Cochlear Implant Infections and Outcomes: Experience From a Single Large Center.

OBJECTIVE: To review our experience with cochlear implant infections over the past 5 years, the management strategy and to identify predictive factors that led to explantation. STUDY DESIGN: Retrospective record-base case series of cochlear implant infections. SETTING: Tertiary otology and implant center. PATIENTS: All patients who had cochlear implantation over a period of 5 years. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): To identify risk factors, rates and outcomes of cochlear implant infections, and to formulate strategies to develop clearer management protocols to prevent cochlear implant explantation. RESULTS: Of 704 implanted patients, 22 suffered a postoperative soft tissue infection (3%). Fifty-nine percent of these infected patients resulted in explantation, giving an explantation rate of 1.8% over the whole study population. One hundred percent of the infected implants identified as having either Staph. Aureus or Pseudomonas spp. as the single causative organism resulted in explantation. CONCLUSIONS: There is a high rate of explantation when infection is detected. Currently there is no clear consensus on medical management, such as choice of antibiotics or length of antibiotic course. A registry of cochlear implants would facilitate standard reporting methods for severity and type of infection, to be able to pool data across centers and form a more robust management protocol for cochlear implant infections.

Smart phone ophthalmoscopy: a potential replacement for the direct ophthalmoscope.

PURPOSE: The purpose of this study is to evaluate a commercially available smartphone ophthalmoscope, D-EYE, as compared with the direct ophthalmoscope when used by a cohort of final-year medical students in a prospective study. METHODS: Two-hundred fundal examinations were performed on the eyes of 10 mannequins featuring 5 unique fundal images by 20 final-year medical students from Newcastle University. Each student examined the five fundal images twice, once each with a direct ophthalmoscope and D-EYE in a random order. Students recorded their findings at the optic nerve, macula, and retina in an objective questionnaire, and the findings were analysed by an observer masked to the examination technique. RESULTS: Students provided more accurate clinical descriptions of their findings when using D-EYE as opposed to using the direct ophthalmoscope (p < 0.05). In addition, we found that students were overall more likely to make a correct diagnosis based on their findings when using D- EYE compared with the direct ophthalmoscope. CONCLUSION: Our study suggests that the use of a smartphone-based alternative to the direct ophthalmoscope may improve the accuracy and quality of fundal examinations by non-ophthalmologists.