Mathieu Côté

Cochlear reimplantation : Causes of failure, outcomes, and audiologic performance

Objectives/Hypothesis: To review Quebecs experience with cochlear reimplantation in adults and children and describe failure rates, causes of revision, surgical findings, and the impact of reimplantation on audiologic performances.

Bat Rabies in the United States and Canada from 1950 through 2007: Human Cases With and Without Bat Contact

BACKGROUND Since the 1980s, rare cases of rabies in humans in Canada and the United States have been almost exclusively caused by the bat-variant virus. METHODS We reviewed indigenously acquired cases of bat-variant rabies in humans in Canada and the United States from 1950 through 2007. RESULTS Of 61 cases identified, 5 occurred after organ transplantation and were excluded from further analysis. A bite was reported by 22 (39%) of the case patients, 9 (16%) had a direct contact (i.e., were touched by a bat) but no history of a bite, 6 (11%) found bats in their home (2 [4%] in the room where they slept) but reported no direct contact, and 19 (34%) reported no history of bat exposure whatsoever. With the exception of California (8 cases) and Texas (7 cases), no state or province had >3 cases. Of the case patients, 76% were men, and 40% were 10-29 years of age. The median incubation period was 7 weeks (<10 weeks in 72% of cases). The incidence of bat-variant rabies cases increased from 2.2 per billion person-years in 1950-1989 to 6.7 per billion person-years in 1990-2007. Of 36 case patients with bat rabies described since 1990, 16 had no history of direct bat contact; 2 (13%) of the 16 would have qualified for rabies postexposure prophylaxis on the basis of exposure criteria expanded in 1995 to include bats that were in the same room as a sleeping person. The incidence of rabies for this type of exposure was 0.6 cases per billion person-years. CONCLUSION The true preventable proportion of cases and the number needed to treat with rabies postexposure prophylaxis to prevent 1 case would be useful information to inform the current guidelines.

OCTO "Outcomes of cochlear implant for the octogenarians: audiologic and quality-of-life".

Objective The aim of this study is to assess the impact on quality of life, hearing performance, and surgical complications among patients aged 80 years and older, at the time of cochlear implantation. Design Retrospective chart review and quality of life assessment. Setting Tertiary referral center. Patients All elderly cochlear implant recipients aged 80 years and older (30 patients), who underwent implantation through the Quebec Cochlear Implant Program. Intervention(s) Postoperative validated quality-of-life questionnaire with clinical and audiologic data extraction using the medical record. Main Outcome Measure(s) The validated “Glasgow Benefit Inventory” questionnaire was used to quantify the impact on quality of life. Audiologic preoperative and postoperative evaluation consisted of speech recognition scores (MAT and HINT scores). Complications were retrospectively collected after each cochlear implantation. Results A majority of them reported using their cochlear implant almost always with great quality-of-life benefits (increase +37.5 on the GBI). They also experienced a significant improvement in audiologic performance as seen with speech recognition scores (p < 0.0001). There were very few surgical complications, but 4 patients had delayed complications (otalgia, tinnitus, and hyperacusis). Conclusion This is the most extensive study on the impact of quality of life for patients aged 80 years and older who received a cochlear implant. The audiologic benefit in this population is undeniable, and the quality-of-life improvement is comparable to studies made on much younger patients. It is also well-tolerated surgery with relatively low risk but with possible delayed complications. Given all these results, there should be no concerns regarding implantation in well-selected octogenarians.

Stapes surgery in profound hearing loss due to otosclerosis.

