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Anwar A, Singleton A, Fang Y, Wang B, Shapiro W, Roland JT, Waltzman SB. The value of intraoperative EABRs in auditory brainstem implantation. Int J Pediatr Otorhinolaryngol 2017; 101:158-163. [PMID: 28964288 DOI: 10.1016/j.ijporl.2017.08.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 08/04/2017] [Accepted: 08/05/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To compare the intraoperative electrically evoked auditory brainstem response (EABR) morphologies between neurofibromatosis II (NF2) adult auditory brainstem implant (ABI) recipients who had auditory percepts post-operatively and those who did not and between NF2 adult ABI recipients and non-NF2 pediatric ABI recipients. METHODS This was a retrospective case series at a single tertiary academic referral center examining all ABI recipients from 1994 to 2016, which included 34 NF2 adults and 11 non-NF2 children. The morphologies of intraoperative EABRs were evaluated for the number of waveforms showing a response, the number of positive peaks in those responses, and the latencies of each of these peaks. RESULTS 27/34 adult NF2 patients and 9/10 children had EABR waveforms. 20/27 (74.0%) of the adult patients and all of the children had ABI devices that stimulated post-operatively. When comparing the waveforms between adults who stimulated and those who did not stimulate, the proportion of total number of intraoperative EABR peaks to total possible peaks was significantly higher for the adults who stimulated than for those who did not (p < 0.05). Children had a significantly higher proportion of total number of peaks to total possible peaks when compared to adults who stimulated (p < 0.02). Additionally, there were more likely to be EABR responses at the initial stimulation than intraoperatively in the pediatric ABI population (p = 0.065). CONCLUSIONS The value of intraoperative EABR tracing may lie in its ability to predict post-operative auditory percepts based on the placement of the array providing the highest number of total peaks.
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Shabashev S, Fouad Y, Huncke TK, Roland JT. Cochlear implantation under conscious sedation with local anesthesia; Safety, Efficacy, Costs, and Satisfaction. Cochlear Implants Int 2017; 18:297-303. [PMID: 28934019 DOI: 10.1080/14670100.2017.1376423] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate the safety, efficiency, cost effectiveness, and satisfaction of patients undergoing cochlear implantation under conscious sedation versus general anesthesia. STUDY DESIGN Retrospective case review of 20 patients who underwent cochlear implantation under conscious sedation which was compared to 20 age-matched patients where surgery was performed under general anesthesia. METHODS Perioperative times, length of stay, anesthesia drug costs, postoperative complications, and patient satisfaction were compared between the two groups. RESULTS Conscious sedation was associated with decreased drug costs, surgery time, and anesthesia time. Length of stay was significantly longer for patients undergoing general anesthesia. Patient satisfaction was superior with conscious sedation. Perioperative morbidity was not significantly different between the two groups. CONCLUSION Conscious sedation for cochlear implantation is a safe, efficient, and cost-effective alternative to general anesthesia. The efficacy of conscious sedation for cochlear implant surgery may expand the treatment of profound hearing loss to the elderly who are deemed too sick for general anesthesia or are fearful of the cognitive or medical consequences of general anesthesia.
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Golfinos JG, Hill TC, Rokosh R, Choudhry O, Shinseki M, Mansouri A, Friedmann DR, Thomas Roland J, Kondziolka D. A matched cohort comparison of clinical outcomes following microsurgical resection or stereotactic radiosurgery for patients with small- and medium-sized vestibular schwannomas. J Neurosurg 2016; 125:1472-1482. [DOI: 10.3171/2015.12.jns151857] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
A randomized trial that compares clinical outcomes following microsurgery (MS) or stereotactic radiosurgery (SRS) for patients with small- and medium-sized vestibular schwannomas (VSs) is impractical, but would have important implications for clinical decision making. A matched cohort analysis was conducted to evaluate clinical outcomes in patients treated with MS or SRS.
