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Mostafa BE, El Fiky L. Complications of cochlear implantation: a decade's experience. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08855-y. [PMID: 39126508 DOI: 10.1007/s00405-024-08855-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 07/16/2024] [Indexed: 08/12/2024]
Abstract
PURPOSE Surgery for cochlear implantation is becoming increasingly common. It is a precise surgery and carries with it a number of very specific complications. Although uncommon, they can profoundly affect the recipients' quality of life. We report on our patients' population and compare with different series. METHODS This is a retrospective analysis of patients who underwent cochlear implant surgery in our center or who were referred for management of complications between November 2012 and November 2022. RESULTS There were 2126 patients aged 9 months-68 years [mean 3.2 yrs] with 147 adults > 18 yrs. The male: female ratio was nearly 1. We are reporting on late complications excluding device failures. There were 186 complications [8.7%], 124 minor complications [66% of the complications, 5.8% of the total population; and 62 major complications [ 33% of the complications and 2.9% of the total]. The commonest minor complication was surgical site infection [16%] and the commonest major complication was flap necrosis and device extrusion [26%]. CONCLUSION Complications in our series were comparable to other series from different locations. But there seems to be a difference in the frequency of each complication depending on many factors which must be addressed. Standardization of reporting should be also more homogenized.
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Affiliation(s)
- Badr Eldin Mostafa
- Department of Otorhinolaryngology Head and Neck surgery, Faculty of Medicine, Ain-Sham,s University, 75 El Nozha Street 11351, Heliopolis-Cairo, Egypt.
| | - Lobna El Fiky
- Department of Otorhinolaryngology Head and Neck surgery, Faculty of Medicine, Ain-Sham,s University, 75 El Nozha Street 11351, Heliopolis-Cairo, Egypt
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Gülüstan F, Yazıcı ZM, Koç RH, İnan BK, Aşaroğlu CB, Sayın İ. Delayed-onset facial paralysis following cochlear implantation: a case study and comprehensive analysis. Cochlear Implants Int 2024:1-4. [PMID: 38970817 DOI: 10.1080/14670100.2024.2370685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2024]
Abstract
OBJECTIVES Cochlear implantation (CI) is a surgical intervention used to rehabilitate hearing in individuals, both pediatric and adult, with severe hearing loss. It is generally a safe procedure with rare postoperative complications. Facial nerve paralysis following cochlear implant surgery poses challenges in diagnosis and treatment. METHODS This case report details a 48-year-old male who experienced delayed facial paralysis after cochlear implantation, an uncommon occurrence with limited documentation. RESULTS The facial nerve palsy of the patient resolved by the third week with combined therapy. DISCUSSION The etiology of this complication is not fully understood, with latent virus reactivation, particularly HSV and VZV, hypothesized as a probable cause. CONCLUSION Successful management involves a combination of corticosteroids, antiviral therapy, and antibiotics, leading to a favorable outcome.
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Affiliation(s)
- Filiz Gülüstan
- Department of Otorhinolaryngology & Head and Neck Surgery, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba, Dr. Tevfik Sağlam Street, 11, Istanbul 34147, Turkey
| | - Zahide Mine Yazıcı
- Department of Otorhinolaryngology & Head and Neck Surgery, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba, Dr. Tevfik Sağlam Street, 11, Istanbul 34147, Turkey
| | - Recep Haydar Koç
- Department of Otorhinolaryngology & Head and Neck Surgery, Sultangazi Haseki Training and Research Hospital, Istanbul 34260, Turkey
| | - Burak Kaan İnan
- Department of Otorhinolaryngology & Head and Neck Surgery, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba, Dr. Tevfik Sağlam Street, 11, Istanbul 34147, Turkey
| | - Can Berk Aşaroğlu
- Department of Otorhinolaryngology & Head and Neck Surgery, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba, Dr. Tevfik Sağlam Street, 11, Istanbul 34147, Turkey
| | - İbrahim Sayın
- Department of Otorhinolaryngology & Head and Neck Surgery, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba, Dr. Tevfik Sağlam Street, 11, Istanbul 34147, Turkey
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Orlando VR, Cruz OLM. Postoperative complications in cochlear implant surgery and their possible risk factors. Braz J Otorhinolaryngol 2024; 90:101428. [PMID: 38603969 PMCID: PMC11016860 DOI: 10.1016/j.bjorl.2024.101428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 02/18/2024] [Accepted: 03/03/2024] [Indexed: 04/13/2024] Open
Abstract
OBJECTIVE This is a retrospective analysis of the major and minor complications of cochlear implants, as well as the Risk Factors (RF) involved. METHODS We analyzed the medical records of patients submitted to cochlear implants at public University from 2006 to July 2019, and list here the major and minor complications found, and their risk factors. RESULTS There were 193 ears, 100 (51.3%) from females and 93 (48.2%) from males, with a mean age of 23.63 years. In 54 of them (28%), there were alterations seen in the Temporal Bone CT scan, and 44 (22.8%) in the brain MRI. There were 158 (81.9%) insertions performed; 127 (65.8%) of them through the round window. There were 78 complications: 19 (9.8%) major and 56 (29%) minor complications. Among the major complications, there were 3 (1.6%) Surgical Site infections (SS); 5 (2.6%) hematomas/seromas; 5 (2.6%) electrode extrusion; 5 (2.6%) device faults; 1 (0.5%) wrong path. Among the minor complications, there were 6 (3.1%) Acute Otitis Media (AOM); 9 (4.7%) SS infections; 4 (2.1%) facial paresis; 17 (8.8%) vertigos; 9 (4.7%) with tinnitus. The most important RF was age. Patients younger than 2.5 years had more major complications: SS infection (p = 0.018) and electrode extrusion (p = 0.017). There was a higher rate of vertigo in adults (p = 0.003), and it was more often associated with comorbidities (p = 0.008). The insertion route, the presence of changes in CT and MRI and the CI brand used did not impact the number of complications. CONCLUSION Among the minor complications, those involving the vestibular system were the most common, especially in adults with comorbidities. Regarding major complications, there was an emphasis on SS infections, hematomas, seromas, electrode extrusion, especially in children under two years of age. There were implanted device faults (2.6%), with none of the brands evaluated standing out.
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Affiliation(s)
- Vanessa Ribeiro Orlando
- Hospital Santa Casa de Belo Horizonte, Belo Horizonte, MG, Brazil; Universidade Federal de São Paulo (UNIFESP), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil.
| | - Oswaldo Laércio Mendonça Cruz
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, São Paulo, SP, Brazil; Universidade de São Paulo (USP), São Paulo, SP, Brazil; Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil; Universidade Federal de São Paulo (UNIFESP), Hospital São Paulo (HSP), Centro do Deficiente Auditivo, São Paulo, SP, Brazil
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Koutná S, Kalitová P, Jeřábek J, Slabý K, Kučerová K, Bouček J, Čakrt O. Comparison of postural control and space perception outcomes between robotic and conventional cochlear implantation in adults. Eur Arch Otorhinolaryngol 2024; 281:3839-3843. [PMID: 38825603 DOI: 10.1007/s00405-024-08664-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 04/06/2024] [Indexed: 06/04/2024]
Abstract
PURPOSE The aim of the study is to capture the difference between the groups in direct relation to the type of electrode array insertion during cochlear implantation (CI). The robotic insertion is expected to be a more gently option. As recent studies have shown, there is a difference in perception of visual vertical (SVV) and postural control related to the CI. We assume that there can be differences in postural control and space perception outcomes depending on the type of the surgical method. METHODS In total, 37 (24 females, mean age ± SD was 42.9 ± 13.0) candidates for CI underwent an assessment. In 14 cases, the insertion of the electrode array was performed by a robotic system (RobOtol, Colin, France) and 23 were performed conventionally. In all of these patients, we performed the same examination before the surgery, the first day, and 3 weeks after the surgery. The protocol consists of static posturography and perception of visual vertical. RESULTS The both groups, RobOtol and conventional, responded to the procedure similarly despite the dissimilar electrode insertion. There was no difference between two groups in the dynamic of perception SVV and postural parameters. Patients in both groups were statistically significantly affected by the surgical procedure, SVV deviation appeared in the opposite direction from the implanted ear: 0.90° ± 1.25; - 1.67° ± 3.05 and - 0.19° ± 1.78 PRE and POST surgery (p < 0.001). And this deviation was spontaneously adjusted in FOLLOW-UP after 3 weeks (p < 0.01) in the both groups. We did not find a significant difference in postural parameters between the RobOtol and conventional group, even over time. CONCLUSION Although the robotic system RobOtol allows a substantial reduction in the speed of insertion of the electrode array into the inner ear, our data did not demonstrate a postoperative effect on vestibular functions (SVV and posturography), which have the same character and dynamics as in the group with standard manual insertion. REGISTRATION NUMBER The project is registered on clinicaltrials.gov (registration number: NCT05547113).
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Affiliation(s)
- Sára Koutná
- Department of Rehabilitation and Sport Medicine, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic.
| | - Petra Kalitová
- Department of Otorhinolaryngology, Head and Neck Surgery, 1st Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Jaroslav Jeřábek
- Department of Neurology, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Kryštof Slabý
- Department of Rehabilitation and Sport Medicine, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Klára Kučerová
- Department of Rehabilitation and Sport Medicine, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Jan Bouček
- Department of Otorhinolaryngology, Head and Neck Surgery, 1st Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Ondřej Čakrt
- Department of Rehabilitation and Sport Medicine, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
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Kasuga M, Yoshimura H, Takumi Y. Temporal Swelling Following Cochlear Implantation: Frequency, Treatment, and Outcomes. Otol Neurotol 2024; 45:e400-e405. [PMID: 38573599 DOI: 10.1097/mao.0000000000004179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
OBJECTIVE To investigate the frequency, treatment, and outcomes of postoperative delayed-onset swelling around cochlear implants. STUDY DESIGN Retrospective, observational, nonrandomized group study. SETTING Academic medical center. PATIENTS/INTERVENTIONS Among 354 patients (516 ears) who underwent cochlear implantation (CI) at our hospital between May 2009 and October 2022, 329 (472 ears: 138 children [246 ears] and 191 adults [226 ears]) with a follow-up period of >3 months were included. MAIN OUTCOME MEASURES Physical examination and computed tomography of the head were performed. RESULTS In total, 5.5% (26/472 ears) had a history of delayed-onset swelling around the implant. This complication occurred in 9.8% (24/246 ears) of children and 0.9% (2/226 ears) of adults. The mean time to onset of swelling was 50 (range, 5.5-147) months following CI. In 60% (21/35) of the cases, the cause was unknown, whereas in 25.7% (9/35) and 11.5% (4/35) of cases, it was head trauma and acute inflammation, respectively. Conservative treatment (observation, antibiotics, and/or strong magnetic compression) was adapted in 91.4% (32/35) of cases. After conservative treatment, revision CI surgery was performed in one ear. Additionally, recurrent swelling was observed in 23.1% (6/26 ears) of swelling cases. CONCLUSIONS The results suggest that delayed-onset swelling around implants occurs more frequently in children than in adults because of the higher incidence rates of head trauma and acute otitis media in children. In most cases, conservative treatment was adequate; however, careful follow-up is necessary. Our findings can serve as a reference for optimizing care and intervention options after CI.
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Affiliation(s)
- Mariko Kasuga
- Department of Otorhinolaryngology-Head and Neck Surgery, Shinshu University School of Medicine, Matsumoto, Nagano 390-8621, Japan
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MacKay CI, Kuthubutheen J, Campbell AJ. An overview of risk factors, management and prevention of cochlear implant infections. Curr Opin Infect Dis 2024; 37:220-225. [PMID: 38545833 DOI: 10.1097/qco.0000000000001011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
PURPOSE OF REVIEW With cochlear implantation becoming increasingly performed worldwide, an understanding of the risk factors, preventive measures, and management of cochlear implant (CI) infection remains important given the significant morbidity and cost it conveys. RECENT FINDINGS At the turn of the 21st century there was a decrease in rates of CI infection, particularly meningitis, following the discontinuation of positioner use for CI. However, in more recent years rates of CI infection have remained largely static. Recently, studies evaluating preventive measures such as pneumococcal vaccination, S. aureus decolonization and surgical antibiotic prophylaxis have emerged in the literature. SUMMARY Prompt recognition of CI infection and appropriate investigation and management are key, however at present treatment is largely informed by cohort and case-control studies and expert opinion. Preventive measures including pneumococcal vaccination, S. aureus decolonization and preoperative antibiotic prophylaxis play a role in reducing rates of CI infection. However, there remains a need for well designed clinical trials to provide higher level evidence to better guide preventive measures for, and management decisions of, CI infections in the future.
