Efficacy in patients with outer and middle ear deformities of using bone-anchored hearing aids / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy and satisfaction of bone-anchored hearing aids (BAHA) in patients with outer and middle ear deformities.</p><p><b>METHODS</b>Seven patients with bilateral microtia and aural atresia, and three patients with unilateral microtia and bilateral middle ear malformation were fitted with soft-band BAHA for a few months, followed by receiving unilateral BAHA implantation. Mean pure-tone thresholds and speech audiometry tests results were compared among patients without hearing aid, with soft-band BAHA, and with implanted BAHA. Scores from the BAHA users' questionnaires and Glasgow children's benefit inventory (GCBI) were used to measure patient satisfaction and subjective health benefit.</p><p><b>RESULTS</b>The mean pure-tone thresholds of the patients were (64.8 ± 5.9) dBHL for those without hearing aid, (30.2 ± 3.7) dBHL for those with soft-band BAHA, and (20.3 ± 3.9) dBHL for those with implanted BAHA. The average decline in pure-tone threshold was (36.2 ± 8.0) dBHL for those with soft-band BAHA, and an additional decline of (12.2 ± 3.4) dBHL was achieved with implanted BAHA. The average gains in speech discrimination scores (SDS) were (3.00 ± 1.07)% for those without hearing aids and (89.39 ± 5.83)% for those with implanted BAHA in sound field of 45dBHL. SDS were (57.55 ± 10.30)% for those without hearing aids and (91.19 ± 4.16)% for those with implanted BAHA in sound field of 65dBHL. The average gains in SDS were (88.21 ± 6.86)% and (38.04 ± 7.56)% tested with 45dBHL and 65dBHL respectively. Sound reception thresholds (SRT) without hearing aids were (63.1 ± 5.9) dBHL and (24.7 ± 3.5) dBHL for those with implanted BAHA. The average gains in SRT was (39.6 ± 6.2) dBHL. The BAHA application questionnaire demonstrated excellent patient satisfaction. The general benefit score was 35.59 ± 14.35.</p><p><b>CONCLUSION</b>BAHA remains one of the most reliable methods of auditory rehabilitation and improves quality of life for patients with ear deformities.</p>

Measurement of electrical evoked middle latency response in cochlear implantation operation / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To establish the method of conducting electrical evoked middle latency response (EMLR) monitoring in cochlear implantation operation and further to assess the neural response of auditory pathway under electrical stimulation.</p><p><b>METHODS</b>Twenty cases of cochlear implantation subjects were investigated in this study. Fourteen cases were pre-lingual deaf and 6 were post-lingual deaf. The surface recording electrodes were placed on the patients under general anesthesia, with language processor connected to the triggering port of the auditory evoked potential device. After the electrode was implanted, the electrode No.3 was selected to conduct. The electrically evoked auditory nerve compound active potentials (ECAP) were firstly tested in all patients, thereafter the EABR mode was selected, and the stimulation parameters were changed to EMLR mode with monopole biphasic, alternation stimulation, pulse width from 50 to 100 µs, the stimulation intensity decreased or increased from 20 CL above the strength of the ECAP threshold to the reaction threshold with a step of 5CL. To evaluate the correlation between the ECAP thresholds and EMLR, another 6 cases of normal hearing healthy subjects were recruited to record their short-sound evoked auditory middle-latency response (AMLR), as the control of morphology and latency of MLR by electrical stimulation.</p><p><b>RESULTS</b>The typical AMLR waveforms could be recorded by the composition of five waves in the 6 cases of normal hearing healthy subjects, with an average response threshold of (12.5±8.6) dBnHL, close to the behavioral audiometric threshold (10.8±7.3) dBHL. The EMLR waveforms could be recorded in 20 patients, which was similar to the AMLR waveforms. However, the wave latency and wave interval shortened. There were lower volatility and longer latency in pre-lingual deaf than post-lingual deaf. The EMLR threshold (140.55±9.92) CL was significantly lower than the ECAP threshold (160.75±13.34) CL (t=10.467, P<0.01), a positive correlation between the thresholds was detected (r=0.763, P<0.01).</p><p><b>CONCLUSIONS</b>We successfully established the method of EMLR monitoring in cochlear implantation surgery. The EMLR threshold is lower than the ECAP threshold but it is close to the behavioral audiometric threshold; EMLR can provide neural response information closer to the auditory center, and can serve as an effective objective method to evaluate the effect of hearing rehabilitation.</p>

