Verification of improved patient outcomes with a partially implantable hearing aid, The SOUNDTEC direct hearing system.

INTRODUCTION: Partially implantable hearing devices have been developed to address some of the user-perceived shortcomings of standard amplification systems. Partially implantable devices are purported to provide improved sound quality as a result of decreased occlusion, decreased feedback, and enhanced clarity resulting from increased high-frequency gain. Such improvements may result in greater user satisfaction. To justify selection of a partially implantable device and undergoing a minor surgical procedure, verification techniques must be used to document user improvement or increased satisfaction over conventional amplification. OBJECTIVE: To evaluate patient satisfaction with the SOUNDTEC direct hearing system. STUDY DESIGN: Within-subjects repeated measures design. METHODS: Objective and subjective evaluation pre- and post-implantation with the SOUNDTEC device. Verification techniques included tonal functional gain measures with traditional amplification and the SOUNDTEC device, word recognition in quiet (NU-6) and in noise (SPIN), the Abbreviated Profile of Hearing Aid Benefit (APHAB), and the Hough Ear Institute Profile (HEIP). RESULTS: Although there was no significant difference between optimal traditional amplification and the SOUNDTEC device for speech perception measures, the SOUNDTEC device yielded statistically significant increased high-frequency functional gain. Subjective reports indicated that the SOUNDTEC device provides a cleaner, more natural sound without feedback than traditional amplification. CONCLUSIONS: Partially implantable hearing aids may address some of the limitations of traditional amplification systems.

Concurrent cisplatin therapy and iodine 125 brachytherapy for recurrent malignant brain tumors.

OBJECTIVE: Toxicity and safety study of concurrent cisplatin therapy and iodine 125 (125I) brachytherapy. BACKGROUND: Iodine 125 brachytherapy has an established role in surgically accessible recurrent tumors of brain. Cisplatin has antitumoral activity against glial neoplasms and has demonstrated sensitization of tumor to radiotherapy. DESIGN/METHODS: In 16 patients (age range, 13 to 68 years, median, 47 years), stereotactically placed catheters were afterloaded with 125I sources. A median 50-Gy minimum treatment volume dose was delivered during a 100-hour period along with cisplatin (20 mg/m2 per day for 5 days). Histologic diagnoses included glioblastoma multiforme (n = 11), anaplastic astrocytoma (n = 3), ependymoma (n = 1), and anaplastic oligodendroglioma (n = 1). Tumor volumes ranged from 7.0 to 73 cm3 (median, 25 cm3). RESULTS: Early complications included headache (n = 7), transient exacerbations of preexisting neurologic deficits (n = 5), seizures (n = 3), and nausea/vomiting (n = 3). Late complications included steroid dependency (n = 10), progressive dementia in the absence of recurrent tumor (n = 1), and radiation-induced necrosis (n = 9) requiring reoperation (n = 9). Fifteen of 16 patients were assessable, with a median follow-up time of 9.5 months. Brachytherapy was discontinued in one patient owing to an acute subdural hematoma. A partial response was seen in five patients, disease remained stable in seven patients, and disease progressed in three patients. CONCLUSIONS: We conclude that 125I brachytherapy with concurrent cisplatin therapy is associated with an acceptable level of toxic effects and warrants further investigation.

The momentum of human behavior in a natural setting.

Adults with mental retardation in a group home received popcorn or coffee reinforcers for sorting plastic dinnerware. In Part 1 of the experiment, reinforcers were dispensed according to a variable-interval 60-s schedule for sorting dinnerware of one color and according to a variable-interval 240-s schedule for sorting dinnerware of a different color in successive components of a multiple schedule. Sorting rates were similar in baseline, but when a video program was shown concurrently, sorting of dinnerware was more resistant to distraction when correlated with a higher rate of reinforcement. In Part 2 of the experiment, popcorn or coffee reinforcers were contingent upon sorting both colors of dinnerware according to variable-interval 60-s schedules, but additional reinforcers were given independently of sorting according to a variable-time 30-s schedule during one dinnerware-color component. Baseline sorting rate was lower but resistance to distraction by the video program was greater in the component with additional variable-time reinforcers. These results demonstrate that resistance to distraction depends on the rate of reinforcers obtained in the presence of component stimuli but is independent of baseline response rates and response-reinforcer contingencies. Moreover, these results are similar to those obtained in laboratory studies with pigeons, demonstrating that the determination of resistance to change by stimulus-reinforcer relations is not confined to controlled laboratory settings or unique to the pigeon.

Ensoulment and IVF embryos.

This paper examines the metaphysical question of 'ensoulment' in relation to the theory, put forward in an earlier paper, that human life begins when the newly formed body organs and systems of the embryo begin to function as an organised whole, at which stage there is evidence of a change of nature. Although Roman Catholic theology teaches that a human being is a union of physical body and spiritual soul, it is incorrect to interpret this in a dualistic sense. The meaning of 'soul' is considered and the conclusion reached that although both in the religious context and apart from it abortion is difficult to justify at any stage after conception, it does not follow that the use of 'spare' In Vitro Fertilisation (IVF) embryos should be rejected. If 'ensoulment' does not occur until the new organism functions as a whole then a decision not to make use of IVF embryos for medical purposes would be a heavy responsibility and not a 'safe' way out.

