Magdalena Lachowska

Is cochlear implantation a good treatment method for profoundly deafened elderly

Purpose To assess the benefits of cochlear implantation in the elderly. Patients and methods A retrospective analysis of 31 postlingually deafened elderly (≥60 years of age) with unilateral cochlear implants was conducted. Audiological testing included preoperative and postoperative pure-tone audiometry and a monosyllabic word recognition test presented from recorded material in free field. Speech perception tests included Ling’s six sound test (sound detection, discrimination, and identification), syllable discrimination, and monosyllabic and multisyllabic word recognition (open set) without lip-reading. Everyday life benefits from cochlear implantation were also evaluated. Results The mean age at the time of cochlear implantation was 72.4 years old. The mean postimplantation follow-up time was 2.34 years. All patients significantly improved their audiological and speech understanding performances. The preoperative mean pure-tone average threshold for 500 Hz, 1,000 Hz, 2,000 Hz, and 4,000 Hz was 110.17 dB HL. Before cochlear implantation, all patients scored 0% on the monosyllabic word recognition test in free field at 70 dB SPL intensity level. The postoperative pure-tone average was 37.14 dB HL (the best mean threshold was 17.50 dB HL, the worst was 58.75 dB HL). After the surgery, mean monosyllabic word recognition reached 47.25%. Speech perception tests showed statistically significant improvement in speech recognition. Conclusion The results of this study showed that cochlear implantation is indeed a successful treatment for improving speech recognition and offers a great help in everyday life to deafened elderly patients. Therefore, they can be good candidates for cochlear implantation and their age alone should not be a relevant or excluding factor when choosing candidates for cochlear implantation.

Second stage of Universal Neonatal Hearing Screening – A way for diagnosis and beginning of proper treatment for infants with hearing loss

PURPOSE To analyze retrospectively the results of hearing testing in infants at the second stage of the Polish Universal Neonatal Hearing Screening Program carried out in the Department of Otolaryngology at the Medical University of Warsaw. MATERIAL/METHODS A total of 351 infants referred to our Department for the second stage of UNHS were included in the study. There were 39.60% infants referred due to positive result of hearing screening at the first stage of the Program performed in neonatal units, 55.27% with negative screening but risk factors present, and 5.13% without any tests due to equipment failure in the maternity unit. RESULTS Risk factors were identified in 86.61% of the infants. The most frequent ones were hyperbilirubinemia (71.51%), premature birth (63.25%), and ototoxic medication (62.11%). Otoacoustic emission test showed fail results in 17.66% of the infants, and auditory brainstem responses confirmed hearing loss in 16.81%. Correlation between risk factors and confirmed hearing loss was found for hyperbilirubinemia, low birth weight, intensive therapy for at least 7 days, low Apgar scores, and craniofacial abnormalities. CONCLUSIONS The early identification of infants with hearing loss is essential for early intervention. Not only infants who fail the initial screening but also the ones with risk factors of hearing impairment should be referred to the centers that are capable of providing the necessary diagnostic services required for the second stage of the UNHSP. Those two steps are needed to both minimize the risk of overlooking a child with hearing loss and properly diagnose hearing impairment.

Ocena rozwoju postępów słuchowych i językowych po wszczepieniu implantu ślimakowego u dzieci z dodatkowymi obciążeniami

Summary Aim The study aimed to assess the auditory skills in multi-handicapped children with cochlear implants. Material and methods The study assessed 34 children, who were implanted due to the bilateral profound sensorineural hearing loss. Apart from the hearing loss, all of the subjects suffered from additional impairments (mild motor disabilities, cerebral palsy, cognitive disability, specific learning disability, behavioral disorders, sight impairment), 29 (85.29%) from more than one. Cochlear implantation took place in the Department of Otolaryngology at the Medical University of Warsaw in Poland. The age at implantation ranged from 1.3 to 7.5 years old (mean 3.2 years, SD 1.64). The retrospective review of medical charts, audiology and speech pathology records was based on Champions profile with evaluation at 6, 12, 18–24 months, and 3 years after implantation. When a patient had been referred for developmental evaluation by psychologist, this source of information was also used. Results All of the subjects suffered from additional impairments, and most of them presented more than one additional disability. Individually and as a group, these patients respond well to cochlear implantation. The study population showed improvement in communication code in 31 patients (91.18%), and no improvement in 3 patients (two of them had 6 months follow up and one 12 months follow-up). Also progress in auditory skills was noted in the study population, which was measured as the awareness in environmental sounds – Categories of Auditory Performance (CAP). Conclusions Multi-handicapped children receive benefit from cochlear implantation. The rate of this improvement is slow but offers better quality of life due to better auditory-communication skills, better self-independence and social integration. The results of implantation in presented group of patients is encouraging.

