Antoniu-Oreste Gostian

Young age is a positive prognostic factor for residual hearing preservation in conventional cochlear implantation.

Objective To investigate the prognostic significance of various factors in hearing preservation after traditional cochlear implantation (CI). Study design Retrospective case review. Setting Academic tertiary referral center. Patients A total of 153 implantations with mean patient age at implantation of 36 years (from 10 mo to 83 yr) and residual hearing at the frequencies 250, 500, and 1,000 Hz on the unaided preoperative pure-tone audiometry were included. Intervention(s) CI with a conventional full-length electrode. Main outcome measure(s) The changes on the residual hearing 3 months after implantation were analyzed regarding patients’ demographic factors, shape of the preoperative threshold curve, type of the electrode carrier, and approach of electrode insertion in the cochlea. Preservation of residual hearing was defined as measurable postoperative threshold at the frequencies 250, 500, and 1,000 Hz. Results Preservation of residual hearing was observed in almost half of the cases (47%). In more than half of these patients (54%), a maximal to complete hearing preservation (0–10 dB loss) was achieved. About one-third of these implantations (29%) showed a moderate preservation of residual hearing (11–20 dB loss). In the remaining 17%, the preservation of hearing was marginal (>21 dB loss). Hearing preservation and its extent were significantly better in children and adolescents compared with those in adults. Conclusion The preservation of residual hearing after conventional CI is possible. Young age seems to have a positive impact on hearing preservation.

Insertion of Cochlear Implant Electrode Array Using the Underwater Technique for Preserving Residual Hearing.

Objective: To describe a method of cochlear implantation in which the opening of the cochlea and the electrode array insertion are performed under water (underwater technique). Study Design: Retrospective patient review. Setting: Academic tertiary referral center. Patients: Fifteen implantations in children and adult patients with residual hearing at the frequencies 250, 500, and 1000 Hz on the unaided preoperative pure-tone audiometry were included in this study. Intervention(s): Cochlear implantation with a conventional full-length electrode, in which the opening of the cochlea and the electrode array insertion are performed after the tympanic cavity was filled with body-temperature Ringer solution. Main Outcome Measure(s): Changes on residual hearing 6 to 8 weeks after surgery and at subsequent follow-up appointments were analyzed. Preservation of residual hearing was defined as measurable postoperative threshold at the frequencies 250, 500, and 1000 Hz. Results: Overall postimplant hearing preservation 6 to 8 weeks after implantation was achieved in 13 of the patients (87%). Subsequent follow-up was performed on average 15.2 months after surgery (range, 7–32) in 14 out of 15 patients. At this late postoperative evaluation preservation of hearing was recorded in nine patients (64%), whereas in the remaining five patients (36%) no residual hearing was measured. Conclusion: The underwater technique offers a reliable nontraumatic method for electrode array insertions during cochlear implantation. The method respects the physiology of the cochlea und minimizes the pressure variations during cochlear opening and implantation.

Comparison of digital volume tomography and high-resolution computed tomography in detecting superior semicircular canal dehiscence - a temporal bone study

Abstract Conclusion: In detecting a thin bony coverage of a superior semicircular canal (SSC), digital volume tomography (DVT) scans in Poeschl projection seem to be superior to high-resolution computed tomography (CT) scans. Still, a definite diagnosis of SSC dehiscence (SSCD) is not possible with any radiologic imaging technique. Objective: To compare CT and DVT to find out whether DVT is equal, better or worse in showing a thin bony layer on top of an SCC. Methods: In 11 human temporal bone specimens, the SSC was microscopically blue-lined leaving a thin bony coverage on top of it. All specimens were assessed with both high-resolution CT and DVT. After reconstructing the images in Stenvers and Poeschl projections, all images were evaluated by five independent examiners experienced in radiologic imaging of the temporal bone using a four-point ordinal scale, from 1 (distinct dehiscence) to 4 (distinct coverage). Results: The mean score for all CT scans was 2.58 compared with 3.22 for DVT scans (p = 0.000). Poeschl projection showed a mean score of 3.25 compared with 2.55 for Stenvers projection (p = 0.000). The best imaging modality was found to be DVT scans in Poeschl projections, with a mean score of 3.60.

