Hearing Outcomes with Percutaneous and Transcutaneous BAHA® Technology in Conductive and Mixed Hearing Loss.

OBJECTIVES: To evaluate outcomes of BAHA Connect® and BAHA Attract® implantations, and to examine the prognostic utility of a preimplantation Softband®-attached processor trial. STUDY DESIGN: Retrospective case review. SETTING: Tertiary referral center. PATIENTS: Patients who underwent Connect® (19 ears) and Attract® (25 ears) implantation between 2007 and 2017. INTERVENTION: BAHA® implantation. MAIN OUTCOME MEASURES: Unaided air conduction (AC), bone conduction (BC), and speech reception thresholds (SRTs), as well as free field (FF) aided with Softband®-attached processor and with implant-attached processor thresholds. RESULTS: Serviceable implant-attached processor PTA0.5,1,2 kHz (≤35 dB HL) was achieved in 89 and 88% of the Connect® and the Attract® ears, respectively, while at 4 kHz this was achieved in 68 and 32% of the Connect® and the Attract® ears, respectively (p  =  0.032). Significantly more Connect® ears showed alignment between FF aided with implant-attached processors thresholds and BC thresholds. The alignment between the Softband®-attached processors thresholds and implant-attached processors thresholds was similar in the two groups. Both groups exhibited similar positive improvement in the quality of life questionnaires. CONCLUSIONS: Accessibility to sound with the implant-attached processor is well predicted by the pre-implantation Softband® trial, both in the BAHA Connect® and in the BAHA Attract® ears. Hearing rehabilitation targets at 0.5, 1, and 2 kHz are met by most Connect® and Attract® ears, while at 4 kHz the outcome with Attract® is poorer. This information should be presented to the patient during consultation prior to a decision as to the type of BAHA® device to be implanted.

[FOCUSING AND UPDATING INDICATIONS FOR VENTILATING TUBES INSERTION IN PEDIATRIC COCHLEAR IMPLANT CANDIDATES WHO SUFFER FROM OTITIS MEDIA].

BACKGROUND: After cochlear implantation (CI) there is concern regarding the potential risks of spread of middle ear infection along the electrode array into the cochlea and central nervous system and regarding late sequela of otitis media (OM): eardrum perforation, atelectasis and cholesteatoma. The age for implantation in children overlaps the peak age incidence of acute OM (AOM) and secretory OM (SOM) and delay of implantation reduces the potential benefit from the intervention. Therefore, control of OM by inserting ventilating tubes (VT) is widely performed in pediatric CI candidates who also suffer from otitis media. OBJECTIVES: To refine indications for VT insertion in candidates for cochlear implantation who also suffer from OM. METHODS: Of 200 children referred for CI and implanted one after another, 126 were classified as OM-prone, 98 due to AOM and 28 due to SOM. The rate of development of late sequela of middle ear disease was compared between the two subgroups of OM-proneness. RESULTS: A total of 15 children (7.5%) developed late sequela of middle ear disease; all belonged to the SOM group; 3.5% developed eardrum perforation; 3.5% atelectasis and 0.5% cholesteatoma. CONCLUSIONS: Pre-CI VT insertion in children with SOM who underwent CI did not prevent development of late sequela of middle ear disease; VT insertion with the object of preventing late sequela of middle ear disease in CI candidates who suffer from SOM only is not required; in otitis-prone children a long term oto-microscopic follow-up is needed in order to identify late sequela of middle ear disease.

Acute mastoiditis: 20 years of experience with a uniform management protocol.

OBJECTIVES: To characterize the clinical presentation of pediatric patients who, upon AM diagnosis, also had imaging-diagnosed ICCs (ID-ICCs); to define the group of AM patients at risk of developing ID-ICCs; and to update knowledge about organisms causing AM. STUDY DESIGN: Analysis of all AM patients admitted between 1997 and 2018 and treated according to an obligatory protocol including both brain imaging and sampling for bacterial culture upon clinical diagnosis of AM. RESULTS: Of 166 admitted patients (0.5-19 years old) 22 (13%) already had ID-ICCs. In patients who, on admission, had already received antibiotics for acute otitis media (AOM) and also had CRP (C-reactive protein) levels above 93.5 mg/L, the risk of ID-CC was increased by 22.5-fold (P < 0.0001). Bacterial culture results were available for all patients and were positive in 115 (69%). Organisms most commonly found in patients without prior antibiotic treatment were group A Streptococcus pyogenes (53%), Streptococcus pneumoniae (23%), and Haemophylus influenzae (11%), while with prior antibiotic treatment they were Fusobacterium necrophorum (21%), Streptococcus pyogenes (18%) and Pseudomonas aeruginosa (18%). CONCLUSIONS: Since the risk of ID-ICC in patients with the abovementioned CRP and prior antibiotic treatment was significantly higher than in the others, these high-risk patients should undergo diagnostic imaging on admission. Antibiotic treatment prior to AM development may promote growth of non-AOM pathogen.

