Successful hearing improvement with direct acoustic stimulation in a patient with schizophrenia.

OBJECTIVE: A direct acoustic cochlear implant provides its power directly to the inner ear by vibrating the perilymph via a conventional stapes prosthesis. Our experience with a patient with severe mixed hearing loss due to otosclerosis is described.Case reportThe patient, a 47-year-old male, had a pre-operative speech recognition score of 10 per cent and had been treated for many years for schizophrenia, both of which made him a poor candidate for a direct acoustic stimulation device. Nevertheless, the surgery was performed, which preserved the pre-operative bone conduction level and significantly improved hearing. His speech recognition score rose to 100 per cent. He uses the device all day and his auditory hallucinations have subsided. Improvement of schizophrenia symptoms has enabled the patient to reduce his psychiatric medications intake. CONCLUSION: Hearing restoration was the main reason for the reduction of auditory hallucinations in our patient. Hearing loss is a potentially reversible risk factor for psychosis, but this association is often overlooked.

Soft tissue reactions in patients with bone anchored hearing aids.

AIMS: To establish the incidence and correlation between the degree of soft tissue reaction and the body mass index (BMI) according to age and gender after a bone anchored hearing aid (BAHA) implant. METHODS: We did a 1-9-year follow-up for the all the patients who underwent surgery in our department with BAHA implant system. Soft tissue reactions were classified in accordance with the Holgers classification on regular patient visits. BMI was calculated for each patient, and changes were recorded at least once a year. RESULTS: 47 patients were evaluated. 58% were operated on for chronic otitis with mixed or conductive hearing loss; 20% had unilateral or bilateral atresia and 16% had single sided deafness (SSD); other indications were otosclerosis and syndromic patients. The grade of Holgers classification significantly correlated at a 0.001 level with BMI (Spearmans rho 0.452). Holgers grade also differed significantly between the sexes-skin reactions in females were less frequent. An ANOVA test did not reveal any statistical difference between patients with dissimilar indications for BAHA. CONCLUSION: If performed carefully, BAHA surgery produces a favorable outcome. The Holgers grade may change as time passes. If skin reactions appear, they can be treated through local or systemic therapy, and they may turn into a normal grade. Adipose patients should be treated with special care because they are more prone to soft tissue reactions.

3D power Doppler analysis of the vascularisation in tumours of the oral cavity.

PURPOSE: The aim of this study was to determine the volume and vascularisation of tumours by three-dimensional (3D) power Doppler ultrasound in patients with "tumours of the oral cavity". MATERIALS AND METHODS: Three-dimensional (3D) power Doppler ultrasound investigation was performed pre-operatively on 49 patients with carcinomas of the oral cavity. Digitally-stored data were analysed with 3D View program software, a part of which is the "VOCAL-Imaging program". By using VOCAL, the borders of a structure (tumour) can be determined and its volume calculated. The vascularisation of the tumour was determined by analysing three-dimensional colour histograms, and the vascularisation indices were calculated. RESULTS: Vascularisation indices VI and VFI were significantly higher in patients with neck metastases. The differences between the vascularisation indices in N+ and N0 necks were statistically significant (p < 0.05). The flow index (FI) values between N+ and N0 necks were not statistically different. CONCLUSION: The volume and vascularisation of tumours of the oral cavity could be determined effectively by three-dimensional power Doppler ultrasound. Tumour vascularisation is higher in metastatic than in non-metastatic tumours.

Side-to-end hypoglossal-facial anastomosis via transposition of the intratemporal facial nerve.

The technique of facial nerve repair with side-to-end hypoglossal-facial anastomosis is presented and evaluated in five patients who were operated on for facial nerve paralysis after acoustic schwannoma surgery, or had cranial base trauma. The end-to-end hypoglossal-facial anastomosis is accompanied by hemilingual paralysis, with difficulty in swallowing, chewing and speaking. In this new technique, the facial nerve is mobilised in the temporal bone, transected at the second genu and transposed to the hypoglossal nerve where a tensionless side-to-end anastomosis is performed. The hypoglossal nerve is transected in oblique fashion to about one third of its circumference. We were able to achieve a tensionless anastomosis in all patients. The idea is to bring about re-innervation of the previously denervated tissue via a collateral sprouting of axons of the donor nerve through the site of coaptation without sacrificing the innervation of the donor nerve's original targets. With side-to-end hypoglossal-facial anastomosis, two patients attained a House- Brackmann grade of III (one of them with independent movement of eyelids and mouth); one achieved grade IV, another grade V and grade VI. No patient had hemilingual atrophy nor any problems associated with swallowing or chewing.

Internal auditory canal involvement of acoustic neuromas: surgical correlates to magnetic resonance imaging findings.

OBJECTIVE: Factors that play a role in the selection of surgical approach for acoustic neuromas include patient health and age, size of tumor, hearing status, and location of tumor in the internal auditory canal (IAC) and the cerebellopontine angle. Deep extension into the IAC makes hearing preservation extremely difficult when a retrosigmoid craniotomy is used, and the best approach is a middle fossa subtemporal route. Modern gadolinium-enhanced magnetic resonance imaging (MRI) can be inaccurate in identifying the presence of tumor laterally in the IAC. This may affect the selection of a surgical approach. STUDY DESIGN: This study was a retrospective case review. SETTING: Patients were accrued from a tertiary referral otologic practice. PATIENTS: From 1997 through 2000, the authors identified six patients who had undergone acoustic neuroma surgery, had adequate imaging and intraoperative data, and demonstrated a lack of correlation between MRI and intraoperative findings of the lateral IAC. INTERVENTION: The interventions were preoperative MRI of the IAC and surgical resection of an acoustic neuroma. MAIN OUTCOME MEASURE: Comparison of MRI and intraoperative findings of the lateral IAC were the main outcome measures. RESULTS: Six patients demonstrated a lack of correlation between MRI and intraoperative findings of the lateral IAC. CONCLUSIONS: Gadolinium-enhanced T1-weighted MRI findings of the depth of penetration into the lateral aspect of the IAC do not always correlate with intraoperative findings and thus may have implications in the selection of surgical approaches to acoustic neuromas.

Intraoral sonographic evaluation of parapharyngeal space tumors.

We performed transcutaneous (external) sonography and then intraoral sonography to evaluate 3 parapharyngeal space tumors (1 vagal paraganglioma, 1 pleomorphic adenoma, and 1 carcinoma arising in a pleomorphic adenoma). All 3 patients had medial displacement of a tonsil. In all cases, we could measure the size and see the borders of the tumors and their relation to other structures on intraoral sonography. Intraoral sonography is useful for differentiating between unilaterally enlarged and medially displaced tonsils.