David Proops

Consensus statements on the BAHA system: where do we stand at present?

After more than 25 years of clinical experience, the BAHA (bone-anchored hearing aid) system is a well-established treatment for hearing-impaired patients with conductive or mixed hearing loss. Owing to its success, the use of the BAHA system has spread and the indications for application have gradually become broader. New indications, as well as clinical applications, were discussed during scientific roundtable meetings in 2004 by experts in the field, and the outcomes of these discussions are presented in the form of statements. The issues that were discussed concerned BAHA surgery, the fitting range of the BAHA system, the BAHA system compared to conventional devices, bilateral application, the BAHA system in children, the BAHA system in patients with single-sided deafness, and, finally, the BAHA system in patients with unilateral conductive hearing loss.

Clinical experience with the Vibrant Soundbridge implant device.

Objective To evaluate the full degree and range of benefits provided by the Vibrant Soundbridge (VSB; Symphonix Devices, Inc., San Jose, CA, U.S.A.) and analyze pre-and postoperative results of audiologic tests. Study Design Single-subject study with each subject serving as his or her own control. Setting Multicenter clinical study conducted at 10 centers in Europe. Patients 47 patients who met the selection criteria for participation in the study. Interventions Implantation of the VSB direct-drive middle ear hearing device. Main Outcome Measures Average change in unaided thresholds with the patient wearing headphones at each frequency pre-and postsurgery was measured. A mean threshold change less than 5 dB across all frequencies was considered clinically nonsignificant. Results 47 patients had successful surgery for implantation and fitting with the VSB device. Conclusion The VSB is a new middle ear implant device that can be used safely in the treatment of patients with moderate to severe sensorineural hearing loss.

Evaluation of bilaterally implanted adult subjects with the nucleus 24 cochlear implant system.

Objective: To evaluate the speech perception benefits of bilateral implantation for subjects who already have one implant. Study Design: Repeated measures. Patients: Thirty adult cochlear implant users who received their second implant from 1 to 7 years with a mean of 3 years after their first device. Ages ranged from 29 to 82 years with a mean of 57 years. Setting: Tertiary referral centers across the United Kingdom. Main Outcome Measures: Monosyllabic consonant-nucleus-consonant words and City University of New York sentences in quiet with coincident speech and noise and with the noise spatially separated from the speech by ±90°. Results: At 9 months, results showed the second ear in noise was 13.9 ± 5.9% worse than the first ear (p < 0.001); a significant binaural advantage of 12.6 ± 5.4% (p < 0.001) over the first ear alone for speech and noise from the front; a 21 ± 6% (p < 0.001) binaural advantage over the first ear alone when noise was ipsilateral to the first ear; no binaural advantage when noise was contralateral to the first ear. Conclusions: There is a significant bilateral advantage of adding a second ear for this group. We were unable to predict when the second ear would be the better performing ear, and by implanting both ears, we guarantee implanting the better ear. Sequential implantation with long delays between ears has resulted in poor second ear performance for some subjects and has limited the degree of bilateral benefit that can be obtained by these users. The dual microphone does not provide equivalent benefit to bilateral implants.

Cochlear implantation in 53 patients with otosclerosis: demographics, computed tomographic scanning, surgery, and complications.

Objectives: To collect data from a large number of cochlear implant recipients with otosclerosis and to make an assessment of these patients’ clinical characteristics, computed tomographic scans, surgical findings, and complications, and to quantify the occurrence of postoperative facial nerve stimulation. Study Design: Retrospective multicenter study. Patients: Fifty-three patients with otosclerosis from four cochlear implant centers in the United Kingdom and The Netherlands were reviewed. Sixty surgical procedures were performed in these patients: 57 devices were placed in 56 ears. Results: The computed tomographic imaging demonstrated retrofenestral (cochlear) otosclerotic lesions in the majority of patients. Although not statistically significant, the extent of otosclerotic lesions on the computed tomographic scan as categorized in three types tends to be greater in patients with rapidly progressive hearing loss, in patients in whom there is surgically problematic insertion of the electrode array, and in patients with facial nerve stimulation. In four patients, revision surgery had to be performed. Twenty of 53 (38%) patients experienced facial nerve stimulation at various periods postoperatively. Conclusion: Cochlear implant surgery in patients with otosclerosis can be challenging, with a relatively high number of partial insertions and misplacements of the electrode array demanding revision surgery. A very high proportion of patients experienced facial nerve stimulation mainly caused by the distal electrodes. This must be discussed with patients preoperatively.