Cochlear implantation outcome in straightforward cases: can we do more for adults who cannot understand speech using hearing aids alone?

BACKGROUND: Many adults with moderate-profound hearing loss whose speech recognition has deteriorated and are no longer benefitting from hearing aids (HAs) could benefit from cochlear implantation (CI). Of these, only <5% are implanted. In order to inform eligible patients about expected results and ease the route to implantation, better guidelines for candidate selection are needed. OBJECTIVES: To provide reliable guidelines by determining, in a well-characterized group of implantees, the minimal expected post-CI scores for monosyllabic (MS) word recognition. PATIENTS AND METHODS: In total, 20 adults unilateral implantees considered (prior to implantation) straightforward CI candidates were assessed ≥20 months post-CI. Their post-CI CI-aided thresholds and MS word recognition were compared to their pre-CI scores. In addition, SSQ12 scores were evaluated post-CI. RESULTS: Post-CI, thresholds were 40 dB or better in all participants, and 35 dB or better in 95% of them. 90% scored 60% or better on MS words in quiet. In speech noise all scored 15-60% and 50% scored 45-60%. Poorer unaided pre-CI thresholds yielded greater patient satisfaction. CONCLUSIONS: Adults with moderate-profound hearing loss, whose speech recognition has deteriorated, are no longer benefitting from HAs and fulfil defined criteria for straightforward CI, should be referred for formal CI candidacy evaluation.

Acute Acoustic Trauma among Soldiers during an Intense Combat.

BACKGROUND: During military actions, soldiers are constantly exposed to various forms of potentially harmful noises. Acute acoustic trauma (AAT) results from an impact, unexpected intense noise ≥140 dB, which generates a high-energy sound wave that can damage the auditory system. PURPOSE: We sought to characterize AAT injuries among military personnel during operation "Protective Edge," to analyze the effectiveness of hearing protection devices (HPDs), and to evaluate the benefit of steroid treatment in early-diagnosed AAT injury. RESEARCH DESIGN: We retrospectively identified affected individuals who presented to military medical facilities with solitary or combined AAT injuries within 4 mo following an intense military operation, which was characterized with an abrupt, intensive noise exposure (July-December 2014). STUDY SAMPLE: A total of 186 participants who were referred during and shortly after a military operation with suspected AAT injury. INTERVENTIONS: HPDs, oral steroids. DATA COLLECTION AND ANALYSIS: Data extracted from charts and audiograms included demographics, AAT severity, worn HPDs, first and last audiograms and treatment (if given). The Student's independent samples t test was used to compare continuous variables. All tests were considered significant if p values were ≤0.05. RESULTS: A total of 186 participants presented with hearing complaints attributed to AAT: 122, 39, and 25 were in duty service, career personnel, and reservists, with a mean age of 21.1, 29.2, and 30.4 yr, respectively. Of them, 92 (49%) participants had confirmed hearing loss in at least one ear. Hearing impairment was significantly more common in unprotected participants, when compared with protected participants: 62% (74/119) versus 45% (30/67), p < 0.05. Tinnitus was more common in unprotected participants when compared with protected participants (75% versus 49%, p = 0.04), whereas vertigo was an uncommon symptom (5% versus 2.5%, respectively, p > 0.05). In the 21 participants who received steroid treatment for early-diagnosed AAT, bone-conduction hearing thresholds significantly improved in the posttreatment audiograms, when compared with untreated participants (p < 0.01, for 1-4 kHz). CONCLUSIONS: AAT is a common military injury, and should be diagnosed early to minimize associated morbidity. HPDs were proven to be effective in preventing and minimizing AAT hearing sequelae. Steroid treatment was effective in AAT injury, if initiated within 7 days after noise exposure.

