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Appreciation of music in children with cochlear implants
Otolaryngology– Head and Neck Surgery Volume 129 Number 2
Room OCCC 204 •
Scientific Session: Otology/Neurotology Karen J Doyle MD PhD; Patrick J Antonelli MD (moderators)
8:00
AM
Advances in Congenital Aural Atresia Surgery: Effects on Outcome Karen Borne Teufert MD (presenter); Antonio De la Cruz MD Glendale CA; Los Angeles CA
Objectives: To compare modifications in the surgical technique of congenital aural atresia (use of argon laser, thinner split-thickness skin graft, Silastic sheets in the external auditory canal [EAC], and Ambrus ear packs) by examining hearing results and complications prior to and after initiation of these changes. Methods: A retrospective chart review of patients who underwent congenital aural atresiaplasty between 1985 and 2002 in a tertiary referral neurotologic private practice was performed. There were 116 atretic ears. Complication rates and hearing results were compared before and after modifications in the surgical technique of congenital aural atresia. Results: Closure of the air-bone gap (ABG) to 30 dB or less at short-term follow-up occurred in 65.7% of surgeries performed after modifications in the surgical technique and 45.0% of surgeries performed before these changes (P ⬍ 0.044). The long-term postoperative ABG was 30 dB or less in 52.1% of the surgeries performed after and 42.9% of the cases performed before the changes in surgical technique. Soft tissue stenosis was seen in 4.2% of surgeries performed after and 11.6% of surgeries performed before the surgical technique changes. Bony growth of the EAC was seen in 2.8% and 14.0% of cases after and prior to these changes, respectively. Ossicular chain refixation occurred in 5.6% of surgeries after and 18.6% of surgeries prior to such changes. There were no dead ears. Conclusions: The use of argon laser, thinner split-thickness skin graft, Silastic sheets in the EAC, and Ambrus ear
packs have, as a group, helped to improve our results and decrease the incidence of complications. 8:08
AM
Safety Evaluation of Titanium Middle Ear Prostheses at 3.0 Tesla Angela Diane Martin MD (presenter); Colin L W Driscoll MD; Christopher P Wood MD; Joel P Felmlee PhD Rochester MN; Rochester MN; Rochester MN; Rochester MN
Objectives: To assess the magnetic resonance imaging (MRI) safety of titanium middle ear prostheses at 3.0 Tesla (T). Methods: Titanium middle ear prostheses from three commercial vendors were examined for magnetic field interactions at 3T. Initially, ex vivo studies were performed testing for rotational motion and forward displacement (translational motion) of the prostheses in a static magnetic field. If movement was observed during this “screening” study, then the prosthesis was tested to determine the translational or rotational force acting upon the prosthesis. In addition to testing for prosthesis displacement, temperature changes of the prostheses were measured to assess for radiofrequency (RF) heating during imaging. Results: 21 of the 24 titanium prostheses tested revealed no movement when tested in the 3T static magnetic field. Three prostheses revealed minimal movement during the screening study. A translational force test (“string test”) was performed upon these 3 prostheses and the measured angle of displacement was used to determine the force. This calculated force acting upon each prosthesis was essentially zero. Therefore, we conclude that the magnetic field interaction is negligible. A positive control with a ferromagnetic stainless steel prosthesis demonstrated obvious displacement during the screening study, as well as deflection of the prosthesis ⬎90 degrees in the translational force test. Lastly, heating of the titanium prostheses did not occur in the seven models tested. Conclusions: Middle ear prostheses made from titanium are safe, neither deflecting nor heating during MR examinations conducted at 3T. 8:16
AM
Appreciation of Music in Children with Cochlear Implants Showkat Mirza FRCS (presenter); Susan Douglas FRCS Ed; Philip Lindsey Newcastle U Tyne United Kingdom; Nottingham United Kingdom; Middlesbrough United Kingdom
Objectives: The cochlear implant has been designed primarily to enhance speech discrimination and the awareness of environmental sounds. However, many patients express hopes that they will enjoy music following implantation. Our aim was to subjectively assess the appreciation of music after cochlear implantation in our pediatric patients.