METHODS
The records of 399 VS patients who were cared for by 2 neurosurgeons and 1 neurotologist between 2001 and 2014 were evaluated. From this data set, 3 retrospective matched cohorts were created to compare hearing preservation (21 matched pairs), facial nerve preservation (83 matched pairs), intervention-free survival, and complication rates (85 matched pairs) between cases managed with SRS and patients managed with MS. Cases were matched for age at surgery (± 10 years) and lesion size (± 0.1 cm). To compare hearing outcomes, cases were additionally matched for preoperative Class A hearing according to the American Academy of Otolaryngology-Head and Neck Surgery guidelines. To compare facial nerve (i.e., cranial nerve [CN] VII) outcomes, cases were additionally matched for preoperative House-Brackmann (HB) score. Investigators who were not involved with patient care reviewed the clinical and imaging records. The reported outcomes were as assessed at the time of the last follow-up, unless otherwise stated.
RESULTS
The preservation of preoperative Class A hearing status was achieved in 14.3% of MS cases compared with 42.9% of SRS cases (OR 4.5; p < 0.05) after an average follow-up interval of 43.7 months and 30.3 months, respectively. Serviceable hearing was preserved in 42.8% of MS cases compared with 85.7% of SRS cases (OR 8.0; p < 0.01). The rates of postoperative CN VII dysfunction were low for both groups, although significantly higher in the MS group (HB III–IV 11% vs 0% for SRS; OR 21.3; p < 0.01) at a median follow-up interval of 35.7 and 19.0 months for MS and SRS, respectively. There was no difference in the need for subsequent intervention (2 MS patients and 2 SRS patients).
CONCLUSIONS
At this high-volume center, VS resection or radiosurgery for tumors ≤ 2.8 cm in diameter was associated with low overall morbidity. The need for subsequent intervention was the same in both groups. SRS was associated with improved hearing and facial preservation rates and reduced morbidity, but with a shorter average follow-up period. Facial function was excellent in both groups. Since patients were not randomly selected for surgery, different clinical outcomes may be of different value to individual patients. Both anticipated medical outcomes and patient goals remain the drivers of treatment decisions.
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Thomas Roland J, Buchman C, Eisenberg L, Henderson L, He S, Firszt J, Francis H, Dunn C, Sladen D, Arndt S, May B, Zeitler D, Niparko JK, Emmett S, Tucci D, Chen J, McConkey Robbins A, Schwefler E, Geers A, Lederberg A, Hayes H, Hughes M, Bierer J, Schafer E, Sorkin D, Kozma-Spytek L, Childress T. Proceedings of the Annual Symposium of the American Cochlear Implant Alliance. Cochlear Implants Int 2016; 17:211-237. [PMID: 27635521 PMCID: PMC5062039 DOI: 10.1080/14670100.2016.1225348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Landsberger DM, Svrakic M, Roland JT, Svirsky M. The Relationship Between Insertion Angles, Default Frequency Allocations, and Spiral Ganglion Place Pitch in Cochlear Implants. Ear Hear 2016; 36:e207-13. [PMID: 25860624 DOI: 10.1097/aud.0000000000000163] [Citation(s) in RCA: 163] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Commercially available cochlear implant systems attempt to deliver frequency information going down to a few hundred Hertz, but the electrode arrays are not designed to reach the most apical regions of the cochlea, which correspond to these low frequencies. This may cause a mismatch between the frequencies presented by a cochlear implant electrode array and the frequencies represented at the corresponding location in a normal-hearing cochlea. In the following study, the mismatch between the frequency presented at a given cochlear angle and the frequency expected by an acoustic hearing ear at the corresponding angle is examined for the cochlear implant systems that are most commonly used in the United States. DESIGN The angular insertion of each of the electrodes on four different electrode arrays (MED-EL Standard, MED-EL Flex28, Advanced Bionics HiFocus 1J, and Cochlear Contour Advance) was estimated from X-ray. For the angular location of each electrode on each electrode array, the predicted spiral ganglion frequency was estimated. The predicted spiral ganglion frequency was compared with the center frequency provided by the corresponding electrode using the manufacturer's default frequency-to-electrode allocation. RESULTS Differences across devices were observed for the place of stimulation for frequencies below 650 Hz. Longer electrode arrays (i.e., the MED-EL Standard and Flex28) demonstrated smaller deviations from the spiral ganglion map than the other electrode arrays. For insertion angles up to approximately 270°, the frequencies presented at a given location were typically approximately an octave below what would be expected by a spiral ganglion frequency map, while the deviations were larger for angles deeper than 270°. For frequencies above 650 Hz, the frequency to angle relationship was consistent across all four electrode models. CONCLUSIONS A mismatch was observed between the predicted frequency and the default frequency provided by every electrode on all electrode arrays. The mismatch can be reduced by changing the default frequency allocations, inserting electrodes deeper into the cochlea, or allowing cochlear implant users to adapt to the mismatch. Further studies are required to fully assess the clinical significance of the frequency mismatch.
