Emmanuel A M Mylanus

Radboud University Nijmegen, Nymegen, Gelderland, Netherlands

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Publications (134)183.08 Total impact

  • Rik C Nelissen · Emmanuel A M Mylanus · Cor W R J Cremers · Myrthe K S Hol · Ad F M Snik
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    ABSTRACT: Patients with congenital unilateral conductive hearing loss (UCHL) can either be watchful monitored or treated surgically through the fitting of a percutaneous bone conduction device (BCD) or, in some cases, atresia repair. The current study evaluated the long-term compliance and satisfaction with a percutaneous BCD in this specific population. Fifty-three consecutive patients with congenital UCHL treated with a percutaneous BCD in our tertiary referral center between 1998 and 2011 were identified. Clinical and audiological data were retrospectively gathered from the patients' files. The patients were interviewed by telephone about their current device usage status and were asked to complete the Speech, Spatial and Qualities of Hearing Scale (SSQ). Compliance with the BCD was 56.6% after a mean follow-up of 7 years. The mean age at implantation of the users (22 years) was significantly higher than that of the nonusers (10 years). The mean time of device usage before the patients stopped using the BCD was 5 years. The primary reasons mentioned for quitting the BCD were experiencing excess background noise and/or subjectively not receiving enough benefit. Objectively measured features of binaural processing affected by the BCD were found to correlate with long-term BCD usage. The SSQ revealed significant improvement in the aided condition compared with the nonaided condition in the users, in contrast to the nonusers. The current disappointing long-term compliance figures indicate the need for an even more careful and individualized approach with life-long follow-up when fitting BCDs in this specific population, especially in children.
    Otology & neurotology: official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology 04/2015; 36(5). DOI:10.1097/MAO.0000000000000765 · 1.60 Impact Factor
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    ABSTRACT: To identify risk factors for complications after bone-anchored hearing implant (BAHI) surgery. Retrospective cohort study. Tertiary referral center. All adult patients who received titanium bone-anchored hearing implants at our clinic between September 1, 1988 and December 31, 2007 were approached to fill out a questionnaire on comorbidity factors. A total of 581 patients with 669 implants were included in the analysis. Implant loss, soft tissue reactions, and revision surgery after BAHI implantation. Skin disease and profound learning difficulties were risk factors for time to first soft tissue reaction, hazard rate ratio of 3.41 (95% CI 1.45-8.01) and 3.42 (1.03-11.39), respectively. Female gender showed a trend toward a negative risk for time to first soft tissue reaction, hazard rate ratio 0.60 (0.35-1.03). In multivariable analysis, skin disease and female gender were observed as independent associative factors, adjusted hazard ratio 3.08 (1.32-7.16) and 0.56 (0.33-0.94). For revision surgery, female gender and cardiovascular disease were identified as negative risk factors in univariable analysis, and smoking showed a trend toward a negative risk, with hazard ratios of 0.15 (0.07-0.32), 0.07 (0.03-0.20), and 0.51 (0.24-1.07), respectively. In multivariable analysis, smoking and female gender were observed as independent associative factors, adjusted hazard ratio 0.45 (0.22-0.95) and 0.14 (0.06-0.30). Smoking could be identified as a risk factor for implant loss with a hazard ratio of 3.32 (1.36-8.09). Retrospective analysis of comorbidity factors and clinical outcomes revealed risk factors for postoperative complications after BAHI surgery.
    Otology & neurotology: official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology 03/2015; 36(5). DOI:10.1097/MAO.0000000000000745 · 1.60 Impact Factor
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    ABSTRACT: Cochlear implantation is a treatment for deafness and severe sensorineural hearing loss in pediatric and adult patients. Cochlear implants (CIs) bypass damaged or missing hair cells in the cochlea by directly stimulating auditory nerve fibers, allowing for speech perception in most users.Although very successful in most cases, the incidence of medical complications is somewhere between 9 and 19 percent (1,2). These complications can be classified as minor or major complications. Minor complications are treated expectantly and/or with medication alone, while major complications require additional surgery and/or hospitalization. (2)This article is protected by copyright. All rights reserved.