Fragmentation of salivary stones with a 980 nm diode laser

OBJECTIVE Intraductal laser lithotripsy is a preferred method to fragment large, immobile intraglandular salivary stones. A number of different laser systems has been investigated for this purpose. It was our aim to study the effectiveness of a 980nm diode laser when fragmenting salivary stones in an experimental set up. METHODS In an experimental set up we used a 980nm diode laser for the lithotripsy of 9 salivary stones. The temperature circle around the laser fibre tip was measured and stone remnants were chemically analysed for their composition. RESULTS The salivary stones had a mean diameter of 6.7mm×5.6mm×3.0mm. Laser fragmentation with the diode laser was successful at all stones. The temperature next to the salivary stone increased to around 30°C during the active lithotripsy with continuous rinsing (fluid temperature 21°C). At a distance of 2mm the temperature around the laser fibres tip is reduced by already about 50%. The salivary stones mainly consisted of carbonate apatite, followed by β-calcium phosphate and other calcium phosphates. CONCLUSION The fragmentation of salivary stones with a 980nm diode laser is possible in principle. Under a continuous irrigation with a positioning of the laser fibres tip at the centre of the stone, no relevant temperature increase in the vicinity of the stone occurs. However, before the laser is used in humans, in vivo experiments on animal material seem to be advisable.

Impact of coupling techniques of an active middle ear device to the round window membrane for the backward stimulation of the cochlea.

Hypothesis Interposed cartilage and the round window coupler (RWC) increase the efficiency of cochlea stimulation with the floating mass transducer (FMT) of a single active middle ear implant (AMEI) placed against the round window membrane. Background Treatment of mixed and conductive hearing loss with an AMEI attached to the round window is effective, yet the best placement technique of its FMT for the most efficient stimulation of the cochlea remains to be determined. Methods Experimental study on human temporal bones with the FMT placed against firstly the unaltered round window niche and then subsequently against the fully exposed round window membrane with and without interposed cartilage and the RWC. Cochlea stimulation is measured by the volume velocities of the stapes footplate using LASER vibrometry. Results At the undrilled round window niche, placement of the FMT by itself and with the RWC resulted in similar volume velocities. The response was significantly raised by interposing cartilage into the undrilled round window niche. Complete exposure of the round window membrane allowed for significantly increased volume velocities. Among these, coupling of the FMT with interposed cartilage yielded responses of similar magnitude compared with the RWC but significantly higher compared with the FMT by itself. Conclusion Good contact to the round window membrane is essential for efficient stimulation of the cochlea. Therefore, interposing cartilage into the undrilled round window niche is a viable option. At the drilled round window membrane, the FMT with interposed cartilage and attached to the RWC are similarly effective.

Acoustic Properties of Collagenous Matrices of Xenogenic Origin for Tympanic Membrane Reconstruction.

Hypothesis: The acoustic properties of scaffolds made from decellularized extracellular cartilage matrices of porcine origin are comparable to those of the human tympanic membrane. Background: Currently, the reconstruction of tympanic membrane in the context of chronic tympanic membrane defects is mostly performed using autologous fascia or cartilage. Autologous tissue may be associated with lack of graft material in revision patients and requires more invasive and longer operative time. Therefore, other materials are investigated for reconstruction. An increasingly important role could be played by scaffolds from different materials, which are known to induce constructive tissue remodeling. Methods: To analyze the acoustic properties, the vibrations of the scaffolds, cartilage, perichondrium and tympanic membrane were measured by laser scanning doppler vibrometry under different static pressures. Results: The analysis of volume velocities serves as an indicator for sound transmission. The results of the average volume velocities at atmospheric pressure show a similar frequency response of the tympanic membrane and the scaffolds with a peak at about 800 Hz. After changing the artificial ear-canal pressure from atmospheric pressure to negative pressure (−100, −200, and −300 daPa) the vibration characteristics of the different membranes remain fairly constant, whereas the results of the perichondrium show a decrease after changing the pressure into the negative range in the frequencies 1 to 3 kHz. Conclusion: The present study showed that the vibration characteristics of the scaffolds under atmospheric and negative pressure can be interpreted as similar to those of thin cartilage (<0.5 mm) and human tympanic membranes. However, in relation to the behavior of these scaffolds made from decellularized extracellular cartilage matrices in vivo, further investigations should be carried out.

