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Objectives X-linked deafness is a potential etiology of sensorineural hearing loss characterized by bulbous dilatation of the fundus of the internal auditory canal (IAC) and the absence of the bony plates separating the basal turn of the cochlea and IAC. These malformations predispose patients to IAC insertion during cochlear implantation (CI). Our objective is to describe the surgical technique, audiometric and speech performance outcomes in a group of patients with this unique cochlear malformation. Methods A retrospective chart review was performed of all patients at a tertiary care facility who underwent CI between January 2006 and July 2011. Results A total of five patients were identified with radiographic findings characteristic of X-linked deafness, specifically a deficient modiolous, absent lamina cribrosa and bulbous IAC. A modified cochleostomy was utilized to ensure electrode insertion within the scala tympani avoiding the IAC. In each case, fluoroscopy was utilized to visual electrode progression during insertion and complete insertion was accomplished. All patients demonstrated improved speech performance following implantation. Conclusions Utilizing the techniques described, patients with these unique radiographic findings consistent with X-linked deafness may successfully undergo CI with excellent potential for auditory rehabilitation.

Cochlear implants are the treatment of choice for individuals with severe to profound sensorineural hearing loss. In most cases, the anatomy is normal and the insertion of the electrode-array is straightforward, complete and in the correct position. In the presence of inner-ear malformations, the risk of an intra or extra-cochlear malpositioned electrode-array increases.To describe the technique of fluoroscopic assisted cochlear implantation in children with severe inner-ear malformations and present the results with respect to the number of active electrodes and function.Fifteen fluoroscopy assisted implantations in 9 children were conducted at the Shaare Zedek Cochlear Implant Center between 2009-1014. All implanted ears had severe anatomic malformations. Mean implantation age was 3.5 years (range 1-11). Six children underwent sequential bilateral implantation. Two children underwent revision surgery due to a malpositioned electrode initially implanted without fluoroscopy at other centers.There was no radiologic or electro-physiologic evidence of kinking, bending or electrode damage in all 15 implantations. Complete insertion was achieved in all ears except one with partial insertion. There were no extra-cochlear or intrameatal placements. In 9 ears, all electrodes were active at switch-on and in the remaining, 15-20 were active. In all ears the Ling-6 sounds were detected and in 13 they were also identified.Fluoroscopy is an effective tool in complex cochlear implant surgeries and its use is simple and safe. As demonstrated in this study, with fluoroscopy assistance, good results are achieved in children with inner-ear malformations.

Electrode insertion is the most important step in cochlear implant (CI) surgery. Optimal electrode placement is a prerequisite for maximizing CI success. This article describes CI electrode insertion in the normal and abnormal cochlea, including technical considerations unique to cochlear malformations, dysplasia, ossification, and revision implantation. Currently available electrodes and device specific operative techniques are reviewed.

This thesis manuscript treats about the influence of wind on modulational instability. A first part merges the works of Segur at al. which take into account viscous dissipation and Leblanc's work which deals with wind. A nonlinear Schrödinger equation is derived, with a forcing linear term which represents the result of the balance between wind forcing and dissipation. Visous dissipation is represented by Lundgren's model and the effect of wind is integrated into atmospheric pressure following Miles' model. Depth is finite. The stability of Stokes's waves is investigated, and numerical simulations are presented to illustrate the results. Some experimentations are done to confirm qualitatively these works. This first part was validated by a publication in the Journal of Fluid Mechanics~(2010). The second part studies the influence of the wind on the modulational instability by the intermediary of the vorticity whom it creates on the water at the surface. The model is simplified by the hypothesis of an unidirectional flow and a constant vorticity. The depth is still supposed finite. A non linear Schrödinger equation is derived, which takes into account this constant vorticity. The stability of the Stokes' wave is studied then in detail (instability diagram function of vorticity and depth, instability bandwidth, instability rate, etc.). It is demonstrated that a negative vorticity, beyond a certain threshold, eliminates the modulational instability independently of the depth. This second part has been submitted for publication in the journal Physics of Fluids., Cette thèse étudie l'influence du vent sur l'instabilité modulationnelle. Une première partie unifie les travaux de Segur et al. qui intègrent la dissipation et ceux de Leblanc qui prennent en compte le vent. Une équation non linéaire de Schrödinger est établie avec un terme additionnel linéaire résultant de la compétition entre le vent et la dissipation. La dissipation est traduite par le modèle de Lundgren et l'effet du vent se manifeste par l'intermédiaire de la pression atmosphérique selon le modèle de Miles. La profondeur est finie. Une étude de stabilité de l'onde de Stokes est détaillée, et des simulations numériques sont menées pour illustrer les résultats. Des expérimentations sont menées pour apporter une validation qualitative à ces travaux. Cette première partie a été validée par une publication au Journal of Fluid Mechanics~(2010). La deuxième partie étudie l'influence du vent sur l'instabilité modulationnelle par l'intermédiaire de la vorticité qu'il crée en surface. Le modèle est simplifié par l'hypothèse d'un écoulement unidirectionnel et d'une vorticité constante. La profondeur est encore supposée finie. Une équation non linéaire de Schrödinger est établie, qui prend en compte cette vorticité constante. La stabilité de l'onde de Stokes est alors étudiée en détail (diagramme d'instabilité en fonction de la vorticité et de la profondeur, bande d'instabilité, taux d'instabilité, etc.). Il est démontré qu'une vorticité négative, au delà d'un certain seuil, supprime l'instabilité modulationnelle indépendamment de la profondeur. Cette deuxième partie a été soumise pour publication au journal Physics of Fluids.