Panel 2: Anatomy (Eustachian Tube, Middle Ear, and Mastoid-Anatomy, Physiology, Pathophysiology, and Pathogenesis).

Objective In this report, we review the recent literature (ie, past 4 years) to identify advances in our understanding of the middle ear-mastoid-eustachian tube system. We use this review to determine whether the short-term goals elaborated in the last report were achieved, and we propose updated goals to guide future otitis media research. Data Sources PubMed, Web of Science, Medline. Review Methods The panel topic was subdivided, and each contributor performed a literature search within the given time frame. The keywords searched included middle ear, eustachian tube, and mastoid for their intersection with anatomy, physiology, pathophysiology, and pathology. Preliminary reports from each panel member were consolidated and discussed when the panel met on June 11, 2015. At that meeting, the progress was evaluated and new short-term goals proposed. Conclusions Progress was made on 13 of the 20 short-term goals proposed in 2011. Significant advances were made in the characterization of middle ear gas exchange pathways, modeling eustachian tube function, and preliminary testing of treatments for eustachian tube dysfunction. Implications for Practice In the future, imaging technologies should be developed to noninvasively assess middle ear/eustachian tube structure and physiology with respect to their role in otitis media pathogenesis. The new data derived from these structure/function experiments should be integrated into computational models that can then be used to develop specific hypotheses concerning otitis media pathogenesis and persistence. Finally, rigorous studies on medical or surgical treatments for eustachian tube dysfunction should be undertaken.

Prognostic factors for facial nerve palsy in a pediatric population: A retrospective study and review.

OBJECTIVES/HYPOTHESIS: To identify and analyze factors influencing the outcome of facial nerve palsy (FNP) in a pediatric population. STUDY DESIGN: Retrospective study. METHODS: Sixty-seven pediatric patients (72 consecutive cases) diagnosed with and treated for FNP were divided into two severity subgroups. Associations between recovery in these groups and categorical variables were assessed using the Fisher exact test and for age using the t test. RESULTS: Mean age on admission was 12.0 ± 4.5 years. Neither FNP outcome (graded by severity) nor improvement rates (expressed as the percentage of patients achieving a higher FNP grade over time) were influenced by gender, affected side, presence of polyneuropathy, etiology, or recurrent or familial FNP. In cases with comparable final outcome, improvement rates of those diagnosed with severe FNP on presentation (38.9% of cases) were significantly higher than mild-to-moderate FNP. Of the 47 patients who attended a follow-up examination 2 months after discharge, 70.2% have already recovered (by at least one House-Brackmann [H-B] grade) by the time they were discharged, whereas 90.9% achieved H-B grade ≤2, and 72.3% fully recovered (H-B grade 1) 2 months postdischarge. Adding antiviral medication did not affect FNP improvement rates or outcomes. CONCLUSIONS: Rates of infectious and traumatic etiology in our patients were higher than reported for adults, but the most common etiology-as in those adults-was idiopathic. Routine extended diagnostic workup was not helpful, and antiviral medications were ineffective. The prognosis of FNP in pediatric patients is excellent, with 90% recovery by 2 months after initial presentation. LEVEL OF EVIDENCE: 4 Laryngoscope, 127:1175-1180, 2017.

Indications for Elective Tracheostomy in Reconstructive Surgery in Patients With Oral Cancer.

BACKGROUND: Oral cancer surgery carries a high risk of upper airway obstruction; yet optimal airway management approach remains controversial. AIM OF STUDY: The purpose of the present study was to evaluate the use of tracheostomy in oncological patients undergoing oral cancer surgery with intra oral flap reconstruction. METHODS: The study cohort included 75 patients with oral cancer, who underwent major intraoral resections and reconstruction with vascularized flaps. RESULTS: Thirty-six percent of the patients received elective tracheostomy (27 patients). Mean hospital stay of the patients with tracheostomy was 28.4 ±â€Š12.5 days compared with 9.7 ±â€Š2.1 days in the nontracheostomy patients. A scoring system rendered from this study suggests that patients with a total scoring at or above 8 should be considered for elective tracheostomy. CONCLUSIONS: With appropriate postoperative monitoring, selected patients can be managed without routine elective tracheostomy, yet, patients with comorbidities, mostly elderly patients, which undergo surgical resection and reconstruction in high-risk areas that can result in a bulky flap that pose danger to the postoperative airway, should receive elective tracheostomy.