Does effect of rehabilitation based on sensory conflicts in patients with vestibular deficits exceed learning effect

OBJECTIVE The purpose was to assess learning and rehabilitation effect and their influence on Sensory Organization Test results in young and elderly patients with peripheral, central and mixed vestibular pathology. MATERIAL AND METHODS 26 patients with different vestibular system deficits participated in this study. Rehabilitation was held five days a week, for two weeks. To assess learning effect, SOT was administered to each patient twice and compared: 1) on the day preceding the beginning of rehabilitation (SOT1), and 2) on the first day of rehabilitation (SOT2). To evaluate rehabilitation effect, results of SOT2 were compared to SOT3 (administered on the last day of rehabilitation). RESULTS Learning effect showed similar improvement in CS in all groups but young. Rehabilitation caused further improvement in CS in all groups but central pathology. This improvement was similar between those groups. There was no significant difference found between learning and rehabilitation effect in CS. CONCLUSIONS The results of our study indicate that none of the groups achieved significant benefit from rehabilitation based on sensory conflicts that would overcome the learning effect. However, the lack of significant advantage of rehabilitation over learning does not mean that it does not exist.

First bilateral simultaneous implantation with fully implantable middle ear hearing device

The majority of moderate to severe sensorineural hearing loss individuals must rely on amplification of the acoustic signal to improve communication skills. This aim is generally accomplished with conventional air conduction hearing aids [1]. In some cases, hearing aid wearers report difficulties and limited adoption of hearing aids due to ear canal occlusion, pain or irritation of the skin in the ear canal, social stigma, and cosmetic issues [2]. The fully implantable middle ear hearing device is now an alternative solution for those patients. It resides completely underneath the skin behind the ear, with nothing in the external ear canal. The Otologics Carina implant is composed of an electronic capsule, microphone, and electromagnetic transducer. The battery, magnet, digital signal processor, coil, and connector make up the electronic capsule [1, 2]. The sensitive subcutaneous microphone picks up the acoustic signal, which is then translated into a digital signal, amplified according to the wearers needs, and converted into the electrical signal. This electrical signal is sent to the electromagnetic transducer, which translates it into a mechanical motion that directly stimulates the ossicles. The tip of the transducer touches the middle ear ossicular chain, round or oval window and in this way bypasses the external ear canal [1–5].

Videolaryngoscopic and videostroboscopic evaluation following laser CO2 and conventional cordectomy of Tis and T1 glottic carcinoma

Introduction This paper is an analysis of long-term functional results, observed on videolaryngoscopic and videostroboscopic examination, of two different types of surgical intervention for Tis and T1 glottic carcinoma: laryngofissure conventional cordectomy and endoscopic laser CO2 cordectomy, with or without additional radiation therapy (using 60Co). Material and methods A total of 46 patients with Tis and T1 glottic carcinoma, 43 men (93.48%) and 3 women (6.52%), served as subjects. All were treated surgically with laryngofissure conventional cordectomy (15 patients, 32.61%) or endoscopic laser CO2 cordectomy (31 patients, 67.39%). The procedures were performed in the Department of Otolaryngology at the Medical University of Warsaw between November 1990 and February 2004. Videolaryngoscopic and videostroboscopic examinations were conducted a minimum of 3 years after the surgery, between January 2006 and February 2007. The appearance of the neocord (the scar after cordectomy), scar or synechia formation in the anterior commissure, movements of the vocal folds on respiration and phonation, difference in level between the neocord and the normal vocal fold, glottic closure, phonation type, and ventricular folds hyperfunction were examined. The symmetry of vocal fold vibrations, regularity of vibrations, glottic closure, amplitude of vibrations, and mucosal wave were also evaluated. Results In our study, the videolaryngoscopic and videolaryngostroboscopic examination showed a significantly higher occurrence of the following findings in patients after endoscopic laser cordectomy: phonation at the glottic level, complete glottic closure, and a tendency to vibration of the neocord on phonation. Conclusions Ventricular hyperfunction on phonation and scar or synechia formation in the anterior commissure were observed statistically more frequently in patients after laryngofissure conventional cordectomy.

