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Cochlear implantation in children with mondini deformity.
Scientific Session—Wednesday
Objectives: To observe the influence of electrode pullback after cochlea implant insertion of a nucleus 24 contour electrode. Methods: In a prospective intraoperative study, we analyzed the impedances and NRT level of 12 patients after cochlea implant insertion and a subsequent controlled electrode pull-back. All patients were implanted with a Nucleus 24 modiolus hugging electrode system. Postoperative electrode position due to the localization and modiolar position were controlled by x-ray. Results: Independent of the electrode position of more than 180 insertion depth, we observed in all cases a decrease of the intraoperative impedances after electrode pull-back. NRT-levels decreased significantly up to 30% in all cases after electrode pull-back. Conclusions: Controlled pull-back is a novel technique to decrease impedances and NRT-levels in Nucleus 24 RCS or RCA implantees. An advantage in postoperative fitting and power consumption can be assumed.
10:00 AM Intratympanic Dexamethasone for Profound Idiopathic Sudden Sensorineural Hearing Loss Robert A Battista, MD (presenter) Hinsdale IL
Objectives: To determine hearing recovery using intratympanic dexamethasone for profound idiopathic sudden sensorineural hearing loss (ISSNHL). Methods: A prospective clinical study was performed of 20 consecutive patients seen with profound ISSNHL. Patients received 4 intratympanic treatments of 24 mg/mL dexamethasone over the course of 2 weeks. Significant hearing recovery was defined as the final PTA within 10 dB of baseline or final PTA with a 50% or greater percentage of recovery. The hearing in the contralateral ear was used as baseline. Results: All patients had normal hearing in the contralateral ear (PTA⬍25 dB). The average time to treatment was 31 days (range, 2–180 days; median, 19 days). Ten percent (2/20) of patients had significant hearing recovery. The two patients with significant hearing recovery were treated within 11 days of onset of hearing loss. Conclusions: Using the protocol of this study, intratympanic dexamethasone does not result in significant hearing recovery for patients with profound ISSNHL.
10:08 AM Cochlear Implantation in Children with Mondini Deformity. Sandra Genevieve DeSaSouza, MS DORL (presenter); Dillon JFF Dsouza, MS DORL; Natasha A Dsouza, BSc ASR Mumbai India; Mumbai India; Mumbai India
Objectives: This study reviews the results of cochlear implantation in 11 children between the ages of 2 to 18 years with Mondini deformity of the cochlea, who underwent surgery between 1988 and 2003. Of these, 7 children had a true Mondini with incomplete partition and 4 had a “cocks” common cavity. Methods: A Hortmann ball electrode device was used in 3 cases, a medel ball electrode device in 1 case, and a Medel compressed Combi40 in 1 case. Six cases received Clarion devices, 4 precurved enhanced bipolar, 1 HiFocus I, and 1 HiRes 90K. In all cases, there was complete insertion of electrodes and intraoperative sealing of the gusher. The precurved electrode was the safest and easiest to surgically introduce. Three cases with a common cavity developed a postoperative leak and had to have a lumboperitoneal shunt Results: The speech perception and speech production average scores attained were higher in patients with a true Mondini deformity and with multielectrode devices. The highest scores were attained with children using paired pulsatile stimuli strategies. On long-term follow-up, the 3 Hortmann single electrode devices failed between 3 and 4 years and the Medel single electrode device after 5 years, although functioning could not maintain sufficient hearing thresholds. Conclusions: From this study, we can conclude that children with true Mondini deformity (incomplete partition) and multielectrode devices, using a paired pulsatile strategy, although slower, perform as well as their matched counterparts with a normal cochlea. 10:16 AM Minimal Invasive Technique for Implantation of Clarion 90K Hi Res Cochlear Implant Alec F Fitzgerald O’Connor, FRCS (presenter) London United Kingdom
Objectives: Patient and parental pressure has led to the development of minimally invasive techniques for cochlear implantation. New devices such as the Clarion Hi Res 90K require modified surgical approaches. The procedure should ensure an incision less than 5 cm, fixation of the device to the skull, and positioning of the receiver coil such that the auditory stimulator can be worn comfortably behind the ear. The surgery should have a low morbidity. Methods: Eighteen patients undergoing implantation with the Clarion Hi Res 90K device were managed with the designed technique. The skin incision was centered behind the external auditory meatus. The mastoidectomy fashioned to ensure a safe posterior tympanotomy and cochleostomy. The well for the stimulator was placed posterior to the edge of the mastoidectomy at a distance the length of strengthened connector link to the electrode array and fixed passively by a groove and canl to the skull. Results: In all cases, the technique was able to be used.