MONDAY
Many treatment modalities for keloid have been tried with variable degrees of success, including surgery, corticosteroids, laser excision, cryotherapy, silicone gel sheeting, pressure devices, and radiotherapy or brachytherapy. The use of MC for preventing recurrence of keloid was prospectively studied. Methods: Patients with keloid were enrolled in a prospective study. The scar was excised under local or general anesthesia, and prior to skin closure, a pledget with 1 cc of MC 0.4 mg/mL was applied for 5 minutes. Results: Five patients with at least 3 months’ follow-up are currently enrolled in the study. In all (mean follow-up of 4 months), the residual scar was appreciably reduced with considerable patient satisfaction. No adverse side effects were noted. Conclusions: MC application following scar resection appears to be a promising treatment option for keloid.
Scientific Session—Monday P69
Scientific Session—Monday
Methods: Questionnaires were sent to the parents of 57 children with a minimum age of 6 years, who had received a cochlear implant in the North East Programme between 19902002. Thirty-five (61%) patients responded. Further information such as type of implant was obtained from a database. Results: The mean age of patients was 9.5 years (range, 6-16 years). There were 21 males and 14 females. Thirtythree patients had pre-lingual deafness and 2 post-lingual deafness. The majority of children (33/35 [94%]) listened to music after implantation. Enjoyment of music on a selfassessment scale was scored a mean of 6/10 after implantation. Parents scored the importance of their child being able to enjoy music a mean of 7.9/10. Ten patients played a musical instrument and 23 sang though only 1 was in the school choir. Conclusions: Appreciation of music after cochlear implantation in children is reasonably good and this is of much importance to parents. Future developments in implant technology should strive to improve satisfaction with music listening.
8:30
AM
Stapedectomy in Patients with a Prolapsed Facial Nerve Brian A Neff MD (presenter); William H Lippy MD; Arnold G Schuring MD Philadelphia PA; Warren OH; Warren OH
Objectives: To evaluate our hearing results and method of stapedectomy in patients who have 50% or more of the foot plate covered by a prolapsed facial nerve. Methods: Twenty-four out of 1497 stapedectomy patients had 50% or more of the oval window covered by a prolapsed facial nerve. The hearing results and facial nerve outcomes of this group were compared to a matched control group of 50 stapedectomies with normal facial nerve anatomy. Results: In the facial nerve prolapse group, closure of the postoperative air-bone gap to less than 10 dB was achieved in 19 of 23 ears (83%) and 16 of 20 ears (80%) at 6 months and 1 year, respectively. At 6 months and 1 year, the control group had 47 of 50 ears (94%) and 40 of 43 ears (93%) close the postoperative air-bone gap to less than 10 dB. The average postoperative air-bone gap was 5.1 dB at 6 months and 6.8 dB at 1 year for the facial nerve prolapse group. In comparison, the average postoperative air-bone gap in the control group was 3.9 dB and 3.7 dB, respectively. The difference in the two groups’ hearing results were not statistically significant (P ⬎ 0.05). Conclusions: The facial nerve prolapse group and control group showed no difference in postoperative hearing results at 6 months and 1 year. There were no short- or long-term facial nerve complications in either group. In light of these results, we conclude that stapedectomy in patients with significant facial nerve prolapse can be performed safely with good hearing results.
