Noam Yehudai

Hearing progress and fluctuations in bimodal-binaural hearing users (unilateral cochlear implants and contralateral hearing aid).

Conclusions. Mean scores achieved using a cochlear implant (CI) plus a hearing aid (HA) were consistently higher (statistically non-significant) than those for CI alone. The addition of a contralateral HA partially compensated for the negative hearing fluctuations as well as for the slow initial progress with the CI. Objectives. To examine hearing progress over the first 3 years after unilateral cochlear implantation in users who had residual hearing in the non-implanted ear at the time of surgery and continued to use a HA in that ear thereafter. Patients and methods. Thirteen patients were followed up for 36months after continuous concomitant use of a CI and a contralateral HA. To evaluate hearing progress, sentence identification in background noise (presentation level, 55dB; S/N ratio, +10 dB) was tested for CI alone and for CI with contralateral HA (CI+HA). Subjects were tested after 6, 12, 18, 24, and 36months of concomitant use of both devices. Mixed regression model was used to evaluate the groups progression of scores and the added value of a contralateral HA over time. Results. When last tested (36 months after CI) the mean group score for CI alone was 72.6%±19.3%, and 12/13 patients scored at least 65% with either CI alone or CI+HA. Mean scores achieved using CI+HA were consistently higher than those for CI alone. Percentage improvement in CI+HA relative to CI alone was highest (19.2%) after 18 months of concomitant usage and then diminished gradually to 7.7% at 36months. Most patients showed some negative fluctuations in performance with CI alone at some point during the 36months of post-CI follow-up.

Functional status of hearing aids in bilateral-bimodal users.

Objective To assess the functional status of the hearing aid (HA) in bilateral-bimodal users, in whom HA monitoring is often neglected because fitting efforts are focused on the cochlear implant (CI). Also, to define an audiometric pattern of residual hearing that might explain why, despite nonoptimal bimodal fitting, certain cochlear implantees still opt to use a HA. Study Design Retrospective case review. Setting Ambulatory care clinic. Participants Experienced bimodal (CI/HA) adult users (N = 31) who use their HA during most of their waking hours. HA settings were required to meet a selected prescriptive (NAL-NL1) electro-acoustical Verifit Speechmap target at low frequencies using the simulated real-ear mode. Intervention After initial evaluation, HAs that did not meet the Speechmap target underwent appropriate fitting and reevaluation. Main Outcome Measure(s) Number of patients whose HAs met the defined Speechmap criteria after refitting; residual hearing levels in patients who achieved optimal bimodal fitting and in those who did not. Results At initial evaluation, the HA in 25 (81%) of the 31 participants was malfunctioning or poorly tuned. After HA replacement or retuning, 19 participants (61%) met the Speechmap targets, and 12 (39%) did not. However, the 2 groups had similar mean levels of unaided and aided residual hearing thresholds at 250 or 500 Hz. Conclusion To maximize the benefit for bilateral-bimodal users, specific guidelines must be established also for fitting of their HAs. The focus should be on achieving the maximum amplification possible at low frequencies.

From hearing with a cochlear implant and a contralateral hearing aid (CI/HA) to hearing with two cochlear implants (CI/CI): a within-subject design comparison.

Objective To compare within-subject bilateral–binaural and bimodal complementary abilities between bimodal (cochlear implant and hearing aid; CI/HA) and bilateral CI hearing (CI/CI), thereby enabling better-informed counseling of experienced CI/HA users contemplating contralateral implantation. Study Design Comparative within-subject case review. Setting Outpatient hearing clinic. Patients Ten experienced adult CI/HA users with severe-to-profound hearing loss in the HA ear, who converted to CI/CI between 2 and 11 years after initial implantation. Intervention Task-specific testing of bilateral–binaural hearing (sound lateralization, binaural summation/redundancy/unmasking, head-shadow effect), bimodal complementary benefit (contribution of low-frequency information), and a self-report Speech, Spatial, and Qualities of Hearing (SSQ) questionnaire, all before and 1 year after contralateral cochlear implantation. Main Outcome Measures Test result differences between CI/HA and CI/CI conditions. Results CI/CI hearing was better than CI/HA for speech lateralization and for perception of semantically unpredictable sentences in speech noise with speech at 0 degrees and noise at +90 degrees azimuth on the old CI side. CI/HA was better than CI/CI only for differences between perception of natural prosody speech and of speech with flattened fundamental frequency (F0) contour with speech and noise in front (at 0 degrees azimuth). Total scores on the SSQ questionnaire were higher in CI/CI than in CI/HA users. Conclusion Counseling regarding contralateral implantation for CI/HA users with severe-to-profound hearing loss in the HA ear, though generally positive, should consider individual functional needs, and cover expectations about the expected trade-off between gaining improved understanding and speech lateralization in challenging listening conditions and losing some low-frequency cues still available with CI/HA hearing.