Embryonic life and human life.

A new human life comes into being not when there is mere cellular life in a human embryo, but when the newly developing body organs and systems begin to function as a whole, the author argues. This is symmetrical with the dealth of an existing human life, which occurs when its organs and systems have permanently ceased to function as a whole. Thus a new human life cannot begin until the development of a functioning brain which has begun to co-ordinate and organise the activities of the body as a whole.

PIP: The author argues that human life comes into being when the newly developing body organs and systems begin to function as a whole. According to this approach, human life is not a state but an activity. Support for this thesis comes from the biologic definition of life: a living organism is cellular, can store and transmit information, reproduce itself, and is the product of an evolutionary process. For the whole to function as one organism, there needs to be sufficient brain activity to regulate and coordinate the workings of the various body organs and systems. The nature of the fetus is sufficiently different from that of the embryo to make to evident that a change of nature has occurred. The transitional status of the fetus offers a means of addressing the ethical dilemmas of abortion and fetal research--to extend care and protection to embryonic life unless this conflicts with the good of fully human life. If regard is given to the embryo's transitional, near-human status, a decision to abort would be unethical unless all relevant facts were weighed.^ieng

Use of the carbon dioxide laser for acoustic tumor surgery.

The carbon dioxide laser has been used clinically in both otorhinolaryngology and neurological surgery for approximately 10 years. Only recently, however, have technical modifications allowed its use with the operating microscope, providing the increased precision and control necessary for intracranial surgery. This paper reports the authors' experience with the carbon dioxide laser in the removal of acoustic tumors, details the surgical technique involved, and describes the advantages that may accompany the use of the laser in the removal of these difficult lesions.

The use of Silastic in tympanoplasty surgery.

Silastic has a relatively high incidence of late complications when used as a middle ear liner in unstaged tympanoplasty procedures. This does not seem to be the case in staged procedures when it is removed at the second operation or in cases where small pieces are used to prevent refixation of the malleus or stapes. At the present time, the use of gelfilm seems to be the most acceptable alternative.

Giant cell lesions of the temporal bone.

Giant cell lesions are rare in the temporal bone. A review of world literature reveals twenty-three reported cases. Histopathologic differentiation has been difficult in the past; several tumors of bone which are characterized by multinucleated giant cells have been grouped together under the term "giant cell tumor." In the temporal bone, true giant cell tumor of bone, osteoclastoma, should be differentiated from the less aggressive reparative granuloma. The clinical course of these two lesions can be greatly different. Two additional cases of giant cell reparative granuloma are added to the literature. In addition, a tabulation is presented of signs, symptoms, treatment, and follow-up in the cases reported in the literature. Surgical excision is recommended when possible.

Acoustic neuroma removal: a comparative study of translabyrinthine and suboccipital approaches.

A comparative study of the suboccipital and translabyrinthine approaches for acoustic neuroma removal in 91 cases using a otologic-neurosurgical team is presented. Fifty of these cases involved the suboccipital route using microsurgical techniques; the remaining cases involved the standard otologic routes. The same neurosurgeon participated in all 91 cases. Two otologists participated in the study. The results of our series of cases indicate that the suboccipital route is the procedure of choice for acoustic neuroma removal.

Comparison of product moment and rank correlation coefficients in the assessment of laboratory method-comparison data.

We have studied the effects of range and distribution of data on product moment and rank correlation coefficients when deviation from a linear relationship was due solely to experimentally produced random error. All correlation coefficients (Pearson r, Spearman rho, and Kendall tau) were markedly influenced by the range of the data, and, for the rank correlation coefficients, the effect of range varied for different data distributions. While correlation coefficients may be useful in assessing whether an association exists between two variables, they are not useful in assessing the degree of random error about the regression line when a strong linear association is presumed to exist between the two variables. Thus, neither product moment nor rank correlation coefficients are of value in analysis of laboraoty method-comparison data. The standard deviation of the residual error of regression should be calculated as a measure of the random error about the regression line.

Postinflammatory osteogenic fixation of the stapes.

Stapes fixation existing with chronic otitis media has been attributed usually to either tympanosclerosis or concomitant otosclerosis. A different type of stapes fixation has been encountered which the author has termed "post-inflammatory osteogenic stapes fixation." One thousand five hundred and two surgical procedures for chronic otitis media were reviewed with 112 rigid stapes fixations found of which 19 were classified as post-inflammatory osteogenic stapes fixation. Surgical techniques were discussed, case histories were presented, and photomicrographs were shown illustrating two varieties of post-inflammatory osteogenic stapes fixations classified according to the side of the fixing lesion. The etiology and pathogenesis of this condition were felt to have a direct relationship to infection and prior surgery. Post-inflammatory osteogenic stapes fixation probably occurs more frequently than realized. Further research is needed to evaluate this type of stapes fixation.

Stapes fixation in chronic middle ear disease.

Rigid stapes fixation is not uncommonly found in chronic otitis media and can be caused by several conditions. Careful stapedectomy with some form of ossicular chain reconstruction is the treatment of choice, usually as a second stage procedure. Hearing results to date have been gratifying.