Simultaneous versus Sequential Cochlear Implantation in Adults: Quantitative and Qualitative Outcomes.

OBJECTIVE: To compare speech recognition and quality of life outcomes between bilateral sequentially and simultaneously implanted adult cochlear implant (CI) recipients who initially qualify for a CI in both ears. STUDY DESIGN: Retrospective chart review. SETTING: Tertiary referral center. METHODS: Retrospective chart review identified adults who underwent bilateral CI, either simultaneously or sequentially, at a high-volume center between 2012 and 2022. Sequentially implanted patients were only included if the second ear qualified for CI in quiet (defined as best-aided AzBio quiet testing <60%), at time of initial CI evaluation. RESULTS: Of 112 bilateral CI patients who qualified in both ears at initial evaluation, 95 underwent sequential implantation and 17 simultaneous. Age, duration, and etiology of hearing loss, and CI usage were similar between groups. Preoperatively, the sequential group had lower pure-tone average (PTA) in the 1st ear than the simultaneously implanted group (P = <.001) but, no difference in 2nd ear PTA (P = .657). Preoperative speech recognition scores were significantly higher for the sequential group; however, this was not true for postoperative scores. There was no difference in the proportion of patients showing significant CI-only or bilateral performance improvement between the groups. Both groups demonstrated similar benefit in quality of life measures. CONCLUSION: Our findings indicate both simultaneous and sequential cochlear implantation are effective in improving hearing performance and quality of life. Thus, bilateral versus simultaneous implantation should be discussed and tailored for each individual patient.

A graftless maxillary sinus lifting approach with simultaneous dental implant placement: a prospective clinical study.

PURPOSE: This study aimed to introduce a graftless sinus lifting approach with simultaneous dental implant placement in the alveolus of the posterior maxilla and compare this approach's outcomes in freshly extracted sockets versus healed sockets. MATERIALS AND METHODS: A prospective study was conducted on 60 patients aged between 27 and 59 years old, requiring dental implants in the posterior maxilla, and diagnosed with reduced vertical bone height (30 with freshly extracted sockets (group A) and the remaining 30 with healed sockets (group B). Before the sinus lifting approach, a cone beam computed tomography (CBCT) was taken, followed by another CBCT at least one-year post-sinus lifting (range: 12-36 months). Biological and mechanical complications were assessed, and the primary implant stability was measured using the Implant Stability Quotient (ISQ). Parametric data were analyzed using an independent t-test for intergroup comparisons, with significance set at P < 0.05. RESULTS: No significant differences were found among groups concerning gender, placement side, and follow-up. All dental implants demonstrated high survival rates with no observed biological or mechanical complications. Moreover, the primary implant stability was satisfactory, and there was no statistically significant difference (P = 0.38). In terms of new intrasinus bone formation, both groups exhibited satisfactory and successful outcomes, with increased new bone formation in group A. However, there was no statistically significant difference (P = 0.26). Regarding the vertical sinus floor elevation without new bone formation, group B showed (0.11 ± 0.64) mm of intrasinus implant height without bone formation, while group A showed an increment of bone formation above the intrasinus implant (0.22 ± 0.33) mm, with no statistically significant difference between both groups (P = 0.30). CONCLUSION: Our approach proves to be predictable, low-cost, and efficient option for sinus lift procedures, demonstrating high survival rates with acceptable primary implant stability. Moreover, it yields satisfactory outcomes in terms of new intrasinus bone formation, both in freshly extracted and healed sockets. Consequently, our approach holds promise as a reliable procedure for sinus lifting with simultaneous dental implant placement.

Effect of the implant apical exposure and coverage < or ≥ 2 mm bone graft on transcrestal sinus floor elevation: a 1- to 7-year retrospective cohort study.