Objectives: Multichannel auditory brainstem implants (ABI) are currently indicated for patients with neurofibromatosis type II (NF2) and schwannomas involving the internal auditory canal (IAC) or cerebellopontine angle (CPA), regardless of hearing loss (HL). The implant is usually placed in the lateral recess of the fourth ventricle at the time of tumor resection to stimulate the cochlear nucleus. This study aims to review the surgical and audiologic outcomes in 18 patients implanted by our Skull Base Surgery Team from 1994 through 2003. Study Design: A retrospective chart review of 18 patients with ABIs. Methods: We evaluated demographic data including age at implantation, number of tumor resections before implantation, tumor size, surgical approach, and postoperative surgical complications. The ABI auditory results at 1 year were then evaluated for number of functioning electrodes and channels, hours per day of use, nonauditory side effect profile and hearing results. Audiologic data including Monosyllable, Spondee, Trochee test (MTS) Word and Stress scores, Northwestern University Children's Perception of Speech (NU-CHIPS), and auditory sensitivity are reported. Results: No surgical complications caused by ABI implantation were revealed. A probe for lateral recess and cochlear nucleus localization was helpful in several patients. A range of auditory performance is reported, and two patients had no auditory perceptions. Electrode paddle migration occurred in two patients. Patient education and encouragement is very important to obtain maximum benefit. Conclusions: ABIs are safe, do not increase surgical morbidity, and allow most patients to experience improved communication as well as access to environmental sounds. Nonauditory side effects can be minimized by selecting proper stimulation patterns. The ABI continues to be an emerging field for hearing rehabilitation in patients who are deafened by NF2.

Objectives/Hypothesis: Postoperative cerebrospinal fluid (CSF) leak is reported in 2% to 30% of cases following vestibular schwannoma surgery. The authors' current surgical techniques for translabyrinthine, retrosigmoid transmeatal, and middle cranial fossa approaches have evolved from analysis of their prior experience in an effort to minimize their complication rate. The authors evaluated the efficacy of their current surgical technique in decreasing the postoperative CSF leak rate. Study Design: Retrospective review. Methods: The vestibular schwannoma database from the New York University Medical Center (New York, NY) neurotological service was reviewed. Data were extracted for type of approach, tumor size, and CSF leak rate. Liberal leak criteria were used. Surgical techniques and management of CSF leak were reviewed. Results: Data from 215 patients who had surgery from 1995 to 2000 manifested a 6.6% CSF leak rate for primary surgeries. This compared favorably with the authors' 17% overall CSF leak rate in 555 total primary surgeries performed between 1979 and 1995. Translabyrinthine closure was performed with dural sutures used as a sling across the posterior fossa dura and abdominal fat placed as a series of corks through the sutures. Abdominal fat was used to obliterate the mastoid cavity in conjunction with aditus and mastoid obliteration. Attention must be paid to soft tissue obliteration of potentially open air cell tracts. Retrosigmoid transmeatal closure was performed with a soft tissue graft in the internal auditory canal drill-out held in position by a saloon-door dural flap. Bone wax was used to block perimeatal cells in all cases. Watertight dural closure was achieved with a sutured temporalis fascia graft. Abdominal fat obliteration of the mastoidectomy cavity was performed with an additional firm pressure from the Palva periosteal flap. Middle cranial fossa closure was performed with attention to potential air cell tracts of the internal auditory canal drill-out, as well as abdominal fat graft, tissue glue, and bone wax. Fibrin glue was used in all approaches to temporarily secure fat in situ. Management of CSF leaks starts with nonoperative measures including bed rest, oversewing of incisional wounds, and placement of a lumbar subarachnoid spinal fluid diversion drain. If these conservative measures fail, repeat exploration is necessary and is directed at identifying and corking the cell or cells (usually perimeatal or perilabyrinthine) opening directly into the posterior fossa. Conclusion: Evolution in surgical techniques, with particular attention to exposed air cell tracts, abdominal fat graft, and Palva periosteal flap for closure, has had a significant effect in decreasing the author's CSF leak rate after vestibular schwannoma surgery. Conservative management was successful in approximately 50% of cases. Repeat exploration, when needed, was directed at blocking the air cell tract (usually perimeatal or perilabyrinthine) responsible for the CSF leak.

