Clinical evaluation of an over-the-counter hearing aid (TEO First®) in elderly patients suffering of mild to moderate hearing loss.

BACKGROUND: Presbycusis has a direct influence on autonomy of the elderly but hearing aids lack of affordability. Moreover a recent review demonstrate that electroacoustic characteristics of OTC hearing aids were generally not suitable for the elderly people. In our study, we assessed the clinical value of a new over-the-counter (OTC) hearing aid device (TEO First®) in the elderly. METHOD: This prospective monocentric open label study included patients over 60 years of age with a mild to moderate presbycusis. Patients were assessed with acceptable noise level test (ANL), pure tone (PTA) and speech (SA) audiometry in silent and noisy environment, with and without TEO First®. A Glasgow Hearing Aid Benefit Profile, acceptability and satisfaction surveys were completed after one month of using the device. RESULTS: Thirty one patients were included. There was an improvement of hearing with TEO First® in silence (SA: +39.2 %, p < 0.01; PTA: -9.04 dB, p < 0.01) or in noise (SA +47.7 %, p < 0.01; PTA: -5.23 dB, p < 0.05). After one month of use of the device, quality of life has improved with regards to the following parameters: decrease of perceived hearing difficulties during conversation without background noise (-9.6 % p = 0.018), in conversation with several people (-16.2 % p = 0.0076), decrease of negative emotions while watching TV (-18.5 % p = 0.011), during conversation without background noise (-16.5 % p = 0.0024), during conversation in noisy background (-17.1 % p = 0.027) and during conversation with several people (-20 % p = 0.014). The acceptability of the device was low to moderate. CONCLUSION: TEO First® is an effective OTC hearing aid that improves the patient's quality of life. TRIAL REGISTRATION: Current Controlled Trials NCT01815788.

Necrotizing otitis externa: a systematic review.

OBJECTIVE: To carry out a systematic review of scientific evidence available about necrotizing otitis externa, emphasizing epidemiologic data, diagnosis criteria, treatment protocols, follow-up criteria, prognosis factors, and chronologic evolution. DATA SOURCES: PubMed/MEDLINE and the Cochrane Database of Systematic Reviews were searched for publications in English and French languages, between 1968 and October 1, 2011. STUDY SELECTION: We included publications of all types including at least 6 cases. We excluded publications focused on cranial base osteomyelitis not originating from the external ear and publications limited to a specific population. DATA EXTRACTION: We assessed publication quality according to international guidelines. DATA SYNTHESIS: For each publication, data were entered in a spreadsheet software for analysis. We excluded individual data already published in other studies or reviews. CONCLUSION: Our review revealed the absence of strong scientific evidence regarding diagnosis criteria, treatment protocols and follow-up criteria. This implies the use of highly empirical indexes of suspicion in clinical practice. Our review confirmed the existence of a typical but not exclusive population at risk (aged, male, and diabetic patient) and also revealed major issues: lack of primary prevention in population at risk, delays before referral and management, bacteriologic issues caused by antibiotic misuse (agent identification problems, rise of resistant strains), persistence of recurrent cases. A better diffusion of medical information should help improve the management of this severe disease.

Multicenter evaluation of Neurelec Digisonic® SP cochlear implant reliability.

Over the past decade, the adoption of universal hearing screening in newborns has led to earlier detection of hearing problems and significant lowering of the age of first cochlear implantation. As a consequence, recipients are now expected to keep their cochlear implants (CIs) for a longer period of time. Comprehensive longitudinal information on CI reliability is essential for device choice. The aim of this study was to assess the reliability (in children and adults) of the latest generation of the Digisonic(®) SP CI launched in 2006 by Neurelec. Failure rate (FR) and cumulative survival rate (CSR) for a 5-year period were calculated. This survey is a multicenter retrospective study. A questionnaire was sent to nine CI centers requesting information about patients implanted with Neurelec Digisonic(®) SP CIs. FR and CSR over a 5-year period were calculated on this group. Collaborating centers collected data on 672 patients (362 children and 310 adults) implanted between March 2006 and March 2011. The overall rate of explantation was 2.23 % (15 cases): six devices were explanted due to device failure (0.89 %) and nine were explanted for medical reasons (1.34 %). Four patients were lost to follow-up. The CSR at 5 years was 98.51 % on all patients, 98.48 % for children and 98.57 % for adults. FR was 0.97 % for adults and 0.83 % for children. This first independent study that assesses FR and CSR on the current generation of Digisonic(®) SP CI represents an important resource that can help clinicians and patients during their device choice.

Multicenter evaluation of the digisonic SP cochlear implant fixation system with titanium screws in 156 patients.

OBJECTIVES: We describe and evaluate the process of fixation of the Digisonic SP cochlear implant with two titanium screws. METHODS: The characteristics of this implant allow cochlear implantation using a minimal incision, a subperiosteal pocket, and fixation with two titanium screws, without drilling a custom-fitted seat or creating suture-retaining holes in the skull. The fixation system relies on two tailfins for use of osseo-integratable screws, incorporated into the cochlear implant housing. The first version of this fixation system was modified after a case of device migration: the size of the titanium insert inside the silicone tailfin was increased. Data on 156 patients (8 months to 86 years of age) from a 4-year period in 6 cochlear implantation centers were retrospectively evaluated. Ten patients have undergone bilateral implantation. RESULTS: Of 166 implantations, 4 postoperative infections and 1 device failure after head trauma were reported. No cerebrospinal fluid leaks or epidural hematomas were reported. One device migration was observed in the first series; no device migrations occurred in the second series. CONCLUSIONS: The fixation system with screws embedded in the Digisonic SP involves a fast and simple surgical technique that seems to efficiently prevent implant migration.

Cochlear implantation surgery without posterior tympanotomy: can we still improve it?

CONCLUSION: The amendments made to pre-existing transcanal approaches limit the possibility of extrusion of the electrode and reduce the time of 'blind' surgery. OBJECTIVE: Alternative techniques to classic mastoidectomy and posterior tympanotomy for cochlear implantation have already been described but their main drawbacks result in either: (i) the risk of an electrode extrusion through the skin as the groove is drilled into the auditory canal or (ii) the risk of a facial nerve injury as the tunnel is drilled blindly into the posterior canal wall. The aim of this study was to describe and evaluate a new transcanal approach for cochlear implantation ruling out these difficulties. PATIENTS AND METHODS: Through a minimal retroauricular skin incision, a cochleostomy is performed directly via the auditory canal. The passage for the electrode is performed after drilling both a suprameatal hollow and a 1.5 mm hole into the superior-posterior canal wall, which opens the facial recess by an anterior approach. Thanks to this hole a transwall tunnel can afterwards be dug safely. RESULTS: Twenty-three patients (8 adults, 15 children) were implanted without any difficulty. The mean follow-up was 22 months. No postoperative complication was observed.