- Email: [email protected]
B007 Cochleo-Vestibular Nerve (CVN) malformations with normal or dysplastic cochlea – Cochlear or brain stem implantation?
Abstracts, ESPCI 2011 / International Journal of Pediatric Otorhinolaryngology 75 (2011) 10–32
Results: The surgical key points include: thin cortex of the skull, small distance between cortex and antrum, undeveloped mastoid tip, superficial facial nerve trajectory, mastoid filled with bone marrow, more horizontal position of the round window, and the altering dimensions of the growing skull. Conclusions: Cochlear implantation in children younger than 8 months is feasible, if specific surgical aspects are taken into consideration. Implantation at this young age is indicated when postponing surgery would decrease the chances of successful implantation. B006 Cochleostomy versus round window approach in children, comparation J.A. Rivas. Cl´ınica Jos´e A Rivas, Bogot´ a, Colombia Aim: Assess chance for hearing preservation during cochlear implant surgery by comparing different cochleostomy techniques in children Methods: Retrospective Study in 230 ears that underwent cochlear implantation compared with respect to approach for electrode insertion. Pre-Postoperative pure tone thresholds were measured and the latest values that exceeded the limit of the maximum audiometer output (120 dB) at frequencies 250–4000 Hz were recorded as no measurable. Results: 151 procedures were by standard cochleostomy, 43 by soft surgery and 36 by round window. Post-operative hearing thresholds were taken as main measure. Independent T-tests showed no significance (p > 0.05) between cochleostomy and soft surgery, but there were significance (p < 0.05) in the differences between cochleostomy vs. round window, and soft surgery vs. round window approaches too. Conclusion: The advantages of the round window approach compared with the standard cochleostomy in order to increase the probability to preserve residual hearing are demonstrated. B007 Cochleo-Vestibular Nerve (CVN) malformations with normal or dysplastic cochlea – Cochlear or brain stem implantation? C. Morera, C. De-Paula, F. Mas, L. Cavalle. ´ Hospital Universitario “la Fe”. University of Valencia, Spain Aims: Review the results obtained in our cases and to present a protocol to select the treatment CI/ABI. Material and Methods: Descriptive and retrospective study in 14 deafness patients (2 months to 12 years). RM study according with Casselman technique. Preoperative functional study with brain stem responses evoked electrically (eEAP) with round window stimulation. Tonal and speech test results. Results: All patients presented preoperatively no response in BERA and OEA 7 patients had type IIb aplasia and 2 type IIa. Six patients were syndromic. Five presented bilateral aplasia of the VCN (type I). The eEAP with round window stimulation showed responses in four patients (candidates to CI). Cases without response were treated with ABI. Conclusions: Cochlear responses could be observed in CVN malformations CI could achieve good performance mainly in type IIb patients eEAP round window stimulation is a good test to select the treatment. B008 Minimal invasive surgery for cochlear implantation in children; transcanal and modified transcanal technique N. Arsovic, B. Bukurov, Z. Dudvarski, B. Mikic, M. Dragisic, V. Djukic. Institute for Otorhinolaryngology and Maxillofacial Surgery, Clinical Centre of Serbia, Belgrade, Serbia Aim: The authors present series of 95 patients operated by minimal invasive surgery and their results. Materials and Methods: Primary surgery was preformed on group of 95 children with pre- or perilingual deafness aged from
11
17 months to 12 years. Modified transcanal technique was used in 35 patients. Preoperative radiological assessment on CT and MRI scans was preformed in vast majority of patients. Results: No perioperative or postoperative complications occurred in this series. In five cases deafness was due to bacterial meningitis with incomplete ossification of the cochlea. Conclusions: We found these techniques feasible for cochlear implantation both in children and adults. Comparative advantages are minimal drilling of the bone and preservation of mastoid structure, which is extremely important in children. These techniques enable safer access and better angle in performing cochleostomy in cases with normal anatomy as well as cochlear malformations. B009 Simultaneous bilateral cochlear implantation in children D. Murbe, ¨ B. Pilz, S. Heinemann, Th. Zahnert. Saxonian Cochlear Implant Center, Dept. of Otolaryngology, University Hospital Dresden, Germany Aim: Simultaneous bilateral cochlear implantation in children is often placed back in favour of sequential bilateral implantation. The aim of the study was to assess surgical times, complications, and patient outcomes for simultaneous bilateral cochlear implantation in children. Material and Methods: 34 children with profound bilateral sensorineural hearing loss who received simultaneous bilateral cochlear implantation were included in the study. Mean age at implantation was 18 months, minimum and maximum ages 8 and 47 month, respectively. Results: No complications have been reported for the simultaneous bilateral implantations. In comparison with sequentially implanted children a reduced cumulative surgical time and hospital stay has been found. Patient outcomes benefits from the continuity of the rehabilitation process without interruption of an additional hospital stay. Conclusions: For children with clear medical findings for bilateral cochlear implantation simultaneous surgery is a safe procedure which offers the chance of best possible speech and language development after implantation. B010 The challenges and implications of delivering a cochlear implant service in the South of England J. Eyles. South of England Cochlear Implant Centre, Institute of Sound and Vibration Research, The University, Southampton, UK Aim: To report on current issues in the service delivery of a regional cochlear implant service. Material and Methods: Purchasers of the service required registration with the Care Quality Commission, this process will be discussed. An evaluation of patient satisfaction of the delivery of a changed assessment process as measured by questionnaire will be reported. The Centre also undertook a web based assessment using the Quality Enhancement Tool that was developed to enable audiology departments to assess how well they provide a patientcentred service. The impact of delivering a service to a younger patient population will be reported along with maintaining an ever increasing number of implanted patients. Results: The centre has been established for 21 years, maintains 600 patients and has an implantation rate of over 100 patients per annum. Conclusions: Responsiveness to changing service requirements, process implementation and service delivery has been achieved.
