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Findlay C, Edwards M, Hough K, Grasmeder M, Newman TA. Leveraging real-world data to improve cochlear implant outcomes: Is the data available? Cochlear Implants Int 2023:1-12. [PMID: 37088565 DOI: 10.1080/14670100.2023.2198792] [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: 04/25/2023]
Abstract
OBJECTIVES A small but persistent proportion of individuals do not gain the expected benefit from cochlear implants(CI). A step-change in the understanding of factors affecting outcomes could come through data science. This study evaluates clinical data capture to assess the quality and utility of CI user's health records for data science, by assessing the recording of otitis media. Otitis media was selected as it is associated with the development of sensorineural hearing loss and may affect cochlear implant outcomes. METHODS A retrospective service improvement project evaluating the medical records of 594 people with a CI under the care of the University of Southampton Auditory Implant Service between 2014 and 2020. RESULTS The clinical records are suitable for data science research. Of the cohort studied 20% of Adults and more than 40% of the paediatric cases have a history of middle ear inflammation. DISCUSSION Data science has potential to improve cochlear implant outcomes and improve understanding of the mechanisms underlying poor performance, through retrospective secondary analysis of real-world data. CONCLUSION Implant centres and the British Cochlear Implant Group National Hearing Implant Registry are urged to consider the importance of consistently and accurate recording of patient data over time for each CI user. Data where links to hearing loss have been identified, such as middle ear inflammation, may be particularly valuable in future analyses and to inform clinical trials.
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Affiliation(s)
- Callum Findlay
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Building 85, Highfield Campus, Southampton S017 1BJ, UK
- Department of Otolaryngology, University Hospital Southampton NHS FT, Tremona Road, Southampton SO16 6YD, UK
| | - Mathew Edwards
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Building 85, Highfield Campus, Southampton S017 1BJ, UK
| | - Kate Hough
- Faculty of Engineering and Physical Sciences, Highfield Campus, University of Southampton, Building 85, Southampton, UK
| | - Mary Grasmeder
- Faculty of Physical Sciences, Highfield Campus, University of Southampton Auditory Implant Services, B19, Southampton SO171BJ, UK
| | - Tracey A Newman
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Building 85, Highfield Campus, Southampton S017 1BJ, UK
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Meor Abdul Malik MF, Hashim ND, Wan Mansor WN, Abdul Gani N. Infected Cochlear Implant and Re-implantation in a Pediatric Case. Cureus 2023; 15:e35613. [PMID: 37007321 PMCID: PMC10063338 DOI: 10.7759/cureus.35613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2023] [Indexed: 03/03/2023] Open
Abstract
Cochlear implant (CI) surgery is relatively safe, however reports of complications and failure following cochlear implant surgery are higher nowadays due to the increasing number of patients with CI. Herein, we report a case of infected cochlear implant 10 months after surgery. A three-year-six-month-old girl underwent right cochlear implantation for bilateral profound sensorineural hearing loss. From day one until six months after the surgery, it was uneventful and the wound healed well. However, at 10 months post-surgery, she presented with a chronic discharging wound over the previous surgical site. Despite being on IV antibiotics for six weeks and daily dressing, the wound over the implant site keep discharging and eventually the implant was removed two months later. She was later re-implanted with a cochlear implant on the same side at the age of five years 10 months old. Currently, she is showing good speech improvement with the right CI. Her aided hearing threshold is at 30-40 dB at all frequencies. Early diagnosis is crucial, and the proper course of action should be taken as soon as possible if implant failure is suspected. Prior to implant surgery, any potential risk factors that could lead to implant failure should be identified and addressed appropriately to reduce the risk of an infected cochlear implant.