Objectives This study was designed to determine the effectiveness of stapes surgery in patients with profound hearing loss related to far-advanced otosclerosis and if improvement in hearing is sufficient to avoid the need for cochlear implantation. Study Design Retrospective chart review. Methods We retrospectively studied the charts of 16 patients who had stapes surgery in 1 or 2 ears between 2005 and 2010 for far-advanced otosclerosis. These patients were all candidates for a cochlear implant according to our institution’s criteria but were offered stapes surgery first. Preoperative and postoperative audiologic data, surgical data, postoperative satisfaction, and telephone use were noted. Results Sixteen patients were included, 3 of which had had bilateral surgery. Status of the oval window was evaluated at the time of surgery. Sixteen footplates had bipolar otosclerosis, and 3 had obliterative otosclerosis. Average gain in air-conduction threshold pure-tone average was 33 dB (range, 13–52 dB) and average gain in speech perception scores was 54.4% (range, 0%–93%); 94% of the patients were satisfied by the surgery, and 94% were able to use the phone postoperatively. Overall, 87% of the patients had sufficient improvement to no longer be candidates for cochlear implantation. Conclusion Stapes surgery in patients with profound hearing loss due to otosclerosis is safe and can restore enough hearing to make ears aidable and averting the need to consider cochlear implantation. Level of evidence: 3, Retrospective series

Outcomes review of modern hearing preservation technique in cochlear implant

INTRODUCTION Preservation of residual hearing in cochlear implantation is a main concern for patients and otologists. New electrode arrays as well as development of minimally invasive technique have allowed the expansion of indication criteria for cochlear implantation. The loss of residual low-frequency hearing is thought to be the result of many factors. Opinions differ in regards with the electrodes array characteristics, the surgical implantation technique and the pharmacological therapy used. OBJECTIVE The aim of this research is to analyze the available information pertaining to hearing preservation with cochlear implantation. RESULTS Both cochleostomy and round window approaches are adequate, but should rely on the anatomic position of the round window membrane. No electrode design had a higher rate of hearing preservation, either a standard or shorter length was used, or a straight or contoured array. The speed of insertion has a significant impact on hearing preservation and vestibular function. A slow insertion should be used for all cochlear implant insertion, hearing preservation or not. However, the optimal speed of insertion is still unclear. Moreover, the use of steroids regardless of the route or the timing, along with intraoperative topical steroids, had a positive impact on hearing preservation. CONCLUSION Classic atraumatic insertion maneuvers, very slow and delicate insertion and the use of intraoperative corticosteroids improve hearing outcomes. Whichever the surgeons preferences, all surgical modifications are aimed at the same goal: protection of the delicate intracochlear structures with preservation of residual low-frequency hearing to improve speech perception abilities.

Improving Quality of Life With Nabilone During Radiotherapy Treatments for Head and Neck Cancers A Randomized Double-Blind Placebo-Controlled Trial

Objectives: Patients treated for head and neck carcinomas experience a significant deterioration of their quality of life during treatments because of severe side effects. Nabilone has many properties that could alleviate symptoms caused by radiotherapy and improve patients’ quality of life. The aim of the present study was to compare the effects of nabilone versus placebo on the quality of life and side effects during radiotherapy for head and neck carcinomas. Methods: Fifty-six patients were randomized to nabilone or placebo. Patients filled the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 and the EORTC QLQ-H&N35; three independent questionnaires assessing appetite, nausea, and toxicity; and a visual analog scale for pain. These data were collected before radiotherapy, each week during radiotherapy, and 4 weeks after radiotherapy. Patients were weighed every week. Results: Nabilone did not lengthen the time necessary for a 15% deterioration of quality of life (P = .4279), and it was not better than placebo for relieving symptoms like pain (P = .6048), nausea (P = .7105), loss of appetite (P = .3295), weight (P = .1454), mood (P = .3214), and sleep (P = .4438). Conclusion: At the dosage used, nabilone was not potent enough to improve the patients’ quality of life over placebo.

BAHA or MedEl Vibrant Soundbridge: results and criteria of decision.