[COCHLEAR IMPLANTATION IN ELDERLY INDIVIDUALS: INSIGHTS BASED ON A RETROSPECTIVE EVALUATION].

INTRODUCTION: In old age, the typical decline in temporal processing, auditory memory, speed of information processing, and ability to filter out irrelevant competing auditory input lead to deterioration in speech perception. This thereby broadens the target population for cochlear implantation among elderly individuals with severe-to-profound hearing loss. These features also raise concern regarding cochlear implant (CI) fitting and outcomes. AIM: To establish expectations from CI in older individuals. METHODS: This is a retrospective case review of 20 individuals with severe or severe-to-profound hearing loss, aged 60 or older (mean, 66.6 ± 5.25; range, 60-81 at the time of CI. Evaluation included speech-perception tests and the Glasgow Benefit Inventory (GBI) for testing quality of life. RESULTS: Between pre- and post-implantation, mean group values improved from 18.6% to 55.5%, from 37.2% to 84.5%, and from 11.2% to 60.5%, respectively, on the above speech-perception tests. No major postoperative complications were observed. The device was used consistently by all but one patient. GBI revealed improvement on all subscales. CONCLUSIONS: After implantation speech perception improved, there were no major post-CI complications, and post-implantation vertigo was less significant than expected in this age group. These results diminish concerns regarding CI in elderly individuals.

Risk factors for sensorineural hearing loss in pediatric chronic otitis media.

OBJECTIVES: To assess the clinical significance of sensorineural hearing loss (SNHL) in a group of pediatric patients suffering from unilateral chronic otitis media (COM) with or without cholesteatoma, using the contralateral healthy ear as a control, and to define risk factors for the development of SNHL in such patients. METHODS: The subjects of this retrospective study were 124 pediatric patients with unilateral COM admitted for surgery. Mean age at surgery was 13.3±3.2 years (range, 7-18) and mean duration of the disease was 88.4±45.0 months (range, 6-192 months). The preoperative pure-tone average value (PTA) for bone conduction (BC) was calculated in each ear (BC-PTA) as the average of BC thresholds at 500, 1000, 2000, and 4000Hz. Potential risk factors for SNHL that we evaluated were demographics, duration of disease, presence of cholesteatoma, and previous otologic history. RESULTS: Mean BC-PTA values in the diseased ears prior to surgery differed significantly from those in the healthy ears (12.74±8.75dB and 9.36±6.33dB, respectively; P<0.01). The degree of SNHL in the diseased ear at 2000Hz was found to be significantly correlated with the presence of cholesteatoma and with age above 10 years. CONCLUSIONS: One of the complications of COM, with or without cholesteatoma, in addition to the conductive hearing loss, is the development of clinically significant SNHL. It is therefore imperative to actively treat pediatric patients diagnosed with COM, with the aim of preventing the possible development of SNHL.

From hearing with a cochlear implant and a contralateral hearing aid (CI/HA) to hearing with two cochlear implants (CI/CI): a within-subject design comparison.

OBJECTIVE: To compare within-subject bilateral-binaural and bimodal complementary abilities between bimodal (cochlear implant and hearing aid; CI/HA) and bilateral CI hearing (CI/CI), thereby enabling better-informed counseling of experienced CI/HA users contemplating contralateral implantation. STUDY DESIGN: Comparative within-subject case review. SETTING: Outpatient hearing clinic. PATIENTS: Ten experienced adult CI/HA users with severe-to-profound hearing loss in the HA ear, who converted to CI/CI between 2 and 11 years after initial implantation. INTERVENTION: Task-specific testing of bilateral-binaural hearing (sound lateralization, binaural summation/redundancy/unmasking, head-shadow effect), bimodal complementary benefit (contribution of low-frequency information), and a self-report Speech, Spatial, and Qualities of Hearing (SSQ) questionnaire, all before and 1 year after contralateral cochlear implantation. MAIN OUTCOME MEASURES: Test result differences between CI/HA and CI/CI conditions. RESULTS: CI/CI hearing was better than CI/HA for speech lateralization and for perception of semantically unpredictable sentences in speech noise with speech at 0 degrees and noise at +90 degrees azimuth on the old CI side. CI/HA was better than CI/CI only for differences between perception of natural prosody speech and of speech with flattened fundamental frequency (F0) contour with speech and noise in front (at 0 degrees azimuth). Total scores on the SSQ questionnaire were higher in CI/CI than in CI/HA users. CONCLUSION: Counseling regarding contralateral implantation for CI/HA users with severe-to-profound hearing loss in the HA ear, though generally positive, should consider individual functional needs, and cover expectations about the expected trade-off between gaining improved understanding and speech lateralization in challenging listening conditions and losing some low-frequency cues still available with CI/HA hearing.

