Minimally Invasive Surgery for Intracochlear Schwannoma Removal and Simultaneous Cochlear Implantation

Abstract Introduction Hearing preservation has not yet been reported in patients undergoing resection of intracochlear schwannomas. This study describes a minimally invasive procedure for intracochlear schwannoma resection with simultaneous cochlear implantation that resulted in good hearing. Objective This study aims to describe a minimally invasive procedure for intracochlear schwannoma resection with simultaneous cochlear implantation. Data Synthesis The technique described in this study was developed for a 55-year-old male with a 20-year history of bilateral progressive hearing loss and tinnitus that had a mass in the left apical turn of the cochleameasuring 0.3 cm. Surgery accessed the apical turn of the cochlea. We performed mastoidectomy and posterior tympanotomy and removed incus and tensor tympani muscle to expose the cochlear apex. The tumor was identified and completely resected. After the cochleawas anatomically preserved, it was implanted with a straight electrode via round window insertion. The histopathological examination confirmed intracochlear schwannoma. Speech perception test revealed 100% speech recognition with closed sentences and the average audiometric threshold (500 to 2000 Hz) was 23 dB. Conclusion Our technique led to rehabilitation of the patient and improved hearing without damaging the intracochlear structure, making it possible to perform CI in the same procedure with good results.

Hearing Rehabilitation with Sophono(R) in Patients with Unilateral Hearing Loss after Meningioma Removal / 대한이비인후과학회지

Various bone conduction hearing aids have been widely used to improve hearing fuction for the last 30 years. Sophono(R), a newly introduced device without percutaneous abutment, improved disadvantages of previously used bone conduction hearing aids. Recently, we experienced a case of Sophono(R) implantation in a patient presenting with mixed hearing loss followed by tumor surgery. The patient gained air conduction threshold of 60 dB HL compared to preoperative pure tone audiogram and a speech discrimination test in noisy environment showed improved results. Furthermore, the patient has had no cutaneous complications since implantation. The results of this case demonstrate the feasibility of implanting Sophono(R) in patients similar to this case. Considering its advantages of MRI compatibility and non-invasive surgery, as well as esthetical benefit, Sophono(R) implantation could be a preferable option for hearing rehabilitation.

Hearing Rehabilitation of Single-Sided Deafness: Benefit and Selection Criteria of Bone Anchored Hearing Aid and Contralateral Routing of Signal Hearing Aid / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: There are two ways to route sound from a deaf hemifield to a functional ear: the bone anchored hearing aid (BAHA) and the contralateral routing of signal hearing aid (CROS HA). BAHA uses transcranial bone conduction; on the other hand, CROS HA uses air conduction. The objectives of this study were to evaluate the benefit of these auditory rehabilitation devices objectively and subjectively, and to analyze factors that affect daily using time. SUBJECTS AND METHOD: We retrospectively reviewed the medical records of 19 patients who selected BAHA and 9 patients who selected CROS HA to undergo rehabilitation of unilateral hearing loss. Preoperative pure tone air and bone conduction thresholds, BAHA-aided thresholds and CROS HA-aided thresholds were measured. Hearing in noise test (HINT) was measured with unaided and aided in signal to noise ratio 10 (signal 75 dB HL, noise 65 dBA). Bern Benefit in Single-Sided Deafness Questionnaire (BBSS) was evaluated for all patients to assess subjective satisfaction and also, daily device using time was investigated. RESULTS: The aided pure tone audiometry was 44.58 dB HL, 42.71 dB HL for in BAHA and CROS HA, respectively, whereas the unaided PTA was 111.29, 103.28 dB HL for BAHA and CROS HA, respectively. The aided HINT was 63.03 and 64.06%, whereas the unaided HINT was 22.13% and 37.44% for BAHA and CROS, respectively. BBSS showed more satisfactory results with BAHA and CROS HA when compared unaided in all items. Daily using time did not correlate with the degree of satisfaction, better ear hearing levels or etiology. CONCLUSION: It was found that not only the preoperative BAHA rod test and HA trials but also the customized and detail counseling were needed for single sided deaf patients to use auditory rehabilitation devices frequently.

