1,721,008 research outputs found
Delayed facial nerve palsy after surgery for the Esteem(®) fully implantable middle ear hearing device.
No full textConclusion: Delayed facial nerve (FN) impairment was shown to occur after Esteem® surgery, and taste disturbances were found in a limited number of subjects. Thus, when this type of active middle ear implant (AMEI) is to be implanted, these specific complications need to be shared with the candidate. Objectives: To report on FN involvement in Esteem® AMEI surgery. Methods: A total of 23 males and 11 females, who presented with sensorineural hearing loss of varying severity, underwent surgical implantation of the Esteem® AMEI. FN function was assessed according to the House-Brackmann (HB) grading system. A specific question regarding taste impairment was administered to each patient on the first day and 3 months after surgery. Results: None of the patients presented with a FN deficit in the first postoperative days. In three patients (8.8%), FN palsy developed after 7 days (two patients) and 10 days (one patient), and the severities were HB 4 (two cases) and HB 5 (one case). All patients fully recovered (HB 1) after 6-8 weeks. In 10 of the 34 implanted subjects (29.4%), taste disturbances were found on postoperative day 1, and these impairments remained in only 6 (17.6%) patients at the 3-month postoperative follow-up. © Informa Healthcare
Transcutaneous bone-conduction hearing device: audiological and surgical aspects in a first series of patients with mixed hearing loss
No full textConclusions: The Bonebridge (R) (BB) transcutaneous bone conductive implant (BCI) may overcome some of the issues related to a percutaneous BCI, such as management of the external screw, delayed activation or possible skin complications. Moreover, it has been shown to enable a functional outcome similar to percutaneous BCI in both conductive and mixed types of hearing loss. Objectives: To obtain clinical data from a preliminary series of patients implanted with a new transcutaneous BCI. Methods: Four subjects affected by conductive/mixed hearing loss underwent implantation of the BB by two approaches: the transmastoid, presigmoid approach and the retrosigmoid approach. Soundfield thresholds were assessed with warble tones in a soundproof audiometric booth, and word recognition scores (WRSs) as speech reception thresholds (SRTs) were used to compare the unaided versus the post-implantation condition. Results: The surgical procedure was completed in all cases, with only minor intraoperative divergence from the CT-based planning and no postoperative complications. The average improvement of the SRT in quiet with the BB in comparison to the unaided condition was 36.25 dB. All the implanted subjects reached SRT values below 65 dB, indicating a better understanding in quiet, with 100% word recognition
Temporal bone fibrous dysplasia: A rare mastoid localization
No full textObjective: To present a rare case of mastoid localization of temporal bone fibrous dysplasia and to give some insight on diagnostic and therapeutic strategies. Patients: A 39 year-old female presented with unilateral, left temporal headache. Imaging diagnostic investigation revealed the presence of a cystic lesion localized at the level of the superficial left mastoid bone, surrounded by a ground glass bony halo and plates of bone matrix in its central portion. Due to the uncertain diagnosis as well as to the persistence of the painful symptomatology, the patient was scheduled for surgery. Interventions: Retro-auricular approach extended superiorly, with cortical mastoidectomy and isolation of the lesion, followed by its full removal. Main Outcome Measures: Clear signs of fibrous dysplasia were found, with typical cystic pattern, associated with mature bone tissue fragments, remodeling aspects and multiple foamy hystiocitary cells. Results: The patient fully recovered with subsiding of painful symptomatology. Conclusion: Fibrous dysplasia affecting the temporal bone may also occur at the mastoid level, as it was described in the present report. Hence, this rare localization must be taken into consideration for a differential diagnosis of cystic-like lesions of the temporal bone. Since imaging alone is unable to formulate an appropriate diagnosis, surgical removal and subsequent pathological examination reveal to be crucial for the identification of this rare pathology. © 2005 The Mediterranean Society of Otology and Audiology
Inner Ear Active Hearing Device in Non-Otosclerotic, Severe, Mixed Hearing Loss
Full text linkOBJECTIVE:
To verify the efficacy of a powerful active hearing device in a patient different from far-advanced otosclerosis, specifically when the stapes footplate is mobile.
PATIENT:
A patient with severe-to-profound mixed hearing loss, who was not benefiting from the use of a conventional hearing aid, was selected for an inner ear active implant. This was justified by a bone conductive threshold above 60 dB, which had discouraged any other rehabilitative solutions such as a bone conductive implant, or an active middle ear implant (AMEI).
