Performance of older adult cochlear implant users in Hong Kong.

OBJECTIVE: To compare the speech perception performance of older adults with that of adult cochlear implant (CI) recipients in a single center in Hong Kong. DESIGN: A retrospective study of 14 older adult CI users (age at operation, 56 to 77 yr old) and 14 adults (age at operation, 18 to 53 yr old) who received CIs and were matched for duration of profound deafness. The outcome indicator of their performance includes ratings of 0 to 7 on the speech perception category (SPC), which is based on their speech perception test scores at 6, 12, and 24 mo after implantation. Statistical analyses were used to compare SPC ratings between the two groups at the tested intervals. Results of specific speech perception tests between the two groups were also analyzed at the tested intervals, along with the rate of improvement of the specific tasks from 0 to 6 mo, 0 to 12 mo, and 0 to 24 mo postoperatively. Multiple regression analysis was used to assess which variables would independently predict the outcome performance of CIs. RESULTS: There were no significant differences (p = 0.228 to 0.724) between the SPC ratings of the adult group and the older adult group at the tested intervals. The adult group scored significantly better in the postoperative 0- to 6-mo improvement rate (p = 0.047) in open-set sentence recognition, but the improvement decelerated so that it was comparable with that of the older adult group by 12 mo after implantation. The adult group also scored significantly better (p = 0.031) in tone identification at 24 mo after implantation compared with the older adult group. The majority of the speech perception task scores, and rates of improvement were comparable between the older adult group and the adult group at the tested time intervals. Multiple regression analysis revealed a significant relationship (p = 0.025) between the outcome indicator of everyday sentence recognition at 12 mo after implantation and the outcome predictor of duration of profound deafness. However, the goodness of fit (r) of this model was 0.11, suggesting that only 11% of the variance in 12-mo postoperative everyday sentence recognition was explained by duration of profound deafness, leaving a large proportion of unexplained variance. CONCLUSION: : The overall performance of the older adult CI recipients is comparable with that of the adult group. Duration of profound deafness, irrespective of age, is accountable for a small part of the outcome. Because older adults as well as younger adults can benefit from CIs, age should not be the predominant factor for declining CIs among older adults.

Age and outcome of cochlear implantation for patients with bilateral congenital deafness in a Cantonese-speaking population.

OBJECTIVE: To evaluate the effect of age at implantation by assessment of speech perception in cochlear implant users with bilateral congenital deafness. DESIGN: A retrospective cohort analysis of 60 cochlear implant users (age at implantation, 1.01 to 22.0 yr) who have at least 2 yr of experience. Their outcome performance was defined by the change in i) speech perception category (SPC) score based on postoperative assessment results and ii) the type of education attended after implantation. The association of age at implantation with SPC scores was analyzed at different ages at implantation (2, 3, 4, 5, and 6 yr old). The SPC scores for a particular age at implantation were compared at 6, 12, and 24 mo after implantation. The impact of age at implantation on choice of education was evaluated by analyzing the transition from a school for the deaf to mainstream education for the 45 children who were operated on before the age of 10, because older children are less likely to make such a change. RESULTS: Children implanted at the ages of 2, 3, 4, 5, and 6 yr all obtained significant improvements in SPC scores 24 mo after implantation. The greatest improvement was noted at 24 mo after implantation among those operated on before age 3. For all age groups, improvement at 24 mo after implantation is greater than at 12 mo, whereas the latter is greater than the improvement noted at 6 mo after implantation. Comparison of children implanted before the age of 3 and between ages 3 and 10 showed a significant difference in the choice of education after implantation. Children who were implanted before the age of 3 were more likely to attend mainstream education after implantation. CONCLUSION: Results from the present study are consistent with the current belief that implantation at a younger age provides greater benefit. The proportion of children attending mainstream education was significantly higher for those implanted before age 3, which may be a potential benefit to early implantation for relieving the burden of governments in providing special education.

Risk factors for otitis media with effusion in Chinese schoolchildren: a nested case-control study and review of the literature.