8:38
AM
Patient Choice in Treatment of Vestibular Schwannoma Matthew S Pogodzinski MD (presenter); Stephen G Harner MD; Michael Link MD Rochester MN; Rochester MN; Rochester MN
Objectives: There are currently three methods used to treat vestibular schwannomas: watchful waiting, stereotactic radiosurgery, and surgery. There are no studies in the literature examining which of these treatment options patients are choosing. Our institution is uniquely able to offer all three of these options to patients and is ideally suited to study patient choice of treatment. Methods: Using retrospective chart analysis over the years 2000-2001, we looked for patients’ initial treatment choices. Patients were grouped according to age, size of tumor, initial audiogram, co-morbidities, and previous surgery requiring inpatient stay. All patients presenting with a new diagnosis of vestibular schwannoma who made a clear initial choice were included. Patients with NF-2 or prior management of the vestibular schwannoma with surgery or radiation therapy were excluded. Results: The analysis showed 140 patients were seen at our institution between 2000-2001 with a new diagnosis of vestibular schwannoma and had clear initial treatment choices. Of these, 41 patients (29%) underwent watchful waiting as their initial treatment choice. Of the remaining patients, 55 (39%) underwent surgical treatment while 44 (32%) underwent stereotactic radiosurgery. There was also a correlation between both younger age and larger tumor size with surgical excision. Conclusions: Our initial hypothesis, that patients choosing treatment would choose stereotactic radiosurgery over 50% of the time, was proven false over the time course studied. These percentages are specific to our institution but reflect patient treatment choice when presented with all three options. 8:46
AM
Multisensor-based Navigation of Robotic Drilling at the Lateral Skull Base Peter K Plinkert MD PhD (presenter); Philippe A Federspil MD; Beate Plinkert MD; Steffen H Tretbar; Urban Geisthoff MD; Dominik Henrich PhD Tubingen Germany; Homburg/Saar Germany; Homburg Germany; St Ingbert Germany; Homburg Germany; Kaiserslauten Germany
Objectives: Robotic surgery at the lateral skull base must be navigated. Intraoperative navigation by computed tomography suffers inherent inaccuracy due to slice thickness. The accuracy and safety could be substantially improved by the use of ultrasound but also by use of other input as force/torque data. Methods: 20 human temporal bone specimen fixed in formaldehyde (body donation approved by the Board on Ethics) were acoustically characterized by an ultrasound
MONDAY
P70
Otolaryngology– Head and Neck Surgery August 2003
Room OCCC 204 •
Scientific Session: Otology/Neurotology Karen J Doyle MD PhD; Patrick J Antonelli MD (moderators)
8:00
AM
Advances in Congenital Aural Atresia Surgery: Effects on Outcome Karen Borne Teufert MD (presenter); Antonio De la Cruz MD Glendale CA; Los Angeles CA
Objectives: To compare modifications in the surgical technique of congenital aural atresia (use of argon laser, thinner split-thickness skin graft, Silastic sheets in the external auditory canal [EAC], and Ambrus ear packs) by examining hearing results and complications prior to and after initiation of these changes. Methods: A retrospective chart review of patients who underwent congenital aural atresiaplasty between 1985 and 2002 in a tertiary referral neurotologic private practice was performed. There were 116 atretic ears. Complication rates and hearing results were compared before and after modifications in the surgical technique of congenital aural atresia. Results: Closure of the air-bone gap (ABG) to 30 dB or less at short-term follow-up occurred in 65.7% of surgeries performed after modifications in the surgical technique and 45.0% of surgeries performed before these changes (P ⬍ 0.044). The long-term postoperative ABG was 30 dB or less in 52.1% of the surgeries performed after and 42.9% of the cases performed before the changes in surgical technique. Soft tissue stenosis was seen in 4.2% of surgeries performed after and 11.6% of surgeries performed before the surgical technique changes. Bony growth of the EAC was seen in 2.8% and 14.0% of cases after and prior to these changes, respectively. Ossicular chain refixation occurred in 5.6% of surgeries after and 18.6% of surgeries prior to such changes. There were no dead ears. Conclusions: The use of argon laser, thinner split-thickness skin graft, Silastic sheets in the EAC, and Ambrus ear