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Dharmarajan S, Dham R, Kurkure R, Arumugam SV, Maheswari S, Kameswaran M. Role of Immediate Pre-Operative Tympanometry in Cochlear Implantation: MERF Protocol and Experience. Indian J Otolaryngol Head Neck Surg 2021; 73:351-355. [PMID: 34471625 DOI: 10.1007/s12070-021-02591-z] [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: 03/31/2021] [Accepted: 04/26/2021] [Indexed: 11/27/2022] Open
Abstract
(1) To study the association between an immediate pre-operative tympanometric profile in patients undergoing cochlear implantation with their intraoperative findings. (2) To analyse the intraoperative middle ear findings that require a staged cochlear implantation in patients presenting with a B-type tympanogram. (3) To study the complications in this group of patients during the 1-year follow-up. This retrospective non-interventional cohort study is done over a period of 6 years. Bilaterally profound deaf children, less than 6 years of age, and no history of otitis media with effusion were included in the study. Children who met the inclusion criteria were divided into 4 groups based on their tympanometric profiles that are A, As, B, and C type tympanogram and, their intraoperative findings were categorized as normal, mild oedema, minimal granulation with mild oedema, moderate to extensive granulation with or without oedematous mucosa and glue. Then finally, depending on the intraoperative middle ear and mastoid finding, a single-stage surgery or a two stage surgery was decided upon. A total of 1025 patients were implanted during the study period, 975 patients met our inclusion criteria. In our series, we found a statistically significant difference (p < 0.0001) between the tympanograms and their respective intra-operative middle ear findings. A statistically significant difference was seen (p < 0.0001) between patients who underwent a single-stage cochlear implant and those who underwent a two-staged surgery, regarding their intraoperative middle ear findings. No statistical significance was seen in the occurrence of complications between the groups undergoing a single stage and a two-staged surgery (p > 0.5). This study showcases the importance of immediate pre-operative tympanometry in cochlear implant surgeries. Two-stage surgery is a decision taken on the operating table, depending on the extent of pathology and visibility of the round window niche.
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Affiliation(s)
| | - Ruchima Dham
- Madras ENT Research Foundation (Pvt) Ltd, 1, First Cross, Street, Off Second Main Road, RA Puram, Chennai, Tamil Nadu 600028 India
| | | | - Senthil Vadivu Arumugam
- Madras ENT Research Foundation (Pvt) Ltd, 1, First Cross, Street, Off Second Main Road, RA Puram, Chennai, Tamil Nadu 600028 India
| | - Sudha Maheswari
- Madras ENT Research Foundation (Pvt) Ltd, 1, First Cross, Street, Off Second Main Road, RA Puram, Chennai, Tamil Nadu 600028 India
| | - Mohan Kameswaran
- Madras ENT Research Foundation (Pvt) Ltd, 1, First Cross, Street, Off Second Main Road, RA Puram, Chennai, Tamil Nadu 600028 India
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Elzayat S, Nada I, El sherif H, Mahrous A. The safety of posterior tympanotomy in otitis media with effusion during cochlear implantation: clinical retrospective cohort study. Acta Otolaryngol 2021; 141:1-4. [PMID: 32921210 DOI: 10.1080/00016489.2020.1813905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Posterior tympanotomy (PT) is an important step in cochlear implant (CI) surgery, as it is the main access to the round window. Some CI candidates, especially children, may have concomitant otitis media with effusion (OME) which may result in technical issues during PT. There is still a debate whether to wait for OME resolution preoperatively or to proceed to surgery with suspected difficulties. AIMS/OBJECTIVE To evaluate the safety of PT during CI surgery in patients with OME. MATERIAL AND METHODS we included 102 consecutive pediatric candidates in this retrospective study with an age range of 12 months to 6 years. All the patients underwent CI surgery using trans-mastoid, PT to access round window (RW) area. We investigated the effect of the pathology caused by OME on the operative procedure in PT and post-operative consequences. THE RESULTS out of 102 patients included in this study, there were 22 patients with OME who had unilateral cochlear implantation with no major operative or post-operative events. Nevertheless, some minor intra operative events and difficulties were encountered. CONCLUSION AND SIGNIFICANCE The presence of OME in CI surgery indicates possible surgical challenges such as difficult PT, minor intra-operative risks and with no major post-operative events.