Surgical Treatment for Early Stage Glottic Carcinoma with Involvement of the Anterior Commissure

Objective Assessment of the value of transoral laser microsurgery (TLM) compared with open surgery (OS) for early stage squamous cell carcinoma of the glottic larynx with special regard to involvement of the anterior commissure (AC). Study Design Case series with chart review. Setting Tertiary care otolaryngology clinic. Subjects and Methods Review of clinicopathological data of all patients with previously untreated T1a, T1b, and T2 glottic squamous cell carcinoma of the larynx who were consecutively enrolled over a 10-year period (January 1, 1992, to December 31, 2002). Results Local recurrence rate was 20.4% (10 of 49) for TLM and 10.7% (3 of 28) for OS. Comparison of the TLM and OS groups regarding local recurrence rates revealed a significant difference only for tumors invading the AC (P = .046). Within the TLM group, tumors with involvement of the AC showed a significantly higher recurrence rate (38.1%; 8 of 21) compared with tumors without involvement of the AC (7.1%; 2 of 28; P = .008). In the OS group, involvement of the AC revealed no significant difference (P = .45). The overall survival in both groups was comparable in both groups (TLM, 93.9%; OS, 89.3%; P = .47). Conclusion TLM and OS are equally effective surgical treatments for early stage glottic cancer without involvement of the AC, with selection of treatment based on pretreatment endoscopy. However, TLM is associated with less morbidity. In case of invasion of the AC, OS yields lower recurrence rates.

Long-Term Results of TORP-Vibroplasty.

Objective Assessing long-term results of patients treated with total ossicular replacement prosthesis (TORP)–vibroplasty. Design Retrospective analysis. Setting Tertiary referral center. Patients A total of five patients (two women, three men; mean age, 66 yr) were eligible for evaluation after an average follow-up period of 5.1 years after TORP-vibroplasty. Interventions Implantation of an active middle ear device in conjunction with a titanium coupler for oval window placement in patients with chronic middle ear disease with missing stapes suprastructure. Main Outcome Measures Audiometric outcomes and satisfaction of the patients. Results The functional gain was 45.2 and 45.6 dB HL at 6 months and 5.1 years after implantation, respectively. The speech recognition using the Freiburg monosyllabic word test and speech intelligibility showed postoperatively a distinct improvement and revealed no statistically significant change across time for the entire follow-up period. According to the International Outcome Inventory for Hearing Aids questionnaire, the patients stated considerable subjective benefits and satisfaction with the device. Conclusion The good outcomes of TORP-vibroplasty in chronic disabled ears are stable. They provide long-term and long-lasting satisfying audiologic results combined with a high satisfaction of the patient. Prerequisite is the stable attachment to the cochlear windows.

Pharyngeal fistulas after total laryngectomy with and without tracheostoma plasty according to Herrmann

PurposePharyngeal fistula (PF) is one of the most common complications after total laryngectomy (TL). The tracheostoma plasty technique according to Herrmann (TPH) represents an alternative surgical technique to shape the tracheostoma. The aim of this study was to determine whether the performance of a TPH affects the incidence of PF after TL. A secondary aim was to identify potential risk factors for the development of PF with regard to TPH.MethodsRetrospective evaluation of records of 151 consecutive patients at two tertiary care centers with regard to the occurrence and risk factors of PF after TL with and without TPH.Results60 patients with TPH and 91 patients without TPH contributed to the results. The overall incidence of PF was 21.2% (32 out of 151). 23.3% (14 out of 60) of patients with TPH and 19.8% (18 of 91) of patients without TPH developed a PF (p = 0.91). Binary logistic regression analysis revealed significant influence of salvage surgery on the risk to develop PF (odds ratio = 2.9; 95% CI 1.16–7.23; p = 0.026). The occurrence of PF was not significantly influenced by any other investigated factors including performance of TPH.ConclusionsPerformance of TPH after TL does not increase the incidence of PF. Thus, TPH can be considered as a safe alternative surgical technique for the shaping of the tracheostoma following TL.

Influence of Backside Loading on the Floating Mass Transducer: an in vitro experimental study

The vibration of the floating mass transducer (FMT) of a single active middle‐ear implant (AMEI) is distinctly influenced by the properties of the material coupled to its back side.