Introduction Middle-ear implants have been used in the last decade for rehabilitation of mild-to-severe sensorineural hearing loss in patients who cannot benefit from conventional hearing aids (HAs). In general, patients appreciate the more natural sound quality, the absence of occlusion effect and distortion, the lack of feedback, the improved speech understanding in noise, and the favourable cosmetic appearance with their middle-ear implant versus their conventional HA (Lenarz et al., 2001). One of them, the Vibrant Soundbridge (VSB, Vibrant Med-El, Innsbruck, Austria), is a semi-implantable middle-ear device. The original candidacy criteria for the VSB excluded any conductive or mixed hearing loss with an air–bone gap greater than 10 dB. The work of Colletti et al. (2006) that showed great benefit of round window (RW) implantation has the effect of a catalyser, stimulating the publication of clinical case studies and trials. We have seen different kinds of vibroplasties like the use of the FMT (floating mass transducer) with concomitant stapedotomy, with partial or total ossicular chain reconstruction prostheses (Huber et al., 2006), with an alternative fixation on the stapes’ head and the new concept of direct perilymph stimulation like is done with the FMT on the oval window or RW membrane (Coletti et al., 2006). In these new indications, middle-ear implants may sometimes take the place of a BAHA (bone-anchored hearing aid). In this paper, we wanted to review our experience and to discuss the advantages and the disadvantages of middle ear implant versus the BAHA on patients with mixed hearing loss.

Primary Larynx Cryptococcus neoformans Infection: A Distinctive Clinical Entity

Cryptococcus neoformans can directly infect the vocal cords. Endoscopic findings were undistinctive from most infiltrative diseases. Tissue biopsy was essential for the diagnosis. Inhaled corticosteroids can predispose to the infection, and fluconazole 400 mg daily for at least 6 weeks appeared to be minimal to achieve a permanent cure.

Single-sided deaf tactical unit officer treated with cochlear implantation

Objectives: To demonstrate the efficacy of cochlear implantation for management of a severe single-sided deaf tactical unit officer. Showing that hearing improvement provided by cochlear implantation was sufficient for him to return to work as a police tactical officer. Methods: Case report. Results: A 43 years-old man working as a tactical unit officer suffered from a work-related severe single-sided hearing loss. He tried unsuccessfully many types of hearing aids including a contralateral routing of sound (CROS) system and a bone conduction hearing aid with a headband. He was finally treated with cochlear implantation which provided enough localization and hearing abilities for a complete return to work as a tactical unit officer. Discussion: This case report demonstrates that cochlear implantation was very successful for a patient suffering from severe single-sided hearing loss. The current literature demonstrates benefits from cochlear implant over CROS and osseointegrated devices in unilateral hearing loss. Nevertheless, literature does not report any case of patient suffering from single-sided deafness that received a cochlear implant and a complete bilateral hearing rehabilitation that allowed him to return to work as a police tactical officer. Conclusion: Cochlear implantation was the only effective treatment to provide our patient enough localization and hearing abilities for a complete return to work as a police tactical officer. As no consensus has been established about selection criteria for cochlear implantation in single-sided deafness, we suggest that the patient’s occupation should be considered when reviewing his candidacy for cochlear implantation.

Bilateral stapes agenesis: What can we find?

Abstract We describe the youngest case of bilateral stapes agenesis and systematically reviewed the literature. Among those cases, 8/12 (66.7%) showed a bilateral agenesis. There is a male predominance 8/12 (66.7%). The most common associated anomaly reported being either a dehiscent or displaced facial nerve (7/12–58%). Furthermore, 5/12 patients (42%) had a narrow or an absent oval window. In our case, a 5-year-old male patient was referred for bilateral conductive hearing loss (air-bone gap 65 dB, bilateral). Operating findings on the left side included an inferiorly displaced facial nerve over the promontory, a narrow ossified oval window and an absent stapes. A stapedotomy with insertion of a modified stapes prosthesis allowed us to close the conductive gap. Even with possible good outcomes, surgical management should not be taken lightly, considering amplification is almost always a safe and effective option.