Peter Walshe

Sleep apnoea of unusual origin

A 72-year-old man presented with a history of progressive sleep apnoea. The cause was a large superior laryngeal nerve schwannoma arising in the left parapharyngeal space. This had a ball-valve effect on the laryngeal inlet. Superior laryngeal nerve schwannomas are very rare. No documented case has presented with obstructive sleep apnoea before.

Objective assessment of spectral ripple discrimination in cochlear implant listeners using cortical evoked responses to an oddball paradigm

Cochlear implants (CIs) can partially restore functional hearing in deaf individuals. However, multiple factors affect CI listeners speech perception, resulting in large performance differences. Non-speech based tests, such as spectral ripple discrimination, measure acoustic processing capabilities that are highly correlated with speech perception. Currently spectral ripple discrimination is measured using standard psychoacoustic methods, which require attentive listening and active response that can be difficult or even impossible in special patient populations. Here, a completely objective cortical evoked potential based method is developed and validated to assess spectral ripple discrimination in CI listeners. In 19 CI listeners, using an oddball paradigm, cortical evoked potential responses to standard and inverted spectrally rippled stimuli were measured. In the same subjects, psychoacoustic spectral ripple discrimination thresholds were also measured. A neural discrimination threshold was determined by systematically increasing the number of ripples per octave and determining the point at which there was no longer a significant difference between the evoked potential response to the standard and inverted stimuli. A correlation was found between the neural and the psychoacoustic discrimination thresholds (R2 = 0.60, p<0.01). This method can objectively assess CI spectral resolution performance, providing a potential tool for the evaluation and follow-up of CI listeners who have difficulty performing psychoacoustic tests, such as pediatric or new users.

The use of fibrin glue to arrest epistaxis in the presence of a coagulopathy.

INTRODUCTION When a patient has a coagulopathy, epistaxis can be difficult to treat. When the source of the bleeding is identifiable, local cautery can sometimes make the bleeding worse. In other cases, it can create an area of sloughing mucosa that may bleed persistently. Currently, patients who have coagulopathies and continue to bleed after attempted cautery are usually managed by admission to hospital and nasal packing with or without attempts to correct the underlying coagulopathy.

Computerized tomography is not reliable in the diagnosis of brainstem infection

The case of a 17-year-old girl who presented with a two-day history of absolute dysphagia secondary to a bulbar palsy due to a pre-pontine abscess is described. Rigid oesophagoscopy was normal and a neurology consultation suggested a central cause for her dysphagia. However the diagnosis was delayed because a computed tomography (CT) scan of her brain and brainstem was reported as normal. A subsequent magnetic resonance image (MRI) scan revealed a pre-pontine abscess. CT scanning is not as reliable as MRI in the diagnosis of infective lesions of the brainstem/brain, especially early in the course of the infection.

Auditory mismatch negativity in cochlear implant users: A window to spectral discrimination

A cochlear implant (CI) can partially restore hearing in patients with severe to profound sensorineural hearing loss. However, the large outcome variability in CI users prompts the need for more objective measures of speech perception performance. Electrophysiological metrics of CI performance may be an important tool for audiologists in the assessment of hearing rehabilitation. Utilizing electroencephalography (EEG), it may be possible to evaluate speech perception correlates such as spectral discrimination. The mismatch negativity (MMN) of 10 CI subjects was recorded for stimuli containing different spectral densities. The neural spectral discrimination threshold, estimated by the MMN responses, showed a significant correlation with the behavioral spectral discrimination threshold measured in each subject. Results suggest that the MMN can be potentially used to obtain an objective estimate of spectral discrimination abilities in CI users.

An Alternative Technique For Nasal Biopsy

Objectives/Hypothesis: The objective was to investigate the effectiveness of co‐phenylcaine as a topical anesthetic agent for nasal mucosal biopsy.

