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B039 Postoperative CI activation within 24 hours
Abstracts, ESPCI 2011 / International Journal of Pediatric Otorhinolaryngology 75 (2011) 10–32
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B037 Cochlear implantation in cases with congenital deformations and rare genetic syndromes: Goldenhar and Branchio-Oculo-Facial M. Porowski, H. Skarzy ˙ nski, ´ M. Mrowka, ´ P. Młotkowska-Klimek. International Center of Hearing and Speech Institute of Physiology and Pathology of Hearing, Warsaw, Poland
Conclusion: Using our methods, most of the implantees successfully activated their devices within 24 hours postoperatively without major complications and extra mapping.
Aim: The aim of the study was to specify the indications for cochlear implantation in patients with rare genetic syndromes: Goldenhar and BOF and assess the results obtained after surgical treatment. Material and Methods: Two children with Goldenhar syndrome and one with BOF syndrome were operated on in our Clinic. Various cochlear implant systems were used to each of these patients. The technique of cochlear implantation was in all cases facial recess. Results: In all cases we achieved satisfactory hearing level. No early or late surgical complications were observed. Conclusions: We point that even in cases with very complicated anatomy and congenital malformations there is possibility to improve hearing using implantable devices. It is of crucial importance to focus on hearing improvement to maintain appropriate hearing level and to give chance for those children to be active society members.
B. Thierry, N. Loundon, A. Delamaze, W. El Bakkourri, F. Denoyelle, E.N. Garabedian. ORL department, Hˆ opital Armand Trousseau, France
B038 CI in children preserving intracochlear strucutures – the Hybrid concept in children A. Lesinski-Schiedat, M. Schußler, ¨ N. Neben, A. Buchner, ¨ Th. Lenarz. Medical University of Hannover, ENT Clinic and Hearing Center, Hannover, Germany Aim: Cochlear Implantation is an established therapy in patients with profound hearing impairment and the indications were extended towards patients with residual hearing. Especially in children it is important to discuss the input of the low frequencies and the consequences for children with profound hearing loss. Material and Methods: We have (winter 2010) implanted about 20 children unilateral and bilateral with the so called HYBRID-L electrode. Preoperative all patients underwent complete audiological and radiological diagnostics. Results: All children underwent a special surgical technique to avoid intracochlear damage. Residual hearing could be sustained after CI surgery in all patients. All patients had better understanding in electroacoustic stimulation compared to HA alone preoperatively, especially in noise. Conclusion: CI in high frequency deafness is a challenge for surgical and audiological skills. It should be considered whether also in bilateral profound deaf children the surgical concept should be followed in the respect to prospective technologies. B039 Postoperative CI activation within 24 hours J.K.C. Chen, M.R. Lien. Department of Otolaryngology, Cheng Hsin General Hospital, Taipei, Taiwan Aim: Usually, cochlear implants are activated 2 to 4 weeks postoperatively. Most surgeons also suspect that prematurely activated CI, with probable inflamed cochlea, significantly increases the frequency of mapping and inconvenience to the patients. Thus we have modified our CI surgery to enable activation within 24 hours. Material and Methods: Our modification included a 2.5 cm postauricular incision, posterior-based periosteal flap, and soft technique or round window approach. 145 cochlear implantees activated their devices in 24 hours postoperatively with modified CI operation. ECAP, impedance and speech tests were measured. Results: 142/145 of our patients activated their devices 20 hours postoperatively. No wound or other complications were encountered. The occurrence of mapping was not increased due to stable ECAP and impedance. The speech tests were excellent.