Despite being the foundation of, or supplement to, many skull base exposures, the retrolabyrinthine approach has not been adequately illustrated in the skull base literature. As an aid to skull base surgeons in training, this article provides a step-by-step description of the microsurgical anatomy and operative nuances of this important technique.

Hypothesis: Real-time intraoperative fluoroscopy is a useful adjunct to cochlear implantation in selected cases. The advantages include the avoidance of complications such as extracochlear array placement, intrameatal array insertion, and avoidance of significant bending or kinking. This is particularly useful when implanting a severely abnormal cochlea. Background: The technique was initially developed for laboratory study of electrode prototypes in cadaver temporal bones to evaluate insertion dynamics and mechanisms of intracochlear trauma. The technique was subsequently adapted for use in live surgeries. Methods: Live surgeries were performed using fluoroscopic guidance on nine patients. Results: Five patients were implanted with the Nucleus 24 RCS during preclinical trials. Two patients with severe cochlear malformations were implanted with a Nucleus CI24M straight array. Two patients with severe cochlear ossification were implanted with the Nucleus CI24 double array. Appropriate insertions were achieved without electrode damage in all cases. Conclusions: Intraoperative fluoroscopy is a useful adjunct to cochlear implantation, which can be performed with minimum risk to the patient and operating room staff if the outlined precautions are taken. Intraoperative fluoroscopy is indicated in cases where the intracochlear behavior of the electrode array cannot be predicted, a condition encountered when implanting new electrode designs, cases with severely malformed inner ears, or cases of severe intraluminal obstruction requiring a double-array insertion.

Objectives/Hypothesis To evaluate the safety and efficacy of acoustic and electric sound processing for individuals with significant residual low‐frequency hearing and severe‐to‐profound high‐frequency sensorineural hearing loss. Study Design Prospective, single‐arm repeated measures, single‐subject design. Methods Fifty individuals, ≥ 18 years old, with low‐frequency hearing and severe high‐frequency loss were implanted with the Cochlear Nucleus Hybrid L24 implant at 10 investigational sites. Preoperatively, subjects demonstrated consonant‐nucleus‐consonant word scores of 10% through 60% in the ear to be implanted. Subjects were assessed prospectively, preoperatively, and postoperatively on coprimary endpoints of consonant‐nucleus‐consonant words, AzBio sentences in noise, and self‐assessment measures. Results Significant mean improvements were observed for coprimary endpoints: consonant‐nucleus‐consonant words (35.8 percentage points) and AzBio sentences in noise (32.0 percentage points), both at P

A 35-year-old woman presented for evaluation of slowly progressive right-sided hearing loss. For the past 6 months, she noted when lying on her left side an inability to hear the television or her baby crying. She also noted right-sided aural fullness and occasional right-sided headache. She had no facial weakness, tinnitus, vertigo, otorrhea, or otalgia; and no history of prior ear surgery, ear infections, noise exposure, or ear or head trauma. She currently takes no medications. Otoscopic examination results were normal. A 512-Hz tuning fork examination showed a left-sided lateralization when the vibrating tuning fork was placed on the center of her forehead (Weber test) and bilateral air greater than bone conduction with the vibrating tuning fork placed in front of her ear canal vs her mastoid tip (Rinne test). Facial motor and sensory function were intact and symmetric. The rest of the head and neck examination was unremarkable. An audiogram was ordered (Figure).

Physical review letters 115(15), 152003(2015). doi:10.1103/PhysRevLett.115.152003, We present the final combination of CDF and D0 measurements of cross sections for single-top-quark production in proton-antiproton collisions at a center-of-mass energy of 1.96 TeV. The data correspond to total integrated luminosities of up to 9.7 fb$^{−1}$ per experiment. The t-channel cross section is measured to be σ$_t$=2.25$_{-0.31}^{+0.29}$ pb. We also present the combinations of the two-dimensional measurements of the s- vs t-channel cross section. In addition, we give the combination of the s+t channel cross section measurement resulting in σ$_{s+t}$=3.30$_{-0.40}^{+0.52}$ pb, without assuming the standard model value for the ratio σ$_s$/σ$_t$. The resulting value of the magnitude of the top-to-bottom quark coupling is |V$_{tb}$|=1.02$_{-0.05}^{+0.06}$, corresponding to |V$_{tb}$|>0.92 at the 95% C.L., Published by APS, College Park, Md.