    Clinical otolaryngology: official journal of ENT-UK; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery 03/2015; DOI:10.1111/coa.12417 · 2.27 Impact Factor
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    Rik C Nelissen · Christine A den Besten · Emmanuel A M Mylanus · Myrthe K S Hol
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    ABSTRACT: The objective of this study was to compare the stability, survival, and tolerability of 2 percutaneous osseointegrated titanium implants for bone conduction hearing: a 4.5-mm diameter implant (test) and a 3.75-mm diameter implant (control). Fifty-seven adult patients were included in this randomized controlled clinical trial. Sixty implants were allocated in a 2:1 (test-control) ratio. Follow-up visits were scheduled at 7, 14, 21, and 28 days; 6 and 12 weeks; and 6 months. At every visit, implant stability quotient (ISQ) values were recorded by means of resonance frequency analysis (RFA) and skin reactions were evaluated according to the Holgers classification. Implants were loaded with the bone conduction device at 3 weeks. Hearing-related quality of life was evaluated using the Abbreviated Profile of Hearing Aid Benefit (APHAB), the Glasgow Benefit Inventory (GBI), and the Glasgow Health Status Inventory (GHSI). ISQ values were statistically significantly higher for the test implant compared to the control implant. No implants were lost and soft tissue reactions were comparable for both implants. Positive results were reported in the hearing-related quality of life questionnaires. These 6-month results indicate that both implants and their corresponding hearing devices are safe options for hearing rehabilitation in patients with the appropriate indications. Loading at 3 weeks did not affect the stability of either implant.
    Archives of Oto-Rhino-Laryngology 03/2015; DOI:10.1007/s00405-015-3593-x · 1.61 Impact Factor
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    ABSTRACT: Modulation of a materials surface topography can be used to steer various aspects of adherent cell behaviour, such as cell directional organization. Especially nanometric sized topographies, featuring sizes similar to for instance the axons of the spiral ganglion cells, are interesting for such purpose. Here, we utilized nanosized grooves in the range of 75–500 nm, depth of 30–150 nm, and pitches between 150 nm and 1000 nm for cell culture of neuron-like PC12 cells. The organizational behaviour was evaluated after 7 days of culture by bright field and scanning electron microscopy. Nanotopographies were shown to induce aligned cell-body/axon orientation and an increased axonal outgrowth. Our findings suggest that a threshold for cell body alignment of neuronal cells exists on grooved topographies with a groove width of 130 nm, depth of 70 nm and pitch of 300 nm, while axon alignment can already be induced by grooves with 135 nm width, 52 nm depth and 200 nm pitch. However, no threshold has been found for axonal outgrowth, as all of the used patterns increased outgrowth of PC12-axons. In conclusion, surface nanopatterns have the potential to be utilized as an electrode modification for a stronger separation of cells, and can be used to direct cells towards the electrode contacts of cochlear implants.
    Hearing Research 01/2015; 320. DOI:10.1016/j.heares.2014.12.009 · 2.85 Impact Factor
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    ABSTRACT: Image quality of low-dose multi-slice computed tomography (MSCT) after cochlear implantation is comparable to that of cone-beam computed tomography (CBCT). CBCT has been described as a low-dose alternative with superior image quality to MSCT for postoperative cochlear implant (CI) imaging, but to our knowledge, no dose-matched comparisons of image quality have been published. Five human cochleae were implanted with CI electrodes and scanned on two CBCT and two MSCT systems. Four independent observers rated aspects of image quality on a five-point scale. CBCT scans were compared to clinical and dose-matched MSCT scans. Declining-dose MSCT protocols were compared to the clinical protocol. CT phantoms were used to determine effective dose and resolution for each acquisition protocol. Effective dose of the CBCT protocols was 6 to 16% of the clinical MSCT dose. Visibility of cochlear inner and outer walls and overall image quality were positively correlated with radiation dose on MSCT and image quality was better with clinical MSCT than with CBCT protocols. In other comparisons, differences between systems were found, but a distinction between CBCT and MSCT could not be made. CBCT and dose-matched MSCT are both suitable for postoperative CI imaging. Selecting a CT system and radiation dose depends on which cochlear structures need to be visualized.
