ABSTRACT
The Pakistan cochlear implant programme was started in Lahore in August 2000. It was initially established with the technical support of the Manchester cochlear implant team. There are no government resources available for cochlear implantation in Pakistan and the cost of cochlear implantation is met by the candidates and their families. Up till December 2005, 52 individuals have been implanted. Forty-four (84.6 per cent) of these patients were children and eight (15.4 per cent) patients were adults. Congenital deafness (94 per cent) is the main aetiological factor in children. Seventy-six per cent of these children were born to blood related parents. All patients received a Med-El Combi 40+ device. The listening progress profile, the meaningful auditory integration scale and the meaningful use of speech scale were used to assess the auditory performance in children. Thirty-nine children achieved an average listening progress profile score of 37.7 after 12 months of implantation. The overall rate of major and minor complications was 11.5 per cent. Failure rate for the device itself has been 3.8 per cent. In addition to considering these preliminary outcomes and funding issues, the problems of setting up a cochlear implant programme in a developing country are discussed.
Subject(s)
Cochlear Implants , Correction of Hearing Impairment/organization & administration , Hearing Loss, Sensorineural/rehabilitation , Adolescent , Adult , Child , Child, Preschool , Developing Countries , Female , Humans , Infant , Male , Pakistan , Program Development , Program EvaluationABSTRACT
OBJECTIVE: To determine the effectiveness of BioGlue surgical adhesive in dural and middle ear closure after translabyrinthine vestibular schwannoma surgery. STUDY DESIGN: A prospective study. SETTING: Tertiary neurotological referral center. PATIENTS: There were 24 patients in the BioGlue series. BioGlue was used in the same manner in all cases. All patients received similar postoperative care. INTERVENTIONS: We studied the use of BioGlue and its possible effect on further reducing our department's cerebrospinal fluid leak rate for translabyrinthine vestibular schwannoma surgery. MAIN OUTCOME MEASURES: Postoperative events were documented that enabled us to determine the overall cerebrospinal fluid leak rate (including incidence of various leak routes and morbidity). RESULTS: The overall cerebrospinal fluid leak rate was 62.5% (15 of 24). Rhinorrhoea was the commonest route (80%), followed by postaural wound leak (33.3%) and external auditory canal otorrhoea (33.3%). Forty percent of cases had more than one cerebrospinal fluid leak route; 73.3% of leak cases required lumbar drain insertion, 40% needed pressure bandaging, and 66.7% had to undergo formal surgical repair. Forty percent had recurrent leaks after the initial episode had completely ceased. The mean extra stay in hospital as a result of the cerebrospinal fluid leak was 13.3 days. CONCLUSION: Our preliminary prospective study of the use of BioGlue for dural and middle ear closure in translabyrinthine vestibular schwannoma surgery demonstrated poor results. The high cerebrospinal fluid leak rate associated with the unusual presentations and ensuing management difficulties in controlling these leaks lead us to recommend that BioGlue not be used in translabyrinthine vestibular schwannoma surgery. The manufacturers have noted our results and have considered adding our recommendation to the product data sheet.
Subject(s)
Cerebrospinal Fluid Otorrhea/prevention & control , Cranial Nerve Neoplasms/surgery , Neurilemmoma/surgery , Proteins/therapeutic use , Vestibular Nerve , Vestibulocochlear Nerve Diseases/surgery , Adult , Aged , Aged, 80 and over , Cerebrospinal Fluid Otorrhea/etiology , Ear, Inner/surgery , Female , Humans , Male , Middle Aged , Postoperative Complications/etiology , Postoperative Complications/prevention & control , Prospective Studies , Treatment Outcome , Vestibule, Labyrinth/surgeryABSTRACT
Stenotic malformations of the internal auditory meatus (IAM) are rare. They are known to symptomatically mimic vestibular schwannomas leading to potential diagnostic error. We present a case (along with literature review) where a stenotic IAM was clinically and radiologically misdiagnosed as a vestibular schwannoma.
Subject(s)
Cranial Nerve Neoplasms/diagnosis , Ear, Inner , Labyrinth Diseases/diagnosis , Neuroma, Acoustic/diagnosis , Vestibulocochlear Nerve Diseases/diagnosis , Adult , Constriction, Pathologic/diagnosis , Diagnosis, Differential , Hearing Loss, Sensorineural/etiology , Humans , Magnetic Resonance Imaging/methods , Male , Petrous Bone/abnormalities , Tomography, X-Ray Computed/methodsABSTRACT
Cochlear implantation is usually a safe procedure but, as in most surgical interventions, it can carry some risk of complications. These can be divided into major and minor that, in turn, in turn can present early or late. This case report highlights a potential late, major complication of cochlear implantation namely extrusion, which was averted by prompt intervention. The patient presented with a three months' history of otalgia some six years after successful implantation. The posterior half of the tympanic membrane was found to be retracted on the electrode, which appeared to be on the point of extruding through the drum. A tragal cartilage myringoplasty was performed to separate the electrode from the medial surface of the tympanic membrane. There was immediate and lasting relief of the otalgia, the electrode was well protected and performance with the device was unchanged. The authors recommend reinforcing an atrophic tympanic membrane at the time of the cochlear implantation by a cartilage graft to avoid this potentially serious complication. The case also highlights the need for regular otoscopy for all implanted patients.
