1,720,962 research outputs found
USAIS Outcomes of Cochlear Implantation in Mondini Dysplasia
No full textA anonymised dataset of cochlear implant outcomes for individuals with Mondini Dysplasia at University of Southampton Auditory Implant Service.
This dataset is available 'on request' to bone fide researchers with ethical clearance. Please complete the attached request form and return it to [email protected]</span
Auditory performance outcomes for cochlear implant users with mondini dysplasia: the need for consistency and collaboration
No full textRefractory catatonia in old age: a case report
No full textBackground: catatonia is a clinical syndrome characterized by psychomotor disruption, which often goes undiagnosed. Most reports have focused on interventions and outcomes for catatonia in younger people and those with schizophrenia. The clinical characteristics and course of catatonia in old age are poorly understood. We present a report of an older person whose catatonia was refractory to extensive treatment, and we identify important implications for the management of catatonia in old age.Case representation: we describe a 73-year-old white man with longstanding autistic spectrum disorder who presented with symptoms of depression. Following a period of diagnostic uncertainty and failure to improve with antidepressant medication, a lorazepam challenge yielded an abrupt improvement in presentation. The patient was treated extensively with lorazepam, zolpidem, and electroconvulsive therapy during his 16-month hospital admission, but his catatonia ultimately proved refractory to treatment.Conclusions: catatonia should be considered promptly as a differential diagnosis in older people presenting with atypical features of functional mental illness. Although partial improvement of catatonic features was achieved using benzodiazepines and electroconvulsive therapy, these were not sustained in our patient. We identified comorbid autistic spectrum disorder, prolonged duration of catatonia, and sensitivity to benzodiazepines as important factors in prognostication in old age.</p
Protocol for CHIEF (cochlear implants and inner ear inflammation) study; an observational, cross-sectional study of children and young people undergoing cochlear implantation
No full textIntroduction: cochlear implantation is a surgical intervention for people with severe-to-profound hearing loss. Electrodes in the cochlea generate electrical currents that stimulate the auditory nerve to elicit hearing. Despite the success of cochlear implants, some people do not receive the expected hearing benefits. One reason for this is that tissues in the cochlea vary in their response to implantation of the electrode array. Many people have a healthy wound-healing response that results in mature scar tissue (fibrosis). However, some individuals have a heightened inflammatory response associated with excessive fibrosis. This leads to greater electrical resistance to the current flow (impedance) and reduces the quality of electrical stimulation, both of which can lead to poorer hearing outcomes with the implant. Excessive inflammation can damage cochlear structures and result in loss of residual hearing.This study will increase our understanding of why some people have a heightened inflammatory response that leads to poorer hearing. We propose that there are detectable individual inflammatory differences between people when they are implanted, which may result in variable hearing outcomes following implantation. If we could understand and identify these differences, we could detect people who may be at risk of less favorable outcomes and use therapies to modulate inflammation and improve outcomes.Methods and analysis: a cross-sectional study of children and young people undergoing cochlear implantation. On the day of surgery, a middle ear mucosa sample, swabs of the nasopharynx and middle ear, cochlear fluid, and blood samples will be collected.Samples will be analyzed using molecular techniques to determine the inflammatory status of the person at the time of implantation. Clinical hearing data will be collected for up to five years after implantation to explore the relationship between inflammation at the time of implantation and long-term hearing outcomes.<br/
Should we measure and modulate inflammation before cochlear implantation to improve long-term hearing outcomes?