    Ontology & Neurotology 11/2014; 36(4). DOI:10.1097/MAO.0000000000000673 · 1.60 Impact Factor
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    Marloes Sparreboom · Margreet C. Langereis · Ad F. M. Snik · Emmanuel A. M. Mylanus
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    ABSTRACT: Sequential bilateral cochlear implantation in profoundly deaf children often leads to primary advantages in spatial hearing and speech recognition. It is not yet known how these children develop in the long-term and if these primary advantages will also lead to secondary advantages, e.g. in better language skills. The aim of the present longitudinal cohort study was to assess the long-term effects of sequential bilateral cochlear implantation in children on spatial hearing, speech recognition in quiet and in noise and receptive vocabulary. Twenty-four children with bilateral cochlear implants (BiCIs) were tested 5–6 years after sequential bilateral cochlear implantation. These children received their second implant between 2.4 and 8.5 years of age. Speech and language data were also gathered in a matched reference group of 26 children with a unilateral cochlear implant (UCI). Spatial hearing was assessed with a minimum audible angle (MAA) task with different stimulus types to gain global insight into the effective use of interaural level difference (ILD) and interaural timing difference (ITD) cues. In the long-term, children still showed improvements in spatial acuity. Spatial acuity was highest for ILD cues compared to ITD cues. For speech recognition in quiet and noise, and receptive vocabulary, children with BiCIs had significant higher scores than children with a UCI. Results also indicate that attending a mainstream school has a significant positive effect on speech recognition and receptive vocabulary compared to attending a school for the deaf. Despite of a period of unilateral deafness, children with BiCIs, participating in mainstream education obtained age-appropriate language scores.
    Research in Developmental Disabilities 11/2014; 36. DOI:10.1016/j.ridd.2014.10.030 · 3.40 Impact Factor
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    ABSTRACT: Objective: To create a system for the uniform registration and classification of complications and failures in cochlear implant surgery, and apply it to all the patients who underwent implantation in our clinic. Method: The definition of a medical complication was established, and data for all cochlear implantations performed between 1987 and 2012 were entered into a custom-made database system. Results: One or more medical complications were registered in 19.0 per cent of 1003 cochlear implantations. The incidence of 'hard failure' was 2.3 per cent. Findings revealed a decrease in device failures over the years; the rate of medical complications remained constant. Conclusion: Our database system, which is available free of charge, enables fast and accurate data entry. There were a relatively high number of (minor) complications in our series, but comparison with the relevant literature is difficult. This emphasises the need for a uniform definition of 'complication' as it relates to cochlear implant surgery, and an appropriate classification system for such complications.