O processo de inclusão de crianças com deficiência auditiva na escola regular: vivências de professores / The inclusion process of hearing impaired children in regular schools: the experience of teachers

O objetivo do presente estudo foi descrever e discutir, a partir da vivência de professores, o processo de inclusão de crianças com deficiência auditiva em escola regular. Foram selecionadas três crianças entre 05 e 08 anos de idade, e seus respectivos professores. Por meio de entrevistas com as professoras das crianças, foi selecionado o material que permitiu caracterizar o processo de inclusão de cada criança do estudo. Os relatos das professoras sobre suas experiências com as crianças deficientes auditivas deste estudo parecem indicar que, ainda hoje, apesar da evolução das práticas inclusivas, prevalecem nas escolas muito mais os pressupostos da integração do que da inclusão. As professoras foram unânimes em admitir que não vêm sendo suficientemente preparadas para receber deficientes auditivos e pouco sabem sobre o desenvolvimento da audição, da linguagem e sobre como esses aspectos influenciam e determinam formas particulares de apreensão de conteúdos. Prevalece a idéia de que é a criança com necessidades educacionais especiais quem deve se adaptar ao ambiente, empenhar-se para ser nele integrada; ou então, as professoras buscam estratégias individuais de aproximação, sem que essa questão seja problematizada junto ao corpo técnico da escola, que ainda não vem efetivando transformações em sua organização para receber esses alunos.

The aim of this study was to describe and discuss the process of inclusion in regular schools of children who are hearing impaired, based on teachers' perceptions of the process. Three children between the ages of 5 and 8 years and their teachers participated in the study. The interviews with the children's teachers were recorded, and material was selected from the transcripts that allowed us to characterize the inclusion process of each child in the study. The teachers' reports about their experiences with the hearing impaired children of this study seem to indicate that, even today, despite enhancement of inclusive practices, there is evidence that what prevails in schools are the presuppositions of integration rather than the principles of inclusion. Teachers were unanimous in admitting that they are not being sufficiently prepared to receive hearing impaired children and few of them have knowledge of language and hearing development and how such aspects influence and determine the specific ways hearing impaired students apprehend academic content. The main idea that seems to prevail is that it is the obligation of the child with special needs to adapt to the environment, and attempt to integrate him or herself into it. Teachers seek individual strategies of contacting the child, as the issues are not coped with collectively by the administrative and teaching staff. It seems that the school is slow to change in ways that would help to welcome these students.

Clinical Analysis of Hearing Aid Failure / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: An hearing aid is a useful tool for hearing rehabilitation when surgical hearing correction is not indicated. Successful hearing aid rehabilitation is affected by various factors such as the degree and types of hearing impairment, personality, motivation and duration of adaptation. We aimed to identify factors for satisfying hearing aid by analysis and comparison of the successful and the failure groups of hearing aid users, and to recognize problems of hearing aid prescribed in the non-medical institutes. SUBJECTS AND METHOD: Two hundred and sixty six ears of 202 hearing aid users were referred to the Ajou Hearing Center for two years, and their clinical data were retrospectively reviewed including hearing status and hearing aid type. Twenty ears were prescribed by the non-medical institutes and others were 1st time users. The failure group of hearing aid users was defined when they gave up using hearing aid and requested for refund after an adaptation period of more than one month. RESULTS: Hearing aids failed to work in 9% of 266 ears. All problems of previous hearing aid users were solved by represcription and functional modification of hearing aids. The portion of patients older than 65 year old was not different in two groups, but the portion of female patients in the failure group was significantly larger than that in the success group (p=0.01). The unaided speech discrimination score was significantly higher in the success group (p=0.02). The most common cause of hearing aid failure was poor speech discrimination than expectation. CONCLUSION: The speech discrimination score and sex are considered as important factors for successful rehabilitation of hearing aid. The prescription of hearing aids and follow-ups in the experienced medical institutes would predict better outcome. The realization of expectation level is of importance when interviewing hearing aid candidates. Further clinical study is necessary for satisfying hearing aid rehabilitation.

Large vestibular aqueduct syndrome:23 cases report / 中国康复理论与实践

@#This paper reports 23 cases of the large vestibular aqueduct syndrome.All cases are sensori-neural hearing loss,23.91% is moderately severe hearing loss,54.35% is severe hearing loss,and 21.74% is profound hearing loss.The contour of audiogram in high frequency dctcrioration is 74%,che flat contour of audiogram is 13%,the islanded contour audiogram is 13%.Some cases are progressive hearing loss,and the others are sudden hearing loss,two cases among whole cases were found vestibular dysfunction after examination.After high resolution CT scan in inner ear,27 ears were found pathological changes only in vestibular aqueduct enlargement,in addition to these changes,12 ears were found malformation of vestibule and semicircular canals,and 7 ears were showed cochlea malformation.It is said that the disease is caused by abnormal development on endolymphatic duct in early embryonic stage,and the principal inducement is infectious factor.There is not an effective treatment,but the better results can be reached in deaf children with residual hearing,after they wearing hearing aids and getting the auditory-verbal training in the early period of time.If the hearing aid can not reach effective hearing compensation for these patients,cochlea implantation is considered and suggested.