The Effect of Universal Newborn Hearing Screening on Spoken Language after Cochlear Implantation.

BACKGROUND: The universal newborn hearing screening (UNHS) was fully implemented across New Zealand by 2010 to improve outcomes for children with prelingual deafness. A previous audit undertaken by our center, the Southern Cochlear Implant Programme (SCIP), demonstrated that UNHS has significantly reduced the time to referral and surgery for cochlear implants in these children. AIMS: This study aims to evaluate the relationship between earlier implantation and language development, the time taken to achieve age-appropriate language, and the effect of socioeconomic status on language skills. METHODS: This is a retrospective cohort study comparing prelingual children with severe to profound bilateral hearing loss who underwent cochlear implantation in SCIP before and after the introduction of the UNHS. The language outcomes were assessed using the Preschool Language Scale and/or the Peabody Picture Vocabulary Test. For the purpose of our study, the standard scores of these tests were expressed as global language scores (GLS). GLSs between 85 and 115 are considered within normal range for age. The socioeconomic status was categorized based on the New Zealand Index of Deprivation (NZDep). RESULTS: Children in the post-UNHS group (46/95 children) were referred to SCIP and received CI at a significantly earlier age (mean = 7 vs 20 mo, p = 8.95E-10, and mean = 13 vs. 24.7 mo, p = 1.43E-07). At 2 years postimplantation, the GLS was significantly higher in the post-UNHS group (mean scores = 93.3 vs. 79.1, p = 0.0213). The scores remained statistically higher in the post-UNHS group when assessed at 3 and 4 years postimplantation. At 2, 3, and 4 years postimplantation, there is a significant linear decrease in GLS with increasing age at cochlear implantation. We found no correlation between NZDep and GLS. CONCLUSION: Children identified through UNHS have the advantage of earlier diagnosis, earlier hearing intervention, and longer duration with the implants, and they can achieve age-appropriate spoken language after 2 years of implantation.

Pneumococcal vaccine impact on otitis media microbiology: A New Zealand cohort study before and after the introduction of PHiD-CV10 vaccine.

UNLABELLED: We compared the microbiology of middle ear fluid (MEF) in two cohorts of children having ventilation tube (VT) insertion; the first in the era of 7-valent Streptococcus pneumoniae conjugate vaccine (PCV7) and the second following introduction of the ten-valent pneumococcal vaccine (PHiD-CV10). METHODS: During 2011 (Phase 1) and again in 2014 (Phase 2) MEF and NP samples from 325 children and 319 children were taken at the time of VT insertion. A matched comparison group had NP swabs collected with 137 children (Phase 1) and 154 (Phase 2). Culture was performed on all NP and MEF samples with further molecular identification of Haemophilus species, serotyping of S. pneumoniae, and polymerase chain reaction (PCR) testing on all MEF samples. RESULTS: In Phase 2 immunisation coverage with ⩾3 doses of PHiD-CV10 was 93%. The rate and ratios of culture and molecular detection of the 3 main otopathogens was unchanged between Phase 1 and Phase 2 in both MEF and NP. Haemophilus influenzae was cultured in one quarter and detected by PCR in 53% of MEF samples in both time periods. S. pneumoniae and Moraxella catarrhalis were cultured in up to 13% and detected by PCR in 27% and 40% respectively of MEF samples. H. influenzae was the most common organism isolated from NP samples (61%) in the children undergoing VT surgery whilst M. catarrhalis (49%) was the most common in the non-otitis prone group. 19A was the most prominent S. pneumoniae serotype in both MEF and NP samples in Phase 2. Of Haemophilus isolates, 95% were confirmed to be non-typeable H. influenzae (NTHi) over both time periods. CONCLUSION: Following implementation of PHiD-CV10 in New Zealand, there has been no significant change in the 3 major otopathogens in NP or MEF in children with established ear disease. For these children non-typeable H. influenzae remains the dominant otopathogen detected.

What is behind the ear drum? The microbiology of otitis media and the nasopharyngeal flora in children in the era of pneumococcal vaccination.

