Long-term quality of life in children with complex needs undergoing cochlear implantation.

OBJECTIVES: An estimated 30-40% of children undergoing cochlear implantation (CI) have additional disabilities and traditional outcome measures are often not reliable or appropriate. Few studies have evaluated long-term quality of life (Qol) in this group. Our aim was to assess long term QoL of children implanted with complex needs against a cohort of children implanted without. We also compared both groups for secondary outcome measures such as parental opinion, complications and hours of device wear. METHODS: A retrospective casenote review of all children undergoing assessment between 2005 and 2010 was undertaken. Children with complex needs were identified using the Scottish Complex Needs Group Criteria (ISD 2006). Quality of life was measured using the GCBI (Glasgow Children's Benefit Inventory) which is a validated questionnaire suitable for the retrospective assessment of health-related QoL following paediatric surgical interventions. It consists of a 200-point scale which ranges from -100 (maximal harm) to +100 (maximal benefit) and can be analysed in four QoL subdomains (health, vitality, physical, learning). Parents were also asked to complete a simple questionnaire asking if they would recommend CI to other families and whether they would wish their child to undergo CI if given the option again. RESULTS: 174 children were implanted and 17 (10%) were found to have complex needs. Follow-up ranged from 4 to 9 years. Total GCBI scores were similarly high between groups but significantly higher scores were found in the emotion (p = 0.05) and learning domains (p = 0.03) in the complex needs group. Linear regression analysis was used to show that total GCBI score was not influenced by the number of categories of impairment (R2 = 0.0123) in the complex needs group. All parents of children with complex needs said that they would proceed with implantation again or recommend to a friend. The complication rate in the complex needs group was higher (29 vs 15%), with device failure being particularly more common. Data-logging was consistent between both groups. A higher rate of development of significant other health issues that could affect outcome was found in the complex needs group (35% vs 8%). CONCLUSIONS: Our study suggests that children with complex needs have comparable long-term QoL scores to those without and seem to particularly benefit in the domains of learning and emotion. Complications are higher in this group and there remains an increased risk of further development of medical conditions following early implantation, which may influence progress.

Chemical Pollutants Sorbed to Ingested Microbeads from Personal Care Products Accumulate in Fish.

The prevalence of microplastics (<5 mm) in natural environments has become a widely recognized global problem. Microplastics have been shown to sorb chemical pollutants from their surrounding environment, thus raising concern as to their role in the movement of these pollutants through the food chain. This experiment investigated whether organic pollutants sorbed to microbeads (MBs) from personal care products were assimilated by fish following particle ingestion. Rainbow fish (Melanotaenia fluviatilis) were exposed to MBs with sorbed polybrominated diphenyl ethers (PBDEs; BDE-28, -47, -100, -99, -153, -154, -183, 200 ng g(-1); BDE-209, 2000 ng g(-1)) and sampled at 0, 21, 42, and 63 days along with two control treatments (food only and food + clean MBs). Exposed fish had significantly higher Σ8PBDE concentrations than both control treatments after just 21 days, and continued exposure resulted in increased accumulation of the pollutants over the experiment (ca. 115 pg g(-1) ww d(-1)). Lower brominated congeners showed the highest assimilation whereas higher brominated congeners did not appear to transfer, indicating they may be too strongly sorbed to the plastic or unable to be assimilated by the fish due to large molecular size or other factors. Seemingly against this trend, however, BDE-99 did not appear to bioaccumulate in the fish, which may be due to partitioning from the MBs or it being metabolized in vivo. This work provides evidence that MBs from personal care products are capable of transferring sorbed pollutants to fish that ingest them.

Comparison of in-cell lipid removal efficiency of adsorbent mixtures for extraction of polybrominated diphenyl ethers in fish.

Polybrominated diphenyl ethers (PBDEs) have become ubiquitous environmental contaminants due to their incorporation into many consumer products. Their ability to bioaccumulate to alarming levels in fat-rich matrices such as fish demands fast and efficient methods to monitor these contaminants. We present an analytical method for selective-pressurised liquid extraction (S-PLE) of PBDEs from fish tissue. Fat removal performance of different mixtures of Florisil, silica gel and sulphuric acid-impregnated silica gel were evaluated using a response surface experimental design approach for determining the optimal fat-retaining mixture for S-PLE. Acid-silica gel had the greatest individual effect on fat retention; with a two-thirds acid-silica one-third Florisil mixture found to be the most efficient (>97%). Method validation was performed using recovery experiments at three spiked concentration levels (0.05, 0.5 and 5ngg(-1) ww). Mean recoveries of target analytes in spiked samples ranged from 70 to 124%, with relative standard deviations <27%. The S-PLE lipid removal efficiency combined with the sensitivity of triple quadrupole mass spectrometers provides a fast and comparatively inexpensive analytical method for analysis of PBDEs in fish samples.