WEDNESDAY
P226
Otolaryngology– Head and Neck Surgery August 2004
Objectives: To observe the influence of electrode pullback after cochlea implant insertion of a nucleus 24 contour electrode. Methods: In a prospective intraoperative study, we analyzed the impedances and NRT level of 12 patients after cochlea implant insertion and a subsequent controlled electrode pull-back. All patients were implanted with a Nucleus 24 modiolus hugging electrode system. Postoperative electrode position due to the localization and modiolar position were controlled by x-ray. Results: Independent of the electrode position of more than 180 insertion depth, we observed in all cases a decrease of the intraoperative impedances after electrode pull-back. NRT-levels decreased significantly up to 30% in all cases after electrode pull-back. Conclusions: Controlled pull-back is a novel technique to decrease impedances and NRT-levels in Nucleus 24 RCS or RCA implantees. An advantage in postoperative fitting and power consumption can be assumed.
10:00 AM Intratympanic Dexamethasone for Profound Idiopathic Sudden Sensorineural Hearing Loss Robert A Battista, MD (presenter) Hinsdale IL
Objectives: To determine hearing recovery using intratympanic dexamethasone for profound idiopathic sudden sensorineural hearing loss (ISSNHL). Methods: A prospective clinical study was performed of 20 consecutive patients seen with profound ISSNHL. Patients received 4 intratympanic treatments of 24 mg/mL dexamethasone over the course of 2 weeks. Significant hearing recovery was defined as the final PTA within 10 dB of baseline or final PTA with a 50% or greater percentage of recovery. The hearing in the contralateral ear was used as baseline. Results: All patients had normal hearing in the contralateral ear (PTA⬍25 dB). The average time to treatment was 31 days (range, 2–180 days; median, 19 days). Ten percent (2/20) of patients had significant hearing recovery. The two patients with significant hearing recovery were treated within 11 days of onset of hearing loss. Conclusions: Using the protocol of this study, intratympanic dexamethasone does not result in significant hearing recovery for patients with profound ISSNHL.
10:08 AM Cochlear Implantation in Children with Mondini Deformity. Sandra Genevieve DeSaSouza, MS DORL (presenter); Dillon JFF Dsouza, MS DORL; Natasha A Dsouza, BSc ASR Mumbai India; Mumbai India; Mumbai India
Objectives: This study reviews the results of cochlear implantation in 11 children between the ages of 2 to 18 years with Mondini deformity of the cochlea, who underwent surgery between 1988 and 2003. Of these, 7 children had a true Mondini with incomplete partition and 4 had a “cocks” common cavity. Methods: A Hortmann ball electrode device was used in 3 cases, a medel ball electrode device in 1 case, and a Medel compressed Combi40 in 1 case. Six cases received Clarion devices, 4 precurved enhanced bipolar, 1 HiFocus I, and 1 HiRes 90K. In all cases, there was complete insertion of electrodes and intraoperative sealing of the gusher. The precurved electrode was the safest and easiest to surgically introduce. Three cases with a common cavity developed a postoperative leak and had to have a lumboperitoneal shunt Results: The speech perception and speech production average scores attained were higher in patients with a true Mondini deformity and with multielectrode devices. The highest scores were attained with children using paired pulsatile stimuli strategies. On long-term follow-up, the 3 Hortmann single electrode devices failed between 3 and 4 years and the Medel single electrode device after 5 years, although functioning could not maintain sufficient hearing thresholds. Conclusions: From this study, we can conclude that children with true Mondini deformity (incomplete partition) and multielectrode devices, using a paired pulsatile strategy, although slower, perform as well as their matched counterparts with a normal cochlea. 10:16 AM Minimal Invasive Technique for Implantation of Clarion 90K Hi Res Cochlear Implant Alec F Fitzgerald O’Connor, FRCS (presenter) London United Kingdom
Objectives: Patient and parental pressure has led to the development of minimally invasive techniques for cochlear implantation. New devices such as the Clarion Hi Res 90K require modified surgical approaches. The procedure should ensure an incision less than 5 cm, fixation of the device to the skull, and positioning of the receiver coil such that the auditory stimulator can be worn comfortably behind the ear. The surgery should have a low morbidity. Methods: Eighteen patients undergoing implantation with the Clarion Hi Res 90K device were managed with the designed technique. The skin incision was centered behind the external auditory meatus. The mastoidectomy fashioned to ensure a safe posterior tympanotomy and cochleostomy. The well for the stimulator was placed posterior to the edge of the mastoidectomy at a distance the length of strengthened connector link to the electrode array and fixed passively by a groove and canl to the skull. Results: In all cases, the technique was able to be used.
WEDNESDAY
P226
Otolaryngology– Head and Neck Surgery August 2004