Risk factors for sensorineural hearing loss in chronic otitis media.

CONCLUSIONS: Risk factors for sensorineural hearing loss (SNHL) development in patients with chronic otitis media (COM) are longer duration of disease, older age and the presence of cholesteatoma. To prevent the expected development of SNHL, it is imperative to treat COM actively. OBJECTIVES: To assess the severity of SNHL in patients with unilateral COM and to define risk factors for its development. METHODS: The study included 317 patients with unilateral COM. Mean age was 28.7 ± 16.7 years (range 7-78 years) and mean duration of disease was 12.2 ± 11.3 years (range 0.25-60 years). In all patients, air conduction (AC) and bone conduction (BC) thresholds in both ears were measured at 500, 1000, 2000 and 4000 Hz. The parameters evaluated were demographics, duration of disease, presence and location of cholesteatoma and otologic history. RESULTS: The difference in mean BC thresholds between the diseased ears and the healthy ears was statistically significant, ranging from 4.55 ± 10.89 dB to 12.55 ± 19.09 dB across the measured frequency range (p < 0.0001). Multivariate regression analysis revealed statistically significant correlations between advanced age, longer duration of disease and presence of cholesteatoma, and the BC threshold differences between the affected and healthy ears.

Functional status of hearing aids in bilateral-bimodal users.

OBJECTIVE: To assess the functional status of the hearing aid (HA) in bilateral-bimodal users, in whom HA monitoring is often neglected because fitting efforts are focused on the cochlear implant (CI). Also, to define an audiometric pattern of residual hearing that might explain why, despite nonoptimal bimodal fitting, certain cochlear implantees still opt to use a HA. STUDY DESIGN: Retrospective case review. SETTING: Ambulatory care clinic. PARTICIPANTS: Experienced bimodal (CI/HA) adult users (N = 31) who use their HA during most of their waking hours. HA settings were required to meet a selected prescriptive (NAL-NL1) electro-acoustical Verifit Speechmap target at low frequencies using the simulated real-ear mode. INTERVENTION: After initial evaluation, HAs that did not meet the Speechmap target underwent appropriate fitting and reevaluation. MAIN OUTCOME MEASURE(S): Number of patients whose HAs met the defined Speechmap criteria after refitting; residual hearing levels in patients who achieved optimal bimodal fitting and in those who did not. RESULTS: At initial evaluation, the HA in 25 (81%) of the 31 participants was malfunctioning or poorly tuned. After HA replacement or retuning, 19 participants (61%) met the Speechmap targets, and 12 (39%) did not. However, the 2 groups had similar mean levels of unaided and aided residual hearing thresholds at 250 or 500 Hz. CONCLUSION: To maximize the benefit for bilateral-bimodal users, specific guidelines must be established also for fitting of their HAs. The focus should be on achieving the maximum amplification possible at low frequencies.

[Compliance with diagnostic MRI in the workup of sudden sensorineural hearing loss].