OBJECTIVES: This study aimed to analyze the effect of the apex coverage by the bone graft, including exposure and coverage less than or greater than 2 mm on implant survival rate and peri-implant bone and soft tissue remodeling. MATERIALS AND METHODS: A total of 264 implants in 180 patients who had undergone transcrestal sinus floor elevation (TSFE) with simultaneous implant placement were included in this retrospective cohort study. Radiographic assessment was used to categorize the implants into three groups based on apical implant bone height (ABH): ≤ 0 mm, < 2 mm, or ≥ 2 mm. The implant survival rate, peri-implant marginal bone loss (MBL) during short-term (1-3 years) and mid- to long-term (4-7 years) follow-up, and clinical parameters were used to evaluate the effect of implant apex coverage after TSFE. RESULTS: Group 1 had 56 implants (ABH ≤ 0 mm), group 2 had 123 implants (ABH > 0 mm, but < 2 mm), and group 3 had 85 implants (ABH ≥ 2 mm). There was no significant difference in the implant survival rate between groups 2 and 3 compared to group 1 (p = 0.646, p = 0.824, respectively). The MBL during short-term and mid- to long-term follow-up indicated that apex coverage could not be considered a risk factor. Furthermore, apex coverage did not have a significant effect on other clinical parameters. CONCLUSIONS: Despite limitations, our study found that implant apex coverage by the bone graft, including exposure and coverage levels less than or greater than 2 mm, did not significantly affect implant survival, short-term or mid- to long-term MBL, or peri-implant soft tissue outcomes. CLINICAL RELEVANCE: Based on 1- to 7-year data, the study suggests that implant apical exposure and coverage levels of less than or greater than 2 mm bone graft are both valid options for TSFE cases.

Cardiac contractility modulation and subcutaneous defibrillator (S-ICD): First experience with simultaneous implantation.

BACKGROUNDS: Two technologies, cardiac contractility modulation (CCM) and subcutaneous implantable cardioverter-defibrillator (S-ICD), can be successfully combined and applied to patients with advanced heart failure (HF) with reduced left ventricular ejection fraction (LVEF). CASE REPORT: We reported a case of a 51-year-old man with reduced ejection fraction (LVEF = 33%) and a narrow QRS complex who first underwent simultaneous implantation of CCM and S-ICD. CONCLUSION: Our case report aimed to reveal that the simultaneous implantation of CCM and S-ICD could be successfully used in patients with advanced HF, which could significantly improve the clinical symptoms of such patients during one surgery.

Clinical and Radiographic Outcomes of a Novel Transalveolar Sinus Floor Elevation Technique.

Objective: The aim of this study was to evaluate the clinical and radiographic outcomes of the "vertically expander screw" (VES) technique as a novel approach for maxillary sinus floor elevation and simultaneous implant placement. Materials and Methods: Forty-four patients (26 females, 18 males) received 71 implants with simultaneous transalveolar sinus floor elevation via the VES technique. The threaded bone expanders were used to elevate the sinus floor as well as bone expansion. The patients were followed-up on a regular basis, and final clinical and radiographic examinations were performed at least 24 months following functional loading. Statistical analysis was conducted using the Chi-square test, the correlation coefficient, and the independent t test (p < 0.05, 95% confidence interval). Results: All implants showed successful osseointegration. The mean marginal bone loss (MBL; 0.38 ± 0.75 mm) at the site of premolars was not significantly different from the value at the site of molars (0.17 ± 0.50 mm). The mean intrasinus bone gain (IBG) was not significantly different (3.47 ± 1.22 mm and 4.11 ± 1.67 mm, respectively; p = 0.92). Evaluation of implant success index (ISI) score revealed no difference between the premolars and molars (p = 0.12). Conclusion: Despite the limitations of the present study, it seems that the VES technique and simultaneous implant placement in carefully selected cases may result in promising outcomes. Clinical Relevance: Insufficient alveolar bone height and poor bone quality often complicate implant placement in the edentulous posterior maxilla. The VES technique and simultaneous implant placement can bring about favorable clinical and radiographic outcomes and high survival rate in carefully selected cases.

Cochlear Implantation Following Transcanal Infrapromontorial Approach for Vestibular Schwannoma: A Case Series.

