Kevin P. Gibbin

Differential Diagnostic Potential of Otoacoustic Emissions: A Case Study

An 11-year-old boy was identified as having a profound sensorineural hearing loss accompanied by clear click-evoked otoacoustic emissions. Further diagnostic testing by means of electrocochleography and auditory brainstem responses indicated a predominantly retrocochlear disorder with good cochlear function. However, radiological investigation ruled out the presence of any material space-occupying lesion. This case illustrates the contribution that can be made by otoacoustic emission testing to differential diagnosis.

Cochlear implantation — United Kingdom and Ireland surgical survey

Cochlear implantation has now become a routine procedure in the management of severe to profound deafness. An initial survey was carried out in late 1997 of the surgeons carrying out implantation in the United Kingdom and Ireland, requesting details of medical and surgical aspects of cochlear implantation. A follow-up survey was conducted in early 2002 to evaluate any changes in clinical practice. The reported results show a low surgical complication rate in both children and adults. Reasons for this are discussed.

Infections following cochlear implantation

Abstract Cochlear implantation has become routine in the management of children and adults with profound sensorineural hearing loss. In rare cases postoperative infections necessitate removal of the implant. We present six such cases that have been managed within our programme. Extensive infected granulation tissue was found around the implant at exploration despite prolonged intravenous treatment with appropriate antimicrobial agents. All devices were explanted and three have been reimplanted at our unit. We discuss our management of these cases, the need for explantation, consideration for reimplantation and their functional outcome following reimplantation. We also highlight how systemic inflammatory markers can be unhelpful in detecting significant infection surrounding a cochlear implant.

Neonatal upper airway obstruction caused by chlamydial rhinitis

This paper reports the case of a six-week-old infant who presented with severe rhinitis and upper airway obstruction due to infection with Chlamydia trachomatis

Paediatric cochlear implant durability: the Nottingham experience

Abstract Objective To determine durability of cochlear implant devices in a large paediatric cohort. Design Retrospective review of database records of children consecutively implanted between 1989 and March 2002. Methods The records of 363 children were studied. The review examined cases requiring explantation of the implant device for device failure with or without reimplantation. Results 15 failures were identified. The failure rates based on failures per number of implanted devices as well as cumulative user experience were 4.0% and 0.8% respectively. Conclusions As implant programmes grow, so will the number of children requiring device explantation and reimplantation. This will have implications on implant programme development and resource allocation.

An ear canal electrode for electrocochleography.

The authors have been carrying out routine extratympanic electrocochleography on patients for the past five years using a small silver/silver chloride surface electrode positioned in the ear canal close to the tympanic membrane. In early recording sessions the electrode was held in position using a conductive bentonite paste (Mason et al. 1980). More recently, however, the authors have developed a V-shaped spring which can be located in the ear canal; this is as easy to position as the original electrode but maintains more reliable electrode contact for recording periods of up to two hours.

Retrospective study of intra-operative testing with the Nucleus CI24M cochlear implant and use of the back-up device.

Abstract The combined use of integrity testing (IT) and impedance telemetry (ImTe) intra-operatively is evaluated. One hundred and fifty children implanted with the Nucleus device were studied. In 81% of patients, normal results were obtained on all electrodes from both ImTe and IT. In seven cases where the back-up device was used, the intra-operative analysis of the device and subsequent postoperative quality assurance testing did not always correlate. In conclusion, intra-operatively, only ImTe is needed to verify the function of the implant if all impedance values are normal. However, in the case of abnormal ImTe results, additional IT data provide valuable assistance with the decision of whether to leave the implant in place or to use the backup device.