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King J, Shehu I, Roland JT, Svirsky MA, Froemke RC. A physiological and behavioral system for hearing restoration with cochlear implants. J Neurophysiol 2016; 116:844-58. [PMID: 27281743 DOI: 10.1152/jn.00048.2016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 05/31/2016] [Indexed: 12/31/2022] Open
Abstract
Cochlear implants are neuroprosthetic devices that provide hearing to deaf patients, although outcomes are highly variable even with prolonged training and use. The central auditory system must process cochlear implant signals, but it is unclear how neural circuits adapt-or fail to adapt-to such inputs. The knowledge of these mechanisms is required for development of next-generation neuroprosthetics that interface with existing neural circuits and enable synaptic plasticity to improve perceptual outcomes. Here, we describe a new system for cochlear implant insertion, stimulation, and behavioral training in rats. Animals were first ensured to have significant hearing loss via physiological and behavioral criteria. We developed a surgical approach for multichannel (2- or 8-channel) array insertion, comparable with implantation procedures and depth in humans. Peripheral and cortical responses to stimulation were used to program the implant objectively. Animals fitted with implants learned to use them for an auditory-dependent task that assesses frequency detection and recognition in a background of environmentally and self-generated noise and ceased responding appropriately to sounds when the implant was temporarily inactivated. This physiologically calibrated and behaviorally validated system provides a powerful opportunity to study the neural basis of neuroprosthetic device use and plasticity.
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Cosetti MK, Pinkston JB, Flores JM, Friedmann DR, Jones CB, Roland JT, Waltzman SB. Neurocognitive testing and cochlear implantation: insights into performance in older adults. Clin Interv Aging 2016; 11:603-13. [PMID: 27274210 PMCID: PMC4869653 DOI: 10.2147/cia.s100255] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The aim of this case series was to assess the impact of auditory rehabilitation with cochlear implantation on the cognitive function of elderly patients over time. DESIGN This is a longitudinal case series of prospective data assessing neurocognitive function and speech perception in an elderly cohort pre- and post-implantation. SETTING University cochlear implant center. PARTICIPANTS The patients were post-lingually deafened elderly female (mean, 73.6 years; SD, 5.82; range, 67-81 years) cochlear implant recipients (n=7). MEASUREMENTS A neurocognitive battery of 20 tests assessing intellectual function, learning, short- and long-term memory, verbal fluency, attention, mental flexibility, and processing speed was performed prior to and 2-4.1 years (mean, 3.7) after cochlear implant (CI). Speech perception testing using Consonant-Nucleus-Consonant words was performed prior to implantation and at regular intervals postoperatively. Individual and aggregate differences in cognitive function pre- and post-CI were estimated. Logistic regression with cluster adjustment was used to estimate the association (%improvement or %decline) between speech understanding and years from implantation at 1 year, 2 years, and 3 years post-CI. RESULTS Improvements after CI were observed in 14 (70%) of all subtests administered. Declines occurred in five (25%) subtests. In 55 individual tests (43%), post-CI performance improved compared to a patient's own performance before implantation. Of these, nine (45%) showed moderate or pronounced improvement. Overall, improvements were largest in the verbal and memory domains. Logistic regression demonstrated a significant relationship between speech perception and cognitive function over time. Five neurocognitive tests were predictive of improved speech perception following implantation. CONCLUSION Comprehensive neurocognitive testing of elderly women demonstrated areas of improvement in cognitive function and auditory perception following cochlear implantation. Multiple neurocognitive tests were strongly associated with current speech perception measures. While these data shed light on the complex relationship between hearing and cognition by showing that CI may slow the expected age-related cognitive decline, further research is needed to examine the impact of hearing rehabilitation on cognitive decline.