Cochlear implantation and alcohol misuse.

OBJECTIVE: To assess the outcome of patients referred to our national centre for cochlear implantation who have a history of alcohol misuse. METHODS: A retrospective case-note review from 1989 - current was performed. Information was collected on aetiology/duration of deafness, current alcohol habits, and co-morbidities. For those implanted, we assessed implant type, anaesthetic, and complications. Our team rated each patients' engagement with the rehabilitation programme and collected 9-month post-implant Bamford-Kowal-Bench (BKB) and 1-year post-implant categories of auditory performance (CAP) scores. RESULTS: Fourteen patients with a history of harmful drinking or alcohol dependency were identified. Aetiology of deafness was varied but most commonly included sensorineural hearing loss of unknown aetiology (7), neomycin ototoxicity (3), and head injury (2). Twelve were suitable for implantation and 11 have been successfully implanted. Three patients experienced a post-operative complication (one major/two minor). Most (eight) were rated as having good engagement with the rehabilitation process and three rated as average. Nine-month post-implant BKB scores ranged from 10 to 92 (mean 56). One-year post-implant CAP scores range from 4 to 8. CONCLUSION: Patients with a background of alcohol misuse are being increasingly referred to our service. Alcohol is often implicated in the aetiology of deafness or can be sequelae of the psychological issues sometimes experienced by deaf patients. Even in the case of active alcohol misuse at the time of implantation, all surviving patients are currently active users and our results show that these patients can do well following implantation with the right support.

Considerations for design of future cochlear implant electrode arrays: electrode array stiffness, size, and depth of insertion.

The level of hearing rehabilitation enjoyed by cochlear implant (CI) recipients has increased dramatically since the introduction of these devices. This improvement is the result of continual development of these systems and the inclusion of subjects with less severe auditory pathology. Developments include advanced signal processing, higher stimulation rates, greater numbers of channels, and more efficient electrode arrays that are less likely to produce insertion damage. New directions in the application of CIs, particularly in combined acoustic and electrical stimulation, and increasing performance expectations will place greater demands on future electrode arrays. Specifically, the next generation of arrays must be reliably inserted without damage, must maintain residual acoustic function, and may need to be inserted more deeply. In this study, we measured the mechanical properties of eight clinical and prototype human CI electrode arrays and evaluated insertion trauma and insertion depth in 79 implanted cadaver temporal bones. We found that the size and shape of the array directly affect the incidence of observed trauma. Further, arrays with greater stiffness in the plane perpendicular to the plane of the cochlear spiral are less likely to cause severe trauma than arrays with similar vertical and horizontal stiffness.

Cochlear implantation in psoriasis patients.

Cochlear implantation has become a safe and effective method for the auditory rehabilitation of severe to profound sensorineural hearing loss. Flap problems are the commonest of the surgical complications [Axon PR, Mawman DJ, Upile T, Ramsden RT. Cochlear implantation in the presence of chronic suppurative otitis media. J Laryngol Otology 1997;111:228-32] and the risk increases further when associated with medical conditions predisposing to infection. We present two patients with psoriasis who underwent cochlear implant surgery, discussing the risk of surgical site infection and treatment options to minimise infection.

A temporal bone study of insertion trauma and intracochlear position of cochlear implant electrodes. I: Comparison of Nucleus banded and Nucleus Contour electrodes.

In recent years, new designs of cochlear implant electrodes have been introduced in an attempt to improve efficiency and performance by locating stimulation sites closer to spiral ganglion neurons and deeper into the scala tympani. The goal of this study was to document insertion depth, intracochlear position and insertion trauma with the Nucleus Contour electrode and to compare results to those observed with the earlier generation Nucleus banded electrode. For this comparison eight Nuclears banded electrodes and 18 Contour electrodes were implanted in cadaver temporal bones using a realistic surgical exposure. Two experienced cochlear implant surgeons and two otology fellows with specialized training in cochlear implant surgery were selected for the study to represent a range of surgical experience similar to that of surgeons currently performing the procedure throughout the world. Following insertion of the electrodes, specimens were imaged using plain film X-ray, embedded in acrylic resin, cut in radial sections with the electrodes in place, and each cut surface was polished. Insertion depth was measured in digitized X-ray images, and trauma was assessed in each cross-section. The Contour electrode inserted more deeply (mean depth=17.9 mm or 417 degrees ) than the banded electrode (mean depth=15.3 mm or 285 degrees ). The incidence and severity of trauma varied substantially among the temporal bones studied. However, the nature and frequency of injuries observed with the two devices were very similar. The Contour electrode was clearly positioned closer to the modiolus than the banded model, and also appeared easier to use. Based on this difference in position and data from previous studies we conclude that the Contour electrode may provide lower thresholds and improved channel selectivity, but the incidence of trauma remains a problem with the newer design. The relative influences of electrode positioning and neural degeneration that may result from trauma are as yet unclear.