Background: Cochlear implantation (CI) following endoscopic transcanal infrapromontorial vestibular schwannoma (VS) dissection is a feasible intervention in intracanalicular VS, with minimal extension into the cerebellopontine angle, but no audiologic results have ever been reported in the literature. Methods: From 2015 to 2021 in the Otorhynolaryngology Departments of Modena and Verona, three patients underwent this intervention. All were suffering from sporadic left-sided intracanalicular Koos I VS. Intraoperative electrically evoked auditory brainstem responses and electrophysiological measurements were performed before and after the placement of the electrode array, respectively. Since device activation one month after the surgery, each patient was followed up with audiometric tests, data logging, electrode impedance measurements and neural response telemetry performed at each scheduled fitting session at 15 days and 3, 6, 12 and 24 months. Results: Only in patient No. 3, an auditory benefit was observed and still evident even 36 months after activation. Impedances increased progressively in patient No. 1 and a benefit was never reported. Patient No. 2 left the follow-up for worsening comorbidities. Conclusions: CI following transcanal infrapromontorial VS resection is a beneficial intervention. The residual cochlear nerve after the tumour dissection and the course of electrophysiological measurements in the postoperative period were the main predictive factors for audiological outcomes.

[Retrospective study on transcrestal sinus floor elevation with simultaneous implantation of short implants].

OBJECTIVE: To explore the changes in bone height of the maxillary sinus floor at different sinus ridge heights after transcrestal sinus floor elevation (tSFE) with the simultaneous implantation of short implants. METHODS: A total of 74 Bicon short implants were implanted into 37 patients during the same period of maxillary sinus elevation. The residual bone height (RBH)<4 mm group has 43 sites, and the RBH≥4 mm group has 31 sites. After 5 years of follow-up observation, the implant survival rate and the change in bone height achieved in the maxillary sinus over time were measured and analyzed via clinical examination and X-ray imaging. RESULTS: In the 74 implantation sites, the elevation height of the sinus floor was (6.64±1.32) mm and the bone height of the sinus floor was (3.35±1.29) mm 5 years after loading. No statistical difference was observed in the bone resorption of the implant neck between the RBH<4 mm and RBH≥4 mm groups. Meanwhile, a statistical difference was noted in the bone height obtained in the maxillary sinus between the two groups. CONCLUSIONS: When RBH in the maxillary posterior tooth area was <4 mm, the simultaneous implantation of Bicon short implants with tSFE can achieve a high implant survival rate and bone gain in the maxillary sinus, but does not increase the absorption of the alveolar ridge bone.

Retrospective study on transcrestal sinus floor elevation with simultaneous implantation of short implants / 华西口腔医学杂志

OBJECTIVE@#To explore the changes in bone height of the maxillary sinus floor at different sinus ridge heights after transcrestal sinus floor elevation (tSFE) with the simultaneous implantation of short implants.@*METHODS@#A total of 74 Bicon short implants were implanted into 37 patients during the same period of maxillary sinus elevation. The residual bone height (RBH)<4 mm group has 43 sites, and the RBH≥4 mm group has 31 sites. After 5 years of follow-up observation, the implant survival rate and the change in bone height achieved in the maxillary sinus over time were measured and analyzed via clinical examination and X-ray imaging.@*RESULTS@#In the 74 implantation sites, the elevation height of the sinus floor was (6.64±1.32) mm and the bone height of the sinus floor was (3.35±1.29) mm 5 years after loading. No statistical difference was observed in the bone resorption of the implant neck between the RBH<4 mm and RBH≥4 mm groups. Meanwhile, a statistical difference was noted in the bone height obtained in the maxillary sinus between the two groups.@*CONCLUSIONS@#When RBH in the maxillary posterior tooth area was <4 mm, the simultaneous implantation of Bicon short implants with tSFE can achieve a high implant survival rate and bone gain in the maxillary sinus, but does not increase the absorption of the alveolar ridge bone.

Simultaneous versus sequential bilateral cochlear implants in adults: Cost analysis in a US setting.