No full textBackground: deaf children undergoing cochlear implantation have the potential to meet developmental milestones in line with their biological hearing peers. Unfortunately, hearing and language outcomes following implantation are variable. The biological factors contributing to underperformance are poorly understood. This study aims to determine whether the inflammatory/immune state of the ear is one factor contributing to underperformance. Insertion of an electrode array elicits a variable inflammatory response which can result in scar tissue (fibrosis) around the array1. An aberrant response can result in increased inflammation and fibrosis and contribute to poorer hearing2. Macrophages, tissue-resident immune cells, acquire ‘memory’ to previous insults (infections) which can result in an increased inflammatory response to subsequent insults3. Within the ear, an increased inflammatory response will cause tissue damage and contribute to hearing loss4; after implantation, this may contribute to greater fibrosis and poorer hearing outcomes. Early identification of inflammatory risk could mitigate this. Methods: CHIEF (cochlear implants and inner ear inflammation) is a cross-sectional study of children and young people undergoing cochlear implantation. Tissue and fluid samples will be collected from the ear/(s) being implanted during surgery including middle ear mucosa, a middle ear swab and cochlear fluid. A nasal swab and blood sample will be collected at the time of surgery. Following implantation, routine clinical outcome measures and health data will be collected for up to five years. We hypothesise that the tissue response to inflammation varies due to the individual inflammatory differences in the ear at the time of implantation. We will use CosMx5, a spatial transcriptomics technique that measures spatial gene expression, to measure the inflammatory state of the middle ear mucosal samples. We will characterise the expression profile of the major cell types identified in the middle ear mucosa samples. Results: to gather pilot data, we will generate a spatial gene expression profile of the key immune regulators in the middle ear (macrophages) and the surrounding cells. We will use bioinformatic analysis to determine if there are differences in gene expression of the cells within and between samples and determine whether these cells are communicating with each other. This pilot data will allow us to determine whether this technique yields valuable gene expression data for the major middle ear cell types and whether this technique should be used to analyse all mucosal samples collected in CHIEF. Conclusion: this will be the first spatial gene analysis of cells in the middle ear of children and young people undergoing cochlear implantation. This work will provide new knowledge of the immune biology of the ear in children undergoing implantation and inform our understanding of biological factors that can influence hearing outcomes with an implant. Through CHIEF, we will generate a database containing clinical and medical history of children undergoing cochlear implantation and a tissue bank. We will analyse the relationship between the biological data and clinical data (collected over five years) to interrogate how the immune state of the ear is associated with long-term hearing outcomes with an implant. If a predictable relationship is determined, there is potential to improve long-term hearing outcomes in children following implantation by modulating inflammation, using anti-inflammatory therapies. Reference 1.Seyyedi, M. & Nadol, J. B. Intracochlear inflammatory response to cochlear implant electrodes in humans. Otology and Neurotology 35, 1545–1551 (2014).2.Hough, K. et al. Inflammation at the tissue-electrode interface in a case of rapid deterioration in hearing performance leading to explant after cochlear implantation. Otology & Neurotology 42, e445–e450 (2021).3.Cunningham, C., Wilcockson, D. C., Campion, S., Lunnon, K. & Perry, V. H. Central and systemic endotoxin challenges exacerbate the local inflammatory response and increase neuronal death during chronic neurodegeneration. Journal of Neuroscience 25, 9275–9284 (2005).4.Xia, A. et al. Chronic suppurative otitis media causes macrophage-associated sensorineural hearing loss. J Neuroinflammation 19, 224 (2022).5.He, S. et al. High-plex imaging of RNA and proteins at subcellular resolution in fixed tissue by spatial molecular imaging. Nat Biotechnol 40, 1794–1806 (2022). <br/
Is there an inflammatory signature of the middle ear that identifies children at risk of poor hearing with a cochlear implant?
