient of hair cell fluorescence intensity was observed. Systemically delivered dexamethasone was rapidly eliminated from the inner ear, demonstrating mild labelling after 6 hours and none after 12 hours. In contrast, the mice receiving transtympanic injection had persistent moderate intensity fluorescence at 6 and 12 hours post-injection. CONCLUSION: There is similar uptake of dexamethasone by auditory hair cells after transtympanic and high-dose systemic delivery. Novel findings include the presence of a decreasing basal-apical gradient of steroid uptake, and demonstration of greater affinity of inner hair cells for dexamethasone compared to outer hair cells. In this animal model transtympanic injection resulted in prolonged steroid uptake. These findings help further our understanding of the pharmacokinetics of steroids in the cochlea, with a focus on auditory hair cells.

Changes in the cochlear vasculature and vascular endothelial growth factor and its receptors in the aging c57 mouse cochlea.

Introduction. Previous work has shown a strong association between alterations in cochlear vasculature, aging, and the development of presbycusis. The important role of vascular endothelial growth factor (VEGF) and its receptors Flt-1 and Flk-1 in angiogenesis suggests a potential role for involvement in this process. The aim of this study was to characterize vascular structure and VEGF and its' receptors in young and old C57 Mice. Methods. Young (4 weeks, n = 14) and aged (32-36 weeks, n = 14) C57BL/6 mice were used. Hearing was evaluated using auditory brainstem response. Cochleas were characterized with qRT-PCR, immunohistochemistry, and gross histological quantification. Results. Old C57 mice demonstrated significantly decreased strial area, blood vessel number, luminal size, and luminal area normalized to strial area (vascularity). qRT-PCR showed a significant upregulation of Flt-1, a VEGF receptor, in older animals. No differences were found in VEGF-A or Flk-1. Immunohistochemistry did not show any differences in staining intensity or area with age or cochlear turn location. Conclusion. The marked deafness of aged C57 mice could be in part meditated by loss of vascular development and alterations in VEGF signaling.

The utility of the microvascular anastomotic coupler in free tissue transfer.

BACKGROUND: The microvascular anastomosis remains a technically sensitive and critical determinant of success in free tissue transfer. The microvascular anastomotic coupling device is an elegant, friction-fit ring pin device that is becoming more widely used. OBJECTIVE: To systematically review the literature to examine the utility of the microvascular coupler in free tissue transfer. METHODS: A comprehensive database search was performed to identify eligible publications. Inclusion criteria were anastomotic coupler utilization and free-tissue transfer. Recorded information from eligible studies included patient age, follow-up, radiation history, number of free-flaps and failure rates, reconstruction subsites, number of coupled venous and arterial anastomoses, coupling time, conversion to sutured anastomosis, coupler size and thrombosis rates. RESULTS: Twenty-five studies reporting on 3207 patients were included in the analysis. A total of 3576 free-flaps were performed within the following subsites: 1103 head and neck, 2094 breast, 300 limb or body, and 79 nonspecified. There were only 26 reported flap failures (0.7%). A total of 3497 venous and 342 arterial coupled anastomoses were performed. The primary outcome measure was thrombosis rates, and there were 61 venous (1.7%) and 12 arterial (3.6%) thromboses reported. Mean coupling time was 5 min, and 30 anastomoses (0.8%) were converted to suture. CONCLUSION: Flap survival and revision-free application of the microvascular coupler occurred in more than 99% of cases. There is a substantial time savings with coupler use. Venous and arterial thrombosis rates are comparable with the best results achieved by sutured anastomosis and, when used by experienced surgeons, the coupler achieves superior results.

HISTORIQUE: L'anastomose microvasculaire demeure un déterminant délicat et essentiel de la réussite du transfert de tissu libre. Le coupleur d'anastomose miscrovasculaire est un élégant anneau broché adapté à la friction qui est de plus en plus utilisé. OBJECTIF: Procéder à une analyse bibliographique systématique pour évaluer l'utilité du coupleur microvasculaire en cas de transfert de tissu libre. MÉTHODOLOGIE: Les chercheurs ont effectué une recherche approfondie dans les bases de données pour repérer les publications admissibles. Les critères d'inclusion étaient l'utilisation d'un coupleur anastomotique et le transfert de tissus libre. L'information consignée à partir des études admissibles était l'âge du patient, le suivi, les antécédents de radiation, le nombre de lambeaux libres et le taux d'échecs, les sous-foyers de reconstruction, le nombre de couplages anastomotiques veineux et artériels, la durée du couplage, la conversion en anastomose suturée, la dimension du coupleur et le taux de thromboses. RÉSULTATS: Les chercheurs ont inclus 25 études portant sur 3 207 patients dans l'analyse. Au total, 3 576 transferts de lambeaux libres ont été effectués, dans les sous-foyers suivants : 1 103 sur la tête et le cou, 2 094 sur le sein, 300 sur un membre ou le corps et 79 à un foyer non précisé. Seulement 26 échecs du lambeau (0,7 %) étaient déclarés. Au total, 3 497 anastomoses veineuses couplées et 342 anastomoses artérielles couplées ont été exécutées.La mesure d'issue primaire était le taux de thrombose; 61 thromboses veineuses (1,7 %) et 12 thromboses artérielles (3,6 %) ont été déclarées. Le couplage durait en moyenne cinq minutes, et 30 anastomoses (0,8 %) ont été converties en suture. CONCLUSION: On observe la survie du lambeau et l'application sans révision du coupleur microvasculaire dans plus de 99 % des cas. On gagne beaucoup de temps à utiliser le coupleur. Le taux de thromboses veineuses et artérielles est similaire, et les meilleurs résultats proviennent des anastomoses suturées. Lorsqu'il est utilisé par des chirurgiens expérimentés, le coupleur donnait des résultats supérieurs.