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Affiliation(s)
- Conor I MacKay
- Department of Infectious Diseases, Perth Children's Hospital
| | - Jafri Kuthubutheen
- Department of Otolaryngology Head and Neck Surgery, Perth Children's Hospital
- Division of Surgery, Medical School, University of Western, Australia
| | - Anita J Campbell
- Department of Infectious Diseases, Perth Children's Hospital
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands
- Division of Paediatrics, School of Medicine, University of Western Australia, Perth, Australia
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AlRajhi B, AlGhamdi MA, Alenazi N, Alabssi H, Alshammeri ST, Aloweiny Q, Bogari H, Al-Subaie H. Incidence of Cochlear Implantation Complications in Saudi Arabia: A Comprehensive Systematic Review of the Literature. Cureus 2024; 16:e60488. [PMID: 38882947 PMCID: PMC11180416 DOI: 10.7759/cureus.60488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2024] [Indexed: 06/18/2024] Open
Abstract
This review aimed to determine the incidence of complications associated with cochlear implants (CI) in Saudi Arabia. We systematically searched PubMed, AIRE, OaIster, MEDLINE, Directory of Open Access Journals, Scopus, and Ovid from inception to January 2024. The review protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (ID: CRD42023486687). Studies that reported CI complications in Saudi Arabia were included. This systematic review was conducted in accordance with PRISMA guidelines. A total of 17 articles with 2216 patients were included. The most common intraoperative complication was cerebrospinal fluid leakage (23 patients, 0.99%), followed by surgical difficulties (six patients, 0.26%), and dural accidental exposure and bleeding (three patients, 0.13%); the most common postoperative complications were vestibular symptoms (20 patients, 0.86%), followed by infection (17 patients, 0.73%), and device malfunction or migration (12 patients, 0.52%). The total complication rate ranged from 4-13%. Most of the included studies had a low risk. CI in Saudi Arabia has a complication rate similar to that reported in international studies. This review emphasizes the need for continued surveillance of CI outcomes to optimize procedural techniques and improve the safety and efficacy of CI in Saudi Arabia.
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Affiliation(s)
- Bassam AlRajhi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Muhnnad A AlGhamdi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Noura Alenazi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Haila Alabssi
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | - Sham T Alshammeri
- College of Medicine, University of Hail College of Medicine, Hail, SAU
| | - Qusay Aloweiny
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Hassan Bogari
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Haya Al-Subaie
- Otolaryngology Head and Neck Surgery, National Guard Hospital Jeddah, Jeddah, SAU
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Li J, Wang N, Zhang J. Case Report: Antibiotic Irrigation and Drainage Tube for Managing Chronic Suppurative Otitis Media After Cochlear Implantation. EAR, NOSE & THROAT JOURNAL 2024:1455613241238829. [PMID: 38590173 DOI: 10.1177/01455613241238829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024] Open
Abstract
Cochlear implantation (CI) is the most effective solution for patients with severe-to-profound sensorineural hearing loss, especially in children. However, a major postoperative complication, known as chronic suppurative otitis media (CSOM), poses challenges for both doctors and families of the patients, which can affect post-CI hearing outcomes. We present the case of post-CI CSOM in a 15-year-old girl. She had been utilizing a unilateral cochlear implant for 7 years and had been experiencing intermittent earache and discharge in her only audible ear for the past 15 months. After antibiotic treatment failed to resolve her symptoms, we opted for a tympanomastoidectomy, and removed the receiver-stimulator package while keeping the electrode inside her cochlea. Simultaneously, we inserted an irrigation and drainage tube into the mastoid and middle ear space to discharge the exudate and control infection by applying topical antibiotics. The patient's ear discharge had resolved within 1 month, and her tympanic membrane healed naturally. Our successful experience shows that antibiotic irrigation and draining have effectively controlled infection and accelerated wound healing in this patient with post-CI CSOM, and it further prompted the patient to undergo bilateral CI 9 months later.
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Affiliation(s)
- Jiaying Li
- Department of Otolaryngology-Head and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Ningyu Wang
- Department of Otolaryngology-Head and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Juan Zhang
- Department of Otolaryngology-Head and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Tan D, Fujiwara RJ, Lee KH. Current Issues With Pediatric Cochlear Implantation. J Audiol Otol 2024; 28:79-87. [PMID: 38695052 PMCID: PMC11065545 DOI: 10.7874/jao.2024.00073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 03/16/2024] [Indexed: 05/05/2024] Open
Abstract
Cochlear implants (CIs) have demonstrated a clear functional benefit in children with severe-to-profound sensorineural hearing loss (SNHL) and thus have gained wide acceptance for treating deafness in the pediatric population. When evaluating young children for cochlear implantation, there are unique considerations beyond the standard issues addressed during surgery in adults. Because of advances in genetic testing, imaging resolution, CI technology, post-implant rehabilitation, and other factors, issues related to CI surgery in children continue to evolve. Such factors have led to changes in candidacy guidelines, vaccine requirements, and lowering of age requirement for surgery. In addition, differences in the anatomy and physiology of infants require special attention to ensure safety when operating on young children. This review summarizes these issues and provides guidance for surgeons treating children with SNHL.
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Affiliation(s)
- Donald Tan
- Department of Otolaryngology-Head & Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Rance J.T. Fujiwara
- Department of Otolaryngology-Head & Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Kenneth H. Lee
- Department of Otolaryngology-Head & Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Division of Pediatric Otolaryngology, Children’s Health, Dallas, TX, USA
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Sykopetrites V, Di Maro F, Sica E, Cristofari E. Acquired cholesteatoma after cochlear implants: case series and literature review. Eur Arch Otorhinolaryngol 2024; 281:1285-1291. [PMID: 37776344 DOI: 10.1007/s00405-023-08251-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 09/16/2023] [Indexed: 10/02/2023]
Abstract
PURPOSE To assess the prevalence and management of acquired cholesteatoma after cochlear implantation in pediatric and adult patients. METHODS Retrospective case review of pediatric and adult cochlear implants (CI) followed at a tertiary referral center and literature review of acquired cholesteatoma after CI surgery, to identify its prevalence, cause, and treatment. RESULTS Nine pediatric CIs were diagnosed with cholesteatoma in seven patients after 6.4 ± 4 years from CI surgery, and two adults after 11.3 and 21.7 years from CI surgery. Thirty-four pediatric cases and 26 adult cases are described in the literature. Cholesteatoma has a prevalence of 0.54% in pediatric CIs, and 1.79% in adult CIs (case series and literature). Adult cases were diagnosed significantly later compared to pediatric cases (Mann-Whitney test, p = 0.0460). Three pediatric cholesteatomas were treated with conservative surgery and preservation of the CI; they all developed recurrent disease. The remaining pediatric cases underwent subtotal petrosectomy with simultaneous CI explantation and staged reimplantation. Only one case recurred. The adult cases underwent simultaneous subtotal petrosectomy, explantation, and reimplantation. Similarly, 33.3% of cases treated with conservative/reconstructive surgery in the literature required revision surgery or conversion to subtotal petrosectomy against 6.2% of subtotal petrosectomies in the literature. CONCLUSIONS Cholesteatoma after CI is a rare and late-onset complication of CIs. It is more prevalent in the adult CI population, although it affects children significantly earlier. The treatment of choice is subtotal petrosectomy and CI explantation with simultaneous or staged reimplantation.
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Affiliation(s)
- Vittoria Sykopetrites
- Department of Audiovestibology, ASST dei Sette Laghi, Via Lazio, 21100, Varese, VA, Italy.
| | - Flavia Di Maro
- Department of Audiovestibology, ASST dei Sette Laghi, Via Lazio, 21100, Varese, VA, Italy
| | - Eleonora Sica
- Department of Audiovestibology, ASST dei Sette Laghi, Via Lazio, 21100, Varese, VA, Italy
| | - Eliana Cristofari
- Department of Audiovestibology, ASST dei Sette Laghi, Via Lazio, 21100, Varese, VA, Italy
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Honigman T, Cushing SL, Papsin BC, Waltzman S, Woodard J, Neumann S, Fitzgerald MB, Gordon KA. Safety and Early Outcomes of Cochlear Implantation of Nucleus Devices in Infants: A Multi-Centre Study. Trends Hear 2024; 28:23312165241261480. [PMID: 38887094 PMCID: PMC11185016 DOI: 10.1177/23312165241261480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 05/08/2024] [Accepted: 05/27/2024] [Indexed: 06/20/2024] Open
Abstract
This multi-center study examined the safety and effectiveness of cochlear implantation of children between 9 and 11 months of age. The intended impact was to support practice regarding candidacy assessment and prognostic counseling of pediatric cochlear implant candidates. Data in the clinical chart of children implanted at 9-11 months of age with Cochlear Ltd devices at five cochlear implant centers in the United States and Canada were included in analyses. The study included data from two cohorts implanted with one or two Nucleus devices during the periods of January 1, 2012-December 31, 2017 (Cohort 1, n = 83) or between January 1, 2018 and May 15, 2020 (Cohort 2, n = 50). Major adverse events (requiring another procedure/hospitalization) and minor adverse events (managed with medication alone or underwent an expected course of treatment that did not require surgery or hospitalization) out to 2 years post-implant were monitored and outcomes measured by audiometric thresholds and parent-reports on the IT-MAIS and LittlEARS questionnaires were collected. Results revealed 60 adverse events in 41 children and 227 ears implanted (26%) of which 14 major events occurred in 11 children; all were transitory and resolved. Improved hearing with cochlear implant use was shown in all outcome measures. Findings reveal that the procedure is safe for infants and that they show clear benefits of cochlear implantation including increased audibility and hearing development.
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Affiliation(s)
- Tal Honigman
- Department of Otolaryngology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Sharon L. Cushing
- Department of Otolaryngology, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Blake C. Papsin
- Department of Otolaryngology, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Susan Waltzman
- Department of Otolaryngology-Head and Neck Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Jennifer Woodard
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Matthew B. Fitzgerald
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, CA, USA
| | - Karen A. Gordon
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
- Department of Communication Disorders, The Hospital for Sick Children, Toronto, ON, Canada
- Program in Neuroscience and Mental Health, The Hospital for Sick Children, Toronto, ON, Canada
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12
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Africa RE, Quinlan BP, McKinnon BJ. An Investigation of the Impact of Expanding High-Deductible Health Plans on Patient Decision for Cochlear Implant Surgery and Postoperative Outcomes. Otol Neurotol 2024; 45:46-51. [PMID: 38085761 DOI: 10.1097/mao.0000000000004063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
HYPOTHESIS After the expansion of high deductibles, patients will delay cochlear implant (CI) surgery to the end of the year, and the risk of postoperative known risks will increase. BACKGROUND The Affordable Care Act was associated with increased enrollment in high-deductible health plans (HDHPs), which resulted in rising health insurance deductibles. Health insurance plans can cover a patient's cost of healthcare once the deductible is met. Patients have been shown to be economic rational decision makers and make decisions based on cost rather than health. They wait for their deductible to be met, typically at the end of the year, then proceed to have costly care. The goal of this study was to evaluate the impact of rising health insurance deductibles on the rate and postoperative outcomes of cochlear implantation and to assess changes by the Tax Cuts and Jobs Act. METHODS TriNetX was used to accumulate summary data on patients who obtained a CI between 2005 and 2022 at the beginning (quarter 1) and the end of the year (quarter 4) from the electronic medical records of 75 healthcare organizations. The trends in average rate of cochlear implantation and resultant postoperative known risks or complications were statistically evaluated. RESULTS After expansion of HDHPs, the rate of cochlear implantation between quarter 4 (19 cases per year) and quarter 1 (17 cases/year) was similar (p = 0.18). For all patient groups, the case volume significantly increased. Between quarter 4 and quarter 1, postoperative tinnitus was more common in the beginning of the year (risk ratio, 0.68; 95% confidence interval, 0.46-0.99). CONCLUSIONS The number of patients receiving CIs significantly increased despite the expansion of HDHPs. Tinnitus was a rare postoperative known risk in the beginning of the year. Patients are less likely concerned about cost of CI surgery because of the impact of hearing loss on quality of life.
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Affiliation(s)
| | | | - Brian J McKinnon
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Medical Branch, Galveston, Texas
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13
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Ludbrook I, Mair M, Phung D, Corlette T, Huang J, Kong Worimi K, Eisenberg R. Predictive Factors for Subjective Vertigo Following Cochlear Implantation: A Regional Multicenter Cohort Study of 395 Patients. Otol Neurotol 2024; 45:e18-e23. [PMID: 37853779 DOI: 10.1097/mao.0000000000004036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
INTRODUCTION Cochlear implantation (CI) is generally accepted as having a low rate of postoperative complications, but between 9.3% and 13% of cases experience vertigo postoperatively. This study aimed to examine patient, surgical, and device factors contributing toward the risk of postoperative vertigo. METHODOLOGY A retrospective review was conducted of adult patients who underwent cochlear implant in a regional area of New South Wales from 2007 to 2018. A total of 395 cochlear implant cases were included in the final study. RESULTS The overall incidence of vertigo at 3 months of follow-up was 7.1% (n = 28/395). No difference was identified in this study between rates of postoperative vertigo between device factors, including implant make (Cochlear vs. Med-El), electrode shape (perimodiolar vs. straight), and electrode model. No significant difference was found also for surgical factors such as the number of electrode rings inserted, side of implantation, or surgical approach of tympanic ramp (round window insertion vs. cochleostomy).A higher percentage of patients with preoperative vertigo experienced vertigo postoperatively (18.4%, n = 7/38), compared with the population without preoperative vertigo (6.0%, n = 21/352) ( p = 0.005). Patients with previous mastoid surgery also reported a higher rate of postoperative vertigo (20%, n = 9/45) compared with those who had not had mastoid surgery (5.43%, n = 19/350) ( p = 0.006). The mean age of patients experiencing postoperative vertigo was higher than the population without postoperative symptoms (67 vs. 63). CONCLUSION This study of a large multicenter population outlines that patient factors are more critical than surgical or device factors when considering risk factors for vertigo post-cochlear implant.