packs have, as a group, helped to improve our results and decrease the incidence of complications. 8:08
AM
Safety Evaluation of Titanium Middle Ear Prostheses at 3.0 Tesla Angela Diane Martin MD (presenter); Colin L W Driscoll MD; Christopher P Wood MD; Joel P Felmlee PhD Rochester MN; Rochester MN; Rochester MN; Rochester MN
Objectives: To assess the magnetic resonance imaging (MRI) safety of titanium middle ear prostheses at 3.0 Tesla (T). Methods: Titanium middle ear prostheses from three commercial vendors were examined for magnetic field interactions at 3T. Initially, ex vivo studies were performed testing for rotational motion and forward displacement (translational motion) of the prostheses in a static magnetic field. If movement was observed during this “screening” study, then the prosthesis was tested to determine the translational or rotational force acting upon the prosthesis. In addition to testing for prosthesis displacement, temperature changes of the prostheses were measured to assess for radiofrequency (RF) heating during imaging. Results: 21 of the 24 titanium prostheses tested revealed no movement when tested in the 3T static magnetic field. Three prostheses revealed minimal movement during the screening study. A translational force test (“string test”) was performed upon these 3 prostheses and the measured angle of displacement was used to determine the force. This calculated force acting upon each prosthesis was essentially zero. Therefore, we conclude that the magnetic field interaction is negligible. A positive control with a ferromagnetic stainless steel prosthesis demonstrated obvious displacement during the screening study, as well as deflection of the prosthesis ⬎90 degrees in the translational force test. Lastly, heating of the titanium prostheses did not occur in the seven models tested. Conclusions: Middle ear prostheses made from titanium are safe, neither deflecting nor heating during MR examinations conducted at 3T. 8:16
AM
Appreciation of Music in Children with Cochlear Implants Showkat Mirza FRCS (presenter); Susan Douglas FRCS Ed; Philip Lindsey Newcastle U Tyne United Kingdom; Nottingham United Kingdom; Middlesbrough United Kingdom
Objectives: The cochlear implant has been designed primarily to enhance speech discrimination and the awareness of environmental sounds. However, many patients express hopes that they will enjoy music following implantation. Our aim was to subjectively assess the appreciation of music after cochlear implantation in our pediatric patients.
MONDAY
Many treatment modalities for keloid have been tried with variable degrees of success, including surgery, corticosteroids, laser excision, cryotherapy, silicone gel sheeting, pressure devices, and radiotherapy or brachytherapy. The use of MC for preventing recurrence of keloid was prospectively studied. Methods: Patients with keloid were enrolled in a prospective study. The scar was excised under local or general anesthesia, and prior to skin closure, a pledget with 1 cc of MC 0.4 mg/mL was applied for 5 minutes. Results: Five patients with at least 3 months’ follow-up are currently enrolled in the study. In all (mean follow-up of 4 months), the residual scar was appreciably reduced with considerable patient satisfaction. No adverse side effects were noted. Conclusions: MC application following scar resection appears to be a promising treatment option for keloid.
Scientific Session—Monday P69
Scientific Session—Monday
Methods: Questionnaires were sent to the parents of 57 children with a minimum age of 6 years, who had received a cochlear implant in the North East Programme between 19902002. Thirty-five (61%) patients responded. Further information such as type of implant was obtained from a database. Results: The mean age of patients was 9.5 years (range, 6-16 years). There were 21 males and 14 females. Thirtythree patients had pre-lingual deafness and 2 post-lingual deafness. The majority of children (33/35 [94%]) listened to music after implantation. Enjoyment of music on a selfassessment scale was scored a mean of 6/10 after implantation. Parents scored the importance of their child being able to enjoy music a mean of 7.9/10. Ten patients played a musical instrument and 23 sang though only 1 was in the school choir. Conclusions: Appreciation of music after cochlear implantation in children is reasonably good and this is of much importance to parents. Future developments in implant technology should strive to improve satisfaction with music listening.