INTERVENTION:
The hearing device was surgically applied using a combined transmastoid/transcanal approach. During surgery, a mobile stapes were found and was perforated for the insertion of a piston prosthesis, crimped on the new-incus of the device.
MAIN OUTCOME MEASURE:
The bone conduction threshold was assessed postoperatively to identify any possible surgery-related hearing deterioration. Pure tone audiometry was conducted in a sound field, and a speech reception threshold test was performed with the contralateral ear masked. The hearing outcome was assessed soon after the implant activation (6 weeks after surgery), and 6 months after surgery.
RESULTS:
Upon activation of the device, a PTA of 45 dB was obtained (at 0.5, 1, 2 and 4 kHz). At 6 months after surgery, the speech discrimination score reached 90% at 80 dB SPL.
CONCLUSION:
The application of the Codacs device has shown to be compatible with a mobile stapes footplate, as demonstrated in this report. The footplate perforation did not cause any further hearing deterioration, and has allowed to achieve a favorable auditory outcome
Middle ear implantation in stapes fixation
No full textThis book provides the first comprehensive overview of the various conventional and cutting-edge surgical techniques for stapes fixations. After describing the broad range of stapes fixations, it discusses the preoperative diagnostic workup, with special emphasis on the role of CT scanning. It reviews stapedectomy and stapedotomy via the classic tympanotomy approach using different stapes footplate fenestration methodologies, and describes the increasingly popular technique of middle ear endoscopy. A subsequent chapter is devoted to the important topic of robot-assisted surgery. The book then reviews the evolution of the piston prosthesis, highlighting the practical aspects of the different types of piston, their benefits, and their impact on hearing. Lasers are also discussed, and the closing chapters focus on revision surgery and consider outcome measures following stapes surgery. To better illustrate the subject matter, the book features a wealth of photographs (including more than 50 in color), as well as in-depth surgical video
A new semi-implantable middle ear implant for sensorineural hearing loss. three-years follow-up in a pilot patient’s group
No full textObjective: The aim of this article is to report on the long-term follow-up of a new semi-implantable middle ear device utilized for restoration of moderate-to-severe sensorineural hearing loss in a first series of subjects. Methods: Three subjects, affected by sensorineural hearing loss, have undergone implantation of Maxum® middle ear implant, via a transcanal approach. They all underwent an auditory assessment, paying particular attention on the pre- versus post-operative hearing levels under the unaided, best-fitted hearing aided and implant-aided conditions. The audiometric evaluation has been repeated 3 years after implantation and implemented by questionnaires aiming at the evaluation of the quality of life. Results: The post-operative hearing threshold and discrimination in quiet appear to be similar or better than those provided by conventional hearing aids, with a concomitant improvement of the subjects’ quality of life. The application of the present device showed to be easy and reproducible, with no severe adverse effects recorded at the 3-years follow-up. Mild issues due to the external component were also observed, such as difficulty of keeping it continuously in place due to excess canal sweating in one subject, and a temporary loss of stability due to occurring irregularities of the external coating in another subject. Conclusions: Long-term, preliminary data reveal that the Maxum® device may provide equal or better functional gain and word recognition scores in quiet in patients with moderate-to-severe sensorineural hearing loss, in comparison to optimally fitted hearing aids, with a satisfactory improvement of their quality of life
Proposal of a magnetic resonance imaging follow-up protocol after cholesteatoma surgery: a prospective study
No full textBackground: Non-echo planar (EPI) diffusion-weighted (DW) MRI has become an effective tool for the follow-up after cholesteatoma surgery and decreased the rate of second-look surgeries. Objectives: To shed light on the optimal imaging follow-up protocol to detect postoperative residual or recurrent cholesteatoma. Materials and methods: 64 patients were included in this prospective study. Three different surgical procedures were considered: canal-wall-up (26 patients), canal-wall-down (20 patients), and obliterative (18 patients). The imaging follow-up protocol included non-EPI DW MRI during the following postoperative periods: 1 month, 6 months, and 1, 3, 5, and 7 years after the primary surgery. Results: MRI-positive lesions were present in 18.75% of patients. 50% of the MRI-positive findings occurred at the 1-month follow-up. The other peak of MRI positivity occurred at the 3-year follow-up. The last MRI-positive finding appeared at the 5-year follow-up. Conclusions: The timing for the imaging protocol proposed by this prospective study to detect recidivism after cholesteatoma surgery stressed the importance of performing non-EPI DW MRI for detecting residual, though rare, disease. Likewise, extending the follow-up to a least 5 years after primary surgery was also recommended to detect any recurrent cholesteatoma that would appear unlikely to be present beyond this time se
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