AIM: This study aims to describe the microbiology of middle ear fluid (MEF) in a cohort of children vaccinated with Streptococcus pneumoniae conjugate vaccine (PCV7) having ventilation tube insertion. Nasopharyngeal (NP) carriage of otopathogens in these children is compared with children without history of otitis media. METHODS: Between May and November 2011, MEF and NP samples from 325 children aged <3 years were collected in three major centres in New Zealand at the time of ventilation tube insertion. An age-matched non-otitis-prone comparison group of 137 children had NP samples taken. A questionnaire was completed by both groups. RESULTS: Immunisation coverage with at least one dose of PCV7 was 97%. Haemophilus influenzae was cultured in 19.4% of MEF and was polymerase chain reaction (PCR) positive in 43.4%. S. pneumoniae and Moraxella catarrhalis were cultured in <10% of MEF samples but were PCR positive for 23.1% and 38.7%, respectively. H. influenzae was the most common organism isolated from NP samples (60%) in the grommet group, while M. catarrhalis (56%) was the most common in the non-otitis prone group. S. pneumoniae was more commonly found in the nasopharynx of children with ear disease (41% vs. 29%). 19F was the most prominent S. pneumoniae serotype in NP samples of both groups, but no serotype dominated in MEF. Ninety-five per cent of H. influenzae isolates were confirmed to be non-typeable H. influenzae. CONCLUSION: In this cohort of children with established ear disease requiring surgical intervention, non-typeable H. influenzae is the dominant pathogen in both the nasopharynx and MEF.

Systemic immunity influences hearing preservation in cochlear implantation.

HYPOTHESIS: To determine whether a systemic immune response influences hearing thresholds and tissue response after cochlear implantation of hearing guinea pigs. METHODS: Guinea pigs were inoculated with sterile antigen (Keyhole limpet hemocyanin) 3 weeks before cochlear implantation. Pure-tone auditory brainstem response thresholds were performed before implantation and 1 and 4 weeks later. Dexamethasone phosphate 20% was adsorbed onto a hyaluronic acid carboxymethylcellulose sponge and was applied to the round window for 30 minutes before electrode insertion. Normal saline was used for controls. Cochlear histology was performed at 4 weeks after implantation to assess the tissue response to implantation. To control for the effect of keyhole limpet hemocyanin priming, a group of unprimed animals underwent cochlear implantation with a saline-soaked pledget applied to the round window. RESULTS: Keyhole limpet hemocyanin priming had no significant detrimental effect on thresholds without implantation. Thresholds were elevated after implantation across all frequencies tested (2-32 kHz) in primed animals but only at higher frequencies (4-32 kHz) in unprimed controls. In primed animals, dexamethasone treatment significantly reduced threshold shifts at 2 and 8 kHz. Keyhole limpet hemocyanin led to the more frequent observation of lymphocytes in the tissue response to the implant. CONCLUSION: Systemic immune activation at the time of cochlear implantation broadened the range of frequencies experiencing elevated thresholds after implantation. Local dexamethasone provides partial protection against this hearing loss, but the degree and extent of protection are less compared to previous studies with unprimed animals.

Round window insertion of precurved perimodiolar electrode arrays: how successful is it?

HYPOTHESIS: The goal of this human temporal bone study was to assess the safety and efficacy of round window insertion of the Cochlear Contour Advance electrode and identify any anatomic obstacles that may affect its insertion. BACKGROUND: Minimizing intracochlear trauma during electrode insertion reduces the risk of losing residual hearing. The Contour Advance electrode is designed for insertion via an anteroinferior cochleostomy, in which drilling causes a degree of inner ear trauma. If consistently successful round window insertions are possible with this electrode, it would allow for better perimodiolar positioning in the basal turn and greater likelihood of hearing preservation. METHODS: A total of 16 human temporal bone round window insertions with the Contour Advance electrode were performed at the University of Melbourne and Southwestern Medical Center, Dallas. Surgeons' observations, fluoroscopy, histology and anatomic dissections were analyzed. RESULTS: Successful full insertions of the electrode with minimal resistance and good perimodiolar placement were achieved in less that 50% of cases in the Melbourne series and in two-thirds of cases in the Dallas series. A common finding by both centers was obstruction of electrode entry at the anteroinferior margin of the round window, which prevented optimal scala tympani positioning and often resulted in intracochlear trauma. CONCLUSION: The anteroinferior region of the round window bony margin influences the trajectory of insertion of the relatively large Contour Advance electrode as well as physically obstructing and distorting the array. A pure round window insertion is not predictable and reliable enough to be a recommended approach for this electrode.