Results: The surgical key points include: thin cortex of the skull, small distance between cortex and antrum, undeveloped mastoid tip, superficial facial nerve trajectory, mastoid filled with bone marrow, more horizontal position of the round window, and the altering dimensions of the growing skull. Conclusions: Cochlear implantation in children younger than 8 months is feasible, if specific surgical aspects are taken into consideration. Implantation at this young age is indicated when postponing surgery would decrease the chances of successful implantation. B006 Cochleostomy versus round window approach in children, comparation J.A. Rivas. Cl´ınica Jos´e A Rivas, Bogot´ a, Colombia Aim: Assess chance for hearing preservation during cochlear implant surgery by comparing different cochleostomy techniques in children Methods: Retrospective Study in 230 ears that underwent cochlear implantation compared with respect to approach for electrode insertion. Pre-Postoperative pure tone thresholds were measured and the latest values that exceeded the limit of the maximum audiometer output (120 dB) at frequencies 250–4000 Hz were recorded as no measurable. Results: 151 procedures were by standard cochleostomy, 43 by soft surgery and 36 by round window. Post-operative hearing thresholds were taken as main measure. Independent T-tests showed no significance (p > 0.05) between cochleostomy and soft surgery, but there were significance (p < 0.05) in the differences between cochleostomy vs. round window, and soft surgery vs. round window approaches too. Conclusion: The advantages of the round window approach compared with the standard cochleostomy in order to increase the probability to preserve residual hearing are demonstrated. B007 Cochleo-Vestibular Nerve (CVN) malformations with normal or dysplastic cochlea – Cochlear or brain stem implantation? C. Morera, C. De-Paula, F. Mas, L. Cavalle. ´ Hospital Universitario “la Fe”. University of Valencia, Spain Aims: Review the results obtained in our cases and to present a protocol to select the treatment CI/ABI. Material and Methods: Descriptive and retrospective study in 14 deafness patients (2 months to 12 years). RM study according with Casselman technique. Preoperative functional study with brain stem responses evoked electrically (eEAP) with round window stimulation. Tonal and speech test results. Results: All patients presented preoperatively no response in BERA and OEA 7 patients had type IIb aplasia and 2 type IIa. Six patients were syndromic. Five presented bilateral aplasia of the VCN (type I). The eEAP with round window stimulation showed responses in four patients (candidates to CI). Cases without response were treated with ABI. Conclusions: Cochlear responses could be observed in CVN malformations CI could achieve good performance mainly in type IIb patients eEAP round window stimulation is a good test to select the treatment. B008 Minimal invasive surgery for cochlear implantation in children; transcanal and modified transcanal technique N. Arsovic, B. Bukurov, Z. Dudvarski, B. Mikic, M. Dragisic, V. Djukic. Institute for Otorhinolaryngology and Maxillofacial Surgery, Clinical Centre of Serbia, Belgrade, Serbia Aim: The authors present series of 95 patients operated by minimal invasive surgery and their results. Materials and Methods: Primary surgery was preformed on group of 95 children with pre- or perilingual deafness aged from
11
17 months to 12 years. Modified transcanal technique was used in 35 patients. Preoperative radiological assessment on CT and MRI scans was preformed in vast majority of patients. Results: No perioperative or postoperative complications occurred in this series. In five cases deafness was due to bacterial meningitis with incomplete ossification of the cochlea. Conclusions: We found these techniques feasible for cochlear implantation both in children and adults. Comparative advantages are minimal drilling of the bone and preservation of mastoid structure, which is extremely important in children. These techniques enable safer access and better angle in performing cochleostomy in cases with normal anatomy as well as cochlear malformations. B009 Simultaneous bilateral cochlear implantation in children D. Murbe, ¨ B. Pilz, S. Heinemann, Th. Zahnert. Saxonian Cochlear Implant Center, Dept. of Otolaryngology, University Hospital Dresden, Germany Aim: Simultaneous bilateral cochlear implantation in children is often placed back in favour of sequential bilateral implantation. The aim of the study was to assess surgical times, complications, and patient outcomes for simultaneous bilateral cochlear implantation in children. Material and Methods: 34 children with profound bilateral sensorineural hearing loss who received simultaneous bilateral cochlear implantation were included in the study. Mean age at implantation was 18 months, minimum and maximum ages 8 and 47 month, respectively. Results: No complications have been reported for the simultaneous bilateral implantations. In comparison with sequentially implanted children a reduced cumulative surgical time and hospital stay has been found. Patient outcomes benefits from the continuity of the rehabilitation process without interruption of an additional hospital stay. Conclusions: For children with clear medical findings for bilateral cochlear implantation simultaneous surgery is a safe procedure which offers the chance of best possible speech and language development after implantation. B010 The challenges and implications of delivering a cochlear implant service in the South of England J. Eyles. South of England Cochlear Implant Centre, Institute of Sound and Vibration Research, The University, Southampton, UK Aim: To report on current issues in the service delivery of a regional cochlear implant service. Material and Methods: Purchasers of the service required registration with the Care Quality Commission, this process will be discussed. An evaluation of patient satisfaction of the delivery of a changed assessment process as measured by questionnaire will be reported. The Centre also undertook a web based assessment using the Quality Enhancement Tool that was developed to enable audiology departments to assess how well they provide a patientcentred service. The impact of delivering a service to a younger patient population will be reported along with maintaining an ever increasing number of implanted patients. Results: The centre has been established for 21 years, maintains 600 patients and has an implantation rate of over 100 patients per annum. Conclusions: Responsiveness to changing service requirements, process implementation and service delivery has been achieved.