OBJECTIVES/HYPOTHESIS: From a purely surgical efficiency point of view, simultaneous cochlear implantation (SimCI) is more cost-effective than sequential cochlear implantation (SeqCI) when total direct costs are considered (implant and hospital costs). However, in a setting where only SeqCI is practiced and a proportion of initially unilaterally implanted patients do not progress to a second implant, this may not be the case, especially when audiological costs are factored in. We present a cost analysis of such a scenario as would occur in our institution. STUDY DESIGN: Retrospective review and cost analysis. METHODS: Between 2005 and 2015, 370 patients fulfilled the audiological criteria for bilateral implantation. Of those, 267 (72.1%) underwent unilateral cochlear implantation only, 101 (27.3%) progressed to SeqCI, and two underwent SimCI. The total hospital, surgical, and implant costs, and initial implant stimulation series audiological costs between August 2015 and August 2016 (29 adult patients) were used in this analysis. RESULTS: The total hospital, surgical, and implant costs for this period was $2,731,360.42. Based on previous local trends, if a projected eight (27.3%) of these patients decide to progress to SeqCI, this will cost an additional $750,811.04, resulting in an overall total of $3,482,171.46 for these 29 patients. Had all 29 undergone SimCI, the total projected cost would have been $3,332,991.75, representing a total potential saving of $149,179.67 (4.3%). CONCLUSIONS: In institutions where only SeqCI is allowed in adults, overall patient management may cost marginally more than if SimCI were practiced. This will be of interest to CI programs and health insurance companies. LEVEL OF EVIDENCE: 4. Laryngoscope, 127:2615-2618, 2017.

Translabyrinthine vestibular schwannoma resection with simultaneous cochlear implantation.

OBJECTIVES: (1) Report a rare case of translabyrinthine resection of a sporadic vestibular schwannoma (VS) and concurrent cochlear implantation (CI). (2) Discuss pre-, intra-, and post-operative considerations in this unique patient population. (3) Describe surgical and audiologic outcomes reported in this population. METHODS: Case report and review of the literature. PubMed search 'Cochlear Implantation'[Mesh] AND ('Neuroma, Acoustic'[Mesh] OR 'VESTIBULAR SCHWANNOMA'[All Fields] OR 'SCHWANNOMA'[All Fields]) limited to humans and English language. Returned 64 search results, abstracts and references of relevant papers reviewed. RESULTS: A 75-year-old male with longstanding history of slowly progressive severe hearing loss and tinnitus presented for evaluation of worsening imbalance, vertigo, and nausea. Workup revealed a 7 mm right intracanalicular mass on MRI concerning for vestibular schwannoma. Audiogram showed bilateral, symmetric, severe-to-profound sensorineural hearing loss, with poor open-set speech comprehension while bilaterally aided. He underwent successful concurrent right translabyrinthine resection of his VS with complete preservation of the cochlear nerve and uncomplicated cochlear implantation. DISCUSSION: Literature review revealed few previous reports of simultaneous VS and CI. The vast majority of these were in patients with neurofibromatosis Type 2 in whom auditory outcomes were poor. This patient represents one of the few cases of concurrent translabyrinthine tumor removal and CI for a spontaneous VS. CONCLUSION: Single-stage cochlear implantation and translabyrinthine tumor resection is a feasible and safe option to consider for auditory rehabilitation in rare situations.

Clinical Evaluation of Delayed Versus Simultaneous Implantation with Sinus Lifting

PURPOSE: Simultaneous implantation has been traditionally limited to patients with at least 5 mm of residual bone to ensure that the implant is completely stabilized. This is considered to be one of the most critical factors for primary implant stability and parallelism and, subsequently osseointegration. Recently, improved initial implant stability is provided by advancement of surgical techniques, implant designs and surface treatments. This has led surgeons to extending simultaneous treatment option to patients with below 4 mm of residual bone height, despite the lack of much data. The purpose of this study was to retrospectively evaluate and compare the status of implants which are installed by delayed and simultaneous methods. MATERIAL AND METHODS: The subjects were patients(121 patients, 278 implants) who had been operated with sinus lifting from 2003 to 2007 in Sun Dental Hospital. Lateral window approach with autograft and xenograft(1:1 ratio) were carried out for all sinus lifting. 4 types of implant were used. The mean follow up period was 26.3 months(19 - 58 months) in delayed group, and 22.8 months(18 - 43 months) in simultaneous group. RESULTS: The survival rate of implant restoration of this study was 98.2% in delayed group and 91.7% in simultaneous group. In simultaneous group, wide-platform type implants showed 100% survival rate. The total average of marginal bone loss in radiographs was 0.96 +/- 0.29 mm in delayed group and 1.02 +/- 0.31 mm in simultaneous group. CONCLUSION: Simultaneous implantation with sinus lifting(below 4mm of residual bone height) could be predictable treatment.

Stability of simultaneous implantation with autogenous iliac bone graft in the severely atrophic maxilla