INTRODUCTION: Sudden sensorineural hearing loss (SSNHL] can be the presenting symptom of an acoustic neurinoma. High sensitivity and specificity rates define magnetic resonance imaging (MRI) of the brain and internal acoustic canal as the gold standard for the diagnosis of retro-cochlear pathologies. A previous study revealed low compliance rates (49%] for performing an MRI after an episode of SSNHL; 15% of patients who had an MRI were diagnosed with a retro-cochlear pathology. AIM OF STUDY: To evaluate current compliance rates for performing an MRI of the brain and internal acoustic canal after an episode of SSNHL. MATERIAL AND METHODS: The study cohort included 41 patients, 24 females and 17 male, with an average age of 49.8 +/- 16.8 years (range, 16-78 years), who were diagnosed with SSNHL and admitted for treatment between December 2009 and June 2010. RESULTS: Two months after discharge from hospitalization, only 29 patients (70.7%) returned for the scheduled followup. Only 21 patients (51.2% of those admitted) had an MRI of the brain and internal acoustic canal, as was recommended upon their discharge. Three of those who had an MRI were diagnosed with a retro-cochlear pathology. In 20 patients [48.8%) who did not perform an MRI, a retro-cochlear pathology could not be ruled out. CONCLUSIONS: Compliance rates for performing an MRI after an episode of SSNHL haven't changed in recent years. The main reason seems to be poor patients' compliance, as well as their general practitioners and health insurance companies. Ruling out retro-cochlear pathologies by means of MRI is highly important and considered common medical practice. Guidelines regarding the importance of MRI after an episode of SSNHL should be updated and reinforced.

Natural history of contralateral residual hearing in unilateral cochlear implant users - long-term findings.

CONCLUSION: The long-term stability of low-frequency residual hearing found in a significant number of bilateral-bimodal users (cochlear implant (CI) in one ear and a hearing aid (HA) on the other ear; CI/HA) with severe-to-profound or profound hearing loss in the non-implanted ear justifies bilateral-bimodal fitting efforts in this group. Since low-frequency residual hearing tends to deteriorate in some of these CI/HA users, periodic evaluation, which includes pure-tone thresholds and speech perception tests, is mandatory for determining the point in time at which CI/HA hearing is no longer effective, and the patient should accordingly be considered as a candidate for contralateral cochlear implantation. OBJECTIVE: To determine, in bilateral-bimodal (CI/HA) users with severe-to-profound or profound hearing loss in the non-implanted ear, the rate of residual hearing deterioration in the non-implanted ear after cochlear implantation. METHODS: Pure-tone aided and unaided thresholds in the non-implanted ears of 39 CI/HA users at 0.25-4.0 kHz were recorded prospectively up to 6 years after implantation. RESULTS: Group mean threshold values in the non-implanted ears remained stable over 3, 4, 5 and 6 years post-implantation, except for significant deterioration at 4.0 kHz of both unaided (4.2, 5.2, 9.0 and 8.2 dB, respectively) and aided thresholds (8.1, 4.6, 6.1 and 8.3 dB, respectively).

Demographic factors influencing educational placement of the hearing-impaired child with a cochlear implant.

OBJECTIVE: To analyze educational placement settings of Israeli children with cochlear implants (CIs) and evaluate the prognostic influence of the following demographic variables on mainstreaming: age at implantation, experience with CI, socioeconomic status, ethnicity, and parents' educational level. STUDY DESIGN: Retrospective review. SETTING: Tertiary referral center. PARTICIPANTS: The study population comprised 245 children with severe-to-profound hearing impairment and at least 1 year of experience with a unilateral CI. Mean age at implantation was 4.5 ± 3.9 years, and mean duration of CI use was 5.4 ± 2.8 years. INTERVENTION: Follow-up review and statistical analysis of available data on educational placement after cochlear implantation. MAIN OUTCOME MEASURE: Placement in mainstream education. RESULTS: Regular schools were attended by 89 children (36.3%) and special education schools by 156 (63.7%). Variables found to be significantly associated with mainstream educational placement were younger age at implantation, higher level of parental education, higher socioeconomic status, and ethnicity. Multivariate analysis using a logistic regression model revealed that the factor with the highest positive correlation with mainstreaming was parental education level. CONCLUSION: Our results show that parental education, a variable that the health system cannot control, significantly influences postimplantation results in term of educational placement and can thus limit the chances of implanted children to achieve mainstream placement even when identified and implanted at an early age.

[Bilateral sequential cochlear implantation in children].