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Byaruhanga R, Roland JT, Buname G, Kakande E, Awubwa M, Ndorelire C, Namwagala J. A case report: the first successful cochlear implant in Uganda. Afr Health Sci 2015; 15:1342-8. [PMID: 26958040 DOI: 10.4314/ahs.v15i4.38] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Hearing impairment is a significant disability. According to the World Health Organization (WHO), more than 80% of the world's approximately 120 million people with hearing impairment live in developing countries. Cochlear implant is the only therapeutic intervention for those with severe-profound sensorineural hearing loss. We are reporting an interesting case of the very first cochlear implant operation carried out in Uganda. The patient was a 23 year old male whose presenting complaint was inability to hear in the left ear for three and a half years and in the right ear for one year. He had been treated for TB(Tuberculosis) mastoiditis. After the 8 months of treatment, the otorrhea persisted and he underwent a tympanomastoidectomy on the same ear. He reported no familial history of hearing loss. On examination, ENT examination revealed a small pars flaccida retration pocket of the right tympanic membrane with cholesteatoma. The left ear had an intact tympanic membrane. Pure tone audiometry revealed profound sensorineural hearing loss in both ears (see attached PTA results), CT scan of the temporal bone showed normal inner ear anatomy bilaterally and mild sclerotic changes in both mastoid bones. He then had surgery on his right ear which included cochlear implantation. The cochlear implant (CI) was activated on the first postoperative day remotely via internet with the help of the cochlear implant team at New York University Cochlear Implant Center and the patient was immediately able to appreciate some sounds. He received a pneumococcal vaccine on the first postoperative day and was discharged the following day.
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Cosetti MK, Friedmann DR, Heman-Ackah SE, Perez R, Waltzman SB, Roland JT. Surgical techniques and outcomes of cochlear implantation in patients with radiographic findings consistent with X-linked deafness. Int J Pediatr Otorhinolaryngol 2015; 79:1689-93. [PMID: 26250436 DOI: 10.1016/j.ijporl.2015.07.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 07/19/2015] [Accepted: 07/20/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES X-linked deafness is a potential etiology of sensorineural hearing loss characterized by bulbous dilatation of the fundus of the internal auditory canal (IAC) and the absence of the bony plates separating the basal turn of the cochlea and IAC. These malformations predispose patients to IAC insertion during cochlear implantation (CI). Our objective is to describe the surgical technique, audiometric and speech performance outcomes in a group of patients with this unique cochlear malformation. METHODS A retrospective chart review was performed of all patients at a tertiary care facility who underwent CI between January 2006 and July 2011. RESULTS A total of five patients were identified with radiographic findings characteristic of X-linked deafness, specifically a deficient modiolous, absent lamina cribrosa and bulbous IAC. A modified cochleostomy was utilized to ensure electrode insertion within the scala tympani avoiding the IAC. In each case, fluoroscopy was utilized to visual electrode progression during insertion and complete insertion was accomplished. All patients demonstrated improved speech performance following implantation. CONCLUSIONS Utilizing the techniques described, patients with these unique radiographic findings consistent with X-linked deafness may successfully undergo CI with excellent potential for auditory rehabilitation.
