102,605 research outputs found
Vestibulotomy with ossiculoplasty versus round window vibroplasty procedure in children with oval window aplasia
No full textOBJECTIVE: To review the surgical procedures and outcomes in children with bilateral oval window aplasia (OWA). STUDY DESIGN: Retrospective cohort review. SETTING: Tertiary referral center. PATIENTS: Children suffering from OWA between 1990 and 2010. INTERVENTION: Vestibulotomy with ossiculoplasty (V-OPL) or round window vibroplasty (RWV). MAIN OUTCOME MEASURES: Findings at radiology and surgery, preoperative and postoperative bone conduction (BC), air conduction (AC), and RWV-air conduction (RWV-AC) thresholds and speech discrimination scores (SDSs). RESULTS: Among 23 children, 11 underwent V-OPL and 8 RWV. Four children in the V-OPL group had aborted surgery and were excluded from the study. In all the remaining 19 children, the 6-month follow-up time showed postoperative AC and SDS values significantly better than the preoperative thresholds in both groups. At the 36-month long-term follow-up, AC and SDS were stable in the RWV group but showed a significant worsening in the V-OPL children compared with the 6-month follow-up results. Preoperative versus postoperative BC values showed a significant difference between the 2 groups at 36 months; 5 of the V-OPL group underwent revision following the same surgical principles, which did not result in improved outcome. CONCLUSION: In children with OWA, V-OPL provides modest long-term results and carries higher risks of BC degradation compared to RWV. Both procedures are technically challenging but considering the respective hearing results and morbidity of primary and revision surgery, we have abandoned the V-OPL procedure in favor of RWV. In infants and children younger than 5 years with OWA previously not considered candidates for hearing restoration, we consider RWV as the first-choice surgery. It has shown to provide significantly better hearing outcomes than traditional atresia surgery with minimal complication rate
Nervus intermedius guides auditory brainstem implant surgery in children with cochlear nerve deficiency
No full textOBJECTIVE:
To investigate the anatomic features of the nervus intermedius and cranial nerve VII in children with cochlear nerve deficiency and to verify whether the nervus intermedius can provide an additional landmark to help guide placement of the auditory brainstem implant electrode.
STUDY DESIGN:
Case series with chart review.
SETTING:
Tertiary referral center.
SUBJECTS AND METHODS:
High-definition video was captured during retrosigmoid surgery in 64 children (mean age, 3.91 ± 2.83 years) undergoing auditory brainstem implant placement. These videos were examined with particular reference to the number and variety of nervus intermedius bundles and any associated facial nerve anomalies.
RESULTS:
Absence of cranial nerves VI, VII, and VIII was observed in 3, 6, and all 64 children, respectively. Fifteen children had several abnormalities of the facial nerve in the cerebellopontine angle. Anatomic identification of the facial nerve and the bundles composing the nervus intermedius was possible in 46 children. In 12 children, identification was possible with the assistance of intraoperative monitoring. The number of bundles composing the nervus intermedius varied from 1 to 6. The nervus intermedius and cranial nerve IX were useful landmarks for identifying the foramen of Luschka of the lateral recess.
CONCLUSION:
The nervus intermedius provides an additional landmark during auditory brainstem microsurgery since it was identified in all subjects. The nervus intermedius anatomy and its topographic relationship with the neurovascular structures around the foramen of Luschka have been described for the first time in children with cochlear nerve deficiency
The therapeutic dilemma of cochlear nerve deficiency : cochlear or brainstem implantation?
No full textObjective. To compare the outcomes between 2 age-matched cohorts of children with cochlear nerve deficiency: those receiving auditory brainstem implants (group A) or cochlear implants (group B). Study Design. Retrospective cohort study. Setting. Tertiary referral center. Subjects and Methods. Subjects were selected from a pool of 537 children fitted with cochlear implants (n = 443) or auditory brainstem implants (n = 94) over the past 14 years. Performance, examined with the Category of Auditory Performance scale, and complications were compared with a mean follow-up of 5 years. Results. All children had bilateral profound sensorineural hearing loss and cochlear nerve deficiency. Magnetic resonance imaging documented an absent cochlear nerve (n = 12) and a small cochlear nerve (n = 8) in group A and an absent cochlear nerve (n = 11) and a small cochlear nerve (n = 9) in group B (P = 1.000). Children with cochlear implants had Category of Auditory Performance scores spanning from 0 to 3 levels of performance, and all required manual communication mode and visual supplementation. Children with auditory brainstem implants had Category of Auditory Performance scores spanning from 2 to 7, and most patients demonstrated behavioral responses irrespective of inner ear malformations and an absent cochlear nerve or small cochlear nerve (P<.001). Conclusions. In children with cochlear nerve deficiency, patients fitted with cochlear implants did not develop speech understanding and production. Those fitted with auditory brainstem implants had the opportunity to develop open-set speech perception, acquiring verbal language competence using oral communication exclusively and participating in mainstream education. The overall complication rate of auditory brainstem implants was not greater than that of cochlear implants
Surgical visual reference for auditory brainstem implantation in children with cochlear nerve deficiency
No full textImproved outcomes in auditory brainstem implantation with the use of near-field electrical compound action potentials
No full textOBJECTIVE:
To compare the outcomes (auditory threshold and open-set speech perception at 48-month follow-up) of a new near-field monitoring procedure, electrical compound action potential, on positioning the auditory brainstem implant electrode array on the surface of the cochlear nuclei versus the traditional far-field electrical auditory brainstem response.
STUDY DESIGN:
Retrospective study.
SETTING:
Tertiary referral center.