No full textBackground: middle ear infection/inflammation (otitis media) is a leading cause of hearing loss worldwide. Otitis media in childhood increases the risk of hearing loss in adulthood and can affect outcomes following cochlear implantation. Cochlear implants can be life-changing for deaf children. Unfortunately, some children don’t achieve the expected hearing with their implant. Poorer hearing can be caused by aberrant tissue growth, or fibrosis, around the implant. The mechanism is poorly understood.Preclinical and temporal bone studies have shown that otitis media causes macrophage-associated inflammation and damage within the cochlea. There is little understanding of how inflammatory signalling from the middle ear activates cochlear macrophages and how this could affect hearing with a cochlear implant. Aim: to determine whether the inflammatory state of the middle ear, at implantation, is a biological factor contributing to poor performance in children with implants.Methods: CHIEF (cochlear implants and inner ear inflammation) is a cross-sectional study of children undergoing cochlear implantation. Samples of the middle ear mucosa and cochlear fluid have been collected during surgery. A study database of clinical and hearing data spanning five years post-implantation is being built. Results: working with BioR, we carried out secondary analysis of single-cell RNA-sequencing data from a preclinical otitis media model. We identified strong interactions between pro-inflammatory macrophages and fibroblasts in rodent middle ear mucosa. The single-cell transcriptome of the human inflamed middle ear remains largely unexplored. Using spatial transcriptomics (CosMx), we aim to characterise the spatial gene profile and intercellular interactions of macrophages and fibroblasts in the middle ear mucosa collected through CHIEF.Conclusion: the relationship between the biological and clinical data will be analysed to interrogate how the inflammatory signature of the ear is associated with long-term hearing outcomes. If a predictable relationship is determined, anti-inflammatories could be used to modulate inflammation and improve hearing following implantation. <br/
STROBE Checklist for 'Protocol for CHIEF (cochlear implants and inner ear inflammation) study; an observational, cross-sectional, study of children and young people undergoing cochlear implantation'
No full textThis dataset is a STROBE (STrengthening the Reporting of OBservational studies in Epidemiology) checklist for the publication titled 'Protocol for CHIEF (cochlear implants and inner ear inflammation) study; an observational, cross-sectional, study of children and young people undergoing cochlear implantation'. The checklist has been completed to indicate where the appropriate information is in the manuscript.
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Understanding the role of middle ear macrophages in profoundly deaf children; the potential to improve hearing with cochlear implants
No full textBackground: middle ear infection and inflammation (otitis media) is the leading cause of hearing loss worldwide. A history of childhood otitis media increases the risk of hearing loss in adulthood [1] and can affect outcomes following cochlear implantation [2]. Cochlear implants are a life changing intervention for profoundly deaf children. Unfortunately, many children don’t achieve the expected benefits of their implant [3]. A variable tissue, or fibrotic, response to implantation may be factor [4] however this is not well understood. Pre-clinical and temporal bone [5] studies have shown that middle ear infection causes inflammation and damage within the cochlea associated with changes in macrophages [6]. However, there is little understanding of the role of macrophages in how well children hear with a cochlear implant. We hypothesise that the activation state of middle ear macrophages differs between children undergoing cochlear implantation due to their varying immune history [7,8]. This study aims to determine whether immune biology of the middle ear is a biological factor contributing to underperformance in children with cochlear implants. Methods: CHIEF (cochlear implants and inner ear inflammation)[9] is a cross-sectional study of children and young people undergoing cochlear implantation. Samples of the middle ear mucosa and cochlear fluid will be collected during surgery. Following implantation, routine clinical outcome measures and health data will be collected for up to five years. We will use CosMx [10], a spatial transcriptomics platform, to characterise the spatial gene expression of the macrophages in the middle ear of children undergoing cochlear implantation, for the first time. We will use bioinformatic analysis to determine if there are differences in gene expression of the macrophages within and between samples and determine what cells the macrophages are communicating with.Conclusion: this work will provide new knowledge of the immune biology of the ear in children undergoing implantation and inform our understanding of biological factors that can influence hearing outcomes with an implant. Through CHIEF, we will generate a database containing clinical and medical history of children undergoing cochlear implantation and a tissue bank. We will analyse the relationship between the biological and clinical data (collected over five years) to interrogate how the immune state of the ear is associated with long-term hearing outcomes. If a predictable relationship is determined, there is potential to improve long-term hearing outcomes in children following implantation by modulating inflammation, using anti-inflammatory therapies. References1 Aarhus L, Homøe P, Engdahl B. Otitis media in childhood and disease in adulthood: A 40-year follow-up study. Ear Hear. 2020;41:67–71. doi: 10.1097/AUD.00000000000007292 Alzoubi F, Odat H, Nuseir A, et al. Effect of otitis media with effusion on cochlear implant surgery: Technical difficulties, post-operative complications and outcome. Journal of Laryngology and Otology. 