The prevalence of atopic symptoms in children with otitis media with effusion.

OBJECTIVE: To determine the prevalence of allergic symptoms in children with otitis media with effusion (OME). STUDY DESIGN: A validated questionnaire from the International Study of Asthma and Allergies in Childhood was used to determine the prevalence of allergic symptoms in children. The questionnaire was completed by the parents of children with OME undergoing ventilation tube insertion, and the results were compared with a large reference group of school children of the same age. SUBJECTS AND METHODS: Children aged 6 or 7 years old with OME confirmed intraoperatively during ventilation tube insertion between 2001 and 2005 (n=89). The prevalence of allergic symptoms and nasal symptoms in children with OME was compared with an age-matched reference group. RESULTS: There was no difference in the prevalence of allergic symptoms suggesting rhinoconjunctivitis, asthma, or eczema between the OME and reference group. The prevalence of nasal symptoms, however, was greater in the children with OME than in the reference group 38.2 percent versus 23.5 percent (odds ratio=2.01; 95% confidence interval, 1.30-3.10; P<0.001). CONCLUSION: The prevalence of allergic symptoms was similar in 6- to 7-year-old children with OME and the reference group, suggesting a limited effect of allergy in the pathogenesis of OME in this age group. Nasal symptoms were more common in the OME group, which may reflect a higher prevalence of adenoidal hyperplasia.

Giant cell reparative granuloma of the temporal bone treated with calcitonin.

OBJECTIVE: A case report of a giant cell reparative granuloma involving the temporal bone successfully treated with calcitonin. STUDY DESIGN: Case report. SETTING: Teaching hospital, tertiary referral center. PATIENT, INTERVENTION, AND RESULTS: A 62-year-old man was referred to the otolaryngology department with an extensive temporal bone lesion confirmed by biopsy to be a giant cell reparative granuloma. As an alternative to surgery, calcitonin therapy was commenced. After 12 months of treatment, clinical and audiological parameters had returned to normal, and radiological appearances had shown significant bony remodeling. These parameters remain stable 24 months after cessation of treatment. CONCLUSION: Calcitonin is a safe and economical medical treatment, which should be considered for destructive giant cell granulomas of the temporal bone.

Upper airway surgery benefits patients with obstructive sleep apnoea who cannot tolerate nasal continuous positive airway pressure.

Nasal continuous positive airway pressure (CPAP) is the mainstay of treatment for patients with moderate to severe obstructive sleep apnoea (OSA). However, tolerance and compliance are poor. An audit using the Christchurch Hospital ORL surgery database identified patients who underwent upper airway surgery for OSA. Tracheostomy and bimaxillary advancement patients were excluded. Adults with moderate to severe OSA (Desaturation Index (DI) >10 n.h(-1)), who had failed a trial of nasal CPAP, and had pre-operative and post-operative sleep study data were identified. Objective (DI) and Subjective (Epworth Sleepiness Score (ESS)) outcome measures were recorded. The database identified 69 patients who underwent surgery for snoring or OSA; of these, 25 patients formed the study group. Sixteen out of 25 improved (64 per cent) after surgery, seven out of 25 showed no change (28 per cent), two patients (eight per cent) showed deterioration in their DI. Forty-eight per cent of patients had >50 per cent post-operative improvement in DI. Fourteen out of 25 (56 per cent) had a post-operative DI <20 n.h(-1). Seven out of 25 (28 per cent) had a post-operative DI <10 n.h(-1). Upper airway surgery has a role in the management of selected patients with OSA who cannot tolerate nasal CPAP.