SUBJECTS AND METHODS:
Among the 202 patients with auditory brainstem implants fitted and monitored with electrical auditory brainstem response during implant fitting, 9 also underwent electrical compound action potential recording. These subjects were matched retrospectively with a control group of 9 patients in whom only the electrical auditory brainstem response was recorded. Electrical compound action potentials were obtained using a cotton-wick recording electrode located near the surface of the cochlear nuclei and on several cranial nerves.
RESULTS:
Significantly lower potential thresholds were observed with the recording electrode located on the cochlear nuclei surface compared with the electrical auditory brainstem response (104.4 ± 32.5 vs 158.9 ± 24.2, P = .0030). Electrical brainstem response and compound action potentials identified effects on the neighboring cranial nerves on 3.2 ± 2.4 and 7.8 ± 3.2 electrodes, respectively (P = .0034). Open-set speech perception outcomes at 48-month follow-up had improved significantly in the near- versus far-field recording groups (78.9% versus 56.7%; P = .0051).
CONCLUSIONS:
Electrical compound action potentials during auditory brainstem implantation significantly improved the definition of the potential threshold and the number of auditory and extra-auditory waves generated. It led to the best coupling between the electrode array and cochlear nuclei, significantly improving the overall open-set speech perception
Lemmo's Flap for Nasal Dorsum Reconstruction
No full textPurpose: Reconstruction of nasal defects is an antique challenge for surgeons. The first reported technique is dated 600 B.C. Since then a number of reconstructive options have been proposed in the literature. Some principles, first stated by Buget and Menick must be always taken into account when planning such reconstructions. In detail, every reconstruction should respect the subunit principle and the scars should always be well hidden in the passage between adjacent subunits. The flap proposed in the present paper adheres to the cited principles and leads to optimal nasal dorsum reconstruction in selected cases. Materials and Methods: From April 2008 to March 2009, 5 patients were reconstructed with Lemmo's flap after local excision of 3 basal cell carcinomas and 2 squamous cell carcinomas affecting the the skin of the nasal dorsum in its caudal portion. Results: In all cases a pleasing aesthetic result was obtained, no postoperative deformity was observed and all the scars were unnoticeable. Conclusions: The Lemmo's flap described in the present paper can be considered a valid choice for nasal dorsum skin reconstruction and is preferable over other techniques for reconstruction of small to medium sized defects of the skin of the caudal dorsum
Nervus intermedius guides auditory brainstem implant surgery in children with cochlear nerve deficiency
No full textObjective To investigate the anatomic features of the nervus intermedius and cranial nerve VII in children with cochlear nerve deficiency and to verify whether the nervus intermedius can provide an additional landmark to help guide placement of the auditory brainstem implant electrode. Study Design Case series with chart review. Setting Tertiary referral center. Subjects and Methods High-definition video was captured during retrosigmoid surgery in 64 children (mean age, 3.91 ± 2.83 years) undergoing auditory brainstem implant placement. These videos were examined with particular reference to the number and variety of nervus intermedius bundles and any associated facial nerve anomalies. Results Absence of cranial nerves VI, VII, and VIII was observed in 3, 6, and all 64 children, respectively. Fifteen children had several abnormalities of the facial nerve in the cerebellopontine angle. Anatomic identification of the facial nerve and the bundles composing the nervus intermedius was possible in 46 children. In 12 children, identification was possible with the assistance of intraoperative monitoring. The number of bundles composing the nervus intermedius varied from 1 to 6. The nervus intermedius and cranial nerve IX were useful landmarks for identifying the foramen of Luschka of the lateral recess. Conclusion The nervus intermedius provides an additional landmark during auditory brainstem microsurgery since it was identified in all subjects. The nervus intermedius anatomy and its topographic relationship with the neurovascular structures around the foramen of Luschka have been described for the first time in children with cochlear nerve deficiency
Electrocochleography during cochlear implantation for hearing preservation.
No full textAbstract
OBJECTIVE: To determine whether intraoperative electrocochleography during cochlear implant surgery provides online feedback to modify surgical procedure, reduce trauma, and increase preservation of residual hearing.
STUDY DESIGN: Prospective cohort study.
SETTING: Tertiary referral center, Otolaryngology Department, University of Verona.
SUBJECTS AND METHODS: Twenty-seven adult patients undergoing cochlear implant surgery who had low- to mid-frequency (0.25-2 kHz) auditory thresholds measured preoperatively were enrolled. Fifteen subjects had compound action potentials measured to assess cochlear function during surgery. In those patients, surgery was modified according to electrocochleographic feedback. Twelve control subjects underwent cochlear implant surgery with blinded electrocochleographic monitoring.
RESULTS: The average preoperative pure-tone audiometry thresholds (0.25-2 kHz) were 74.3 ± 10.2 and 81.5 ± 12.7 dB hearing level (HL) in the electrocochleographic feedback and control cohorts, respectively (P > .05). Compound action potential recordings showed a mean maximum latency shift of 0.63 ± 0.36 ms and normalized amplitude deterioration of 59% ± 19% during surgery. All of these changes reverted to normal after electrode insertion in all but 1 subject in the electrocochleographic feedback group. The average shifts in postoperative pure-tone average threshold (0.25-2 kHz), evaluated before activation, were 8.7 ± 4.3 and 19.2 ± 11.4 dB HL in the electrocochleographic feedback and control cohorts, respectively (P = .0051). Complete hearing preservation (loss of ≤10 dB) at 1 month before activation was achieved in 85% (11/13) of electrocochleographic feedback subjects and in 33% (4/12) of control patients (P = .0154).
CONCLUSION: Monitoring cochlear function with electrocochleography gives real-time feedback during surgery, providing objective data that might help in modifying the surgical technique in ways that can improve the rate of hearing preservation
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