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Roland JT, Gantz BJ, Waltzman SB, Parkinson AJ. United States multicenter clinical trial of the cochlear nucleus hybrid implant system. Laryngoscope 2015; 126:175-81. [PMID: 26152811 PMCID: PMC4704985 DOI: 10.1002/lary.25451] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 04/30/2015] [Accepted: 05/28/2015] [Indexed: 12/02/2022]
Abstract
Objectives/Hypothesis To evaluate the safety and efficacy of acoustic and electric sound processing for individuals with significant residual low‐frequency hearing and severe‐to‐profound high‐frequency sensorineural hearing loss. Study Design Prospective, single‐arm repeated measures, single‐subject design. Methods Fifty individuals, ≥ 18 years old, with low‐frequency hearing and severe high‐frequency loss were implanted with the Cochlear Nucleus Hybrid L24 implant at 10 investigational sites. Preoperatively, subjects demonstrated consonant‐nucleus‐consonant word scores of 10% through 60% in the ear to be implanted. Subjects were assessed prospectively, preoperatively, and postoperatively on coprimary endpoints of consonant‐nucleus‐consonant words, AzBio sentences in noise, and self‐assessment measures. Results Significant mean improvements were observed for coprimary endpoints: consonant‐nucleus‐consonant words (35.8 percentage points) and AzBio sentences in noise (32.0 percentage points), both at P < 0.001. Ninety‐six percent of subjects performed equal or better on speech in quiet and 90% in noise. Eighty‐two percent of subjects showed improved performance on speech in quiet and 74% in noise. Self‐assessments were positive, corroborating speech perception results. Conclusion The Nucleus Hybrid System provides significant improvements in speech intelligibility in quiet and noise for individuals with severe high‐frequency loss and some low‐frequency hearing. This device expands indications to hearing‐impaired individuals who perform poorly with amplification due to bilateral high‐frequency hearing loss and who previously were not implant candidates. Level of Evidence 2b. Laryngoscope, 126:175–181, 2016
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Tawfik KO, Golub JS, Roland JT, Samy RN. Recurrent cochlear implant infection treated with exteriorization and partial mastoid obliteration. Cochlear Implants Int 2015; 17:58-61. [DOI: 10.1179/1754762815y.0000000010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Friedmann DR, Green J, Fang Y, Ensor K, Roland JT, Waltzman SB. Sequential bilateral cochlear implantation in the adolescent population. Laryngoscope 2015; 125:1952-8. [PMID: 25946482 DOI: 10.1002/lary.25293] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2015] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To examine the variables affecting outcomes for sequential bilateral cochlear implantation patients in the adolescent population. STUDY DESIGN Retrospective chart review at tertiary care center. METHODS Main outcome measures were open set speech recognition tests at the word (Consonant-Nucleus-Consonant/Phonetically Balanced Kindergarten List Test [CNC/PBK]) and sentence levels in noise (Hearing in Noise Test-Noise [HINT-N]) in different test conditions with respect to the age at first and sequential implantation, as well as the interval between implants. RESULTS Despite a mean age at sequential implantation of 13.5 years, sequential bilateral implanted adolescents revealed significant improvement in the sequential cochlear implant (CI2) ear. The mean time interval between implants was 8.2 years. A wide range of performance was noted, and age at implantation and interval between first cochlear implant (CI1) and CI2 did not predict outcome. Mean CNC/PBK score with CI1 alone was 83.0%, with the CI2 alone was 56.5%, and with bilateral implants was 86.8%. Sentence scores (HINT-N) were 89.5% for CI1, 74.2% for CI2, and 94.4% for bilateral CI condition. The clinical relevance of these enhanced perception abilities requires attention to individual device use, performance with the first implant, and subjective benefits reported by patients. CONCLUSIONS Bilateral sequential cochlear implantation leads to improved speech perception in the adolescent population and should be considered in this population, even after a long period of deafness and despite a prolonged interval between implants. Numerous factors affect the ability to predict performance, but age at implantation and interimplant interval were not correlated with performance measures. Extensive preoperative counseling and individualized evaluation are critical to ensure that patients and families understand the range of possible outcomes. LEVEL OF EVIDENCE 4