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Affiliation(s)
- Isabella Ludbrook
- Department of Ear Nose and Throat Surgery, Tamworth Rural Referral Hospital, North Tamworth, New South Wales, Australia
| | - Manish Mair
- Department of Otolaryngology-Head and Neck Surgery, University of Leicester Hospital, United Kingdom
| | - Daniel Phung
- Department of Ear Nose and Throat Surgery, Orange Medical Service, Orange, New South Wales, Australia
| | - Toby Corlette
- Department of Otolaryngology-Head and Neck Surgery, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Johnson Huang
- Department of Otolaryngology-Head and Neck Surgery, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Kelvin Kong Worimi
- Department of Otolaryngology-Head and Neck Surgery, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Robert Eisenberg
- Department of Otolaryngology-Head and Neck Surgery, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
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14
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Shahabaddin L, Al-Jaaf S, Emin A. Intraoperative Difficulties and Postoperative Complications Associated With Cochlear Implantations: A Study From Erbil City. Cureus 2024; 16:e52106. [PMID: 38213935 PMCID: PMC10783599 DOI: 10.7759/cureus.52106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2024] [Indexed: 01/13/2024] Open
Abstract
Background and objective Cochlear implants are highly effective for the treatment of severe to profound hearing loss. Cochlear implant surgery is a safe surgical procedure; however, due to many modifications over the years, it has been associated with certain minor and major complications. This study aimed to examine the intraoperative difficulties and postoperative complications in patients who received cochlear implants in Erbil City. Methods We conducted a retrospective descriptive study regarding complications of cochlear implants involving patients who received unilateral or bilateral cochlear Implants at the Rizgary Teaching Hospital and a private hospital in Erbil City from January 2013 to July 2022. Their medical records were analyzed, and data on demographics, intraoperative difficulties, and postoperative complications were gathered. Results A total of 160 patients with cochlear implants (87 male, 54.4%; 73 female, 45.6%) were included in the study. The mean age of the patients at the time of operation was 6.76 ± 8.02 years (range: 1-53 years); 150 of these patients were children and 10 were adults (18 years and above). Intraoperative difficulties occurred in five patients (3.1%). The overall rate of complication was 10%, 7.5% of which was minor (the most common being wound infection) and 2.5% major (the most frequent being device extrusion). Conclusions Cochlear implant surgery is a safe procedure performed to treat profoundly deaf patients. It is associated with a low rate of complications, most of which can be successfully managed with conservative measures or minimal intervention.
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Affiliation(s)
- Lana Shahabaddin
- Otolaryngology - Head and Neck Surgery, Hawler Medical University, Erbil, IRQ
| | - Said Al-Jaaf
- Otolaryngology, Hawler Medical University, Erbil, IRQ
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15
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Di Stadio A, De Luca P, Ippolito V, Vedova P, Garofalo S, Turchetta R, Ferlito S, della Volpe A. Comparative Analysis of Intellectual Quotient in Developmental Population with Severe Hearing Loss: Hearing Aids vs. Cochlear Implant Users. Life (Basel) 2023; 14:12. [PMID: 38276261 PMCID: PMC10820146 DOI: 10.3390/life14010012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/09/2023] [Accepted: 12/19/2023] [Indexed: 01/27/2024] Open
Abstract
The development of language, memory and intellectual functions is linked to normal hearing and correct sounds interpretation. Hearing loss (HL), especially in its severe form, negatively affects the development of these functions. This prospective study aimed at comparing the Intelligent Quotients (IQ) of children with cochlear implants (CI) with the ones of people wearing hearing aids (HA) after one year of hearing rehabilitation. 21 subjects with severe/profound bilateral hearing loss (deafness) were included in this study. Eleven children with congenital profound HL underwent CI and ten children with moderate to severe HL (congenital and acquired) were rehabilitated by HA. Children's IQs were assessed at enrolment (T0) and 12 months after hearing aids/CI use plus speech therapy. Statistical analyses were performed to analyze the data within and between groups. Comparison of IQs showed no statistically significant differences between CI and HA none at T0 and T1. The subtests showed lower scores in verbal comprehension and process speed index in patients treated with HA when compared to CI. This study showed that auditory rehabilitation can support the normal development of cognitive function in children between six and eight years of age. The use of the correct hearing aids based on the patient's hearing thresholds is important to maximize the rehabilitation outcomes. Due to the small sample size, although stratified for age, our results must be considered preliminary and further analyses on larger samples are needed to confirm our data.
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Affiliation(s)
- Arianna Di Stadio
- GF Ingrassia Department, University of Catania, 95121 Catania, Italy;
| | - Pietro De Luca
- Otolaryngology Department, Isola Tiberina—Gemelli Isola Hospital, 00186 Rome, Italy; (P.D.L.); (A.d.V.)
| | - Valentina Ippolito
- ENT Department, Pediatric CI Regional Referral Centre, Santobono-Pausilipon Children’s Hospital of Naples, 80129 Naples, Italy; (V.I.); (S.G.)
| | - Paola Vedova
- Neuropsychiatric Department, Santobono-Pausillipon Hospital, 80129 Naples, Italy;
| | - Sabina Garofalo
- ENT Department, Pediatric CI Regional Referral Centre, Santobono-Pausilipon Children’s Hospital of Naples, 80129 Naples, Italy; (V.I.); (S.G.)
| | - Rosaria Turchetta
- Pediatric Audiology Unit, Organ of Sense Department, University La Sapienza of Rome, 00185 Rome, Italy;
| | - Salvatore Ferlito
- GF Ingrassia Department, University of Catania, 95121 Catania, Italy;
| | - Antonio della Volpe
- Otolaryngology Department, Isola Tiberina—Gemelli Isola Hospital, 00186 Rome, Italy; (P.D.L.); (A.d.V.)
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16
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Matin F, Krueger C, Avallone E, Rossberg W, Demyanchuk A, Guenther A, Lenarz T, Lesinski-Schiedat A. Influence of the Electrode Array Design on Incidence of Vertigo Symptoms and Vestibular Function After Cochlear Implantation. EAR, NOSE & THROAT JOURNAL 2023; 102:701-708. [PMID: 34182811 DOI: 10.1177/01455613211022075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To evaluate if a specific type of cochlear implant (CI) electrode array (EA) reveals higher rates/prevalence of vestibular symptoms and to characterize their respective relationship to intracochlear position and objective vestibular function. METHODS This retrospective study included 71 cochlear implantations in patients older than 18 years. The electrode position within the cochlea, electrode insertion angle, and cochlear coverage were determined from postoperative multiplanar reconstructed cone-beam computed tomography scans. All device manufacturers were represented. Data related to preoperative and postoperative PTA as well as vestibular symptoms in the preoperative and postoperative stages were collected from the patient's records. RESULTS Twelve of the 71 (16.9%) CI patients experienced vertigo symptoms in the early postoperative period. In 5 (7.0%) patients, the vertigo complaints lasted until the time of the first activation (5-6 weeks postoperative). Postoperative onset of vestibular symptoms was more often seen in patients receiving lateral wall (LW)/straight EAs (19%) compared to perimodiolar/precurved EAs (7%), but this was only a trend and no statistical significance was observed. Moreover, preoperative pathologic caloric responses (CRs) better predicted the postoperative onset of vestibular symptoms. CONCLUSION The preoperative consideration of a complicated CI-induced vertigo is important in the counseling particularly of elderly patients. We identified some risk factors for post-CI vertigo that should be considered in the patient's counseling: preoperative pathologic CRs, the extent of surgical trauma, and possibly the use of an LW EA, regardless of the length.
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Affiliation(s)
- Farnaz Matin
- Otorhinolaryngology Department, Head and Neck Surgery, Hanover Medical University, Hannover, Germany
| | - Caroline Krueger
- Otorhinolaryngology Department, Head and Neck Surgery, Hanover Medical University, Hannover, Germany
| | - Emilio Avallone
- Otorhinolaryngology Department, Head and Neck Surgery, Hanover Medical University, Hannover, Germany
| | - Willi Rossberg
- Otorhinolaryngology Department, Head and Neck Surgery, Hanover Medical University, Hannover, Germany
| | - Alexey Demyanchuk
- Otorhinolaryngology Department, Head and Neck Surgery, Hanover Medical University, Hannover, Germany
| | - Annette Guenther
- Otorhinolaryngology Department, Head and Neck Surgery, Hanover Medical University, Hannover, Germany
| | - Thomas Lenarz
- Otorhinolaryngology Department, Head and Neck Surgery, Hanover Medical University, Hannover, Germany
| | - Anke Lesinski-Schiedat
- Otorhinolaryngology Department, Head and Neck Surgery, Hanover Medical University, Hannover, Germany
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Abstract
OBJECTIVE A retrospective cross-sectional analysis was conducted of the US Food and Drug Administration's MAUDE (Manufacturer and User Facility Device Experience) database, to evaluate the complication profile of cochlear implantation according to manufacturer. METHODS A review of the MAUDE database was conducted from 1 January 2010 to 31 December 2020. Complications, including infection, extrusion, facial nerve stimulation, meningitis and cerebrospinal fluid leak, were identified using key word searches. The categorised data were analysed using a chi-square test to determine a difference in global complication incidence between three major cochlear implant manufacturers: manufacturer A (Cochlear Limited), manufacturer B (Med-El) and manufacturer C (Advanced Bionics). RESULTS A total of 31 857 adverse events were analysed. Implants of manufacturer C were associated with a statistically higher rate of infection (0.97 per cent), cerebrospinal fluid leak (0.07 per cent), extrusion (0.44 per cent) and facial nerve stimulation (0.11 per cent). Implants of manufacturer B were associated with a statistically higher rate of meningitis (0.07 per cent). CONCLUSION Consideration of patient risk factors along with cochlear implant manufacturers can heighten awareness of cochlear implant complications pre-operatively, intra-operatively and post-operatively.
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Affiliation(s)
- S Jinka
- Northeast Ohio Medical University, Rootstown, Ohio, USA
| | - S Wase
- Northeast Ohio Medical University, Rootstown, Ohio, USA
| | - A Jeyakumar
- Northeast Ohio Medical University, Rootstown, Ohio, USA
- Department of Otolaryngology, Mercy Bon Secours, Youngstown, Ohio, USA
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18
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Khurana L, Harczos T, Moser T, Jablonski L. En route to sound coding strategies for optical cochlear implants. iScience 2023; 26:107725. [PMID: 37720089 PMCID: PMC10502376 DOI: 10.1016/j.isci.2023.107725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023] Open
Abstract
Hearing loss is the most common human sensory deficit. Severe-to-complete sensorineural hearing loss is often treated by electrical cochlear implants (eCIs) bypassing dysfunctional or lost hair cells by direct stimulation of the auditory nerve. The wide current spread from each intracochlear electrode array contact activates large sets of tonotopically organized neurons limiting spectral selectivity of sound coding. Despite many efforts, an increase in the number of independent eCI stimulation channels seems impossible to achieve. Light, which can be better confined in space than electric current may help optical cochlear implants (oCIs) to overcome eCI shortcomings. In this review, we present the current state of the optogenetic sound encoding. We highlight optical sound coding strategy development capitalizing on the optical stimulation that requires fine-grained, fast, and power-efficient real-time sound processing controlling dozens of microscale optical emitters as an emerging research area.
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Affiliation(s)
- Lakshay Khurana
- Institute for Auditory Neuroscience, University Medical Center Göttingen, Göttingen, Germany
- Auditory Neuroscience and Optogenetics Laboratory, German Primate Center, Göttingen, Germany
- Auditory Neuroscience and Synaptic Nanophysiology Group, Max-Planck-Institute for Multidisciplinary Sciences, Göttingen, Germany
- Junior Research Group “Computational Neuroscience and Neuroengineering”, Göttingen, Germany
- The Doctoral Program “Sensory and Motor Neuroscience”, Göttingen Graduate Center for Neurosciences, Biophysics, and Molecular Biosciences (GGNB), Göttingen, Germany
- InnerEarLab, University Medical Center Göttingen, Göttingen, Germany
| | - Tamas Harczos
- Institute for Auditory Neuroscience, University Medical Center Göttingen, Göttingen, Germany
- Auditory Neuroscience and Optogenetics Laboratory, German Primate Center, Göttingen, Germany
| | - Tobias Moser
- Institute for Auditory Neuroscience, University Medical Center Göttingen, Göttingen, Germany
- Auditory Neuroscience and Optogenetics Laboratory, German Primate Center, Göttingen, Germany
- Auditory Neuroscience and Synaptic Nanophysiology Group, Max-Planck-Institute for Multidisciplinary Sciences, Göttingen, Germany
- InnerEarLab, University Medical Center Göttingen, Göttingen, Germany
- Cluster of Excellence “Multiscale Bioimaging: from Molecular Machines to Networks of Excitable Cells” (MBExC), University of Göttingen, Göttingen, Germany
| | - Lukasz Jablonski
- Institute for Auditory Neuroscience, University Medical Center Göttingen, Göttingen, Germany
- Auditory Neuroscience and Optogenetics Laboratory, German Primate Center, Göttingen, Germany
- Junior Research Group “Computational Neuroscience and Neuroengineering”, Göttingen, Germany
- InnerEarLab, University Medical Center Göttingen, Göttingen, Germany
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Baird SM, Wong D, Levi E, Robinson P. Otolaryngological burden of disease in children with primary ciliary dyskinesia in Victoria, Australia. Int J Pediatr Otorhinolaryngol 2023; 173:111722. [PMID: 37699305 DOI: 10.1016/j.ijporl.2023.111722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/04/2023] [Accepted: 09/06/2023] [Indexed: 09/14/2023]
Abstract
OBJECTIVES The aim of this study was to summarize the otolaryngological manifestations amongst children with primary ciliary dyskinesia (cwPCD) to improve diagnosis, investigations and management amongst otolaryngologists. METHODS A retrospective review of primary ciliary dyskinesia (PCD) diagnoses at our institution over an 8-year period between January 2014 and October 2022 was conducted. Patient characteristics, diagnosis, otolaryngological symptomatology, treatment and outcomes were recorded. RESULTS 24 patients were identified. Thirteen patients (54%) had documented conductive hearing loss on audiological evaluation; with 11 (85%) requiring hearing aids. Six patients (25%) underwent middle ear ventilation tube (MEVT) insertion with 67% experiencing post-MEVT otorrhoea. Twenty children (83%) reported chronic nasal discharge however only 3 (13%) reported nasal obstruction. Nine patients (38%) had symptoms consistent with sleep disordered breathing with 79% of them requiring operative management with adenotonsillectomy. CONCLUSION Middle ear effusion is common amongst cwPCD and should be managed with conservative measures due to the significant burden of post-MEVT otorrhoea. Sinonasal symptoms rarely need surgical intervention. Many otolaryngological symptoms of PCD are often underreported, particularly sleep-disordered breathing. Paediatric PCD patients should be managed in a multidisciplinary team with routine and tailored therapies to manage all aspects of the condition.