Depth of stapes prosthesis in the vestibule: Baseline values and correlation with stapedectomy outcome

Abstract Conclusion: Deeper protrusion of the prosthesis into the vestibule does not correlate with worse postoperative hearing outcome. Objectives: To establish baseline values for the depth of the stapes prosthesis in the vestibule after stapedectomy and to investigate a possible correlation between the relative prosthesis depth (actual depth expressed as a percentage of the vestibule depth) and the hearing results. Methods: This was a prospective case study. Sixteeen patients underwent stapedectomy and were examined by high-resolution CT of the temporal bone during the first week after surgery. They then underwent audiometric follow-up at specified intervals during the first postoperative year. The actual depth of the prosthesis in the vestibule, its relative depth, and correlations between the relative depth and postoperative hearing results (at 1 week, 1 month, and 1 year) or postoperative complications (prolonged vertigo and sensorineural hearing loss) were measured. Results: The actual depth of the prosthesis in the vestibule (mean ± SD) was 2.39 ± 0.42 mm (range 1.83–3.39 mm). The depth of the prosthesis relative to the depth of the vestibule was 52 ± 9.74% (range 41.3–74.2%). In general, deeper protrusion of the prosthesis into the vestibule did not correlate with a worse hearing outcome. On the contrary, the correlation between prosthesis depth and better hearing results was positive at several frequencies.

Hearing rehabilitation counseling for patients with otosclerosis-related hearing loss.

Objective: To standardize preoperative counseling for stapedectomy candidates. Study Design: Retrospective case review. Setting: Tertiary referral center. Patients: Preoperative and postoperative hearing thresholds of 54 patients (55 stapedectomies) were retrospectively recorded. Patients (age range, 17−67 yr) were divided into 3 groups that differed significantly in their mean preoperative air conduction (AC) pure-tone averages (PTA) (up to 50, 50−70, and 70−90 dB). Intervention: Comparison of the gap between the mean hearing thresholds achieved postoperatively and the target threshold (normal hearing) in the 3 groups. Main Outcome Measures: Preoperative and postoperative AC thresholds, bone-conduction (BC) thresholds, and air-bone gap at 0.5, 1.0, 2.0, and 4.0 Hz. Results: Patients in the group with a mean preoperative AC below 50 dB had excellent postoperative results and achieved normal hearing thresholds. In the group with a mean preoperative AC of 50 to 70 dB, the postoperative results were good, but normal hearing thresholds were not achieved. Postoperative results in the third group were within the range of moderate hearing loss, allowing these patients to use hearing aids much more successfully than preoperatively. In each of the 3 groups, mean group differences between the preoperative and the postoperative values of AC-PTA thresholds, BC-PTA thresholds, and air-bone gap were statistically significant. Comparisons between each pairing of the stratified groups also yielded statistically significant differences. Conclusion: The preoperative AC-PTA threshold value can be viewed as a convenient, valid, and standardized basis for better informed and more comprehensive counseling of stapedectomy candidates with regard to options for hearing rehabilitation.

Natural history of contralateral residual hearing in binaural-bimodal hearing

Conclusions. The range of evaluation tools used in deciding which ear to implant and which to designate for a hearing aid (HA) should be expanded to include additional aspects to those tested by audiometry and basic speech perception. Residual hearing in non-implanted ears remains stable for at least 3 years after unilateral cochlear implantation, but regular refitting and monitoring of the HA function combined with cochlear implant (CI) mapping are mandatory for maximizing benefit from binaural-bimodal hearing. Objectives. To examine whether the clinical decision-making tools currently used to assess hearing are reliable guides when choosing the preferred ear for CI, and to determine the rate of residual hearing deterioration in the non-implanted ear over 36 months post-CI as a guide to recommending subsequent continued use of a contralateral HA as opposed to CI. Patients and methods. This was a retrospective evaluation of patients’ charts. The pre-CI choice of the ear for implantation in a group of 37 binaural-bimodal users was re-evaluated. In a second group of 22 patients, residual hearing deterioration was followed for 36 months post-implantation. Results. In the group of 37 patients, subjective identification of the worse-hearing ear was in agreement with audiometric results in 28 cases, but disagreed with the unaided audiometric results in the other 9. Mean threshold values for the group of 22 patients remained stable over 36 months post-CI, except for the aided threshold at 4.0kHz, which deteriorated by 10.9dB (p=0.003).

Indications for Elective Tracheostomy in Reconstructive Surgery in Patients With Oral Cancer.

Background: Oral cancer surgery carries a high risk of upper airway obstruction; yet optimal airway management approach remains controversial. Aim of Study: The purpose of the present study was to evaluate the use of tracheostomy in oncological patients undergoing oral cancer surgery with intra oral flap reconstruction. Methods: The study cohort included 75 patients with oral cancer, who underwent major intraoral resections and reconstruction with vascularized flaps. Results: Thirty-six percent of the patients received elective tracheostomy (27 patients). Mean hospital stay of the patients with tracheostomy was 28.4 ± 12.5 days compared with 9.7 ± 2.1 days in the nontracheostomy patients. A scoring system rendered from this study suggests that patients with a total scoring at or above 8 should be considered for elective tracheostomy. Conclusions: With appropriate postoperative monitoring, selected patients can be managed without routine elective tracheostomy, yet, patients with comorbidities, mostly elderly patients, which undergo surgical resection and reconstruction in high-risk areas that can result in a bulky flap that pose danger to the postoperative airway, should receive elective tracheostomy.

Prognostic factors for facial nerve palsy in a pediatric population: A retrospective study and review.

To identify and analyze factors influencing the outcome of facial nerve palsy (FNP) in a pediatric population.