8:30
AM
Stapedectomy in Patients with a Prolapsed Facial Nerve Brian A Neff MD (presenter); William H Lippy MD; Arnold G Schuring MD Philadelphia PA; Warren OH; Warren OH
Objectives: To evaluate our hearing results and method of stapedectomy in patients who have 50% or more of the foot plate covered by a prolapsed facial nerve. Methods: Twenty-four out of 1497 stapedectomy patients had 50% or more of the oval window covered by a prolapsed facial nerve. The hearing results and facial nerve outcomes of this group were compared to a matched control group of 50 stapedectomies with normal facial nerve anatomy. Results: In the facial nerve prolapse group, closure of the postoperative air-bone gap to less than 10 dB was achieved in 19 of 23 ears (83%) and 16 of 20 ears (80%) at 6 months and 1 year, respectively. At 6 months and 1 year, the control group had 47 of 50 ears (94%) and 40 of 43 ears (93%) close the postoperative air-bone gap to less than 10 dB. The average postoperative air-bone gap was 5.1 dB at 6 months and 6.8 dB at 1 year for the facial nerve prolapse group. In comparison, the average postoperative air-bone gap in the control group was 3.9 dB and 3.7 dB, respectively. The difference in the two groups’ hearing results were not statistically significant (P ⬎ 0.05). Conclusions: The facial nerve prolapse group and control group showed no difference in postoperative hearing results at 6 months and 1 year. There were no short- or long-term facial nerve complications in either group. In light of these results, we conclude that stapedectomy in patients with significant facial nerve prolapse can be performed safely with good hearing results.
8:38
AM
Patient Choice in Treatment of Vestibular Schwannoma Matthew S Pogodzinski MD (presenter); Stephen G Harner MD; Michael Link MD Rochester MN; Rochester MN; Rochester MN
Objectives: There are currently three methods used to treat vestibular schwannomas: watchful waiting, stereotactic radiosurgery, and surgery. There are no studies in the literature examining which of these treatment options patients are choosing. Our institution is uniquely able to offer all three of these options to patients and is ideally suited to study patient choice of treatment. Methods: Using retrospective chart analysis over the years 2000-2001, we looked for patients’ initial treatment choices. Patients were grouped according to age, size of tumor, initial audiogram, co-morbidities, and previous surgery requiring inpatient stay. All patients presenting with a new diagnosis of vestibular schwannoma who made a clear initial choice were included. Patients with NF-2 or prior management of the vestibular schwannoma with surgery or radiation therapy were excluded. Results: The analysis showed 140 patients were seen at our institution between 2000-2001 with a new diagnosis of vestibular schwannoma and had clear initial treatment choices. Of these, 41 patients (29%) underwent watchful waiting as their initial treatment choice. Of the remaining patients, 55 (39%) underwent surgical treatment while 44 (32%) underwent stereotactic radiosurgery. There was also a correlation between both younger age and larger tumor size with surgical excision. Conclusions: Our initial hypothesis, that patients choosing treatment would choose stereotactic radiosurgery over 50% of the time, was proven false over the time course studied. These percentages are specific to our institution but reflect patient treatment choice when presented with all three options. 8:46
AM
Multisensor-based Navigation of Robotic Drilling at the Lateral Skull Base Peter K Plinkert MD PhD (presenter); Philippe A Federspil MD; Beate Plinkert MD; Steffen H Tretbar; Urban Geisthoff MD; Dominik Henrich PhD Tubingen Germany; Homburg/Saar Germany; Homburg Germany; St Ingbert Germany; Homburg Germany; Kaiserslauten Germany
Objectives: Robotic surgery at the lateral skull base must be navigated. Intraoperative navigation by computed tomography suffers inherent inaccuracy due to slice thickness. The accuracy and safety could be substantially improved by the use of ultrasound but also by use of other input as force/torque data. Methods: 20 human temporal bone specimen fixed in formaldehyde (body donation approved by the Board on Ethics) were acoustically characterized by an ultrasound
MONDAY
P70
Otolaryngology– Head and Neck Surgery August 2003