Improved residual hearing preservation using peri-operative minocycline during cochlear implantation.

OBJECTIVE: To determine whether peri-operative minocycline improves preservation of residual hearing in adult patients undergoing cochlear implantation. STUDY DESIGN: Retrospective age, gender matched study design. SETTING: Tertiary/quaternary referral centre. PATIENTS: Nine patients undergoing cochlear implantation who received minocycline peri-operatively and a historical control group of nine matched patients who did not receive minocycline. INTERVENTION(S): Minocycline 200mg orally pre-operatively and 100mg daily post-operatively for ten days. MAIN OUTCOME MEASURE(S): Change in residual hearing thresholds at 250 and 500 Hz. RESULTS: The average loss of residual hearing at 250 Hz post-cochlear implant for those who had not received minocycline was 18.9 dB (SD 12.2) compared to 16.7 dB (SD 15.0) for those who had received peri-operative minocycline (p-value 0.77). The average loss of residual hearing at 500 Hz post-cochlear implant for those who had not received minocycline was 24.4 dB (SD 15.9) compared to 19.4 dB (SD 14.3) for those who had received minocycline (p-value 0.48). Two patients who did not receive minocycline lost all residual hearing at both 250 Hz and 500 Hz post-implantation and only one patient who had received minocycline lost all residual hearing at 500 Hz. CONCLUSIONS: The neuroprotective effect of minocycline may help to preserve residual hearing post-cochlear implant. Further studies are warranted.

Natural history of hearing loss in children with enlarged vestibular aqueduct syndrome.

OBJECTIVE: To determine the natural history of hearing loss in children with enlarged vestibular aqueduct (EVA) syndrome. DESIGN: (1) Retrospective cohort study and (2) systematic literature review. SETTING: Tertiary pediatric centre. METHODS: (1) Charts of children assessed by one physician between 1993 and 2000 were reviewed. (2) Source articles were identified by a search of Medline, Embase, and the Cochrane Library of the English-language literature through January 2006, with manual review of references. The search was limited to English, human, and age less than 18 years. MAIN OUTCOME MEASURES: Pure-tone average. Hearing was classified as stable, progressive and fluctuating. RESULTS: (1) Twenty-one children (39 ears) with EVA were identified. Eighty-two percent of ears had stable hearing, and 18% of ears demonstrated progressive hearing loss. (2) Seven source articles were identified and combined with the present data for a total of 310 ears with a mean follow-up of 4 years. Bilateral EVA was found to be six times more common than unilateral EVA, and there was an equal male to female ratio. Stable hearing was found in 67% of ears and progressive hearing loss in 33% of ears. Subgroup analysis demonstrated hearing fluctuations in 50% of progressive hearing loss ears and 34% of stable ears. CONCLUSIONS: Stable hearing is observed in 67% of ears with EVA of which 34% will demonstrate fluctuations in hearing. Progression of hearing loss is seen in 33% of ears of which half will demonstrate fluctuations.