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Affiliation(s)
- Samantha M Baird
- Department of Otolaryngology, The Royal Children's Hospital, 50 Flemington Rd, Parkville, VIC, 3052, Australia.
| | - Daniel Wong
- Department of Otolaryngology, The Royal Children's Hospital, 50 Flemington Rd, Parkville, VIC, 3052, Australia.
| | - Eric Levi
- Department of Otolaryngology, The Royal Children's Hospital, 50 Flemington Rd, Parkville, VIC, 3052, Australia.
| | - Philip Robinson
- Department of Respiratory Medicine, The Royal Children's Hospital, 50 Flemington Rd, Parkville, VIC, 3052, Australia.
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Sugaya A, Kariya S, Fukushima K, Omichi R, Ando M. Revision cochlear implant surgery in adults and children is a safe and effective technique: a retrospective single faculty study in Okayama University Hospital, Japan. Acta Otolaryngol 2023; 143:835-839. [PMID: 37897368 DOI: 10.1080/00016489.2023.2270701] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 10/05/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND Cochlear implant (CI) surgery is a safe surgical technique, although some patients require revision CI surgery. AIMS/OBJECTIVES This study investigated the cause and underlying reason of revision CI surgery as well as hearing outcomes in a single institution. PATIENTS AND METHODS This retrospective study evaluated patients who underwent CI surgery between April 2006 to March 2022 (n = 351). Sex, aetiology of hearing loss (HL), age and period from initial CI surgery to reimplantation, cause of revision, and related factors were examined. RESULTS Twelve patients (8 males, 4 females) received CI reimplantation. The revision surgery rate was 2.59% (3.15% children, 1.69% adults); the period from initial surgery to reoperation was 8.60 ± 6.56 years for 9 children with congenital HL and 15.27 ± 5.72 years for 3 adults with progressive HL. Device failure was the most common cause (n = 8), followed by infections (n = 2), advanced facial irritation symptoms (n = 1), and electrode slip-out (n = 1). Mean preoperative and postoperative CI thresholds were 44.0 ± 9.46 dBnHL and 39.19 ± 8.89 dBnHL (p < .068), respectively. CONCLUSION AND SIGNIFICANCE Caregiver education, surgical technique advances, flap design, and extensive antibiotic use may decrease the revision surgery rate. The lack of post-revision deterioration of the hearing threshold contributed to well-being in patients with CI.
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Affiliation(s)
- Akiko Sugaya
- Department of Otolaryngology, Head and Neck Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Science, Okayama, Japan
- Okayama Kanariya Gakuen, Okayama, Japan
| | - Shin Kariya
- Department of Otolaryngology, Head and Neck Surgery, Kawasaki Medical Hospital, Okayama, Japan
| | - Kunihiro Fukushima
- Dermatology & Otolaryngology, Hayashima ENT Clinic, Okayama, Japan
- Child Development Support Office, KIDS*FIRST, Okayama, Japan
| | - Ryotaro Omichi
- Department of Otolaryngology, Head and Neck Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Science, Okayama, Japan
| | - Mizuo Ando
- Department of Otolaryngology, Head and Neck Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Science, Okayama, Japan
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21
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Gröger M, Loth A, Helbig S, Stöver T, Leinung M. Bilateral simultaneous cochlear implantation is a safe method of hearing rehabilitation in adults. Eur Arch Otorhinolaryngol 2023; 280:4445-4454. [PMID: 37191916 PMCID: PMC10477109 DOI: 10.1007/s00405-023-07977-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/11/2023] [Indexed: 05/17/2023]
Abstract
PURPOSE Bilateral cochlear implantation is an effective treatment for patients with bilateral profound hearing loss. In contrast to children, adults mostly choose a sequential surgery. This study addresses whether simultaneous bilateral CI is associated with higher rates of complications compared to sequential implantation. METHODS 169 bilateral CI surgeries were analyzed retrospectively. 34 of the patients were implanted simultaneously (group 1), whereas 135 patients were implanted sequentially (group 2). The duration of surgery, the incidence of minor and major complications and the duration of hospitalization of both groups were compared. RESULTS In group 1, the total operating room time was significantly shorter. The incidences of minor and major surgical complications showed no statistically significant differences. A fatal non-surgical complication in group 1 was particularly extensively reappraised without evidence of a causal relationship to the chosen mode of care. The duration of hospitalization was 0.7 days longer than in unilateral implantation but 2.8 days shorter than the combined two hospital stays in group 2. CONCLUSION In the synopsis of all considered complications and complication-relevant factors, equivalence of simultaneous and sequential cochlear implantation in adults in terms of safety was found. However, potential side effects related to longer surgical time in simultaneous surgery must be considered individually. Careful patient selection with special consideration to existing comorbidities and preoperative anesthesiologic evaluation is essential.
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Affiliation(s)
- Maximilian Gröger
- University Hospital Frankfurt, Dept. of Otorhinolaryngology, Frankfurt am Main, Germany.
| | - Andreas Loth
- University Hospital Frankfurt, Dept. of Otorhinolaryngology, Frankfurt am Main, Germany
| | - Silke Helbig
- University Hospital Frankfurt, Dept. of Otorhinolaryngology, Frankfurt am Main, Germany
| | - Timo Stöver
- University Hospital Frankfurt, Dept. of Otorhinolaryngology, Frankfurt am Main, Germany
| | - Martin Leinung
- University Hospital Frankfurt, Dept. of Otorhinolaryngology, Frankfurt am Main, Germany
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22
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Gowrishankar SV, Fleet A, Tomasoni M, Durham R, Umeria R, Merchant SA, Shah SFH, Muzaffar J, Mohammed H, Kuhn I, Tysome J, Smith ME, Donnelly N, Axon P, Bance M, Borsetto D. The Risk of Meningitis After Cochlear Implantation: A Systematic Review and Meta-Analysis. Otolaryngol Head Neck Surg 2023; 169:467-481. [PMID: 36864717 DOI: 10.1002/ohn.309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/05/2023] [Accepted: 02/08/2023] [Indexed: 03/04/2023]
Abstract
OBJECTIVE This study aims to estimate the rate of postoperative meningitis (both immediate and long-term) in patients following cochlear implants (CIs). It aims to do so through a systematic review and meta-analysis of published studies tracking complications after CIs. DATA SOURCES MEDLINE, Embase, and Cochrane Library. REVIEW METHODS This review was performed in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies tracking complications following CIs in patients were included. Exclusion criteria included non-English language studies and case series reporting <10 patients. Bias risk was evaluated using the Newcastle-Ottawa Scale. Meta-analysis was performed through DerSimonian and Laird random-effects models. RESULTS A total of 116/1931 studies met the inclusion criteria and were included in the meta-analysis. Overall, there were 112 cases of meningitis in 58,940 patients after CIs. Meta-analysis estimated an overall rate of postoperative meningitis of 0.07% (95% confidence interval [CIs], 0.03%-0.1%; I2 = 55%). Subgroup meta-analysis showed this rate had 95% CIs crossing 0% in implanted patients who received the pneumococcal vaccine, antibiotic prophylaxis, those with postoperative acute otitis media (AOM), and those implanted less than 5 years. CONCLUSION Meningitis is a rare complication following CIs. Our estimated rates of meningitis after CIs appear lower than prior estimates based on epidemiological studies in the early 2000s. However, the rate still appears higher than the baseline rate in the general population. The risk was very low in implanted patients who received the pneumococcal vaccine, antibiotic prophylaxis, received unilateral or bilateral implantations, developed AOM, those implanted with a round window or cochleostomy techniques, and those under 5 years.
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Affiliation(s)
- Shravan V Gowrishankar
- Department of Otolaryngology-Head and Neck Surgery, Cambridge University Hospitals NHS Trust, Cambridge, UK
- Department of Clinical Medicine, University of Cambridge, School of Clinical Medicine, Cambridge, UK
| | - Alex Fleet
- Department of Otolaryngology-Head and Neck Surgery, Cambridge University Hospitals NHS Trust, Cambridge, UK
- Department of Clinical Medicine, University of Cambridge, School of Clinical Medicine, Cambridge, UK
| | - Michele Tomasoni
- Department of Otolaryngology-Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Rory Durham
- Department of Clinical Medicine, University of Cambridge, School of Clinical Medicine, Cambridge, UK
| | - Rishi Umeria
- Department of Clinical Medicine, University of Cambridge, School of Clinical Medicine, Cambridge, UK
| | - Serena A Merchant
- Department of Clinical Medicine, University of Cambridge, School of Clinical Medicine, Cambridge, UK
| | - Syed F H Shah
- Department of Clinical Medicine, University of Cambridge, School of Clinical Medicine, Cambridge, UK
| | - Jameel Muzaffar
- Department of Otolaryngology-Head and Neck Surgery, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Hassan Mohammed
- Department of Otolaryngology-Head and Neck Surgery, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Isla Kuhn
- Cambridge University Medical Library, Cambridge, UK
| | - James Tysome
- Department of Otolaryngology-Head and Neck Surgery, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Matthew E Smith
- Department of Otolaryngology-Head and Neck Surgery, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Neil Donnelly
- Department of Otolaryngology-Head and Neck Surgery, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Patrick Axon
- Department of Otolaryngology-Head and Neck Surgery, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Manohar Bance
- Department of Otolaryngology-Head and Neck Surgery, Cambridge University Hospitals NHS Trust, Cambridge, UK
- Department of Clinical Medicine, University of Cambridge, School of Clinical Medicine, Cambridge, UK
| | - Daniele Borsetto
- Department of Otolaryngology-Head and Neck Surgery, Cambridge University Hospitals NHS Trust, Cambridge, UK
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al-khatib T, Banjer HMM, Alzahrani RA, Basharaheel HA, Aljefri YF, Bakheet HA, Zawawi F, Garrada M. Comparison of Cochlear Implantation Complications with Subperiosteal Pocket Technique Versus Well-Drilling Technique in Pediatric Patients: A Retrospective Study. Indian J Otolaryngol Head Neck Surg 2023; 75:1792-1798. [PMID: 37636685 PMCID: PMC10447757 DOI: 10.1007/s12070-023-03735-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 03/27/2023] [Indexed: 08/29/2023] Open
Abstract
Aims: Cochlear implantation is becoming the standard treatment for rehabilitating patients with sensorineural hearing (SNH) impairment. Various techniques can be used to achieve this goal. In the current study, we compared the subperiosteal technique (SPT) with the development of a subperiosteal pocket without fixation to the well-drilling method (WD) by constructing an incision into the scalp with suture fixation. Materials and methods: Our study weighted the efficiency of children who underwent WD or SPT from 2017 to 2021 at King Abdulaziz University Hospital. In this retrospective records review, we compared 63 SPT cases with 104 WD cases during a 5-year period who were followed for 1 month or more. Results: There were 88 females (50.9%) and 79 male (45.7%) with a mean age of 4.49 ± 3.06 years at the time of surgery. The mean WD duration was 2.47 ± 1.05 h, and 2.91 ± 1.05 h for SPT (P = 0.01). Moreover, there was a significant relationship between comorbidities and electrode complications (P = 0.022). There was no significant correlation between the surgical method and intraoperative complications (P = 0.714), electrode array issues (P = 0.88), or serious postoperative complications including device failure and migration skin problems (P = 0.207). Conclusion: Overall, the WD technique was faster. However, both methods can be used safely and effectively, as no significant intraoperative or postoperative complications were observed. Further long-term studies are required to validate our findings. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-023-03735-z.