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Friedmann DR, Peng R, Fang Y, McMenomey SO, Roland JT, Waltzman SB. Effects of loss of residual hearing on speech performance with the CI422 and the Hybrid-L electrode. Cochlear Implants Int 2015; 16:277-84. [PMID: 25912363 DOI: 10.1179/1754762815y.0000000008] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE Preservation of residual low-frequency hearing has become a priority in cochlear implantation. The purpose of this study was to compare rates of hearing preservation and effects on performance of loss of low-frequency acoustic hearing with two different length electrodes. STUDY DESIGN Retrospective chart review. SETTING Tertiary Care Hospital. PATIENTS Twelve patients were implanted with the CI422 a slim-straight electrode; the second group consisted of 10 patients implanted with the Hybrid-L, a shorter hearing preservation electrode. MAIN OUTCOME MEASURE Audiometric thresholds and speech perception measures. RESULTS At 1 year, 3/10 (30%) patients with the Hybrid-L and 7/12 (58%) patients with the CI422 lost residual acoustic hearing resulting in a profound hearing loss in the implanted ear. In comparing these patients in particular, mean CNC words in the implanted ear were 72% in the CI422 electrode group and 15% in the Hybrid-L electrode group at 1 year (P = 0.03). While hearing preservation rates with the Hybrid-L tended to be better, among recipients who lost residual hearing, speech perception was better in those with the longer CI422 electrode. CONCLUSIONS With emphasis on preservation of residual hearing, patients need to be counseled regarding possible outcomes and options should loss of residual hearing occur following implantation. While shorter electrodes may have better rates of hearing preservation, the patients with the longer straight electrode in our study had significantly better speech understanding following the loss of residual hearing.
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Cosetti MK, Golfinos JG, Roland JT. Quality of Life (QoL) Assessment in Patients with Neurofibromatosis Type 2 (NF2). Otolaryngol Head Neck Surg 2015; 153:599-605. [PMID: 25779467 DOI: 10.1177/0194599815573002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 01/26/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aim of this study was to develop a multidimensional metric for assessing quality of life (QoL) in patients with neurofibromatosis type 2 (NF2). STUDY DESIGN Electronically distributed questionnaire. SETTING University tertiary care hospital, NF2 support groups. SUBJECTS AND METHODS Structured interviews with NF2 providers and patients identified relevant domains. Items in each domain were extracted from validated QoL modules, then combined with items unique to NF2 and pretested on NF2 providers and patients. The final 61-item questionnaire was administered electronically to patients with NF2 (N = 118). The form assessed overall QoL and 11 additional domains, including hearing, balance, facial function, vision, oral intake, future uncertainty, psychosocial, cognition, sexual activity, pain, and vocal communication. Responses were compared with reference values for the general population, patients with head and neck cancer, and patients with brain cancer. RESULTS Overall, QoL in patients with NF2 was lower than that of the general population (P < .01) and similar to that of patients with cancer. Patients with more facial weakness, hearing loss, and imbalance reported significantly lower QoL. However, domains most predictive of overall QoL were psychosocial, future uncertainty, and pain. Compared with patients with head and neck and brain cancer, patients with NF2 demonstrated significantly higher levels of psychosocial stressors, including disease-related anxiety, personal and financial stress, and lack of social support (P < .01). CONCLUSION Psychosocial stress and pain significantly affect QoL in NF2, indicating that mental health, pain management, and financial counseling could have an important impact on QoL in this population.