    The Journal of Laryngology & Otology 10/2014; 128(11):1-6. DOI:10.1017/S0022215114002126 · 0.70 Impact Factor
  • Rik C Nelissen · Emmanuel A M Mylanus · Myrthe K S Hol
    Ontology & Neurotology 09/2014; 36(6). DOI:10.1097/MAO.0000000000000578 · 1.60 Impact Factor
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    ABSTRACT: Objective: To compare the 3-year stability, survival, and tolerability of 2 osseointegrated implants for bone conduction hearing: a wide 4.5-mm-diameter moderately roughened implant with a rounded 6-mm abutment (test) and a 3.75-mm diameter as-machined implant with a conically shaped 5.5-mm abutment (control). Study Design: In this randomized, prospective, controlled, multicenter clinical study, 77 adult patients were included. Test and control implants were randomly assigned in proportions of 2:1. The implants were loaded with the sound processor from 6 weeks postimplantation. Follow-up after surgery was conducted at 10 days; at 4, 6, 8, and 12 weeks; and at 6, 12, 24, and 36 months after surgery. At every visit, implant stability quotient (ISQ) values were recorded by means of resonance frequency analysis (RFA), and skin reactions were evaluated according to Holgers’ classification. Results: Statistically significantly higher mean ISQ values were recorded for the test implant compared with the control implant at each evaluation time point. Between 2 and 3 years after surgery, ISQ values decreased but remained above baseline values. Implant survival was high for both implants: 96.2% of the test implants and 100% of the control implants survived these 3 years. Statistically significantly improved soft tissue outcomes were observed in the test implant group. Conclusion: This extensive long-term clinical investigation demonstrated that the test implant is more stable in terms of ISQ-values and provides high tolerability for the soft tissue. The results show that implant loading at 6 weeks is safe.
    Ontology & Neurotology 07/2014; 35(8). DOI:10.1097/MAO.0000000000000533 · 1.60 Impact Factor
  • Joost W Zwartenkot · Ad F M Snik · Emmanuel A M Mylanus · Jef J S Mulder
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    ABSTRACT: To compare amplification options for patients with mixed hearing loss. Devices tested include percutaneous and transcutaneous bone conductors (BCDs) and middle ear implants with their actuator directly coupled to the cochlea. Tertiary academic medical center. Maximum output was studied with simulators. As simulators are lacking for the middle ear implants (the Vibrant Soundbridge [VSB] and the Cochlear's Direct Acoustic Cochlear Stimulator [Codacs]), the maximum output had to be measured in patients (4 and 5 patients, respectively). The maximum output averaged at 0.5, 1, and 2 kHz was the main outcome measure, which was expressed in dB HL, using appropriate transformation tables. The maximum output was the highest for the Codacs device and was above the patients' uncomfortable loudness levels. The maximum output of the VSB varied between 65 and 85 dB HL, and that of percutaneous BCD varied between 68 and 80 dB HL depending on the type of device. The transcutaneous BCD, the Sophono device, had the lowest output. Only with the Codacs device can the complete dynamic range be used. The maximum output of the VSB is lower and variable owing to the coupling to the cochlea. For patients with a sensorineural hearing loss component up to 50 dB HL, a percutaneous BCD forms a good treatment option that is completely independent of the middle ear status. The transcutaneous Sophono BCD is suitable for patients with a (sub-)normal sensorineural hearing loss component of 20 dB or less.
    Otology & neurotology: official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology 02/2014; 35(2):221-6. DOI:10.1097/MAO.0000000000000258 · 1.60 Impact Factor
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    Marloes Sparreboom · Andy J Beynon · Ad F M Snik · Emmanuel A M Mylanus
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    ABSTRACT: To assess the effect of sequential bilateral cochlear implantation on auditory, cortical maturation after various periods of unilateral cochlear implant use. Prospective cohort study. Tertiary academic referral center. Thirty prelingually deaf children, who received their first implant at a mean age of 1.8 years and their second implant at a mean age of 5.3 years. Sequential bilateral cochlear implantation. The electrically evoked auditory cortical response (EACR) was evoked by the 2 implants separately after 12 and 24 months of bilateral cochlear implant use. P1 and N2 latencies and RMS amplitudes were compared between both implant sides and were compared with those of a group of 27 age-matched children with normal hearing. EACR latencies diminished over time for both implant sides. RMS amplitudes and P1 latencies elicited by the second implant were still significantly different from that of the first implant after 24 month. After 24 months, the difference in N2 latencies between both implant sides was no longer significant, although still apparent. Interimplant delay had an adverse effect on RMS amplitudes and waveform morphology. EACR latencies were age appropriate, although RMS amplitudes evoked by the second implant were smaller than those of the children with normal hearing. Auditory cortical maturation is possible after extended unilateral cochlear implant use, although responses evoked by the second implant still lack behind that of the experienced first implant. It is not clear if the auditory cortical response will become similar on both implant sides over time, especially for the children with longer interimplant delays.