INTRODUCTION: Unilateral cochlear implantation (CI) has become the standard of care for patients with severe and profound hearing loss. Most unilateral CI users achieve excellent speech understanding abilities in quiet conditions, but face extreme difficulty in noisy environment, a difficulty which can be minimized with bilateral hearing. AIM OF STUDY: To assess the added benefit from a sequential bilateral cochlear implantation in children, several years after the first CI. MATERIAL AND METHODS: Seven children who underwent sequential CI between 2006 and 2008 were included in the study. Mean age at first CI was 4.1 +/- 3.8 years. Mean age at second CI was 11.3 +/- 2.3 years. The mean interval between implantations was 7.3 +/- 2.8 years. Mean duration of experience with both implants was 11.91 +/- 12.2 months. Performance with the first implant and with the two implants was compared using speech perception tests. RESULTS: All children had significant added benefit from the second implantation. Mean word recognition score with both implants was 71% as compared to 44% with the first CI (P=0.018). Mean sentences recognition score in quiet conditions with both implants was 78% as compared to 60% with the first CI (P=0.028) and mean sentences recognition in noise with both implants was 58% as compared to 26% with the first CI (P=0.028). CONCLUSIONS: Benefit from contralateral implantation was demonstrated in the present study despite the long interval between the first and second implantation and the relatively late age at contralateral implantation. This finding raises the possibility that the window of opportunity for beneficial sequential contralateral implantation is longer than hypothesized so far.

Depth of stapes prosthesis in the vestibule: baseline values and correlation with stapedectomy outcome.

CONCLUSION: Deeper protrusion of the prosthesis into the vestibule does not correlate with worse postoperative hearing outcome. OBJECTIVES: To establish baseline values for the depth of the stapes prosthesis in the vestibule after stapedectomy and to investigate a possible correlation between the relative prosthesis depth (actual depth expressed as a percentage of the vestibule depth) and the hearing results. METHODS: This was a prospective case study. Sixteen patients underwent stapedectomy and were examined by high-resolution CT of the temporal bone during the first week after surgery. They then underwent audiometric follow-up at specified intervals during the first postoperative year. The actual depth of the prosthesis in the vestibule, its relative depth, and correlations between the relative depth and postoperative hearing results (at 1 week, 1 month, and 1 year) or postoperative complications (prolonged vertigo and sensorineural hearing loss) were measured. RESULTS: The actual depth of the prosthesis in the vestibule (mean +/- SD) was 2.39 +/- 0.42 mm (range 1.83-3.39 mm). The depth of the prosthesis relative to the depth of the vestibule was 52 +/- 9.74% (range 41.3-74.2%). In general, deeper protrusion of the prosthesis into the vestibule did not correlate with a worse hearing outcome. On the contrary, the correlation between prosthesis depth and better hearing results was positive at several frequencies.

Hearing rehabilitation counseling for patients with otosclerosis-related hearing loss.

OBJECTIVE: To standardize preoperative counseling for stapedectomy candidates. STUDY DESIGN: Retrospective case review. SETTING: Tertiary referral center. PATIENTS: Preoperative and postoperative hearing thresholds of 54 patients (55 stapedectomies) were retrospectively recorded. Patients (age range, 17-67 yr) were divided into 3 groups that differed significantly in their mean preoperative air conduction (AC) pure-tone averages (PTA) (up to 50, 50-70, and 70-90 dB). INTERVENTION: Comparison of the gap between the mean hearing thresholds achieved postoperatively and the target threshold (normal hearing) in the 3 groups. MAIN OUTCOME MEASURES: Preoperative and postoperative AC thresholds, bone-conduction (BC) thresholds, and air-bone gap at 0.5, 1.0, 2.0, and 4.0 Hz. RESULTS: Patients in the group with a mean preoperative AC below 50 dB had excellent postoperative results and achieved normal hearing thresholds. In the group with a mean preoperative AC of 50 to 70 dB, the postoperative results were good, but normal hearing thresholds were not achieved. Postoperative results in the third group were within the range of moderate hearing loss, allowing these patients to use hearing aids much more successfully than preoperatively. In each of the 3 groups, mean group differences between the preoperative and the postoperative values of AC-PTA thresholds, BC-PTA thresholds, and air-bone gap were statistically significant. Comparisons between each pairing of the stratified groups also yielded statistically significant differences. CONCLUSION: The preoperative AC-PTA threshold value can be viewed as a convenient, valid, and standardized basis for better informed and more comprehensive counseling of stapedectomy candidates with regard to options for hearing rehabilitation.