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Affiliation(s)
- Saad Elzayat
- ENT Department, Kaferelsheikh University, Kaferelsheikh, Egypt
| | - Ihab Nada
- ENT Department, MISR Univesity for Science & Technology, Cairo, Egypt
| | | | - Ali Mahrous
- ENT Department, Al-Azhar University, Cairo, Egypt
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Al Omari A, Nuseir A, Ata MB, Khasawneh L, Alhowary AA, Alzoubi F. Accuracy of intraoperative electrophysiological testing in confirming correct cochlear implant electrode positions. Cochlear Implants Int 2019; 20:324-330. [PMID: 31464178 DOI: 10.1080/14670100.2019.1656904] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: To investigate the accuracy of intraoperative electrophysiological studies in detecting incorrectly positioned electrodes in cochlear implant surgery. Study design: A retrospective chart review. Setting: Tertiary referral centre. Patients: In total, 104 consecutive patients with a mean age of 5 years underwent cochlear implant surgery at our centre between January 2012 and December 2013. All patients were implanted with Cochlear Nucleus Freedom implants. Method: A retrospective study to compare intraoperative neural response telemetry (NRT), impedance and electrode position using Stenver's transorbital plain X-ray view. Results: Intraoperative electrophysiological tests for patients with Cochlear Nucleus Freedom implants showed 97% sensitivity and 100% specificity compared with postoperative X-ray imaging. Conclusion: NRT results for the position of cochlear implants were very accurate when checked by X-ray imaging showing that this technique is sufficient in most cases. Stenver's plain X-ray view is needed in complicated cases with abnormal NRT testing or difficult electrode insertion.
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Affiliation(s)
- Ahmad Al Omari
- Otolaryngology Department, Faculty of Medicine, Jordan University of Science and Technology , P.O Box 3030, Irbid 22110 , Jordan
| | - Amjad Nuseir
- Otolaryngology Department, Faculty of Medicine, Jordan University of Science and Technology , P.O Box 3030, Irbid 22110 , Jordan
| | - Majid Bani Ata
- Otolaryngology Department, Faculty of Medicine, Jordan University of Science and Technology , P.O Box 3030, Irbid 22110 , Jordan
| | - Laith Khasawneh
- Otolaryngology Department, Faculty of Medicine, Hashemite University , P.O Box 3030127, Zarqa , Jordan
| | - Ala A Alhowary
- Department of Anesthesiology, Faculty of Medicine, Jordan University of Science and Technology , P.O Box 3030, Irbid 22110 , Jordan
| | - Firas Alzoubi
- Otolaryngology Department, Faculty of Medicine, Jordan University of Science and Technology , P.O Box 3030, Irbid 22110 , Jordan
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Cevizci R, Dilci A, Celenk F, Karamert R, Bayazit Y. Surgical considerations and safety of cochlear implantation in otitis media with effusion. Auris Nasus Larynx 2018; 45:417-420. [DOI: 10.1016/j.anl.2017.07.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 05/19/2017] [Accepted: 07/11/2017] [Indexed: 11/26/2022]
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Risk factors for complications in cochlear implant surgery. Eur Arch Otorhinolaryngol 2018; 275:895-903. [PMID: 29429025 DOI: 10.1007/s00405-018-4901-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 02/05/2018] [Indexed: 12/31/2022]
Abstract
PURPOSE The objective of this study was to achieve uniform reporting of complications and failures in cochlear implantation, to analyze complications and failures and to identify risk factors for complications in a series of over 1300 cochlear implantations. METHODS In a retrospective chart review and observational study, data from all cochlear implantations from 1987 to 2015 were entered in a custom-made database. Complications were classified using the contracted form of the Clavien-Dindo system and risk factors were identified by statistical analysis. RESULTS A complication rate of 18.4% and a device failure rate of 2.9% were found. There was a higher rate of hematoma in patients with a clotting disorder and when a subtotal petrosectomy was performed, a higher rate of wound infections in patients who were not vaccinated against Streptococcus pneumoniae and a higher rate of meningitis in patients with an inner ear malformation. CONCLUSIONS The use of a strict definition of a medical complication and device failure-in combination with the Clavien-Dindo classification system-enables uniform and objective registration of adverse events and prevents any tendency to downgrade complications. Complication and failure rates in this series are comparable to those reported in the literature. These results stress the need for pneumococcal vaccination, which may prevent general wound infections, but is especially important for patients with inner ear malformation, who have an increased risk of (postoperative) meningitis.
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