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Paul BC, Roland JT. An abnormal audiogram. JAMA 2015; 313:85-6. [PMID: 25562271 DOI: 10.1001/jama.2014.12418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Perez R, Salem R, Roland JT, Sichel JY. [Fluoroscopic assisted cochlear implantation in children with inner ear malformations]. HAREFUAH 2014; 153:713-753. [PMID: 25654911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Cochlear implants are the treatment of choice for individuals with severe to profound sensorineural hearing loss. In most cases, the anatomy is normal and the insertion of the electrode-array is straightforward, complete and in the correct position. In the presence of inner-ear malformations, the risk of an intra or extra-cochlear malpositioned electrode-array increases. OBJECTIVES To describe the technique of fluoroscopic assisted cochlear implantation in children with severe inner-ear malformations and present the results with respect to the number of active electrodes and function. METHODS Fifteen fluoroscopy assisted implantations in 9 children were conducted at the Shaare Zedek Cochlear Implant Center between 2009-1014. All implanted ears had severe anatomic malformations. Mean implantation age was 3.5 years (range 1-11). Six children underwent sequential bilateral implantation. Two children underwent revision surgery due to a malpositioned electrode initially implanted without fluoroscopy at other centers. RESULTS There was no radiologic or electro-physiologic evidence of kinking, bending or electrode damage in all 15 implantations. Complete insertion was achieved in all ears except one with partial insertion. There were no extra-cochlear or intrameatal placements. In 9 ears, all electrodes were active at switch-on and in the remaining, 15-20 were active. In all ears the Ling-6 sounds were detected and in 13 they were also identified. CONCLUSION Fluoroscopy is an effective tool in complex cochlear implant surgeries and its use is simple and safe. As demonstrated in this study, with fluoroscopy assistance, good results are achieved in children with inner-ear malformations.
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Zhou L, Friedmann DR, Treaba C, Peng R, Roland JT. Does cochleostomy location influence electrode trajectory and intracochlear trauma? Laryngoscope 2014; 125:966-71. [DOI: 10.1002/lary.24986] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 08/25/2014] [Accepted: 09/29/2014] [Indexed: 02/05/2023]
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Cosetti M, Golfinos J, Roland JT. Quality of Life Assessment in Patients with Neurofibromatosis Type II. Otolaryngol Head Neck Surg 2014. [DOI: 10.1177/0194599814541627a209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: (1) Develop a multidimensional metric for assessing quality of life (QoL) in patients with NF2. (2) Compare NF2 results with reference values for the general population and patients with head and neck or brain cancer. Methods: Structured interviews with NF2 providers and patients identified relevant domains. Items in these domains were extracted from validated EORTC modules, combined with items unique to NF2 and pre-tested on NF2 providers and patients (N = 118). The questionnaire included 61 items assessing overall QoL and 10 additional domains including hearing, balance, facial function, vision, oral intake, future uncertainty, psychosocial, cognition, sexual activity, pain and vocal communication. Responses were compared to reference values for the general population and head and neck cancer and brain cancer patients. Results: QoL in NF2 patients was lower than that of the general population ( P < .01) and similar to that of patients with cancer. NF2 patients whose treatment included radiation therapy had worse overall QoL than patients who did not undergo radiation. Patients with more facial weakness, hearing loss and imbalance reported significantly lower QoL. However, domains most predictive of overall QoL were psychosocial, future uncertainty and pain. When compared to patients with head and neck and brain cancer, NF2 patients demonstrated significantly higher levels of psychosocial stressors, including disease-related anxiety, personal and financial stress, and lack of social support ( P < .01). Conclusions: Psychosocial stress and pain significantly impact QoL in NF2 indicating that mental health, pain management, and financial counseling could have an important impact on QoL in this population.
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Shaul C, Roland JT, Sichel JY, Perez R. Revision Cochlear Implantation Using a Double-Array Device in the Post-meningitis Ossified Cochlea. Otolaryngol Head Neck Surg 2014. [DOI: 10.1177/0194599814541629a280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: Describe the surgical technique and outcome in a series of patients who underwent revision cochlear implantation using a double-array or split electrode device. All patients had an ossified cochlea due to meningitis and were functioning poorly with a standard electrode cochlear implant. Methods: Four patients between the ages of 4-15 years underwent revision with 5 double-array cochlear implant devices in our center during the years 2010-2012. One patient underwent bilateral revision surgery. All patients suffered from meningitis with computed tomography and magnetic resonance imaging studies that demonstrated an ossified cochlea. The time interval between the disease and initial cochlear implantation was 4 months to 4 years. Patients data were retrospectively analyzed with emphasis on the surgical technique, number of electrodes inserted, and number of active electrodes at follow-up. In addition, pre and post revision surgery function was compared. Results: The revision surgery was carried out 4 to 10 years after the initial surgery. Two tunnels, basal and apical, were drilled in the ossified cochlea. In each of the tunnels 5 to 12 electrodes were inserted. While the number of active electrodes before revision was 0-5, after revision with the double array it increased to 8-16. This resulted in increased auditory and speech function. Conclusions: The double-array device can provide good outcome in the post-meningitis ossified cochlea. In many of these cases function can be better than with a single electrode device.