Application of intraoperative round window electrocochleography for screening the patients with auditory neuropathy / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Most patients with auditory neuropathy (AN) could receive good even the best effects after cochlear implantation. How to diagnose AN objectively and accurately is very important. In this study, we screened the patients with AN according to the presence or absence of compound action potential (CAP) of intraoperative round window electrocochleography (RW ECochG).</p><p><b>METHODS</b>Intraoperative RW ECochG was performed on 32 patients with profound sensorineural deafness, who had normal cochlea during cochlear implantation surgery under general anesthesia in the standard operating room. The cochlear microphonic (CM) and CAP of RW ECochG was observed and recorded.</p><p><b>RESULTS</b>The presence of CM but the absence of CAP of RW ECochG occurred in 12 among the 32 patients. They were suspected to suffer from AN. The rest patients who had CM and CAP of RW ECochG were thought not to suffer from AN.</p><p><b>CONCLUSION</b>Application of intraoperative RW ECochG during the cochlear implantation surgery may objectively and accurately screen the patients with AN, and can give a meaningful clue for implanted device working.</p>

Establishment and rudimentary application of the method of recording auditory brainstem responses electrically stimulated via round-window niche in cochlear implants / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To establish the method of recording auditory brainstem responses electrically stimulated via round-window niche in cochlear implants.</p><p><b>METHODS</b>Self-made platinum iridium alloy as a spherical electrode stimulation electrode, modified cochlear implants connected to in vitro speech processor as a electro-stimulator and evoke potential instrument for Bio-logic Navigator Pro, 17 cochlear implant patients with various ages and of different causes, including auditory neuropathy (2 cases), ossified cochlea (1 case), inner ear malformation (5 cases), leukodystrophy (1 case), unknown and reason (8 cases) were investigated during cochlear implant surgery. Before cochlear implantation, stimulation electrode was placed in the round-window niche while charge balanced biphasic constant current was used as electrical stimulation via round window niche, and then electrically evoked auditory brainstem response was recorded.</p><p><b>RESULTS</b>Electrically evoked auditory brainstem response waveforms were clearly recorded in all 17 cases. The latencies of III and V waves were (2.12 +/- 0.18) ms and (4.18 +/- 0.19) ms respectively, with threshold as (220.0 +/- 16.04) CL. The waveforms of the 2 patients with auditory neuropathy, 5 patients with inner ear malformation, 1 patient with ossified cochlea and 1 patient with leukodystrophy were well differentiated.</p><p><b>CONCLUSIONS</b>Monitoring electrically evoked auditory brainstem response was an objective nerve electrophysiological testing method that accurately reflects function completeness of auditory pathway. It had important value for helping making the judgment whether patients could acquire auditory response after cochlear implantation. This method was safe and gave high emission of auditory response, therefore should be spread widely.</p>

Local response caused by implant after cochlear implantation / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To approach the incidence rate, symptoms, etiologies, correlating reasons, consequences and treatments of local responses caused by implant after cochlear implantation and to provide reference for the future works.</p><p><b>METHODS</b>From 1995 to 2007 there were 997 cases adopted cochlear implantation in Peding Union Medical College Hospital. Ten cases experienced local responses were analyzed retrospectively.</p><p><b>RESULTS</b>The incidence of local response was 1.003%. There were 6 males and 4 females. The ages were between 13 months to 8 years old. The average age was 34 months. The devices mainly were made by Cochlear and Med-EL companies. The mainly symptoms and signs were local swellings, complaint of pruritus after ear, decrease of sound legibility and so on. Onset frequencies of this disease was 1 to 8 times. The bacterium cultured of displacing liquids was negative. But the IgE was detected in 2 cases. Results showed the patients were midrange status of hypersensitivity. Positive conservative treatments must be done including antibiotics, antihistamines, necessarily using immunotherapy.</p><p><b>CONCLUSIONS</b>Besides local infection of bacteria, the allergy caused by silicone of implant coupled be a reason. Although the diagnose of this disease was difficult, but the screening of source of hypersensitivity was necessary before operation. It was recurrent attacks and maybe liable by kindred patients. Onset age was more below 4 years old. The patch test should be done again when the symptoms were occurrence after operation. If severe secondary infection was occurred and the states could not be well controlled the devices in the body must be explanted immediately. When the conditions were stable reimplantation could be experienced by non-sensibilisinogen devices.</p>

