Delayed perception of cochlear implant stimulation in children with postmeningitic ossified cochleae.

A possible complication of postmeningitic deafness is cochlear ossification. Reports of immediate response to electrical stimulation despite this ossification have been encouraging. This report discusses three children who initially failed to perceive stimulation from their Nucleus multichannel cochlear implants. These patients showed no behavioral responses to any of 10 to 20 electrodes inserted into their ossified cochleae, even at maximum stimulus levels (1750 microA). Stimulus-response behavior had been well documented prior to implantation and was not considered a factor in their failure to respond. These patients continued to wear the speech processors programmed at maximum stimulus/current levels. Eventually, all three patients began responding following 5 to 12 months of device use. These results suggest that continued use of electrical stimulation may result in eventual perception.

Investigator differences in the cochlear implantation of children.

Eight investigational sites are involved in clinical trials of the 3M/House cochlear implant for children. Statistical analyses have been performed to examine differences between investigators in patient populations selected for implantation and in the results achieved. Important characteristics of the subjects from different investigational sites were compared for House, Maddox, and all "others" combined. There were no differences between investigators in sex, age at surgery, or duration of deafness of the children enrolled in the study. For age at onset, House and Others had higher proportions of postlingually deaf subjects than Maddox (16% for House and 18% for Others, compared with less than 2% for Maddox). However, all investigators had some subjects in every category: postlingual, prelingual, and congenital. Auditory discrimination and speech production scores for subjects from the three groups were compared using analysis of variance techniques. A few interaction effects between time interval and investigator indicated that not all investigator groups performed similarly over time for all measures. However, postimplant scores were always significantly higher than preimplant scores for all investigators. Differences that did occur appeared to be attributable to differences in subject characteristics.

Pleomorphic adenoma of the middle ear and mastoid with posterior fossa extension.

We describe the case of a pleomorphic adenoma of the middle ear and mastoid, with extension into the posterior cranial fossa. The lesion was characterized by extensive bony destruction and close proximity to the facial nerve. Ectopic or choristomatous salivary gland tissue within the middle ear cleft is the most probable origin of this tumor.

Educational aspects of cochlear implants in children.

An overview of deaf education as it relates to the needs of the cochlear implant child is given. More specific information concerning the developmental approach to successful listening is described. The progress of specific youngsters is discussed following application of this "approach".

Surgery of the endolymphatic sac.

The wide variation in reported success rates in endolymphatic sac surgery has been the subject of much controversy in literature. This series is a follow-up of additional cases done since 1976 that were previously reported with 55% relief of vertigo on relatively long-term follow-ups of 24 months to 10 years. This present series is an additional 30 endolymphatic shunts that were done since that time. This group of patients as a rule had their disease for a shorter period of time. It is interesting that the long-term relief of vertigo in this series is 70%. This is considerably better than the initial series of 66 patients previously reported. It is postulated that there are some benefits to earlier surgery in endolymphatic hydrops before the endolymphatic sac lumen becomes obliterated with fibrous tissue. It is always possible that the shorter follow-up period in this group of patients also adds to this statistical improvement.

Evaluation of the tinnitus masker.

The disabling symptom of tinnitus has no predictable medical or surgical treatment. In most patients, an examination and suitable explanation or, if needed, hearing aid fitting will dispense with the problem. This article deals with another group of individuals who, for reasons of their own, feel "disabled" in their everyday lives by this disturbing, unwanted "noise." A total of thirty-four persons were referred by the otologist for further study and an evaluation of their tinnitus. The benefit of the tinnitus questionnaire and of the patient's personal evaluation of their head noise is discussed and stressed. twenty-three patients (67 percent) were fitted with a tinnitus masker. An additional five individuals (15 percent) benefited from a hearing aid fitting. Five of the total of thirty-four originally evaluated were felt to be unsuitable for a trial with the masker. At the completion of the thirty-day trial period with the instrument, nine patients returned the masker. This left a total of fifteen patients, or almost 50 percent of the original group having the evaluation, wearing the tinnitus masker with relief of their symptoms. This is a carefully selected group of individuals, but still an impressive accomplishment.

Endolymphatic sac surgery.

There is a disturbing variation in the reported success rate in Endolymphatic Sac Surgery in the literature. Relatively long-term (24 months to 10 years) follow-ups are given in a series of 66 patients in this paper. Results reveal only a 55% long-term relief of vertigo in these patients. Only 30% of this series of cases had any improvement in cochlear function. There was a definite trend towards recurrence of vertigo in the longer follow-up cases. It is concluded that Endolymphatic Sac Surgery still is important in the treatment of idiopathic endolymphatic hydrops, but is of questionable value early in the course of the disease. Total removal of the endolymphatic system remains the best single surgical approach in a large number of patients with Ménièr's disease.

The lateral approach to acoustic tumors.

The surgical experience of a decade of acoustic tumor surgery is discussed. This series involves 106 operations. A plea is made to use the "lateral" approach to the cerebellopontine angle which combines the translabyrinthine and retrosinal routes when necessary. The facial nerve is preserved in 88% of the patients using this approach and the mortality rate is only 1 or 2%. The most common complication is cerebrospinal fluid leakage. The posterior, suboccipital approach in acoustic tumors is condemned. Statistics are presented that make the argument of "hearing preservation" by suboccipital surgery academic. Only 11% of the patients in this series of 106 had "good" hearing preoperatively and all of these had normal hearing in the opposite ear.