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Affiliation(s)
- Talal al-khatib
- Department of Otolaryngology- Head and Neck Surgery, Faculty of Medicine, King Abdulaziz University (KAU), Jeddah, Saudi Arabia
| | | | | | | | - Yara Fahad Aljefri
- Faculty of Medicine, King Abdulaziz University (KAU), Jeddah, Saudi Arabia
| | | | - Faisal Zawawi
- Department of Otolaryngology- Head and Neck Surgery, Faculty of Medicine, King Abdulaziz University (KAU), Jeddah, Saudi Arabia
| | - Mohammed Garrada
- Department of Otolaryngology- Head and Neck Surgery, Faculty of Medicine, King Abdulaziz University (KAU), Jeddah, Saudi Arabia
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Potdukhe K, Vishwakarma R, Rao S. Our Experience in 576 Cases of Cochlear Implant Surgery by Veria Technique. Indian J Otolaryngol Head Neck Surg 2023; 75:2017-2024. [PMID: 37636783 PMCID: PMC10447859 DOI: 10.1007/s12070-023-03535-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 01/26/2023] [Indexed: 08/29/2023] Open
Abstract
OBJECTIVE To study and analyse the result obtained in cochlear implantation by Veria technique and evaluate the incidence of surgical complications and their management. METHOD Between Jan 1, 2014 to Jan 1, 2019, 602 cochlear implantations by Veria technique were done out of which 576 patients were analysed retrospectively for the study. The age range was between 18 months and 60 years. RESULT All 576 patients were operated by Veria technique. Out of 576 patients, 57 (9.9%) had abnormal cochlear malformation. Cytomegalovirus (CMV) being the most common non genetic cause of congenital hearing loss accounting to 60%. The overall complication rate of 5.5% was observed in 576 implanted patients. CONCLUSION The analysis of the results shows that this method has certain advantages, which are: it is simple and therefore the learning curve is fast; it is safe for the facial nerve, as the drilling is precisely controlled by the special perforator; it produces minimal bone trauma and due fast healing, it permits early fitting a few days after operation; it can be used for very small children where the mastoid may have not been yet sufficiently developed.
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Affiliation(s)
| | - Rajesh Vishwakarma
- Department of Otorhinolaryngology, Apollo Hospital Ahmedabad, Ahmedabad, India
| | - Saketh Rao
- Civil Hospital Ahmedabad , Ahmedabad, India
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25
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Alahmadi A, Abdelsamad Y, Alothman NI, Alshalan A, Almuhawas F, AlAmari NA, Alyousef MY, Alhabib SF, Hagr A. A Literature Review on Cochlear Implant Activation: From Weeks to Hours. EAR, NOSE & THROAT JOURNAL 2023:1455613231188294. [PMID: 37551795 DOI: 10.1177/01455613231188294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023] Open
Abstract
Objectives: The present literature review discusses the chronological evolution of Cochlear Implant (CI) activation and its definition among the relevant studies in the literature. In addition, the benefits of standardizing the early activation process in implantation centers worldwide are discussed. Methods: A comprehensive literature search was conducted in the major databases such as PubMed, Scopus, and Embase to retrieve all the relevant articles that reported early activation approaches following CI. Results: The evolution of the timing of early activation after CI has been remarkable in the past few years. Some studies reported the feasibility of early activation 1 day after the CI surgery in their users. Conclusions: Within the last decade, some studies have been published to report the feasibility and outcomes of its early activation. However, the process of early activation was not adequately defined, and no apparent guidelines could be found in the literature.
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Affiliation(s)
- Asma Alahmadi
- King Abdullah Ear Specialist Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | - Noura I Alothman
- Department of Health Communication Sciences, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Afrah Alshalan
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Jouf University, Sakaka, Saudi Arabia
| | - Fida Almuhawas
- King Abdullah Ear Specialist Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Nouf A AlAmari
- Otolaryngology-Head & Neck Surgery Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed Y Alyousef
- Otolaryngology-Head & Neck Surgery Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Salman F Alhabib
- King Abdullah Ear Specialist Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdulrahman Hagr
- King Abdullah Ear Specialist Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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26
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Andresen NS, Shneyderman M, Bowditch SP, Wang NY, Santina CCD, Sun DQ, Creighton FX. Cochlear Implant Revisions Over Three Decades of Experience. Otol Neurotol 2023; 44:555-562. [PMID: 37254261 PMCID: PMC10330224 DOI: 10.1097/mao.0000000000003910] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
IMPORTANCE The indications, technology, and surgical technique for cochlear implantation have evolved over the last three decades. Understanding the risk of cochlear implant revision (CIR) is important for patient counseling. OBJECTIVE The objective of this study was to analyze the rates, indications, and audiologic outcomes for CIR over three decades of experience at a single academic medical center. DESIGN A retrospective chart review was performed at a single academic medical center for individuals who underwent cochlear implantation between 1985 and 2022. SETTING Single academic medical center. PARTICIPANTS Three thousand twenty-five individuals who underwent 3,934 cochlear implant operations from 1985 to 2022. EXPOSURE Cochlear implantation. MAIN OUTCOMES AND MEASURES Rates, indications, risk factors, and audiologic outcomes for CIR. RESULTS There were 276 cases of CIR after primary implantation and an overall revision rate of 7.6% (95% confidence interval, 6.8-8.5%) over 37 years of follow-up with many cases of CIR secondary to Advanced Bionics vendor B and field action failure groups. CIR rates increased sharply through the early and mid-2000s and have since remained stable. Hard or soft device failure was the most common indication for CIR, accounting for 73% of cases. Pediatric patient status and previous CIR were associated with an increased risk of CIR. Audiologic outcomes after CIR were similar to those before device failure. CONCLUSIONS AND RELEVANCE CIR remains a common procedure most often performed for device failure. Pediatric patients and those who have undergone previous CIR are at the highest risk for future CIR. Audiologic outcomes remain stable after CIR, and these data will help providers counsel patients at the risk of future CIR and understand the risk factors associated with CIR.
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Affiliation(s)
- Nicholas S. Andresen
- Department of Otolaryngology-Head and Neck Surgery and Center for Hearing and Balance, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Stephen P. Bowditch
- Department of Otolaryngology-Head and Neck Surgery and Center for Hearing and Balance, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nae-Yuh Wang
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Departments of Biostatistics and Epidemiology, Bloomberg School of Public Health, Baltimore, MD, USA
| | - Charles C. Della Santina
- Department of Otolaryngology-Head and Neck Surgery and Center for Hearing and Balance, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Daniel Q. Sun
- Department of Otolaryngology-Head and Neck Surgery and Center for Hearing and Balance, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Francis X. Creighton
- Department of Otolaryngology-Head and Neck Surgery and Center for Hearing and Balance, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Potier M, Gallego S, Fournier P, Marx M, Noreña A. Amplification of the poorer ear by StereoBiCROS in case of asymmetric sensorineural hearing loss: effect on tinnitus. Front Neurosci 2023; 17:1141096. [PMID: 37304020 PMCID: PMC10248029 DOI: 10.3389/fnins.2023.1141096] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 04/12/2023] [Indexed: 06/13/2023] Open
Abstract
Tinnitus is prevalent among patients suffering from Single-Sided Deafness (SSD) and Asymmetrical Hearing Loss (AHL). In addition to bothersome tinnitus in the poorer ear, these patients also report issues with understanding speech in noise and sound localization. The conventional treatment options offered to these patients to improve auditory abilities are cochlear implantation, bone conduction devices or Contralateral Routing Of Signal (CROS) hearing aids. It was recently found that the benefit of cochlear implantation for tinnitus associated with AHL/SSD was greater than the other two approaches. It is conceivable that the lack of stimulation provided to the poorer ear in these last approaches explains their modest impact on tinnitus perception. A new technology that combines the ability to reroute the sound from the poorer ear to the good ear (CROS system) while still stimulating the poorer ear with conventional sound amplification has recently been developed: the StereoBiCROS system. The aim of this study was to investigate the effects of this new device on tinnitus. Twelve AHL and two SSD patients aged 70.7 ± 7.9 years with tinnitus were fitted with bilateral hearing aids that included 3 programs: Stereophonic, BiCROS and StereoBiCROS (CROS + bilateral amplification). The short-and long-term effect of the approach on tinnitus was assessed using a tinnitus Loudness Visual Analog Scale (VAS) and the Tinnitus Handicap Inventory (THI), respectively. Both the VAS and the THI were used before and one month after the hearing aid fitting. Of the 14 patients who used their hearing aids daily (12.6 ± 1.6 h per day) the StereoBiCROS program was the most used program (81.8 ± 20.5% of the time). The average THI total score decreased from 47 (± 22) to 15 (± 16) (p = 0.002) and the VAS-Loudness score decreased from 7 (± 1) to 2 (± 2) (p < 0.001) after the one-month trial period. In conclusion, StereoBiCROS stimulation strategy seems to offer an effective alternative to reduce tinnitus handicap and loudness for patients with AHL/SSD and tinnitus. This effect may be driven by sound amplification of the poorer ear.
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Affiliation(s)
- Morgan Potier
- CNRS UMR, Laboratoire de Neurosciences Cognitives, Aix-Marseille–Université Centre Saint-Charles, Marseille, France
- Laboratoire d’Audiologie Clinique, Narbonne, France
| | - Stéphane Gallego
- CNRS UMR, Laboratoire de Neurosciences Cognitives, Aix-Marseille–Université Centre Saint-Charles, Marseille, France
- Institut des Sciences et Technologies de Réadaptation, Université de Lyon, Lyon, France
| | - Philippe Fournier
- CNRS UMR, Laboratoire de Neurosciences Cognitives, Aix-Marseille–Université Centre Saint-Charles, Marseille, France
- Département de réadaptation, Faculté de Médecine, Université Laval, Quebec, QC, Canada
| | - Mathieu Marx
- CNRS UMR, Centre de Recherche Cerveau et Cognition (CERCO), Université Paul Sabatier, Toulouse, France
| | - Arnaud Noreña
- CNRS UMR, Laboratoire de Neurosciences Cognitives, Aix-Marseille–Université Centre Saint-Charles, Marseille, France
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Rieck JH, Beyer A, Mewes A, Caliebe A, Hey M. Extended Preoperative Audiometry for Outcome Prediction and Risk Analysis in Patients Receiving Cochlear Implants. J Clin Med 2023; 12:3262. [PMID: 37176702 PMCID: PMC10179556 DOI: 10.3390/jcm12093262] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/21/2023] [Accepted: 04/27/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND The outcome of cochlear implantation has improved over the last decades, but there are still patients with less benefit. Despite numerous studies examining the cochlear implant (CI) outcome, variations in speech comprehension with CI remains incompletely explained. The aim of this study was therefore to examine preoperative pure-tone audiogram and speech comprehension as well as aetiology, to investigate their relationship with postoperative speech comprehension in CI recipients. METHODS A retrospective study with 664 ears of 530 adult patients was conducted. Correlations between the target variable postoperative word comprehension with the preoperative speech and sound comprehension as well as aetiology were investigated. Significant correlations were inserted into multivariate models. Speech comprehension measured as word recognition score at 70 dB with CI was analyzed as (i) a continuous and (ii) a dichotomous variable. RESULTS All variables that tested preoperative hearing were significantly correlated with the dichotomous target; with the continuous target, all except word comprehension at 65 dB with hearing aid. The strongest correlation with postoperative speech comprehension was seen for monosyllabic words with hearing aid at 80 dB. The preoperative maximum word comprehension was reached or surpassed by 97.3% of CI patients. Meningitis and congenital diseases were strongly negatively associated with postoperative word comprehension. The multivariate model was able to explain 40% of postoperative variability. CONCLUSION Speech comprehension with hearing aid at 80 dB can be used as a supplementary preoperative indicator of CI-aided speech comprehension and should be measured regularly in the clinical routine. Combining audiological and aetiological variables provides more insights into the variability of the CI outcome, allowing for better patient counselling.
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Affiliation(s)
| | - Annika Beyer
- Audiology, ENT Clinic, UKSH Kiel, 24105 Kiel, Germany; (A.B.); (A.M.); (M.H.)
| | - Alexander Mewes
- Audiology, ENT Clinic, UKSH Kiel, 24105 Kiel, Germany; (A.B.); (A.M.); (M.H.)
| | - Amke Caliebe
- Institute of Medical Informatics and Statistics, CAU Kiel, 24105 Kiel, Germany;
| | - Matthias Hey
- Audiology, ENT Clinic, UKSH Kiel, 24105 Kiel, Germany; (A.B.); (A.M.); (M.H.)
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29
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Yigit E, Kalaycik Ertugay C, Mahmutoglu AS, Kaygisiz I, Yigit O. Olfactory bulb volume in cochlear implant candidates as compared to age-matched control subjects: A potential marker of cognitive function for auditory information processing. Int J Pediatr Otorhinolaryngol 2023; 168:111553. [PMID: 37075591 DOI: 10.1016/j.ijporl.2023.111553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 03/23/2023] [Accepted: 04/13/2023] [Indexed: 04/21/2023]
Abstract
OBJECTIVE To evaluate magnetic resonance imaging (MRI)-based olfactory bulb (OB) volumes in cochlear implant (CI) candidates with sensorineural hearing loss as compared to age-matched control subjects with normal hearing. METHODS A total of 31 pediatric CI candidates (mean ± SD age: 7.0 ± 2.5 years, 51.6% were boys) with sensorineural hearing loss and 35 age-matched control subjects (mean ± SD age: 7.1 ± 2.5 years, 54.3% were boys) with normal hearing were included in this study. Data on demographic characteristics (age, gender) and right and left OB volume (mm3) on MRI using planimetric contouring method were recorded in patients and control groups. RESULTS Median (min-max) values for right OB volume (80(50-120) vs. 90(50-160) mm3, p = 0.006) and left OB volume (70(50-120) vs. 90(50-170) mm3, p = 0.007) were significantly lower in CI candidates vs. controls, regardless of the gender and age. No significant difference was noted between right and left OB volume in CI candidate and control groups. Hearing loss subgroups of CI candidates including hereditary familial (n = 8), hereditary non-familial (n = 14) and mixed syndromic (9) subgroups were also similar in terms of patient demographics and OB volumes. There was a tendency for having lower left OB volume (60(50-120) vs. 80(60-110) mm3) in girls vs. boys in the CI candidate group, along with a tendency for lower left and right OB volume in candidates vs. controls, particularly at age 11 (median 120 vs. 80 mm3 and 120 vs. 60 mm3, respectively). No significant correlation of age was noted with right and left OB volume overall and in the study groups. CONCLUSION In conclusion, our findings revealed lower left and right OB volumes in CI candidates compared to control subjects, regardless of age and gender, indicating the presence of baseline olfactory dysfunction in patients with hearing loss planned to undergo CI. Accordingly, MRI-based measurement of OB volume in the pre-surgical workup of CI candidates may serve as a marker of cognitive function enabling auditory information processing that may also correlate with post-operative CI outcomes.
