[Show abstract][Hide abstract] ABSTRACT: Although successful cochlear implantation of patients with deafness following meningitis is expected, long-term stability of electrical current requirements has not been systematically evaluated. This study evaluated changes in programming for patients deafened by bacterial meningitis and stability of auditory performance over time.
In this retrospective descriptive study, cochlear implant (CI) stimulation mode and performance of 14 patients deafened by meningitis were compared with those of an age-matched control group of patients deafened by other causes.
There were no significant differences in mean performance between the meningitis group and control group (P > 0.05). However, the postmeningitis group required progressively higher stimulation levels and higher programming modes over time as compared to the control group.
Even with deafness accompanied by labyrinthine ossification attributed to meningitis, neural elements were present and could be stimulated. Because increasing levels of stimulation were required over time, postmeningitic children with CIs, and those with cochlear ossification in particular, may need frequent programming adjustments to maintain performance.
These patients need close follow-up of stimulation levels and programming modes postoperatively in order to perform optimally with CIs.
Otolaryngology Head and Neck Surgery 01/2005; 131(6):885-9. DOI:10.1016/j.otohns.2004.05.019 · 1.72 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We sought to determine a dose-response curve for topical mitomycin C when used to prolong the patency of laser-assisted myringotomies.
Bilateral myringotomies were performed using the argon laser in 40 guinea pigs with normal ears. Pledgets with (0.05, 0.2, 0.4, or 2.0 mg/mL) mitomycin C were applied topically. Monitoring consisted of weekly or biweekly otomicroscopy.
As in previous studies, all saline-treated myringotomies closed by day 7. By day 14, all myringotomies (100%) in the 0.05 mg/mL group were closed. By contrast, all myringotomies (100%) remained patent in the 0.2 and 0.4 mg/mL treatment groups, and 56% of the myringotomies remained patent in the 2.0 mg/mL group at day 14. By day 56, all myringotomies were closed in the 2.0 mg/mL group, 5 (50%) myringotomies were patent in the 0.4 mg/mL group, and 1 (11%) myringotomy was patent in the 0.2 mg/mL group. The study was terminated on day 84 (12 weeks). At that time, only the 0.4 mg/mL group had patent myringotomies (n = 3; 30%). The highest dose (2.0 mg/mL) of mitomycin was significantly associated with otorrhea. Otorrhea also appeared to be associated with earlier myringotomy closure.
There is a dose-response curve for topical mitomycin C when used for prolonging myringotomy patency in doses up to 0.4 mg/mL. Higher doses do not appear to prolong patency and are associated with greater otorrhea, suggesting middle ear toxicity.
Otolaryngology Head and Neck Surgery 12/2003; 129(5):471-4. DOI:10.1016/S0194-5998(03)01394-9 · 1.72 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The goal of the present study was to compare the frequencies of cochlear and non-cochlear patterns of distortion-product otoacoustic emissions (DPOAEs) in patients with nonacoustic (non-AN) tumors of the cerebellopontine angle (CPA)/internal auditory canal with those in patients with acoustic neuroma (AN).
We conducted a prospective study of patients with non-AN internal auditory canal/CPA tumors treated between 1992 and 1999 in a tertiary care setting. We collected data on behavioral pure tone average, speech discrimination score, acoustic immittance tests, DPOAEs, and tumor size. DPOAEs were divided into those with a cochlear or a noncochlear pattern. Comparisons were made with a control group of patients with AN of the CPA.
Twenty-four patients were included in the study: 12 patients in the non-AN group and 12 patients in the AN group. In the non-AN group, 5 (42%) patients had a cochlear pattern and 7 (58%) had a noncochlear pattern. In the AN group, 7 (58%) patients had a cochlear pattern and 5 (42%) had a noncochlear pattern. The differences between the non-AN and AN groups were statistically significant. In the non-AN group, patients with a cochlear-pattern DPOAE had significantly smaller tumors (P = 0.03) and a trend (P = 0.07) toward higher speech discrimination score. Age and pure tone average were not significantly different in the non-AN tumor patients. In the AN group, none of the study parameters were significantly related to the pattern of DPOAE.
ANs appear to differ from other tumors of the CPA in their propensity to cause sensory versus neural hearing loss. A larger series of patients would be useful to confirm these preliminary findings.
Otolaryngology Head and Neck Surgery 03/2002; 126(2):115-20. DOI:10.1067/mhn.2002.122264 · 1.72 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Cochlear implants are electronic prostheses that provide a high quality sense of hearing to severely and profoundly deaf children and adults. As improvements in surgical technique and device performance have occurred, indications for implantation have expanded.
Otolaryngologic Clinics of North America 05/2001; 34(2):455-67. DOI:10.1016/S0030-6665(05)70342-X · 1.34 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The indications for cochlear implantation (CI) are continually evolving and, as experience accumulates, the relative contraindications for CI continue to decrease. However, there is little information regarding CI in patients who may be considered to be at risk for poor wound healing due to immunosuppression or intercurrent disease.
To assess and report the complication rates, postoperative course, postimplant rehabilitation, and long-term performance of patients considered at risk due to presumably impaired healing capability. We hypothesized that these patients had outcomes similar to other implanted patients.
This is a retrospective chart review of 277 patients who have received CI at the University of Miami Ear Institute between 1990 and 1999. The clinical courses of 6 patients on immunosuppressive medications and 7 patients with diseases believed to be associated with poor healing are reported.
Long-term follow-up (mean, 33 months) showed postoperative complication rates, performance, and rehabilitation compliance that were similar to published reports of noncompromised patients.
CI of selected patients with potentially reduced healing capabilities is safe and effective.
Otolaryngology Head and Neck Surgery 01/2001; 123(6):738-41. DOI:10.1067/mhn.2000.111355 · 1.72 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Electrocochleography is a technique for measuring stimulus-related electrical potentials generated within the cochlea and auditory nerve. The most commonly suggested areas of clinical usefulness of electrocochleography include evaluation of Meniere disease or endolymphatic hydrops; enhancement of wave I in neurodiagnostic assessment; and intraoperative monitoring of the peripheral auditory structures at risk for damage secondary to surgically induced trauma. Relatively few reports of research related to each of these areas have been published over the past year, with the majority related to the role of electrocochleography in patients with Meniere disease. Methods of improving diagnostic utility in identification of Meniere disease have received attention in current literature. With the development of viable extratympanic electrodes, electrcochleography has the potential to become more clinically useful. This paper reviews the role of electrocochleographic evaluation of inner ear and retrocochlear diseases.
Current Opinion in Otolaryngology & Head and Neck Surgery 09/2000; 8(5):375-379. DOI:10.1097/00020840-200010000-00003 · 1.39 Impact Factor