A temporal bone study of insertion trauma and intracochlear position of cochlear implant electrodes. II: Comparison of Spiral Clarion and HiFocus II electrodes.

In recent years, several new designs of cochlear implant electrodes have been introduced clinically with the goal of optimizing perimodiolar placement of stimulation sites. Previous studies suggest that perimodiolar electrodes may increase both the efficiency and performance of a cochlear implant. This is the second of two studies designed to examine the positioning of electrodes and the occurrence of insertion-related injury with these newer designs and to directly compare two perimodiolar electrodes to their predecessors. In our previous report we compared the Nucleus banded electrode with the Nucleus Contour perimodiolar electrode. In the present study, using the same protocol, we examine the Spiral Clarion electrode and its successor, the HiFocus II electrode with attached positioner. Eight Spiral Clarion arrays and 20 HiFocus II electrodes with positioners were inserted into human cadaver temporal bones. Following insertion, the specimens were embedded in acrylic resin, cut in quarters with a diamond saw and polished. Insertion depth, proximity to the modiolus and trauma were evaluated in X-ray images and light microscopy. The newer electrode was consistently positioned closer to the modiolus than the previous device whereas the angular depth of insertion measured for the two electrodes was similar. The incidence of trauma was minimal when either electrode was inserted to a depth of less than 400 degrees . However, severe trauma was observed in every case in which the HiFocus II with positioner was inserted beyond 400 degrees and in some cases in which the Spiral Clarion was inserted beyond 400 degrees . To evaluate the possible role of electrode size in the trauma observed we modeled both devices relative to the dimensions of the scala tympani. We found that the fully inserted HiFocus II electrode with positioner was larger than the scala tympani in approximately 70% of temporal bones measured. The results suggest that both the Clarion spiral and HiFocus II with positioner can be inserted with minimal trauma, but in many cases not to the maximum depth allowed by the design.

Short-term versus long-term antibiotic prophylaxis in cochlear implant surgery.

OBJECTIVE: The objective of this study to evaluate antibiotic prophylaxis options for cochlear implant surgery. Does long-term antibiotic prophylaxis have any advantage over a single perioperative dose in preventing postoperative infection? STUDY DESIGN: We conducted a retrospective case review. PATIENTS: A total of 292 adult and pediatric patients who underwent cochlear implantation during a 15-year period (1988-2003) were reviewed. MAIN OUTCOME MEASURE: Minor and major postoperative wound infections in first 4 weeks. RESULTS: There were four major and eight minor complication among 292 patients (complication rate 4.1%). The infection rate was higher in patients who had either C incision (11.1%) or extended endaural incision (7.5%) and in patients with a preexisting medical condition. The infection rate was also higher in patients who had long-term antibiotics (5.6% and 13% in the 5-d and 7-d regimes) compared with short-term (single-dose) group. CONCLUSION: Long-term antibiotic prophylaxis did not have any advantage over single perioperative dose. Predisposing medical conditions and extensive surgical incisions were associated with a greater severity of infections and higher risk of wound complications.

Anatomic landmarks for locating parotid lesions in relation to the facial nerve: cross-sectional radiologic study.

OBJECTIVES: To determine the accuracy of using surrogate anatomic structures radiologically to predict the relation of parotid lesions to the intraparotid facial nerve. SETTING: Tertiary centre. DESIGN: Retrospective. PATIENTS AND METHODS: All patients with parotid masses over a 5-year period who undertook parotidectomy were considered. A radiologist and an otolaryngologist reviewed the images. Their decision regarding the location of the lesions using four surrogate structures was compared with intraoperative documentation. OUTCOME MEASURE: We determined the sensitivity and the specificity of using the external carotid artery, retromandibular vein, posterior belly of the digastric muscle, and tragal pointer. RESULTS: Thirty films were examined (24 magnetic resonance images [MRIs] and 6 computed tomographic [CT] scans). The sensitivity and the specificity of the retromandibular vein were 0.85 and 0.57, respectively, whereas for the external carotid artery, they were 0.94 and 0.3, respectively. It was too impractical to relate the other two structures to the lesions. CONCLUSIONS: The retromandibular vein is the most accurate surrogate structure to use on MRI or CT for predicting the location of a parotid lesion to the facial nerve. However, the substantial proportion of deep lesions misjudged limits the benefit of performing the imaging.