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Wazen JJ, Soli SD, Young NM, Goddard JC, Gantz BJ, Roland JT. Current and Developing Management of Single-Sided Deafness. Otolaryngol Head Neck Surg 2014. [DOI: 10.1177/0194599814538403a59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Program Description: The single-sided deafness (SSD) handicap has been underestimated. The purpose of this miniseminar is to present the latest research on the benefits of binaural hearing (Sig Soli, PhD), and the impact of SSD on childhood development and school performance (Nancy Young, MD). The different rehabilitation methods available will be presented, including osseointegrated bone conduction technologies (Jack J. Wazen, MD) and nonsurgical options (John Goddard, MD). Future trends and clinical research on the use of cochlear implants in SSD will be presented (Bruce Gantz, MD, and Tom Roland, MD). Open discussion, questions, and audience participation will follow the presentations. Educational Objectives: (1) Recognize the benefits of binaural hearing in children and adults and the potential deficits imposed by SSD. (2) Differentiate between surgical and nonsurgical options in the rehabilitation of SSD. (3) Use developing technologies and clinical research in the rehabilitation of SSD, including the use of cochlear implants.
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Zhou L, Friedmann DR, Treaba C, Peng R, Roland JT. Does cochleostomy location influence electrode trajectory and intracochlear trauma? Cochlear Implants Int 2014; 15 Suppl 1:S8-S10. [DOI: 10.1179/1467010014z.000000000160] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Karajannis MA, Legault G, Hagiwara M, Giancotti FG, Filatov A, Derman A, Hochman T, Goldberg JD, Vega E, Wisoff JH, Golfinos JG, Merkelson A, Roland JT, Allen JC. Phase II study of everolimus in children and adults with neurofibromatosis type 2 and progressive vestibular schwannomas. Neuro Oncol 2013; 16:292-7. [PMID: 24311643 DOI: 10.1093/neuonc/not150] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Activation of the mammalian target of rapamycin (mTOR) signaling pathway is thought to be a key driver of tumor growth in Merlin (NF2)-deficient tumors. Everolimus is an oral inhibitor of mTOR complex 1 (mTORC1) with antitumor activity in a variety of cancers. METHODS We conducted a single-institution, prospective, 2-stage, open-label phase II study to estimate the response rate to everolimus in neurofibromatosis type 2 (NF2) patients with progressive vestibular schwannoma (VS). Ten eligible patients were enrolled, including 2 pediatric patients. Everolimus was administered at a daily dose of 10 mg (adults) or 5 mg/m(2)/day (children <18 y) orally in continuous 28-day courses, for up to 12 courses. Response was assessed every 3 months with MRI, using 3-dimensional volumetric tumor analysis, and audiograms. Nine patients were evaluable for the primary response, defined as ≥15% decrease in VS volume. Hearing response was evaluable as a secondary endpoint in 8 patients. RESULTS None of the 9 patients with evaluable disease experienced a clinical or MRI response. No objective imaging or hearing responses were observed in stage 1 of the trial, and the study was closed according to predefined stopping rules. CONCLUSION Everolimus is ineffective for the treatment of progressive VS in NF2 patients. We are currently conducting a pharmacokinetic/pharmacodynamic ("phase 0") study of everolimus in presurgical VS patients to elucidate the biological basis for apparent treatment resistance to mTORC1 inhibition in these tumors.
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Waltzman S, Roland JT, Waltzman M, Shapiro W, Lalwani A, Cohen N. Cochlear reimplantation in children: soft signs, symptoms and results. Cochlear Implants Int 2013; 5:138-45. [DOI: 10.1179/cim.2004.5.4.138] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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