OBJECTIVE: To identify the risk factors for otitis media with effusion (OME) in Chinese schoolchildren and analyse the results with reference to the review of the literature. METHODS: The study subjects were 6-7-year-old children drawn from a school-screening program for OME in Hong Kong. Both positive and negative screens attended a hospital clinic for further assessment with repeated otoscopic examination and tympanometry as well as pure tone audiometry within 3 weeks after the initial school-screening. During the visit, parents were interviewed to provide information with regard to the children's birth history, neonatal history, socio-economic background, otological history, past health, and medical history. These data formed the basis in the estimation of potential risk factors for OME. RESULTS: In the univariate analysis of 127 cases and 173 controls, significantly elevated odds ratios (OR) for OME were detected on the symptoms of atopy (OR = 2.21, p = 0.04), hearing loss (OR = 4.13, p = 0.001), nasal obstruction (OR = 1.94, p = 0.005), rhinorrhoea (OR = 1.61, p = 0.04), tonsillitis in the past 12 months (OR = 1.82, p = 0.02), and previous history of acute otitis media (OR = 6.89, p < 0.001). However, only three of them were found to be significant in the multivariate logistic regression model: nasal obstruction (OR = 1.67, 95% CI: 1.01-2.75); acute tonsillitis (OR = 1.68, 95% CI: 1.00-2.80), and previous acute otitis media episodes (OR = 5.75, 95% CI: 2.60-12.69). CONCLUSIONS: Risk factors identified in the Chinese schoolchildren for OME were comparable with previous western reports. A previous attack of acute otitis media was a major determinant for middle ear effusion.

[Comparison of prevalence rates of secretory otitis media in Hong Kong Chinese children with western populations].

OBJECTIVE: To investigate the prevalence rate of secretory otitis media (SOM) in Hong Kong Chinese children and further compare the results with the western studies. METHODS: From 1995 to 1998, primary schools, kindergartens and nurseries were selected by stratified randomization in Hong Kong of China. Six thousand eight hundred and seventy-two children of age 2 to 7 were examined on-site in the school premises by the otolaryngologist and audiologist with otoscope and tympanometry respectively. In order to achieve standardization comparisons, our raw data were retrieved and the prevalence rates were recalculated according to the various diagnostic criteria set by the western studies. RESULTS: The prevalence of SOM in the age-groups 2-3, 4-5 and 6-7 of the present study ranged from 5.2% to 21.6% if criteria were set to clinical otoscopic findings and ranged from 7.3% to 30.7% if criteria were based on tympanometric findings. The variations in the diagnostic criteria with tympanometric findings also lead to a deviation of prevalence rates with the same set of data. Regardless of the criteria set for investigations, there are no significant differences between our findings and those of the western studies with the same age groups. Prevalence rates decrease as age increases. CONCLUSIONS: The prevalence rates of SOM in Chinese children of age 2-3, 4-5 and 6-7 in Hong Kong are not significantly different from those reported in the literature of the West.

Preoperative topical ofloxacin solution for tympanoplasty: a randomized, controlled study.

OBJECTIVE: To establish the efficacy of immediate preoperative ototopical ofloxacin eardrops in eradicating middle ear pathogens and improving operative outcome. STUDY DESIGN: Single-blind, randomized control study. SETTING: Tertiary referral center, ambulatory clinic, and hospital setting. PATIENTS: Consecutive patients with chronic suppurative otitis media for Type I tympanoplasty (myringoplasty). INTERVENTIONS: The patients were randomly assigned to 3 groups: Group A underwent 10-minute daily treatments with eardrops for 2 weeks before surgery, Group B underwent 3-minute daily treatments for 2 weeks before surgery, and Group C underwent no treatment. MAIN OUTCOME MEASURES: Preoperative and perioperative bacteriology and success of the surgery as defined by an intact tympanic membrane in the eighth week postsurgery. RESULTS: There were 101 patients entered in the study. The preoperative, perioperative, and postoperative observation of discharge and quantity of the discharge were compared, and no differences were found among the groups (Kruskal-Wallis test). The perioperative culture results were analyzed and 18/21 (86%) became culture negative in Group A, 23/27 (85%) became culture negative in Group B, and 3/21 (14%) became culture negative in the control group (Group C versus Group A or Group B, chi(2) tests p < 0.001). The success rates of surgery as defined by an intact tympanic membrane showed no difference: 28/33 (85%), 27/33 (82%), and 31/35 (89%) in Groups A, B, and C, respectively. The preoperative positive bacteriology rate in the surgical failures was 10/15 (67%), compared with 16/76 (21%) for the successful procedures (p < 0.001). CONCLUSION: Our study has shown that ofloxacin successfully eradicates most bacterial flora preoperatively. We cannot, however, confirm the benefits of its preoperative usage in improving the graft success rate.