Αναζήτηση αυτού του ιστολογίου

Πέμπτη 10 Μαρτίου 2022

Hearing preservation in cochlear implant recipients: A cross‐sectional cohort study

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Abstract

Objectives

A surge of new developments and research regarding cochlear implants and hearing preservation resulted in several treatment options in the last 5 years. By reviewing our CI population of this period, we aimed to investigate hearing preservation rates and the effect of different treatment options on hearing preservation.

Design

Retrospectively, all adult cochlear implant recipients with preoperative residual hearing at lower frequencies (threshold <80 dB hearing level) in a single tertiary referral centre between 2015 and 2020 were analysed. Patients were classified into four groups based on their hearing preservation outcome. Subsequently, differences between the four groups regarding several patient dependent and independent factors were investigated.

Results

In this study, 140 patients were included, which is 46% of all adult CI recipients. Complete hearing preservation was achieved in 14 patients (10%), and complete loss of residual hearing in 48 patients (34%). The lateral wall array and local application of corticosteroids were associated with better hearing preservation. Intravenous corticosteroids, local hyaluronic acid and surgical experience had no effect on hearing preservation rates. Speech perception was not better in patients with residual hearing.

Conclusion

Approximately half of all adult cochlear implant recipients had residual hearing at lower frequencies before surgery. In current medical practice, only electrode choice seems to have a clear effect on hearing preservation rates. The majority of CI recipients lose their residual hearing after cochlear implantation. Much improvement in treating CI recipients is needed to preserve their residual hearing in the future.

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Defining the limits and indications of the Draf III endoscopic approach to the lateral frontal sinus and maximizing visualization and maneuverability: a cadaveric and radiological study

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Eur Arch Otorhinolaryngol. 2022 Mar 9. doi: 10.1007/s00405-022-07323-9. Online ahead of print.

ABSTRACT

PURPOSE: The DRAF III procedure has been used for access to the lateralmost part of the frontal sinus. We sought to identify anatomical and radiological measurements as well as modifications that predict the lateral limits of visualization and surgical access after this procedure.

METHODS: Seven cadaver heads were imaged with computed tomography scan. The distance from midline to the medial orbital wall (MOWD), midline to the lateral end of the frontal sinus (MLD), the sum of MLDs (SMLD), interorbital distance (IOD) and the shortest anteroposterior distance of the frontal recess (APD) were utilized. The ratios MLD/MOWD, and SMLD/IOD were calculated. The same distances were measured on 41 CT scans. Orbital transposition (OT) and partial resection of the piriform aperture (PAR) were performed; the visualization and reach were ass essed. The angle of insertion was measured before and after the modifications.

RESULTS: Only the ratio MLD/MOWD was consistently predictive of access to the lateral, superior and posterior wall of the frontal sinus. Following the modifications, a visualization of 100% laterally was achieved with the 30- and 45 degree endoscopes and every lateral recess could be reached with the 70 degree suction. A mean increase of the angle of insertion of 25.3 and 59.6% was recorded after OT and PAR, respectively.

CONCLUSIONS: IOD rather than APD defines the limits of the Draf III approach to the lateral frontal sinus and MLD/MOWD ratio can serve as a useful preoperative tool. Along to the already described OT, PAR increases visualization and reach of the lateral frontal sinus.

PMID:35266026 | DOI:10.1007/s00405-022-07323-9

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Quality Indicators for the Diagnosis and Management of Primary Hyperparathyroidism

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This quality improvement study develops quality indicator s to evaluate the diagnosis and treatment of primary hyperparathyroidism that could measure, improve, and optimize quality of care and outcomes for patients with this disease.
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A Perplexing Pediatric Parotid Mass

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A previously healthy 8-year-old boy presented to an outpa tient clinic for further evaluation of a fluctuating right parotid mass that had been present for 3 years. What is your diagnosis?
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Development and Validation of a Novel At-home Smell Assessment

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This diagnostic study develops and validates a simple scr eening assessment for olfactory dysfunction using common household items.
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Is a 4-Day Low-Iodine Diet Sufficient for Radioactive Iodine Ablation in Differentiated Thyroid Cancer Treatment?

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Clinical Thyroidology, Volume 34, Issue 3, Page 123-126, March 2022.
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Possible Association between Lenvatinib Use and Primary Adrenal Insufficiency: Additional Studies Very Much Needed

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Clinical Thyroidology, Volume 34, Issue 3, Page 132-135, March 2022.
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Hypothyroid Patients Describe What Brain Fog Feels Like

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Clinical Thyroidology, Volume 34, Issue 3, Page 106-108, March 2022.
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Prevalence of “Higher-Risk” Adverse Histological Features Found at Autopsy in Patients with Occult Differentiated Thyroid Cancer

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Clinical Thyroidology, Volume 34, Issue 3, Page 127-131, March 2022.
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The Role of a Computer-Aided Diagnosis System in the Interpretation of Thyroid Nodules with Challenging Sonographic Features

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Clinical Thyroidology, Volume 34, Issue 3, Page 112-115, March 2022.
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Pharyngolaryngeal Morbidity With the Laryngeal Mask Airway SupremeTM at Different Fiberoptic Bronchoscopy Grades: An Observational Study

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To assess whether the different fiberoptic bronchoscopy (FOB) grades of laryngeal mask airway (LMA) Supreme™ affects pharyngolaryngeal morbidity (PLM, including sore throat, dysphonia, pharyngoxerosis, and dysphagia) after general anesthesia.
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Surgical Outcomes Following Vestibular Schwannoma Resection in Patients over the Age of Sixty-five

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J Neurol Surg B Skull Base
DOI: 10.1055/a-1771-0504

Objective Vestibular schwannoma (VS) are benign, often slow growing neoplasms. Some institutions opt for radiosurgery in symptomatic patients of advanced age versus surgical resection. The aim of the study is to analyze surgical outcomes of VS in patients over the age of 65 who were either not candidates for or refused radiosurgery. Methods This includes retrospective analysis of VS patients between 1988 and 2020. Demographics, tumor characteristics, surgical records, and clinical outcomes were recorded. Patient preference for surgery over radiosurgery was recorded in the event that patients were offered both. Facial nerve outcomes were quantified using House-Brackmann (HB) scores. Tumor growth was defined by increase in size of >2 mm. Results In total, 64 patients were included of average age 72.4 years (65–84 years). Average maximum tumor diameter was 29 mm (13–55 mm). Forty-five patients were offered surgery or GKRS, and chose surgery commonly due to radiation aversion (48.4%). Gross total resection was achieved in 39.1% (n = 25), near total 32.8% (n = 21), and subtotal 28.1% (n = 18). Average hospitalization was 5 days [2–17] with 75% (n = 48) discharged home. Postoperative HB scores were good (HB1–2) in 43.8%, moderate (HB3–4) in 32.8%, and poor (HB5–6) in 23.4%. HB scores improved to good in 51.6%, moderate in 31.3%, and remained poor in 17.1%, marking a rate of facial nerve improvement of 10.9%. Tumor control was achieved in 95.3% of cases at an average follow-up time of 37.8 months. Conclusion VS resection can be safely performed in patients over the age of 65. Advanced age should not preclude a symptomatic VS patient from being considered for surgical resection.
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Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

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