B040 Cochlear implantation in bilateral profoundly deaf children after meningitis: Retrospective study
Aim: To evaluate epidemiological, radiological and vestibular findings compared to surgical observations in implanted deaf children after meningitis. Material and Methods: Retrospective study, tertiary care center. 45 (6%) patients, among 734 patients implanted between 1989 and 2010, presenting with post meningitic deafness. Bacterial findings, delay to deafness and surgery, preoperative imaging evaluation with CT-scan and MRI, preoperative vestibular testing and surgical observation were studied. Results: Median age of meningitis was 11 months; median age of implantation was 3.5 years. Streptococcus pneumoniae (SP) was found in 70% of cases (28/40). Fourteen patients had bilateral vestibular dysfunction. 19 had bilateral cochlear fibrosis on MRI, and 18 cochlear ossifications on CT-scan. Surgical issues were encountered in 12 cases (27%). Conclusion: Despite systematic vaccination, SP is the principal germ responsible for post meningitis bilateral profound deafness. Systematic vestibular testing should be proposed. MRI is a sensitive tool to predict cochlear fibrosis. B041 Surgical efficiency in bilateral simultaneous cochlear implantation: patient safety and cost containment S.L. Cushing1,2 , K.A. Gordon1,2 , M. Merdad2 , A.L. James1,2 , B.C. Papsin1,2 . 1 Archie’s Cochlear Implant Laboratory, The Hospital for Sick Children, Toronto, Ontario, Canada; 2 Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Ontario, Canada Aim: The costs of bilateral cochlear implantation (CI) must be contained in order to justify the incremental patient benefit. We therefore aimed to determine whether efficiencies from simultaneous bilateral implantation (BSCI) can be realized if achieved safely. Material and Methods: Comparison of duration of operating room time and complication rate in children receiving bilateral versus unilateral CIs in a single surgery. Results: Total in operating room time for bilateral CI was 305 minutes (n = 103) compared to 194 minutes for unilateral CI (n = 107) equaling only a 60% increase. There was no significant difference in complications between BSCI and unilateral CI. Conclusions: Bilateral simultaneous preparation of both surgical fields is feasible and safely reduces overall surgical time, equipment utilized and cost compared with sequential bilateral CI. Strategies that safely reduce time in the operating room and cost are inherent to the success of any bilateral cochlear implant program. B042 Combined technique to avoid cochlear implant complications H. Ruiz, C. Perez ´ Grassano, E. Filas, B. Ruiz. Otolaryngology Department, Centro Dr. Ruiz, Rosario, Argentina Aim: Most frequent mayor complications in this surgery are those related to the scalp and the erosion of the tympanic frame. We develop technique modifications to avoid them. Materials and Methods: In posterior tympanotomy, electrodes can be exposed. We made a roof, with a bone table over the electrode, to avoid the tympanic frame descent.
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B037 Cochlear implantation in cases with congenital deformations and rare genetic syndromes: Goldenhar and Branchio-Oculo-Facial M. Porowski, H. Skarzy ˙ nski, ´ M. Mrowka, ´ P. Młotkowska-Klimek. International Center of Hearing and Speech Institute of Physiology and Pathology of Hearing, Warsaw, Poland
Conclusion: Using our methods, most of the implantees successfully activated their devices within 24 hours postoperatively without major complications and extra mapping.
Aim: The aim of the study was to specify the indications for cochlear implantation in patients with rare genetic syndromes: Goldenhar and BOF and assess the results obtained after surgical treatment. Material and Methods: Two children with Goldenhar syndrome and one with BOF syndrome were operated on in our Clinic. Various cochlear implant systems were used to each of these patients. The technique of cochlear implantation was in all cases facial recess. Results: In all cases we achieved satisfactory hearing level. No early or late surgical complications were observed. Conclusions: We point that even in cases with very complicated anatomy and congenital malformations there is possibility to improve hearing using implantable devices. It is of crucial importance to focus on hearing improvement to maintain appropriate hearing level and to give chance for those children to be active society members.
