Preoperative evaluation, surgical procedure, follow up and results of 150 cochlear implantations.

BACKGROUND: The cochlear implantation is among the most important achievements of medicine and biotechnology in the last 20 years, because it allows individuals who had never heard or had lost their hearing to perceive sound and improve their quality of life. Selection criteria for candidates are strict and are evaluated in each individual by a scientific committee specially trained for implantations which includes Ear Nose and Throat (ENT) surgeon, audiologist, psychiatrist and speech therapist. PATIENTS AND METHODS: In our department, the first cochlear implantation was performed in 1995. During the last ten years more than 250 individuals have been evaluated due to profound hearing loss and 170 of them were found to be suitable candidates for cochlear implantation. One hundred and fifty (150) have already been operated and most of them are children with congenital hearing loss. No major or permanent complications were recorded in any of our 150 patients. Activation and fitting/mapping of the cochlear implant is initiated three weeks post-operatively. Regular follow-up and mapping of the implant are held, more frequently in children, along with specialized speech therapy. Each new mapping is evaluated according to the record of the patient with regard to the acoustic perception of sounds and speech and the discrimination of individual elements of phonation based on a protocol that we have created for the needs of Greek language. RESULTS: Speech discrimination (AHEPA Hospital protocol), before the Implantation, at the activation of the cochlear implant and till 4 years of the follow-up showed that in our patients, we obtained better and faster results in post-speech acquisition adults with recent or chronic deafness and in children with congenital deafness operated before the 5th year of age, who underwent special preoperative speech therapy programme, fact which is in agreement with current literature. Patient satisfaction evaluated by "Sanders" psychometrics tests, was achieved in accordance to pre-operative expectations. CONCLUSIONS: In our patients, we observed better and faster results in children with congenital deafness operated before the third year of age, in post-speech acquisition adults with recent deafness and in post-speech acquisition adults with chronic deafness but with auditory memory reserve.

Hearing and speech assessment of cleft palate patients after palatal closure. Long-term results.

OBJECTIVE: The goal of this study was the development of a clinical methodology to assess speech and hearing impairment 5 years after the primary surgical repair of the cleft and, further, to determine the relative importance and long-term consequences of each cleft type and age to the velopharyngeal and eustachian tube function in patients who did not undergo pharyngeal flap surgery following primary palatoplasty. MATERIALS AND METHODS: We evaluated with a certain assessment protocol hearing and speech abilities of 42 patients between 5 and 15 years of age: 9 with CP (cleft of the soft and hard palate), 19 with unilateral cleft lip and palate (UCLP), 14 with bilateral cleft lip and palate (BCLP), surgically treated by a team of surgeons using two different surgical techniques between 18 and 24 months of age. ACCORDING TO OUR RESULTS WE WERE ABLE TO EVALUATE: (a) the impact of hearing impairment to the development of speech in these patients. (b) The relation of hypernasality with compansatory articulation. (c) The influence of cleft type, by means of extent of the cleft palatal musculature, to speech integrity. RESULTS: Sixty-nine percent of our patients presented with mild and moderate hearing loss. Hypernasality was observed in 40.5%, compensatory articulation in 28.5% of our patients. CONCLUSIONS: Our findings indicated: (a) a simultaneous appearance of speech and hearing impairment at the same age for each cleft type post-surgically in our patients; (b) that the muscular and vomer complex rather than the anatomic extent of the cleft is a significant factor for speech outcome after surgical repair; and (c) that hypernasality is exacerbated by compensatory articulation.

Risk factors associated with hearing loss in neonates.

PURPOSE: To identify the risk factors associated with hearing loss in our neonatal patient population and compare them to the ones listed by the Joint Committee on Infant Hearing. PATIENTS AND METHODS: The medical records of 50 consecutive infants with hearing impairment by auditory brainstem response (ABR) audiometry were reviewed retrospectively and were compared with the records of 50 randomly selected newborns that had normal hearing. RESULTS: In our review, only five of 18 variables were found to be associated with hearing impairment. These are: hyperbilirubinemia, craniofacial anomalies (CFA), length of stay in the intensive care unit, respiratory distress syndrome, and retrolental fibroplasia. The last three variables are not listed in the high-risk register published by the Joint Committee on Infant Hearing. CONCLUSION: The results of this study provide for additional risk factors that may be used in infant-hearing screening programs.

Complicated suppurative otitis media in a Greek diver due to a marine halophilic Vibrio sp.

Halophilic vibrios are distinct from non-cholera vibrios and have been recognized increasingly as potentially pathogenic bacteria in extraintestinal infections. A case of suppurative chronic otitis media in a Greek diver with Vibrio alginolyticus recovered from an ear drainage culture, is reported. The patient received appropriate antimicrobial therapy and her hearing improved significantly after a tympanoplasty type I was performed. The association of halophilic Vibrio spp. infections with prolonged seawater contact, particularly in subtropical climates, is discussed. In swimmers with extensive exposure to salt water, individual preventive measures and aetiological treatment of ear infections seems to be required in order to reduce the severity of possible Vibrio spp. ear infections.

Mandibular ramus osteoblastoma. A case report.

A case of osteoblastoma of the mandibular ramus is presented with an over 2 years history and with a single clinical sign,--progressive enlargement of the cheek and parotid region. Investigation into the limited literature regarding these rare cases confirmed the specific findings in our case, i.e. that destruction of the bone cortex by the expansion of the tumour, along with osteogenesis, is not unusual.