Kimura’s Disease in a Caucasian Female: A Very Rare Cause of Lymphadenopathy

Introduction. Kimuras disease is a rare chronic inflammatory disorder characterized by the head and neck lymphadenopathy often accompanied by eosinophilia and elevated serum IgE. It is benign condition with unknown etiology usually affecting young men of Asian race. Affected Caucasians are very rare. Case Presentation. We report a clinically and histopathologically typical case of this disease in a 40-year-old Caucasian female. In differential diagnosis particular attention has been paid to angiolymphoid hyperplasia with eosinophilia and neoplasms. Conclusion. The diagnosis of Kimuras disease can be very difficult and misleading; it is important not to ignore histopathological features. The presented patient has been under follow-up with no more symptoms of the disease for the last 1.5 years.

Benefits of cochlear implantation in deafened adults.

Aim: The objective was to retrospectively analyze the benefits of cochlear implantation in deafened elderly (>65 years old). Method: Data from 30 elderly patients with a unilateral cochlear implant were included and analyzed. Audiometric threshold and speech data in aided and unaided conditions were examined at pre- and postimplant intervals at 3, 6, and 12 months after activation of the sound processor and compared. Results: All patients demonstrated hearing benefits after implant and over time with results ranging from very good, good, to limited performance in a few cases. The mean postimplantation follow-up time was 2.74 years (minimum 1 year). Our study cohort demonstrates that cochlear implantation is a successful treatment method for improving speech perception in the auditory alone or auditory-visual mode for the majority of elderly patients. No correlations were observed between postimplant outcomes and age, or preimplant hearing thresholds and speech audiometry. Conclusion: Age is not a determining or limiting factor for post-CI outcome performance in deafened elderly patients. Counselling should consider the patient as a whole and include explanation of the risk for a minority of elderly patients who may demonstrate poor outcomes after implant, despite presenting as good candidates before implantation.

Estimating audiometric thresholds using simultaneous acquisition of ASSR and ABR from QASSR in patients with sensorineural hearing loss

Abstract Objectives: To evaluate the accuracy with which the innovative QASSR method predicts behavioral thresholds in adult patients with sensorineural hearing loss. Design: Subjects were tested at four carrier frequencies (500, 1000, 2000, and 4000 Hz).The resulting QASSR recordings were analyzed for thresholds and magnitude/phase characteristics. Tone-burst ABR was recovered from QASSR signal using CLAD method and analyzed in the time domain. The electrophysiological estimates were compared to hearing thresholds determined behaviorally. Study sample: Sixteen ears of nine volunteer subjects recruited from a clinical population. Results: All mean threshold estimates differed less than 3 dB for QASSR and less than 5 dB for ABR at 1000, 2000 and 4000Hz (carrier or pure-tone test frequencies). The largest differences were observed for both at 500 Hz (5.63 and 11.56 dB respectively).The audiometric configurations of QASSR and ABR estimates followed those of the respective behaviorally determined configurations across ears tested. Conclusions: QASSR method merges two dissimilar stimulation techniques, transient and steady-state, to create a hybrid stimulation-and-analysis paradigm that seems to improve the overall performance of the electrophysiological threshold estimation. The unique feature of the QASSR technique is the additional information afforded by the transient ABR, recovered from the same recording. The QASSR thus holds promise to be a very useful tool for practical clinical applications.

Methodology for Intraoperative Laser Doppler Vibrometry Measurements of Ossicular Chain Reconstruction

Objectives Despite the increasing number of research concerning the applications of the Laser Doppler Vibrometry (LDV) in medicine, its usefulness is still under discussion. The aim of this study is to present a methodology developed in our Department for the LDV intraoperative assessment of ossicular chain reconstruction. Methods Ten patients who underwent “second look” tympanoplasty were involved in the study. The measurements of the acoustic conductivity of the middle ear were performed using the LDV system. Tone bursts with carrier frequencies of 500, 1,000, 2,000, and 4,000 Hz set in motion the ossicular chain. The study was divided into four experiments that examined the intra- and interindividual reproducibility, the utility of the posterior tympanotomy, the impact of changes in the laser beam angle, and the influence of reflective tape presence on measurements. Results There were no statistically significant differences between the two measurements performed in the same patient. However, interindividual differences were significant. In all cases, posterior tympanotomy proved to be useful for LDV measurements of the ossicular prosthesis vibrations. In most cases, changing the laser beam angle decreased signal amplitude about 1.5% (not significant change). The reflective tape was necessary to achieve adequate reflection of the laser beam. Conclusion LDV showed to be a valuable noncontact intraoperative tool for measurements of the middle ear conductive system mobility with a very good intraindividual repeatability. Neither a small change in the angle of the laser beam nor performing the measurements through posterior tympanotomy showed a significant influence on the results. Reflective tape was necessary to obtain good quality responses in LDV measurements.