    Otology & neurotology: official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology 01/2014; 35(1):35-42. DOI:10.1097/MAO.0000000000000172 · 1.60 Impact Factor
  • Otology & neurotology: official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology 12/2013; DOI:10.1097/MAO.0000000000000180 · 1.60 Impact Factor
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    ABSTRACT: Objectives: To investigate the preservation of residual hearing in subjects who received the Nucleus Hybrid L24 cochlear implant. To investigate the performance benefits up to one year post-implantation in terms of speech recognition, sound quality, and quality of life. Design: Prospective, with sequential enrolment and within-subject comparisons. Post-operative performance using a Freedom Hybrid sound processor was compared with that of pre-operative hearing aids. Study sample: Sixty-six adult hearing-impaired subjects with bilateral severe-to-profound high frequency hearing loss. Results: Group median increase in air-conduction thresholds in the implanted ear for test frequencies 125-1000 Hz was < 15 dB across the population; both immediately and one year post-operatively. Eighty-eight percent of subjects used the Hybrid processor at one year post-op. Sixty-five percent of subjects had significant gain in speech recognition in quiet, and 73% in noise (≥ 20 percentage points/2 dB SNR). Mean SSQ subscale scores were significantly improved (+ 1.2, + 1.3, + 1.8 points, p < 0.001), as was mean HUI3 score (+ 0.117, p < 0.01). Combining residual hearing with CI gave 22-26 %age points mean benefit in speech recognition scores over CI alone (p < 0.01). Conclusions: Useful residual hearing was conserved in 88% of subjects. Speech perception was significantly improved over preoperative hearing aids, as was sound quality and quality of life.
    International journal of audiology 09/2013; 52(12). DOI:10.3109/14992027.2013.802032 · 1.43 Impact Factor
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    ABSTRACT: To confirm the clinical efficacy and safety of a direct acoustic cochlear implant. Prospective multicenter study. The study was performed at 3 university hospitals in Europe (Germany, The Netherlands, and Switzerland). Fifteen patients with severe-to-profound mixed hearing loss because of otosclerosis or previous failed stapes surgery. Implantation with a Codacs direct acoustic cochlear implant investigational device (ID) combined with a stapedotomy with a conventional stapes prosthesis MAIN OUTCOME MEASURES: Preoperative and postoperative (3 months after activation of the investigational direct acoustic cochlear implant) audiometric evaluation measuring conventional pure tone and speech audiometry, tympanometry, aided thresholds in sound field and hearing difficulty by the Abbreviated Profile of Hearing Aid Benefit questionnaire. The preoperative and postoperative air and bone conduction thresholds did not change significantly by the implantation with the investigational Direct Acoustic Cochlear Implant. The mean sound field thresholds (0.25-8 kHz) improved significantly by 48 dB. The word recognition scores (WRS) at 50, 65, and 80 dB SPL improved significantly by 30.4%, 75%, and 78.2%, respectively, after implantation with the investigational direct acoustic cochlear implant compared with the preoperative unaided condition. The difficulty in hearing, measured by the Abbreviated Profile of Hearing Aid Benefit, decreased by 27% after implantation with the investigational direct acoustic cochlear implant. Patients with moderate-to-severe mixed hearing loss because of otosclerosis can benefit substantially using the Codacs investigational device.