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Affiliation(s)
- Enes Yigit
- Clinic of Otorhinolaryngology, Istanbul Training and Research Hospital, Istanbul, Turkey.
| | | | | | - Ismail Kaygisiz
- Clinic of Otorhinolaryngology, Istanbul Training and Research Hospital, Istanbul, Turkey.
| | - Ozgur Yigit
- Clinic of Otorhinolaryngology, Istanbul Training and Research Hospital, Istanbul, Turkey.
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30
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Cass ND, Totten DJ, Ross JD, O'Malley MR. Characterizing Cochlear Implant Magnet-Related MRI Artifact. Ann Otol Rhinol Laryngol 2023; 132:250-258. [PMID: 35382589 DOI: 10.1177/00034894221089143] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate cochlear implant (CI) magnet-related MRI artifact shape and size, as well as imaging indications and clinical adequacy of scans. METHODS A retrospective chart review was performed for patients undergoing CI and subsequent MRI head imaging from 2014 to 2020 at a single institution. Indications and adequacy of each scan was recorded, and interpretability compared by indication. Magnet-related artifact size was determined by performing ellipsoid modeling at axial slice of greatest signal loss. Artifact radius in centimeters was calculated for 5 sequence categories, and size compared between sequences, manufacturers, and by time from implantation. RESULTS Twenty patients underwent 58 head MRI scans. Approximately 76% of MRIs (n = 44) for 70% of patients (n = 14) were performed for indications known of prior to implantation; the remainder were performed during workup of new issues. Desired structures were interpretable in 23 (52%) of known-indication MRIs and 8 (57%) of new-indication MRIs, without significant difference (P = .751). Magnet-related artifact magnitude, compared to the reference T1-weighted fast spin echo (FSE) (4.47 cm), was similar in T2 FSE (4.57 cm, P = .068) and T1 gradient echo (GRE) sequences (4.79 cm, P = .28), but significantly greater in T2 GRE (6.86, P < .0001) and DWI (7.56 cm, P < .0001) sequences. CONCLUSIONS DWI and T2 GRE sequences are less useful in MRI evaluation of CI patients. With a more favorable artifact profile, T1 FSE, T2 FSE, and T1 GRE sequences more likely yield clinically useful information. The large proportion of scans performed for known pathology represents an opportunity to optimize for magnet location preoperatively.
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Affiliation(s)
- Nathan D Cass
- The Otology Group of Vanderbilt, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - John D Ross
- Department of Radiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Matthew R O'Malley
- The Otology Group of Vanderbilt, Vanderbilt University Medical Center, Nashville, TN, USA
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31
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Quimby AE, Grose E, Reddy D, Webster R, Malic C, Vaccani JP. Predictors of Surgical Site Infection in Pediatric Cochlear Implantation. Otolaryngol Head Neck Surg 2023; 168:484-490. [PMID: 35671142 DOI: 10.1177/01945998221104933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 05/17/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine risk factors for surgical site infection (SSI) after cochlear implantation (CI) in pediatric patients. STUDY DESIGN Case-control study. SETTING A total of 150 hospitals contributing data to the ACS-NSQIP Pediatric database (American College of Surgeons National Surgical Quality Improvement Program) in North America and worldwide. METHODS Pediatric patients (aged <18 years) undergoing CI during the years 2012 to 2017 were identified in the ACS-NSQIP Pediatric database. Uni- and multivariable logistic regression analyses were used to determine the odds ratios (ORs) of SSI (including superficial incisional, deep incisional, organ/space) occurring up to 30 days postoperatively. RESULTS A total of 79 SSIs occurred over a 5-year period (n = 5146). Longer operative time significantly increased the odds of SSI (OR, 1.965; 95% CI, 1.205-3.289). Younger age was also found to raise the odds of SSI, with decreased odds associated with each 6-month increase in age (OR, 0.887; 95% CI, 0.814-0.958). CONCLUSION Longer operative time and younger age appear to significantly increase the odds of SSI in pediatric CI. Body mass index, recent steroid use, American Society of Anesthesiologists class, bilateral vs unilateral implantation, and hospital length of stay do not appear to significantly influence SSI risk. These findings must be interpreted in the context of the limitations inherent to adverse events reporting, which are mitigated by the stringent manner of data collection by the ACS-NSQIP, and those inherent to the definition of SSI. Future prospective studies should investigate the impact of reducing operative time on the risk of SSI and other complications in pediatric CI.
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Affiliation(s)
- Alexandra E Quimby
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Elysia Grose
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Canada
| | - Deepti Reddy
- Clinical Research Unit, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Richard Webster
- Clinical Research Unit, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Claudia Malic
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Ottawa, Ottawa, Canada
- Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Jean-Philippe Vaccani
- Children's Hospital of Eastern Ontario, Ottawa, Canada
- Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ontario, Canada
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Complications after cochlear implantation in adult patients: a retrospective study. J Laryngol Otol 2023; 137:259-262. [PMID: 35950484 DOI: 10.1017/s0022215122001827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To examine the complication rate in adult patients during and after cochlear implantation. METHODS A retrospective chart review was conducted of patients who had undergone cochlear implantation at a tertiary referral centre between 2009 and 2018. All complications and their treatments were categorised as either minor or major, as well as intra- or post-operative. RESULTS The records of 392 patients with 395 implants were reviewed. The mean follow-up period was 89 ± 65.5 months (range, 6-408 months). The mean age of patients was 46 ± 15.2 years (range, 19-84 years). Sixty-two patients (16 per cent) had minor complications and 31 (8 per cent) had major complications. CONCLUSION Although cochlear implantation has the potential for significant intra- and post-operative complications, the actual complication rate is relatively low, and it can therefore be considered a safe procedure.
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Delayed-onset swelling around the implant after cochlear implantation: a series of 26 patients. Eur Arch Otorhinolaryngol 2023; 280:681-688. [PMID: 35870003 DOI: 10.1007/s00405-022-07537-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 07/01/2022] [Indexed: 01/21/2023]
Abstract
PURPOSE We aimed to clarify the clinical features of delayed-onset swelling around cochlear implants (CI), and to present our experience on how to avoid and address this problem. METHODS We performed a retrospective review of all CI cases at our institution between June 2001 and June 2020. Information on postoperative complications of swelling in the receiver area > 3 months after implantation were analyzed, and clinical data sheets were drawn. RESULTS Twenty-six of 1425 patients (1.82%) with an age at implantation ranging from 1 to 9 years experienced delayed-onset swelling around the implant. Swelling episodes occurred as early as 4 months, and as late as 178 months after implantation (median, 79.7 months). The predisposing factor in 12 cases was unclear, 7 cases were caused by trauma at the implantation site, 5 cases were without predisposing factors, and 2 cases were related to infection. We found the frequency of delayed-onset swelling after cochlear implantation with different incision was statistically insignificant (P = 0.423). Nineteen patients (73.1%) were cured after one treatment, and five patients (19.2%) relapsed. Follow-up examinations at least 18 months after surgery revealed that all patients experienced a complete recovery. CONCLUSIONS Delayed-onset swelling at the receiver site is a long term but not exactly uncommon complication after cochlear surgery and long-term follow-up is eagerly required. It can recur more than once, causing more complex treatment strategies in clinical practice. Conservative treatment first recommended, while needle aspiration should initially be considered in recurrent cases also when the effusion swelling is > 3 ml.
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Lovin BD, Sweeney AD, Chapel AC, Alfonso K, Govil N, Liu YCC. Effects of Age on Delayed Facial Palsy After Otologic Surgery: A Systematic Review and Meta-Analysis. Ann Otol Rhinol Laryngol 2022; 131:1092-1101. [PMID: 34706584 DOI: 10.1177/00034894211053966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To report 4 cases of delayed facial palsy (DFP) after pediatric middle ear (ME) surgery and systematically review and analyze the associated literature to evaluate the effects of age on DFP etiology, management, and prognosis. METHODS Systematic review of PubMed, Cochrane Library, and Embase for articles related to DFP after cochlear implantation (CI) was performed. These articles were assessed for level of evidence, methodological limitations, and number of cases. Meta-analysis was performed to assess the effects of age on DFP incidence. Furthermore, a comprehensive list of all pediatric DFP cases after otologic surgery was assembled through a multi-institutional retrospective review and systematic review of the literature. RESULTS Twenty-nine articles fit the criteria for inclusion in the meta-analysis. The incidence of DFP after CI was 0.23% and 1.01% for pediatric and adult cases, respectively. This difference was statistically significant (P < .001, odds ratio 4.36). Twenty-three cases, adding to the 4 presented herein, were suitable for a comprehensive list. The mean age was 6.9 years. Average postoperative day of paresis onset was 5.4, with an average maximum House-Brackmann grade of 3.5. All patients obtained full facial recovery after an average of 23.5 days. CONCLUSIONS The systematic review demonstrates that DFP after pediatric CI is rare and occurs at a significantly lower rate than in adults, further supporting the viral reactivation hypothesis of DFP. The prognosis for pediatric DFP after otologic surgery is excellent, with a high rate of full recovery in a short time frame. However, steroid administration can be considered. LEVEL OF EVIDENCE IIa.
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Affiliation(s)
- Benjamin D Lovin
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Alex D Sweeney
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA.,Division of Otolaryngology, Department of Surgery-Head and Neck Surgery, Texas Children's Hospital, Houston, TX, USA.,Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | | | - Kristan Alfonso
- Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Nandini Govil
- Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, USA.,Division of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Yi-Chun Carol Liu
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA.,Division of Otolaryngology, Department of Surgery-Head and Neck Surgery, Texas Children's Hospital, Houston, TX, USA
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Tepedino MS, Vianna PM, Baptista CHAB, Ferreira DLMS, Junqueira MM. Transnasal endoscopy-guided percutaneous access to the sphenopalatine ganglion for neurostimulation in the treatment of primary headache: operative technique and feasibility. Braz J Otorhinolaryngol 2022; 89:292-299. [PMID: 36369147 PMCID: PMC10071541 DOI: 10.1016/j.bjorl.2022.10.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 10/14/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Cluster headache is considered a trigeminal autonomic cephalalgia and may present with characteristic symptoms of sympathetic/parasympathetic activation on the affected side of the face, such as nasal discharge, tearing, and conjunctival injection. Invasive therapies targeting the sphenopalatine ganglion have been performed in these headache syndromes and can have a medication-sparing effect, especially in refractory, difficult-to-manage cases. The gate control theory of pain suggests that electric pulses delivered to nerve tissues can modulate neuronal activity, thus aiding in management of nociceptive or neuropathic pain, and studies have demonstrated the efficacy and safety of sphenopalatine ganglion neurostimulation. Within this context, we sought to assess the feasibility of a new surgical technique for neurostimulation of the sphenopalatine ganglion in a cadaver dissection model. METHODS The technique was developed through dissection of two cadaver heads. We divided the procedure into two stages: an endonasal endoscopic approach to expose the sphenopalatine ganglion and confirm electrode placement, and a cervicofacial approach to introduce the electrode array and position the internal pulse-generator unit. Computed tomography was performed to confirm implant placement at the end of the procedure. RESULTS The pulse-generator unit was successfully placed through a retroauricular incision, as is already standard for cochlear implant placement. This should reduce the incidence of perioperative sequelae, especially pain and swelling in the oral region, which are a common complication of previous approaches used for this purpose. Control imaging confirmed proper electrode placement. The device used in this study allows the patient to modulate the intensity of the stimulus, reducing or even obviating the need for drug therapy. CONCLUSION The novel technique described herein, based on percutaneous access guided by transmaxillary endoscopy, can provide great precision in electrode array positioning and decreased perioperative morbidity, combining the advantages of endoscopic approaches with those of the retroauricular route. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Miguel Soares Tepedino
- Universidade do Estado do Rio de Janeiro (UERJ), Hospital Universitário Pedro Ernesto, Divisão de Otorrinolaringologia, Rio de Janeiro, RJ, Brazil; Policlínica de Botafogo, Departamento de Otorrinolaringologia, Rio de Janeiro, RJ, Brazil.
| | - Pedro Mino Vianna
- Universidade do Estado do Rio de Janeiro (UERJ), Hospital Universitário Pedro Ernesto, Divisão de Otorrinolaringologia, Rio de Janeiro, RJ, Brazil
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Behnke J, Williamson A, Castaño JE. Cochlear Implant Salvage in Case of Grounding Wire Extrusion. Ann Otol Rhinol Laryngol 2022:34894221126256. [PMID: 36168680 DOI: 10.1177/00034894221126256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Cochlear implantation (CI) is a safe and effective procedure for hearing rehabilitation, with few major complications. Device exposure or extrusion is a rare but major complication that often necessitates explantation due to wound dehiscence or infection. The objective of this report is to present a previously undescribed case in which the cochlear implant grounding wire extruded in 16-month-old patient 3 months post-operatively in the absence of trauma or infection. METHODS We reviewed the case report and the pertinent literature. RESULTS A 16-month old male suffered extrusion of his left cochlear implant grounding wire without known etiology 86 days post-operatively after bilateral cochlear implantation. The patient was taken for surgery, and the electrode was reimplanted without complication followed by 48 hours of prophylactic intravenous antibiotics. Nine month follow up revealed the implant functioning appropriately, with no further major complications encountered. CONCLUSION We present this unique case to demonstrate that a cochlear implant grounding wire extrusion is not necessarily an indication for explantation in the absence of infection.