The birmingham pediatric bone-anchored hearing aid program: a 15-year experience.

Objective: To evaluate the complication rates and outcomes of children who were fitted with a bone-anchored hearing aid (BAHA) on the Birmingham BAHA program. Study Design: Retrospective case analysis of clinical records of all children implanted at Birmingham Childrens Hospital since the beginning of the program in 1992 until February 2007. Patients: A total of 182 children younger than 16 years old fitted with a BAHA. Of these children, 107 had a significant medical history. Results: Surgery was performed as a 2-stage procedure in 174 children. The healing time was between 3 and 4 months in 112 (64%) cases. Single-stage surgery was performed in 8 cases. Implant failures were 14% of 230 loaded fixtures (32 fixtures lost in total). Multiple-fixture failures (18 fixture failures) occurred in 7 patients. Adverse skin reactions appeared in 34 (17%) patients during a 15-year follow-up period. Revision surgery was undertaken in 14 (8%) cases because of skin overgrowth around the abutment. Five of these cases required multiple surgical skin reductions. Conclusion: The Birmingham Program has a high proportion of syndromic patients with complex medical problems. The fixture failure rate was found to be 14%. This included the multiple-fixture failures in children younger than 3 years old. There was 1 serious complication. The BAHA is a reliable and effective treatment for selected patients. Our program currently has 97% of its children wearing their BAHA on a daily basis with continuing audiologic benefit.

The Birmingham bone anchored hearing aid programme: surgical methods and complications

Since 1988, 309 patients have been referred to the Birmingham bone anchored hearing aid programme for assessment. One hundred and eighty-eight have been fitted with bone anchored hearing aids (BAHA). Of these 169 have been fitted with a BAHA alone and 20 with a BAHA and auricular prosthesis(es). Only four (2.1 per cent) are not wearing their BAHAs. Three cases because the hearing had continued to deteriorate and in one case because of repeated failure to integrate. Nineteen patients (10.1 per cent) have lost fixtures but all but one of these have been successfully reimplanted. Of these 19 patients 10 (52.6 per cent) were syndromal and 10 (52.6 per cent) were under 16 years of age. A surgical method has been evolved both to cope with predictable failure of integration and soft tissue control.

An autonomous surgical robot for drilling a cochleostomy: preliminary porcine trial

Objective:  To produce an autonomous drilling robot capable of performing a bony cochleostomy whilst minimising the damage to the underlying cochlear endosteum.

Management of epistaxis in children

A randomised clinical trial of antiseptic nasal carrier cream (Naseptin) and silver nitrate cautery in the treatment of epistaxis in children was carried out. Fifty-four percent responded to cautery with silver nitrate and 50% to treatment with Naseptin antiseptic carrier cream. There were 24 patients in each group. No statistically significant difference was observed between the groups when tested with the chi 2 test. We believe that the first line treatment of epistaxis in children should be the use of antiseptic nasal cream.

Osseointegrated implants in the management of childhood ear abnormalities: the initial Birmingham experience.

Over a four-year period 72 children with ear abnormalities have been referred for assessment by the extraoral osseointegrated implant team at The Queen Elizabeth Hospital, Birmingham. Thirty-two children have been judged suitable for rehabilitation. Twelve children have completed rehabilitation using bone-anchored hearing aids and/or auricular prostheses. Two fixtures (seven per cent of those loaded) have dislodged and required replacement. Audiological assessment of the bone-anchored hearing aid users shows only small improvements in their aided thresholds, compared to thresholds obtained with their previous aid. However all now have thresholds of 30 dB(A) or better and report a marked improvement in sound quality. When surveyed, hearing aid and prosthesis users report high levels of satisfaction with this form of rehabilitation. The technique adds a new dimension to the management of children with aural anomalies. The approach and results of a multidisciplinary programme are reported.

Fine needle aspiration cytology in the management ENT of patients

Aspirates were obtained from 142 masses in 120 patients who presented with palpable swellings in the head and neck region. 120 specimens (84.51 per cent) were adequate for diagnostic purposes and the remaining 22 (15.49 per cent) were unsatisfactory. Final diagnosis was based on resection histology in 87 cases and close clinical follow-up in 55 patients. The overall sensitivity and specificity including unsatisfactory aspirates was 81.37 per cent and 93 per cent respectively (if the technically inadequate specimens were deleted 98.81 per cent and 94.44 per cent). In comparison with the final diagnosis typing of malignant tumours was possible in 58.33 per cent. The correct diagnosis was made in 63.89 per cent of benign lesions.