    Otology & neurotology: official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology 08/2013; 34(7). DOI:10.1097/MAO.0b013e318298aa76 · 1.60 Impact Factor
  • Arjan J Bosman · Ad F M Snik · Myrthe K S Hol · Emmanuel A M Mylanus
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    ABSTRACT: Background: The recent introduction of digital hearing aid technology for bone-conduction devices employing percutaneous stimulation may be beneficial for patients with conductive and mixed hearing loss and single sided deafness. Purpose: Performance of a recently released sound processor for bone-anchored implants, the Ponto Pro Power from Oticon Medical (bone-conduction device 2 [BCD2]), was compared with that of the Baha Intenso from Cochlear (bone-conduction device 1 [BCD1]). Research Design: Direct comparison of the subject's own device (BCD1) with the new device (BCD2) was examined in a nonrandomized design. Subjects were initially tested with BCD1. BCD2 was tested after a 4 wk acclimatization period. Study Sample: Eighteen subjects with mixed hearing loss and with at least 4 mo experience with BCD1 completed the study. Mean air-conduction and bone-conduction thresholds averaged across the frequencies of 500, 1000, 2000, and 4000 Hz were 73.9 and 34.2 dB HL, respectively. Data Collection and Analysis: Performance of the two devices was evaluated objectively by measuring aided free-field thresholds, speech perception in quiet, and speech perception in noise. A subjective evaluation was carried out with the Abbreviated Profile of Hearing Aid Benefit (APHAB) (Cox and Alexander, 1995) and the Speech, Spatial and Qualities of Hearing Scale (SSQ) questionnaire (Gatehouse and Noble, 2004). In addition, user experiences, user satisfaction, and device preference were obtained via proprietary questionnaires. Statistical significance was established with analysis-of-variance (ANOVA) and paired t-statistics with Bonferroni correction. Results: Aided free-field thresholds and speech reception thresholds (SRTs) in quiet were not statistically significantly different for either device (p > 0.05). In contrast, SRTs in noise were 2.0 dB lower (p < 0.001) for BCD2 than for BCD1. APHAB questionnaire scores on all subscales provided statistically significantly greater benefit (p < 0.05) for BCD2 than for BCD1. Also, with the SSQ most items in the speech and sound quality domain were significantly more favorable (p < 0.05) for BCD2 than for BCD1. Finally, all subjects preferred BCD2 over BCD1 with 14 subjects reporting a strong preference and four subjects an average preference for the digital signal processing provided by BCD2 over previous technology provided by BCD1.
    Journal of the American Academy of Audiology 06/2013; 24(6):505-13. DOI:10.3766/jaaa.24.6.6 · 1.59 Impact Factor
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    ABSTRACT: OBJECTIVES: Evaluation of a single-channel linear bone conduction implant sound processor (S-BCI) and a multiple-channel nonlinear bone conduction implant sound processor (M-BCI) with objective and subjective measures in patients with mixed hearing loss. STUDY DESIGN: In total, 20 patients with mixed hearing loss were included in the study. For either sound processor aided thresholds and speech perception in quiet with monosyllables were measured. Speech perception in noise was measured with sentences. Two different configurations were used: speech and noise at 0° (S0N0) and speech at 0° and noise at 180° (S0N180). The M-BCI was tested in both omnidirectional and directional mode. Patients were first fitted with the S-BCI and evaluated 3 weeks later. The M-BCI was fitted and, again 3 weeks later, evaluated. Subjectively, patients compared both sound processors with the APHAB questionnaire. RESULTS: Aided thresholds were similar for both sound processors in the low- and mid-frequency range. For speech in quiet, no significant differences between both sound processors were observed. For speech in noise in the S0N0 condition, the M-BCI-thresholds were 1.7 dB (SD, 2.2dB; p = 0.002) more favorable than with S-BCI. For the S0N180 configuration, an improvement of 5.8 dB (SD, 2.8dB; p < 0.001) was seen for the directional mode relative to S-BCI. The APHAB showed statistically significant subjective improvement with the M-BCI on all subscales relative to S-BCI. CONCLUSION: Speech intelligibility in noise is better with M-BCI than with S-BCI. This was attributed to better high-frequency gain provided by the M-BCI. Improved signal processing strategies may have contributed to subjective preference for the M-BCI.