2015;129:762–6. doi: 10.1017/S00222151150016813 Cupples L, Ching TYC, Button L, et al. Language and speech outcomes of children with hearing loss and additional disabilities: identifying the variables that influence performance at five years of age. Int J Audiol. 2018;57:S93–104. doi: 10.1080/14992027.2016.12281274 Seyyedi M, Nadol JB. Intracochlear inflammatory response to cochlear implant electrodes in humans. Otology and Neurotology. 2014;35:1545–51. doi: 10.1097/MAO.00000000000005405 Monsanto R da C, Schachern P, Paparella MM, et al. Progression of changes in the sensorial elements of the cochlear and peripheral vestibular systems: The otitis media continuum. Hear Res. 2017;351:2–10. doi: 10.1016/j.heares.2017.05.0036 Xia A, Thai A, Cao Z, et al. Chronic suppurative otitis media causes macrophage-associated sensorineural hearing loss. J Neuroinflammation. 2022;19:224. doi: 10.1186/s12974-022-02585-w7 Hough K, Verschuur CA, Cunningham C, et al. Macrophages in the cochlea; an immunological link between risk factors and progressive hearing loss. Glia. 2021;1–20. doi: 10.1002/glia.240958 Cunningham C, Wilcockson DC, Campion S, et al. Central and systemic endotoxin challenges exacerbate the local inflammatory response and increase neuronal death during chronic neurodegeneration. Journal of Neuroscience. 2005;25:9275–84. doi: 10.1523/JNEUROSCI.2614-05.20059 Hough K, Nichani J, Findlay C, et al. Protocol for CHIEF (cochlear implants and inner ear inflammation) study; an observational, cross-sectional, study of children and young people undergoing cochlear implantation [Preprint]. MedXRiv. Published Online First: 26 November 2024. doi: 10.1101/2024.11.25.2431776710 He S, Bhatt R, Brown C, et al. High-plex imaging of RNA and proteins at subcellular resolution in fixed tissue by spatial molecular imaging. Nat Biotechnol. 2022;40:1794–806. doi: 10.1038/s41587-022-01483-z <br/
Leveraging real world data to improve cochlear implant outcomes: is the data available?
No full textObjectives: a small but persistent proportion of individuals do not gain the expected benefit from cochlear implants(CI). A step-change in the understanding of factors affecting outcomes could come through data science. This study evaluates clinical data capture to assess the quality and utility of CI user's health records for data science, by assessing the recording of otitis media. Otitis media was selected as it is associated with the development of sensorineural hearing loss and may affect cochlear implant outcomes. Methods: a retrospective service improvement project evaluating the medical records of 594 people with a CI under the care of the University of Southampton Auditory Implant Service between 2014 and 2020. Results: The clinical records are suitable for data science research. Of the cohort studied 20% of Adults and more than 40% of the paediatric cases have a history of middle ear inflammation. Discussion: data science has potential to improve cochlear implant outcomes and improve understanding of the mechanisms underlying poor performance, through retrospective secondary analysis of real-world data. Conclusion: implant centres and the British Cochlear Implant Group National Hearing Implant Registry are urged to consider the importance of consistently and accurate recording of patient data over time for each CI user. Data where links to hearing loss have been identified, such as middle ear inflammation, may be particularly valuable in future analyses and to inform clinical trials.</p
Design and implementation of the stacked, synchronised and iconographic timeline-structured electronic patient record in a UK NHS Global Digital Exemplar hospital
No full textConventional electronic screen visualisation formats, which use tabs, dropdown menus, lists and multiple windows, present huge navigation challenges to health professionals. A unifying and intuitive interface for the electronic patient record (EPR) has been an elusive goal for software developers for decades. Methods Since 2009, by working in an agile way, we have built and implemented a fully operational and dynamic system, the University Hospital Southampton Lifelines (UHSL), within our clinical data estate, in a UK university hospital. UHSL permits the continuously updated display of the EPR on a single desktop computer screen in an intuitive format. During this iterative evolution, we have resolved a number of practical challenges in data display, while maintaining our core aims of end-user optimisation and radical simplification of the interface. Concurrently, we have upcycled a significant volume of clinical e-content, some from as far back as 1991, into UHSL, and at a marginal cost. Outcomes UHSL went live in 2017 for all authorised staff at the hospital. It displays all e-records for 2.5 million patients and for more than 100 million documents and reports. It significantly reduces the screen time to navigate the individual EPR, and it offers substantial productivity gains in designated clinical services. Conclusions UHSL has considerable further development potential as a National Health Service EPR interface, for the integration, display and ease of understanding of medical records across primary, secondary and community care.</p
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