Auditory pre-attentive processing of Chinese tones / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Chinese tones are considered important in Chinese discrimination. However, the relevant reports on auditory central mechanisms concerning Chinese tones are limited. In this study, mismatch negativity (MMN), one of the event related potentials (ERP), was used to investigate pre-attentive processing of Chinese tones, and the differences between the function of oddball MMN and that of control MMN are discussed.</p><p><b>METHODS</b>Ten subjects (six men and four women) with normal hearing participated in the study. A sequence was presented to these subjects through a loudspeaker, the sequence included four blocks, a control block and three oddball blocks. The control block was made up of five components (one pure tone and four Chinese tones) with equiprobability. The oddball blocks were made up of two components, one was a standard stimulus (tone 1) and the other was a deviant stimulus (tone 2 or tone 3 or tone 4). Electroencephalogram (EEG) data were recorded when the sequence was presented and MMNs were obtained from the analysis of the EEG data.</p><p><b>RESULTS</b>Two kinds of MMNs were obtained, oddball MMN and control MMN. Oddball MMN was obtained by subtracting the ERP elicited by standard stimulation (tone 1) from that elicited by deviant stimulation (tone 2 or tone 3 or tone 4) in the oddball block; control MMN was obtained by subtracting the ERP elicited by the tone in control block, which was the same tone as the deviant stimulation in the oddball block, from the ERP elicited by deviant stimulation (tone 2 or tone 3 or tone 4) in the oddball block. There were two negative waves in oddball MMN, one appeared around 150 ms (oddball MMN 1), the other around 300 ms (oddball MMN 2). Only one negative wave appeared around 300 ms in control MMN, which was corresponding to the oddball MMN 2. We performed the statistical analyses in each paradigm for latencies and amplitudes for oddball MMN 2 in discriminating the three Chinese tones and reported no significant differences. But the latencies and amplitudes for control MMN in discriminating the three tones all were significantly different.</p><p><b>CONCLUSIONS</b>There are evident waveforms for oddball and control MMN obtained in normal hearing persons, indicating that the change of Chinese tones could be detected in the pre-attentive stage. Because control MMN can eliminate reflects for physical characteristics of sound, it is the genuine memory-based pre-attentive processing. Since control MMN can reflect the differences of Chinese tones processing better than oddball MMN, it is more sensitive in evaluating pre-attentive processing in Chinese tones discrimination.</p>

Cochlear implantation in patients with ossified cochleas / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>The ossified cochlea was no longer an absolute contra-indication to cochlear implantation but it was still a challenge even for the experienced otologist. To report the condition of cochlear implantation and the hearing results of 31 cases of cochlear ossification.</p><p><b>METHODS</b>Retrospective analysis of cochlear implantation of 720 cases of cochlear implantation from May 1995 to July 2005 in Peking Union Medical College Hospital.</p><p><b>RESULTS</b>Thirty-one cochlear ossification patients was found from all the 720 surgeries which included 27 mild cases and 4 severe ones, 14 males, 17 females. And the age of operation was 1. 4 - 59. 0 years old , mean age was 13. 2 years old. All of them had cochlear implanted through mastoid-facial recess. There was no complications during or post the operations. And the hearing threshold was about 40 dB in the sound field, the results were similar to those without cochlear ossification.</p><p><b>CONCLUSIONS</b>Although it was difficult of cochlear implantation in cochlear ossification patients, but in most cases especially mild ones all the electrodes could be implanted after clearing the ossified tissue, and had few damage to the electrodes. Now it was possible to practice in the partial cochlea ossification.</p>

Cochlear implantation in patients with otitis media-related diseases / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the indications, surgical techniques and complications of cochlear implantation in patients with otitis media-related diseases.</p><p><b>METHODS</b>Retrospective study of the data collected from patients receiving cochlear implantation. Totally 866 cases of cochlear implantation were performed in Peking Union Medical College Hospital from May 1995 to February 2006. Among which, 41 patients with otitis media-related diseases were grouped into 5 types: chronic secretory otitis media (13 cases), silent (subclinical) otitis media (18 cases), dry eardrum perforation (1 case), bilateral cholesteatoma of middle ear (2 cases) and middle ear granuloma (7 cases). Seven cases were accompanied with deformities of middle ear and (or) inner ear. Pedicled aponeurosis of occipitofrontalis muscle was transplanted to cover and protect the inserted electrodes and facial nerve in a patient with bilateral cholesteatoma after radical mastoidectomy.</p><p><b>RESULTS</b>All the 41 patients with otitis media-related diseases were successfully implanted in one stage or staged operations and followed up uneventfully for 5 months to 6 years and 11 months. All implant devices had worked normally and all patients had performed well.</p><p><b>CONCLUSIONS</b>Patients with chronic secretory otitis media, silent (subclinical) otitis media, middle ear granuloma or dry ear-drum perforation could be operated in one stage or staged procedures safely and effectively. Patients with bilateral cholesteatoma could be implanted after radical removal of related lesions. Pedicled aponeurosis of occipitofrontalis muscle could be transplanted in cases of mastoid bowl to cover and protect the inserted electrodes and the exposed facial nerve and with easy access to observe the mastoid cavity. Active suppurative otitis media was contraindicated for cochlear implantation. Long-term following-up was essential for better evaluation of the outcomes of cochlear implantation in patients with otitis media-related diseases.</p>