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Affiliation(s)
- John Behnke
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, WV, USA
| | - Adrian Williamson
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, WV, USA
| | - Johnathan E Castaño
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, WV, USA
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Kondo M, Vasan K, Jufas NE, Patel NP. Cochlear Implantation in Far Advanced Otosclerosis: A Systematic Review and Meta-Analysis. Laryngoscope 2022; 133:1288-1296. [PMID: 36082830 DOI: 10.1002/lary.30386] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 07/28/2022] [Accepted: 08/18/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate speech outcomes and facial nerve stimulation (FNS) rates in patients with far advanced otosclerosis (FAO) after cochlear implantation. METHODS A systematic review was performed using standardized methodology of Medline, EMBASE, PubMed, Cochrane, and Web of Science databases. Studies were included if adults with FAO underwent cochlear implantation. Exclusion criteria included concurrent otologic history (e.g., Meniere's disease, superior canal dehiscence), non-English-speaking implant users, case reports, abstracts, and letters/commentaries. Bias was assessed using the Newcastle-Ottawa Scale for cohort studies and the National Institute of Health Scale for case series. The primary outcome measure was speech discrimination and the secondary outcomes were rates of partial insertion and FNS. RESULTS Twenty-seven studies evaluated cochlear implantation in FAO. Due to the heterogeneity of testing methods, statistical pooling of speech discrimination was not feasible, but qualitative synthesis indicated a positive effect of implantation. Pooled rates of FNS were 18% (95% confidence interval, CI 12%-27%) and the rate of partial insertion was 10% (95% CI 7%-15%). CONCLUSION Cochlear implantation in FAO demonstrates significant gains in speech discrimination scores with higher rates of FNS and partial insertion. Laryngoscope, 2022.
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Affiliation(s)
- Mickey Kondo
- Division of Otolaryngology Head and Neck Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Kartik Vasan
- Division of Otolaryngology Head and Neck Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Nicholas Emmanuel Jufas
- Division of Otolaryngology Head and Neck Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia.,Discipline of Surgery, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Kolling Deafness Research Centre, Royal North Shore Hospital, Macquarie University and University of Sydney, Sydney, New South Wales, Australia
| | - Nirmal P Patel
- Division of Otolaryngology Head and Neck Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia.,Discipline of Surgery, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Kolling Deafness Research Centre, Royal North Shore Hospital, Macquarie University and University of Sydney, Sydney, New South Wales, Australia
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An Easy to use Periosteal Flap for Cochlear Implantation: Experience from a Tertiary Care Centre. Indian J Otolaryngol Head Neck Surg 2022; 74:472-474. [PMID: 36032818 PMCID: PMC9411405 DOI: 10.1007/s12070-020-02267-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 11/03/2020] [Indexed: 10/23/2022] Open
Abstract
This report describes a novel and easy periosteal flap design for cochlear implantation. This technique has been used in 37 patients between June 2019 and August 2020. The patients have been followed up for a period of 2 months to 15 months. There were no flap related complications attributed to this flap. There was no wound hematoma, wound breakdown or implant migration. The flap design is safe, easy, less time consuming and results in better coverage of the receiver stimulator unit without any tension.
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Chen X, Chen Y, Zhang R, Ye S, Lin Z, Nian S, Lin C. The biofilm characteristics and management of skin flap infection following cochlear implantation. ACTA OTORHINOLARYNGOLOGICA ITALICA 2022; 42:372-379. [PMID: 36254653 PMCID: PMC9577691 DOI: 10.14639/0392-100x-n1985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 04/29/2022] [Indexed: 11/23/2022]
Abstract
Objective This study aims to assess the frequency, bacteriology, biofilm characteristics and management of skin flap infection (SFI) following cochlear implantation (CI). Methods The study enrolled 1,251 patients receiving CI in the First Affiliated Hospital of Fujian Medical University between August 2001 and March 2021. Scanning electron microscopy (SEM) was utilised to characterise the aetiology of infection. A proposed classification system was applied to optimise treatments for post-operative skin flap infection. Results After CI, SFI was reported in 16 patients (1.28%) and occurred more frequently in patients under 6 years of age. Of all SFI cases Staphylococcus aureus was the most common pathogen for flap infection, with 8 cases (50%) and bacterial biofilm was evident within the jelly-like substance on the surface of implanted devices in SFI patients. A two-stage classification was proposed to optimise the treatment schemes. Conservative therapy was recommended for stage I cases and surgical treatment for stage II patients. Conclusions Paediatric patients are more susceptible to SFI after CI, which may be attributed to the formation of bacterial biofilm. The proposed classification can facilitate the management of SFI.
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Affiliation(s)
| | | | | | | | | | | | - Chang Lin
- Correspondence Chang Lin Department of Otorhinolaryngology, Head and Neck Surgery of the First Affiliated Hospital of Fujian Medical University, 20 Cha Zhong Road, Taijiang District, Fuzhou, Fujian, China Tel./Fax +86 18959166588 E-mail:
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40
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Sahai I, Ghosh B, Anjankar A. A Spectrum of Intraoperative and Postoperative Complications of Cochlear Implants: A Critical Review. Cureus 2022; 14:e28151. [PMID: 36148185 PMCID: PMC9482671 DOI: 10.7759/cureus.28151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 08/18/2022] [Indexed: 11/05/2022] Open
Abstract
A cochlear implant is a neuroprosthetic, electrical device that is developed for the treatment of patients who have sensory hearing loss. It directly stimulates the hearing nerve by bypassing the injured or damaged sensory receptors, the hair cells. This implant is directly placed in the inner ear. It is an electronic device which is proved to be very useful in patients with sensorineural hearing loss. This implant consists of a speech processor (externally present), which takes up the sound; transforms it into digital signals, and then internal components take it to convert it into electrical energy, which stimulates auditory nerves, and the brain perceives it and hears it as a sound. This is one of the most successful surgeries, which happens very frequently nowadays. Although, many complications are mostly associated with this implant. This paper deals with the preoperative, operative, and postoperative complications associated with cochlear implant surgery. That includes tinnitus, Meniere's disease, unilateral hearing loss, musical ear syndrome, infections; flap necrosis, facial nerve palsy, improper electrode placement, magnet displacement; failure and re-implantation, cholesteatoma, and pneumocephalus. These are just a few of the complications; there are much more complications which are associated with cochlear implants.
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Affiliation(s)
- Isha Sahai
- Otolaryngology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Benumadhab Ghosh
- Otolaryngology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Ashish Anjankar
- Biochemistry, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND
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Benoiton LA, MacLachlan AL, Mustard J, Jayawardana J, Bird P. Classification of cochlear implant complications using a modified Clavien-Dindo classification. Cochlear Implants Int 2022; 23:317-325. [PMID: 35818635 DOI: 10.1080/14670100.2022.2096193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES Cochlear implantation (CI) surgery is a highly effective procedure for severe to profound hearing loss, with a low complication rate. There are currently multiple grading systems for CI surgery complications, making comparison of outcomes difficult. We propose a modification to the Clavien-Dindo classification of complications, and use this modified classification to analyse our complications. METHODS Complications were classified as: I - Self-limiting complications requiring no treatment or simple pharmacological therapies; II - Complications requiring pharmacological interventions other than those permitted under the criteria for Grade I, or non-invasive radiological imaging; IIIa - Complications necessitating surgical, radiological or endoscopic intervention, but excluding implant explantation and/or reimplantation. IIIb - Complications necessitating implant explantation and/or reimplantation. RESULTS 1053 patients were recorded as having had at least one cochlear implant inserted with 114 complications reported in 90 patients. The 114 complications were classified into the proposed classification with 18 (15.7%) as Grade I, 36 (31.5%) as Grade II, 17 (14.9%) as Grade IIIa and 43 (34.2%) as Grade IIIb. DISCUSSION We found a low complication rate, and were able to use the modified Clavien-Dindo classification system to analyse our data. We would strongly advocate for a uniform reporting system and propose this modification of a widely used system.
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Affiliation(s)
- Lara Angele Benoiton
- Department of Otolaryngology, Head and Neck Surgery, Christchurch Public Hospital, Christchurch, New Zealand
| | | | - Jill Mustard
- Southern Cochlear Implant Programme, Christchurch, New Zealand
| | - Janitha Jayawardana
- Department of Otolaryngology, Head and Neck Surgery, Christchurch Public Hospital, Christchurch, New Zealand
| | - Philip Bird
- Department of Otolaryngology, Head and Neck Surgery, Christchurch Public Hospital, Christchurch, New Zealand.,Department of Surgery, University of Otago, Christchurch, New Zealand.,Southern Cochlear Implant Programme, Christchurch, New Zealand
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Cutler H, Gumbie M, Olin E, Parkinson B, Bowman R, Quadri H, Mann T. The cost-effectiveness of unilateral cochlear implants in UK adults. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2022; 23:763-779. [PMID: 34727294 PMCID: PMC9170662 DOI: 10.1007/s10198-021-01393-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 10/21/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE The National Institute for Health and Care Excellence (NICE) updated its eligibility criteria for unilateral cochlear implants (UCIs) in 2019. NICE claimed this would not impact the cost-effectiveness results used within its 2009 technology appraisal guidance. This claim is uncertain given changed clinical practice and increased healthcare unit costs. Our objective was to estimate the cost-effectiveness estimates of UCIs in UK adults with severe to profound hearing loss within the contemporary NHS environment. METHODS A cost-utility analysis employing a Markov model was undertaken to compare UCIs with hearing aids or no hearing aids for people with severe to profound hearing loss. A clinical pathway was developed to estimate resource use. Health-related quality of life, potential adverse events, device upgrades and device failure were captured. Unit costs were derived mostly from the NHS data. Probabilistic sensitivity analysis further assessed the effect of uncertain model inputs. RESULTS A UCI is likely to be deemed cost-effective when compared to a hearing aid (£11,946/QALY) or no hearing aid (£10,499/QALY). A UCI has an 93.0% and 98.7% likelihood of being cost-effective within the UK adult population when compared to a hearing aid or no hearing aid, respectively. ICERs were mostly sensitive to the proportion of people eligible for cochlear implant, discount rate, surgery and device costs and processor upgrade cost. CONCLUSION UCIs remain cost-effective despite changes to clinical practice and increased healthcare unit costs. Updating the NICE criteria to provide better access UCIs is projected to increase annual implants in adults and children by 70% and expenditure by £28.6 million within three years. This increased access to UCIs will further improve quality of life of recipients and overall social welfare.
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Affiliation(s)
- Henry Cutler
- Macquarie University Centre for the Health Economy, Sydney, Australia.
| | - Mutsa Gumbie
- Macquarie University Centre for the Health Economy, Sydney, Australia
| | - Emma Olin
- Macquarie University Centre for the Health Economy, Sydney, Australia
| | - Bonny Parkinson
- Macquarie University Centre for the Health Economy, Sydney, Australia
| | - Ross Bowman
- Health Technology Analysts, Sydney, Australia
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Davidson L, Foley DA, Clifford P, Blyth CC, Bowen AC, Hazelton B, Kuthubutheen J, McLeod C, Rodrigues S, Tay SM, Campbell AJ. Infectious complications and optimising infection prevention for children with cochlear implants. J Paediatr Child Health 2022; 58:1007-1012. [PMID: 35138003 DOI: 10.1111/jpc.15889] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 01/24/2022] [Indexed: 11/30/2022]
Abstract
AIM To describe the clinical epidemiology of children receiving cochlear implants, as well as the management and outcomes of cochlear implant infections and adherence to infection prevention measures. METHODS A retrospective observational study was conducted in children ≤18 years who received cochlear implants in Western Australia's tertiary paediatric hospital. Information was obtained from medical and laboratory records regarding demographics, indication for implant, implant infection and preoperative Staphylococcus aureus screening/decolonisation. Immunisation history was examined using the Australian Immunisation Register. RESULTS Overall, 118 children received cochlear implants, with 158 devices inserted (599 cochlear implant insertion-years). An implant infection rate of 3.8% (6/158) was identified during the study period (four pneumococcal and two community-acquired methicillin resistant S. aureus infections). All required surgical management, with an overall median duration of antibiotic therapy of 37 days (interquartile range (IQR) 29-48) and median length of stay of 8 days (IQR 8-9.5). All devices were retained and there were no relapses or deaths. Half of the children who developed cochlear implant infections (50%, 3/6) were up-to-date with additional pneumococcal vaccinations and no children (0%, 0/118) received S. aureus screening/decolonisation before implant insertion. CONCLUSIONS Favourable outcomes were achieved with cochlear implant retention; however, the treatment was burdensome for families. We demonstrate significant scope to improve adherence to existing infection prevention strategies and provide direction for optimising preventative measures in the future. These include ensuring parental education, additional pneumococcal vaccinations and S. aureus decolonisation which are delivered as an infection prevention bundle to the growing population of infants receiving cochlear implants.