Quality of life outcomes in cochlear implantation of children with profound and multiple learning disability

This study was performed to investigate the effect of cochlear implantation on the Quality of Life (QoL) of children with profound and multiple learning disability (PMLD). This cohort of children has been viewed historically as poor candidates for cochlear implantation as they generally have poor speech and hearing outcomes. The Irish National Cochlear Implant Program’s prospectively maintained database was examined for all children implanted from July 1996 to July 2015. All charts of the 381 children implanted during this time were reviewed retrospectively; 16 children met criteria for being PMLD. For this cohort of patients, speech and hearing performance and the Glasgow Children’s Benefit Inventory scores were retrospectively analyzed. Speech and hearing outcomes, as measured by Categories of Auditory Performance (CAP) and Speech Intelligibility Rating (SIR) scores, demonstrated little or no improvement from pre-implantation to an interval 3 years post-op; however, 11 out of 16 parents reported an improvement in their child’s quality of life after implantation with 3 out of 16 reporting no improvement. This study suggests that despite children with PMLD performing poorly on traditional outcome measures such as CAP and SIR they may have improvement to their QoL after cochlear implantation. Further study is warranted to characterize the impact of CI on these children.

Occurrence of major complications after cochlear implant surgery in Ireland

Objectives: Cochlear implantation (CI) is considered an effective and relatively safe procedure for patients with severe-profound hearing loss. However, severe complications are reported in several studies. The purpose of this study was to report the frequency and management of major complications following CI surgery at the National CI Programme (NCIP) in Ireland. Methods: Major complications were defined according to the classification of Hansen et al. 2010. The medical records of 1017 patients undergoing CI between 1995 and 2016 were analyzed retrospectively for major complications. In addition, radiological and intraoperative findings as well as therapeutic management of all patients with a major complication were reviewed. Results: Altogether, 1017 patients underwent 1266 CI surgeries. The median follow-up of all CI surgeries was 44 months. The total number of major complications identified was 21 which corresponds to an overall rate of 1.7%. The majority of major complication (71%) occurred at least one week after surgery. The most common major complications were internal receiver/stimulator protrusion and migration (6/21), followed by migration of the electrode array (4/21) and recurrent otitis media requiring re-implantation (4/21). All patients with major complications required additional surgery, with reimplantation necessary in 19 patients (90%). Discussion: CI surgery is a safe surgical procedure for hearing rehabilitation associated with a low rate of severe complications. However, major complications can occur many years after surgery, making revision surgery necessary. Conclusion: Long-term follow-up is necessary for the early identification of complications to facilitate appropriate care.

The usefulness integrity testing in children: A single institution experience of 86 tests over a period of 20 years.

Integrity testing is an in-vivo test that assesses the implant functionality and is used when device failure is suspected. In the last 15 years, integrity testing was performed in 11% of all devices implanted in children. Clinical performance problems, i.e. lack of progress, were the main reason to perform integrity testing in children, followed by technical and auditory problems. Twenty-five devices were explanted and in two cases integrity testing failed to identify device malfunction. Integrity testing is a valuable clinical tool and should be considered when there is a clinical concern about lack of progress in children who might not have the language skills to communicate device related problems, although a multi-disciplinary clinical decision has to prevail despite integrity test results. This article is protected by copyright. All rights reserved.

An approach to develop an objective measure of temporal processing in cochlear implant users based on Schroeder-phase harmonic complexes

Recent evidence suggests that cortical auditory evoked potentials recorded by EEG may be used to obtain an objective measure of spectral sound processing abilities in cochlear implant (CI) users. As speech perception depends on both spectral and temporal processing abilities, developing an objective measure of sound processing in the temporal domain is necessary for a complete evaluation of CI speech performance. This study explored the feasibility to objectively assess sound processing in the temporal domain employing a method based on EEG and complex temporal stimuli such as the Schroeder-phase harmonic complexes. Psychoacoustic discrimination abilities were measured employing a four-interval two-alternative forced choice paradigm. Neural discrimination abilities were measured by recording single-channel EEG during an unattended oddball paradigm. Psychoacoustic and neural discrimination abilities were analyzed for correlation. A strong, but non-significant, correlation was found in three out of six subjects. Schroeder-phase harmonic complexes may have utility as stimuli in the development of an objective measure of temporal processing in CI users. Furthermore, they provide new insights on temporal processing in CI users that may benefit the development of the CI.