Cochlear function after selective spiral ganglion cells degeneration induced by ouabain / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Ouabain, a cardiac glycoside that specifically binds to Na/K-ATPase and inhibits its activity, was applied to gerbils to develop a method for studying auditory neuropathy.</p><p><b>METHODS</b>Ouabain was applied to the round window of the cochlea in each gerbil by using a piece of gelfoam with 3 microl or 24 microl (1 mmol/L) ouabain solution. The changes of the threshold of auditory brainstem response, cochlear function round window electrocochleography, as well as the morphological changes of the spiral ganglion cells of the cochlea were observed after application of ouabain for 24 hours or 96 hours.</p><p><b>RESULTS</b>In ouabain treated gerbils, auditory brainstem response and compound action potential thresholds showed either elevation or no response at all. However, the thresholds of cochlear microphonic and distortion product otoacoustic emissions were not affected. Degeneration and necrosis of some spiral ganglion cells in ears with applications of ouabain (24 hours, 3 microl, 1 mmol/L; 96 hours, 24 microl, 1 mmol/L ouabain). The number of spiral ganglion cells was decreased (24 hours, 3 microl, 1 mmol/L ouabain) or near to a total loss (96 hours, 24 microl, 1 mmol/L ouabain).</p><p><b>CONCLUSIONS</b>These results indicate a high degree of independence between the spiral ganglion cells and the outer hair cell systems in the cochlear transduction mechanism. The method used in this study would provide a valuable tool for studying auditory neuropathy.</p>

Virtual otoscopy of middle ear structure and pathology / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To assess the value of high-resolution CT data of the temporal bone for the virtual endoscopic (VE) visualization of the ossicular chain and the temporal bone.</p><p><b>METHODS</b>Fifty patients with suspected lesions of middle ear underwent a high-resolution CT of the temporal bone with VE, seventeen patients were subsequently operated. CT examinations of the temporal bone were carried out using spiral equipment and endoscopic 3D processing was carried out on a separate workstation equipped with a flying through program.</p><p><b>RESULTS</b>VE is valuable for the evaluation of ossicular dislocation, disruption and ossicular lysis, morphological anomalies of the malleus, incus, and stapes, as well as for evaluation of normal middle ear structures with high detail. The VE assessment in detecting ossicular disruption of chronic otitis media match the operation exploration perfectly (10 in 11 ears), whereas only 3 in 6 ears of cholesteatoma match the operation exploration.</p><p><b>CONCLUSIONS</b>This image processing method can be used pre-operatively for the individual planning, simulation, and post-operatively for assessment of the position of implants.</p>

Voice analysis in pre-lingual cochlear implant adults / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To observe voice characteristic of pre-lingual cochlear implant adults for cochlear implantation and phoniatrics.</p><p><b>METHODS</b>3s-sustained voice of vowel [ a: ] of 28 pre-lingual cochlear implant adults, 18 pre-lingual deafness adults and 10 adults with normal hearing were analyzed. Specifically, the Voice analyses include fundamental frequency, first formant, second formant, frequency perturbation quotient (FPQ), amplitude perturbation quotient (APQ) and harmonic noise ratio (HNR). The outcomes of 3 groups were compared.</p><p><b>RESULTS</b>The fundamental frequency was lower in cochlear implant group [(175.42+/-25. 31) Hz] than that in deafness group [(210.84+/-54.300) Hz] (P = 0.02). The position of formant of cochlear implant group [F2 = (1264. 64 +/- 152.19) Hz] was more access to normal than that of normal hearing group[ F2 = (1422.44 +/- 232. 37) Hz, P = 0. 02]. FPQ of cochlear implant group (2.09 +/- 1.15) was more access to normal than that of deafness group (5.32+/-4.29, P=0.006). The voice of cochlear implanted and deafness adults were much more different individually.</p><p><b>CONCLUSIONS</b>In the aspect of acoustic characteristic of voice, pre-lingual cochlear implant adults could benefit cochlear implantation finitely. As speech perception of pre-lingual cochlear implant adults was far worse than that of children and post-lingual cochlear implant adults, the general outcome of pre-lingual cochlear implant adults was very limited. Cochlear implant of those candidate should be cautious.</p>