B. Thierry, N. Loundon, A. Delamaze, W. El Bakkourri, F. Denoyelle, E.N. Garabedian. ORL department, Hˆ opital Armand Trousseau, France
B038 CI in children preserving intracochlear strucutures – the Hybrid concept in children A. Lesinski-Schiedat, M. Schußler, ¨ N. Neben, A. Buchner, ¨ Th. Lenarz. Medical University of Hannover, ENT Clinic and Hearing Center, Hannover, Germany Aim: Cochlear Implantation is an established therapy in patients with profound hearing impairment and the indications were extended towards patients with residual hearing. Especially in children it is important to discuss the input of the low frequencies and the consequences for children with profound hearing loss. Material and Methods: We have (winter 2010) implanted about 20 children unilateral and bilateral with the so called HYBRID-L electrode. Preoperative all patients underwent complete audiological and radiological diagnostics. Results: All children underwent a special surgical technique to avoid intracochlear damage. Residual hearing could be sustained after CI surgery in all patients. All patients had better understanding in electroacoustic stimulation compared to HA alone preoperatively, especially in noise. Conclusion: CI in high frequency deafness is a challenge for surgical and audiological skills. It should be considered whether also in bilateral profound deaf children the surgical concept should be followed in the respect to prospective technologies. B039 Postoperative CI activation within 24 hours J.K.C. Chen, M.R. Lien. Department of Otolaryngology, Cheng Hsin General Hospital, Taipei, Taiwan Aim: Usually, cochlear implants are activated 2 to 4 weeks postoperatively. Most surgeons also suspect that prematurely activated CI, with probable inflamed cochlea, significantly increases the frequency of mapping and inconvenience to the patients. Thus we have modified our CI surgery to enable activation within 24 hours. Material and Methods: Our modification included a 2.5 cm postauricular incision, posterior-based periosteal flap, and soft technique or round window approach. 145 cochlear implantees activated their devices in 24 hours postoperatively with modified CI operation. ECAP, impedance and speech tests were measured. Results: 142/145 of our patients activated their devices 20 hours postoperatively. No wound or other complications were encountered. The occurrence of mapping was not increased due to stable ECAP and impedance. The speech tests were excellent.
B040 Cochlear implantation in bilateral profoundly deaf children after meningitis: Retrospective study
Aim: To evaluate epidemiological, radiological and vestibular findings compared to surgical observations in implanted deaf children after meningitis. Material and Methods: Retrospective study, tertiary care center. 45 (6%) patients, among 734 patients implanted between 1989 and 2010, presenting with post meningitic deafness. Bacterial findings, delay to deafness and surgery, preoperative imaging evaluation with CT-scan and MRI, preoperative vestibular testing and surgical observation were studied. Results: Median age of meningitis was 11 months; median age of implantation was 3.5 years. Streptococcus pneumoniae (SP) was found in 70% of cases (28/40). Fourteen patients had bilateral vestibular dysfunction. 19 had bilateral cochlear fibrosis on MRI, and 18 cochlear ossifications on CT-scan. Surgical issues were encountered in 12 cases (27%). Conclusion: Despite systematic vaccination, SP is the principal germ responsible for post meningitis bilateral profound deafness. Systematic vestibular testing should be proposed. MRI is a sensitive tool to predict cochlear fibrosis. B041 Surgical efficiency in bilateral simultaneous cochlear implantation: patient safety and cost containment S.L. Cushing1,2 , K.A. Gordon1,2 , M. Merdad2 , A.L. James1,2 , B.C. Papsin1,2 . 1 Archie’s Cochlear Implant Laboratory, The Hospital for Sick Children, Toronto, Ontario, Canada; 2 Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Ontario, Canada Aim: The costs of bilateral cochlear implantation (CI) must be contained in order to justify the incremental patient benefit. We therefore aimed to determine whether efficiencies from simultaneous bilateral implantation (BSCI) can be realized if achieved safely. Material and Methods: Comparison of duration of operating room time and complication rate in children receiving bilateral versus unilateral CIs in a single surgery. Results: Total in operating room time for bilateral CI was 305 minutes (n = 103) compared to 194 minutes for unilateral CI (n = 107) equaling only a 60% increase. There was no significant difference in complications between BSCI and unilateral CI. Conclusions: Bilateral simultaneous preparation of both surgical fields is feasible and safely reduces overall surgical time, equipment utilized and cost compared with sequential bilateral CI. Strategies that safely reduce time in the operating room and cost are inherent to the success of any bilateral cochlear implant program. B042 Combined technique to avoid cochlear implant complications H. Ruiz, C. Perez ´ Grassano, E. Filas, B. Ruiz. Otolaryngology Department, Centro Dr. Ruiz, Rosario, Argentina Aim: Most frequent mayor complications in this surgery are those related to the scalp and the erosion of the tympanic frame. We develop technique modifications to avoid them. Materials and Methods: In posterior tympanotomy, electrodes can be exposed. We made a roof, with a bone table over the electrode, to avoid the tympanic frame descent.