    Otology & neurotology: official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology 04/2013; 34(4). DOI:10.1097/MAO.0b013e318287793a · 1.60 Impact Factor
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    ABSTRACT: To investigate the quality of life of people with an auricular prosthesis. A retrospective case series study was conducted. Quality of life was evaluated by an open-ended question form and 3 questionnaires: the Glasgow Benefit Inventory, the Rosenberg Self-Esteem scale, and the standard Medical Outcome Study Short-Form 12. The occurrence of peri-implant skin reactions (defined by Holgers), along with fixture stability and prosthesis data, were evaluated in 29 implants from 10 patients. The follow-up period varied between several months and more than 17 years. The 3 questionnaires showed an improvement in quality of life scores for all patients, and all patients would recommend the prosthesis. Skin reactions that needed treatment (ie, Holgers grades 2-4) were seen in 6.2% of all observations; 44.8% of the implants demonstrated either no reaction at all or redness only around the implant. A significant correlation was found between the Rosenberg Self-Esteem score and the number of prosthesis replacements. In general, patients seemed to be satisfied with the auricular prostheses, which did improve their quality of life. Furthermore, the quality of life was enhanced with higher quality prostheses and with proper hygiene to prevent skin reactions.
    The Journal of craniofacial surgery 03/2013; 24(2):392-7. DOI:10.1097/SCS.0b013e31827fef2c · 0.68 Impact Factor
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    ABSTRACT: Assessment of the clinical effectiveness of bilateral cochlear implantation compared with unilateral cochlear implantation or bimodal stimulation, in adults with severe-to-profound hearing loss. In 2007, the National Institute for Health and Clinical Excellence (NICE) in the U.K. conducted a systematic review on cochlear implantation. This study forms an update of the adult part of the NICE review. The electronic databases MEDLINE and Embase were searched for English language studies published between October 2006 and March 2011. Studies were included that compared bilateral cochlear implantation with unilateral cochlear implantation and/or with bimodal stimulation, in adults with severe-to-profound sensorineural hearing loss. Speech perception in quiet and in noise, sound localization and lateralization, speech production, health-related quality of life, and functional outcomes were analyzed. Data extraction forms were used to describe study characteristics and the level of evidence. Data Synthesis: The effect size was calculated to compare different outcome measures. Pooling of data was not possible because of the heterogeneity of the studies. As in the NICE review, the level of evidence of the included studies was low, although some of the additional studies showed less risk of bias. All studies showed a significant bilateral benefit in localization over unilateral cochlear implantation. Bilateral cochlear implants were beneficial for speech perception in noise under certain conditions and several self-reported measures. Most speech perception in quiet outcomes did not show a bilateral benefit. The current review provides additional evidence in favor of bilateral cochlear implantation, even in complex listening situations.
    Otology & neurotology: official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology 02/2013; 34(2):190-8. DOI:10.1097/MAO.0b013e318278506d · 1.60 Impact Factor
  • A Snik · E Mylanus
    Clinical otolaryngology: official journal of ENT-UK; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery 02/2013; 38(1):95-6. DOI:10.1111/coa.12059 · 2.27 Impact Factor

Publication Stats

2k Citations
183.08 Total Impact Points

Institutions

  • 2008–2015
    • Radboud University Nijmegen
      • Donders Institute for Brain, Cognition, and Behaviour
      Nymegen, Gelderland, Netherlands
  • 1994–2015
    • Radboud University Medical Centre (Radboudumc)
      • Department of Human Genetics
      Nymegen, Gelderland, Netherlands
  • 2004
    • Utrecht University
      Utrecht, Utrecht, Netherlands
  • 2000
    • University of Amsterdam
      • Department of Otorhinolaryngology
      Amsterdamo, North Holland, Netherlands