Case report: Acute dyspnea secondary to urinothorax following ureteroscopy.

A 63-year-old female presented with a tension urinothorax after pyeloscopy, lithotripsy, and percutaneous nephrolithotomy that manifested as dyspnea and abdominal pain. CT Thorax demonstrated a large right pleural effusion with middle and lower lobe collapse with leftward shift concerning for tension hydrothorax. Analysis of the effusion after pigtail catheter demonstrated an exudative effusion with resultant resolution of the effusion after a 5-day hospital course. This case illustrates a uniquely rare complication of percutaneous urologic intervention. We highlight this case to stress the importance of considering urinothorax as a cause for dyspnea and abdominal pain after renal and ureteric interventions.

Outcomes for cochlear implant users with significant residual hearing: implications for selection criteria in children.

OBJECTIVES: To develop an evidence-based technique for providing recommendations to candidates for cochlear implantation with significant residual hearing and to assess the efficacy of the approach. DESIGN: Modified selection criteria were derived from an analysis of the postoperative performance for a large group of adult cochlear implant users. In particular, the distributions of results for implant users with significant preoperative open-set speech perception were reviewed. This suggested that the candidates had a good chance (>75%) of overall improvement if they obtained open-set sentence scores in quiet of up to 70% in the best-aided condition and scores of up to 40% in the ear to undergo implantation. PATIENTS: A group of 45 adult implantation candidates who fit the modified criteria and who underwent preimplantation and postimplantation assessment to compare actual results with those predicted from the distributions. RESULTS: The speech perception results showed that 36 subjects (80%) had improved open-set sentence scores with the cochlear implant compared with their best-aided preoperative performance (mean improvement, 20.5%). Forty-four (98%) had improved open-set sentence scores for the ear undergoing implantation (mean improvement, 65.3%). CONCLUSIONS: The general concept of using the distribution of speech perception results to make evidence-based recommendations for candidates for cochlear implants is supported by this study. The approach can be used across different subpopulations, including older children with significant residual auditory skills, and for different outcome measures. It is important that the data used to provide recommendations and modify selection criteria are from an unselected sample of implant users of adequate size. This study highlights the continuing need to evaluate speech perception performance carefully before and after cochlear implantation.

Cochlear implants for children with significant residual hearing.

BACKGROUND: Previous research suggests that children with pure-tone averages of greater than 90 dB hearing level and/or open-set sentence perception of less than 30% may derive significant benefit from cochlear implantation. OBJECTIVE: To evaluate postoperative speech perception benefit and bilateral-bimodal benefit for 16 children whose preimplant speech perception scores exceeded conservative candidacy guidelines. STUDY DESIGN: Preimplant and postimplant repeated-measure design. METHODS: Sixteen child subjects who obtained 30% or greater on preimplant open-set sentence material, presented live voice audition alone, were selected for this study. Preimplant pure-tone averages ranged from 73 to 110 dB in the better aided ear. Preimplant and postimplant open-set word and sentence testing was completed in quiet and with competing background noise for separate ear and binaural conditions. RESULTS: Fourteen of 16 subjects had improved speech perception scores across all test materials after implantation. Group means were significantly higher for all test materials. Results in the bimodal-bilateral condition were significantly higher than implant alone for open-set word tests (scored for phonemes) and open-set sentences in quiet. CONCLUSION: The results of this study suggest that, with appropriate counseling and management, some children with significant residual hearing benefit from cochlear implantation, in particular improved speech understanding due to bimodal-bilateral hearing.

Speech perception outcomes in older children who use multichannel cochlear implants: older is not always poorer.

Speech perception outcomes for early-deafened children who undergo implantation as teenagers or young adults are generally reported to be poorer than results for young children. It is important to provide appropriate expectations when counseling adolescents and their families to help them make an informed choice regarding cochlear implant surgery. The considerable variation of results in this group makes this process more difficult. This study considered a number of factors in a group of 25 children who underwent implantation in Melbourne between the ages of 8 and 18 years. Each subject completed open-set speech perception testing with Bamford-Kowal-Bench sentences before and after implantation and preoperative language testing with the Peabody Picture Vocabulary Test. Data were collected regarding the type of hearing loss, age at implantation, age at hearing aid fitting, audiometric details, and preoperative and postoperative communication mode. Results were submitted to a stepwise multiple linear regression analysis with postoperative open-set sentence scores as the dependent variables. The analysis suggested that 3 factors have a significant predictive value for speech perception after implantation: preoperative open-set sentence score, duration of profound hearing loss, and equivalent language age. These 3 factors accounted for 66% of the variance in this group. The results of this study suggest that children who have useful speech perception before implantation, and higher age-equivalent scores on language measures, would be expected to do well with a cochlear implant. Consistent with other studies, a shorter duration of profound hearing loss is also advantageous. The mean sentence score for this group, 47%, was not significantly different from the mean result across all children in the Melbourne program.