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Affiliation(s)
- Lucy Davidson
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - David A Foley
- Department of Infectious Diseases, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Patricia Clifford
- Department of Infectious Diseases, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Christopher C Blyth
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia.,Department of Infectious Diseases, Perth Children's Hospital, Nedlands, Western Australia, Australia.,Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Western Australia, Australia.,Department of Microbiology, Pathwest Laboratory Medicine, QEII Medical Centre, Nedlands, Western Australia, Australia
| | - Asha C Bowen
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia.,Department of Infectious Diseases, Perth Children's Hospital, Nedlands, Western Australia, Australia.,Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Briony Hazelton
- Department of Infectious Diseases, Perth Children's Hospital, Nedlands, Western Australia, Australia.,Department of Microbiology, Pathwest Laboratory Medicine, QEII Medical Centre, Nedlands, Western Australia, Australia
| | - Jafri Kuthubutheen
- Department of ENT, Perth Children's Hospital, Nedlands, Western Australia, Australia.,Division of Surgery, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Charlie McLeod
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia.,Department of Infectious Diseases, Perth Children's Hospital, Nedlands, Western Australia, Australia.,Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Stephen Rodrigues
- Department of ENT, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Siu Min Tay
- Department of Paediatrics, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Anita J Campbell
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia.,Department of Infectious Diseases, Perth Children's Hospital, Nedlands, Western Australia, Australia.,Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Western Australia, Australia
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Bae SH, Jung Y, Jung J, Choi JY. Clinical Experience of Using Active Transcutaneous Bone Conduction Implants (Bonebridge) in Children Under 5 Years Old. Clin Exp Otorhinolaryngol 2022; 15:194-196. [PMID: 35255663 PMCID: PMC9149232 DOI: 10.21053/ceo.2021.02208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/05/2022] [Accepted: 01/08/2022] [Indexed: 11/22/2022] Open
Affiliation(s)
- Seong Hoon Bae
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - Youngrak Jung
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - Jinsei Jung
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Young Choi
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
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Hugel M, Ayari-Khalfallah S, Fieux M, Coudert A, Truy E, Hermann R. Feasibility of day-case pediatric cochlear implantation. Eur Arch Otorhinolaryngol 2022; 279:5123-5133. [PMID: 35476132 DOI: 10.1007/s00405-022-07353-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 03/10/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Pediatric cochlear implantation is performed on an outpatient basis in an inconstant way. The aim of this study is to assess the feasibility of day-case pediatric cochlear implantation by determining the acceptability of outpatient-to-inpatient conversion rate (acceptability threshold of 5%) and to assess the safety by comparing outpatient and inpatient postoperative events. We also want to identify conversion predictive factors. METHODS We conducted a monocentric retrospective study including 267 cases aged 6 months to 18 years who underwent unilateral cochlear implantation between 2016 and 2020. This population was divided into two groups: outpatient group (190 cases) and inpatient group (77 cases). RESULTS Among the 190 cases scheduled as day surgery, 9 cases required conversion to conventional hospitalization which leads to an outpatient-to-inpatient conversion rate of 4.7%. Postoperative nausea and vomiting (PONV) were involved in all cases of conversion. Conversion predictive factors were the presence of an inner ear malformation at risk of gusher (OR 32.51, 95% CI [4.98-370.27], p 0.001) and the intraoperative administration of morphine (OR 8.52, 95% CI [1.38-86.84], p 0.035). There was no statistically significant difference in immediate postoperative complications (outpatient 14.2% vs inpatient 16.9% p 0.715), early-stage complications (outpatient 12.6% vs inpatient 10.4% p 0.812) and early-stage unplanned consultations (outpatient 4.7% vs inpatient 3.9% p 0.748) between outpatient and inpatient groups. Unplanned readmissions were found only in the outpatient group. CONCLUSION Day-case pediatric cochlear implantation is a feasible and safe procedure even in infants. The outpatient-to-inpatient conversion rate of 4.7% is considered acceptable but requires anticipation of human and accommodation needs. No causes of conversion were life-threatening. The risk of postoperative complications and unplanned consultations are not influenced by the mode of hospitalization. Special attention should be paid to the prevention of PONV and the presence of inner ear malformations.
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Affiliation(s)
- Margot Hugel
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Département d'oto-rhino-laryngologie, de chirurgie cervico-maxillo-faciale et d'audiophonologie, 69003, Lyon, France. .,Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, Service d'ORL et de Chirurgie Cervico-Faciale Pédiatrique, F-69500, Bron, France.
| | - Sonia Ayari-Khalfallah
- Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, Service d'ORL et de Chirurgie Cervico-Faciale Pédiatrique, F-69500, Bron, France
| | - Maxime Fieux
- Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Service d'ORL, d'otoneurochirurgie et de chirurgie cervico-faciale, 69495, Pierre-Bénite, France.,Université Claude Bernard Lyon 1, 69003, Lyon, France
| | - Aurélie Coudert
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Département d'oto-rhino-laryngologie, de chirurgie cervico-maxillo-faciale et d'audiophonologie, 69003, Lyon, France.,Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, Service d'ORL et de Chirurgie Cervico-Faciale Pédiatrique, F-69500, Bron, France
| | - Eric Truy
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Département d'oto-rhino-laryngologie, de chirurgie cervico-maxillo-faciale et d'audiophonologie, 69003, Lyon, France.,Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, Service d'ORL et de Chirurgie Cervico-Faciale Pédiatrique, F-69500, Bron, France.,Université Claude Bernard Lyon 1, 69003, Lyon, France
| | - Ruben Hermann
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Département d'oto-rhino-laryngologie, de chirurgie cervico-maxillo-faciale et d'audiophonologie, 69003, Lyon, France.,Université Claude Bernard Lyon 1, 69003, Lyon, France
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Landry EC, Scholte M, Su MP, Horstink Y, Mandavia R, Rovers MM, Schilder AGM. Early Health Economic Modeling of Novel Therapeutics in Age-Related Hearing Loss. Front Neurosci 2022; 16:769983. [PMID: 35310110 PMCID: PMC8930912 DOI: 10.3389/fnins.2022.769983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 01/31/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundHealth systems face challenges to accelerate access to innovations that add value and avoid those unlikely to do so. This is very timely to the field of age-related sensorineural hearing loss (ARHL), where a significant unmet market need has been identified and sizeable investments made to promote the development of novel hearing therapeutics (NT). This study aims to apply health economic modeling to inform the development of cost-effective NT.MethodsWe developed a decision-analytic model to assess the potential costs and effects of using regenerative NT in patients ≥50 with ARHL. This was compared to the current standard of care including hearing aids and cochlear implants. Input data was collected from systematic literature searches and expert opinion. A UK NHS healthcare perspective was adopted. Three different but related analyses were performed using probabilistic modeling: (1) headroom analysis, (2) scenario analyses, and (3) threshold analyses.ResultsThe headroom analysis shows an incremental net monetary benefit (iNMB) of £20,017[£11,299–£28,737] compared to the standard of care due to quality-adjusted life-years (QALY) gains and cost savings. Higher therapeutic efficacy and access for patients with all degrees of hearing loss yields higher iNMBs. Threshold analyses shows that the ceiling price of the therapeutic increases with more severe degrees of hearing loss.ConclusionNT for ARHL are potentially cost-effective under current willingness-to-pay (WTP) thresholds with considerable room for improvement in the current standard of care pathway. Our model can be used to help decision makers decide which therapeutics represent value for money and are worth commissioning, thereby paving the way for urgently needed NT.
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Affiliation(s)
- Evie C. Landry
- Division of Otolaryngology-Head and Neck Surgery, St. Paul’s Hospital, BC Rotary Hearing and Balance Centre, University of British Columbia, Vancouver, BC, Canada
- National Institute for Health Research University College London Hospitals Biomedical Research Centre Hearing Theme, London, United Kingdom
- evidENT, Ear Institute, University College London, London, United Kingdom
| | - Mirre Scholte
- Department of Operating Rooms, Radboud University Medical Center, Nijmegen, Netherlands
| | - Matthew P. Su
- National Institute for Health Research University College London Hospitals Biomedical Research Centre Hearing Theme, London, United Kingdom
- evidENT, Ear Institute, University College London, London, United Kingdom
| | - Yvette Horstink
- Department of Operating Rooms, Radboud University Medical Center, Nijmegen, Netherlands
| | - Rishi Mandavia
- National Institute for Health Research University College London Hospitals Biomedical Research Centre Hearing Theme, London, United Kingdom
- evidENT, Ear Institute, University College London, London, United Kingdom
| | - Maroeska M. Rovers
- Department of Operating Rooms, Radboud University Medical Center, Nijmegen, Netherlands
| | - Anne G. M. Schilder
- National Institute for Health Research University College London Hospitals Biomedical Research Centre Hearing Theme, London, United Kingdom
- evidENT, Ear Institute, University College London, London, United Kingdom
- *Correspondence: Anne G. M. Schilder,
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Albertsen LN, Lauridsen JK. A Review Electroconvulsive Therapy in Cochlear Implant Patients. J ECT 2022; 38:10-12. [PMID: 34699392 DOI: 10.1097/yct.0000000000000803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT The use of electroconvulsive therapy (ECT) in cochlear implant (CI) users is debatable. Currently, no consensus statement exists about the safety for the patients and the implants. Here, we present a summary of the existing literature on ECT in CI users, consisting of 4 case reports and a cadaveric study. No harm to the patients or the CIs was reported. Based on our review, we have found no evidence to indicate that ECT in CI users is contraindicated.
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48
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Yeung JC, Griffin A, Newton S, Kenna M, Licameli GR. In Response to, "Is revision of Cochlear Implants Infrequent?". Laryngoscope 2022; 132:E17. [PMID: 35133012 DOI: 10.1002/lary.30035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 01/15/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Jeffrey C Yeung
- Department of Otolaryngology - Head and Neck Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Amanda Griffin
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Harvard Medical, Boston, Massachusetts, USA
| | - Steven Newton
- Department of Otolaryngology, Children's Hospital Colorado, Colorado Springs, Colorado, USA
| | - Margaret Kenna
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Harvard Medical, Boston, Massachusetts, USA
| | - Greg R Licameli
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Harvard Medical, Boston, Massachusetts, USA
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49
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Walters B, Gaskell P, Muzaffar J, Iftikhar H, Monksfield P, Bance M. Cochlear implantation under local anesthetic: A systematic review and meta-analysis. Laryngoscope Investig Otolaryngol 2022; 7:226-236. [PMID: 35155802 PMCID: PMC8823255 DOI: 10.1002/lio2.720] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/17/2021] [Accepted: 12/11/2021] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES As the population ages and implantation criteria are relaxed, more patients with complex comorbidities are becoming eligible for cochlear implantation (CI). These patients have higher risks associated with general anesthesia. This systematic review assesses outcomes and complications following CI under local anesthetic to examine utility for patients deemed not suitable or at high risk for general anesthesia. METHODS A systematic review and meta-analysis performed according to the 2020 PRISMA guidelines. Databases searched were MEDLINE, PubMed, EMBASE, CINAHL, Web of Science Core Collection, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials and ClinicalTrials.gov. There were no limitations on year of publication or language. RESULTS Then, 132 unique were identified. After screening abstracts and full texts for eligibility criteria a total of 18 articles were included. In the nine studies where audiological data were reported, all patients demonstrated improvement in audiological outcomes following implantation under local anesthetic (LA). Only minor complications of transient vertigo, wound infection, facial nerve paralysis, confusion, and tinnitus were reported but all were transient. Meta-analysis showed surgical time was significantly shorter under LA. CONCLUSIONS CI under LA is safe for patients with comorbidities which preclude them from general anesthesia, with minimal complications and an improved cost-effectiveness profile. However, larger scale, robust trials are required to assess this further.
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Affiliation(s)
- Ben Walters
- Royal Stoke University HospitalStoke On TrentUK
| | - Peter Gaskell
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital BirminghamBirminghamUK
| | - Jameel Muzaffar
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital BirminghamBirminghamUK
- Department of Clinical NeurosciencesUniversity of Cambridge, Addenbrooke's Health CampusCambridgeUK
| | - Haissan Iftikhar
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital BirminghamBirminghamUK
| | - Peter Monksfield
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital BirminghamBirminghamUK
| | - Manohar Bance
- Department of Clinical NeurosciencesUniversity of Cambridge, Addenbrooke's Health CampusCambridgeUK
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50
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Self-Identified Patient Barriers to Pursuit of Cochlear Implantation. Otol Neurotol 2021; 42:S26-S32. [PMID: 34766941 DOI: 10.1097/mao.0000000000003376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Cochlear implantation (CI) is an underutilized treatment for hearing loss in the United States for reasons which remain unclear. This study explores self-identified barriers to CI employing a survey of adults who qualified for CI. METHODS A single-institutional review of CI candidates between December 2010 and December 2018 was performed to identify patients who did not pursue surgery. A 21-question survey was developed, aimed at rating patients' concerns regarding CI, including surgical risks, adaptation, costs, time commitment, loss of residual hearing, and lack of benefit, among others. Current hearing aid usage and familiarity with other CI users were also analyzed. The survey was administered to patients who did not pursue CI and a control group who eventually did pursue CI, via email or telephone. RESULTS There were 199 patients who initially did not pursue CI. Fifty-two survey responses were received, comprised of 27 patients who did not pursue CI and 25 patients who did. A belief that CI would not significantly improve the ability to communicate was the most common reported barrier, followed by the postoperative recovery process, risks of surgery, and risks of losing music appreciation. Anesthetic risk and cost were the least important reasons not to pursue CI. Half of patients reported concerns regarding the period of adjustment with the CI. CONCLUSION The decision not to pursue CI despite eligibility is multifactorial and includes concern for minimal hearing benefit and perioperative risks. These factors should be taken into consideration when counseling patients on CI surgery.
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