CrossFit ist eine relativ junge Sportart, eine neue Form des Trainings, welche darauf abzielt die menschliche Leistungsfähigkeit in allen körperlichen Bereichen zu steigern und weiterzuentwickeln. Neben dem hochintensiven und sehr abwechslungsreichen Training, bietet CrossFit seinen AthletInnen auch ein hohes Maß an positiver, sozialer Gruppendynamik, vor allem durch die übersichtliche Größe der einzelnen CrossFit-Studios und die vorgegebenen, vorwiegend gemeinsamen Trainingseinheiten. Die erste CrossFit-Box wurde 1995 in Santa Cruz (USA) von Greg Glassman, dem Erfinder und Wegbereiter, eröffnet. CrossFit schaffte seinen Durchbruch als effektive und gemeinschaftsfördernde Trainingsform allerdings erst in den letzten zehn Jahren. Sie konnte sich dafür in dieser relativ kurzen Zeit international bereits auf über 10.000 CrossFit-Boxen ausweiten. Auch in Österreich gibt es mittlerweile über 30 Standorte, Tendenz steigend. Das Ziel der vorliegenden Magisterarbeit war es herauszufinden, welche Motive Menschen dazu bewegen diese Trendsportart auszuüben. Vorrangig auf diese sportpsychologischen Motive bezogen, soll die Studie zusätzlich einen erstmals erhobenen Einblick in die soziodemographische Verteilung der CrossFit-Gemeinschaft in Österreich bieten. Im Rahmen eines Online-Fragebogens, welcher das zentrale Forschungsinstrument dieser Arbeit ist, konnten 521 aktive CrossFitterInnen im Alter zwischen 16 und 59 Jahren österreichweit befragt werden. Grundlage der Studie waren die von Lehnert, Sudeck & Conzelmann (2011) in dem Berner Motiv- und Zielinventar für Freizeit- und Gesundheitssport vorgegebenen Motive und Motivkategorien. Diese wurden durch speziell auf CrossFit bezogene Motive und Kategorien erweitert. Die nun vorliegenden Ergebnisse können dadurch mit bereits vorhandenen, themenverwandten Studien verglichen werden und gleichzeitig zukünftigen Untersuchungen ähnlicher Sportarten oder Fragestellungen als Vorlage dienen. Das Ergebnis bestätigt den Charakter der in der Arbeit beschriebene CrossFit-Kultur. Die AthletInnen geben die klassische Motivkategorie Fitness/Gesundheit als Hauptmotiv an, gefolgt von der Motivgruppe Wettkampf/Herausforderung, einer Fusion aus BMZI-Items und speziellen Items des CrossFit. Die Kategorie der Ästhetik rangiert dahinter, gleichauf mit Erholung/Flow, einem weiteren Zusammenschluss aus BMZI-Motiven und CrossFit-Motiven. Ebenfalls vorne dabei ist die spezielle Kategorie der Gruppendynamik, was erneut die Erwartungen an CrossFit bestätigt.

A detailed spectro-temporal analysis of the ultrafast transient absorption and fluorescence signals allows deciphering multiple energy and charge transfer processes in a light-harvesting molecular triad designed as photo-sensitizing unit featuring a novel BODIPY compound.

Objectives: Commercially available cochlear implant systems attempt to deliver frequency information going down to a few hundred Hertz, but the electrode arrays are not designed to reach the most apical regions of the cochlea, which correspond to these low frequencies. This may cause a mismatch between the frequencies presented by a cochlear implant electrode array and the frequencies represented at the corresponding location in a normal-hearing cochlea. In the following study, the mismatch between the frequency presented at a given cochlear angle and the frequency expected by an acoustic hearing ear at the corresponding angle is examined for the cochlear implant systems that are most commonly used in the United States. Design: The angular insertion of each of the electrodes on four different electrode arrays (MED-EL Standard, MED-EL Flex28, Advanced Bionics HiFocus 1J, and Cochlear Contour Advance) was estimated from X-ray. For the angular location of each electrode on each electrode array, the predicted spiral ganglion frequency was estimated. The predicted spiral ganglion frequency was compared with the center frequency provided by the corresponding electrode using the manufacturer’s default frequencyto-electrode allocation. Results: Differences across devices were observed for the place of stimulation for frequencies below 650 Hz. Longer electrode arrays (i.e., the MED-EL Standard and Flex28) demonstrated smaller deviations from the spiral ganglion map than the other electrode arrays. For insertion angles up to approximately 270°, the frequencies presented at a given location were typically approximately an octave below what would be expected by a spiral ganglion frequency map, while the deviations were larger for angles deeper than 270°. For frequencies above 650 Hz, the frequency to angle relationship was consistent across all four electrode models. Conclusions: A mismatch was observed between the predicted frequency and the default frequency provided by every electrode on all electrode arrays. The mismatch can be reduced by changing the default frequency allocations, inserting electrodes deeper into the cochlea, or allowing cochlear implant users to adapt to the mismatch. Further studies are required to fully assess the clinical significance of the frequency mismatch.

This paper deals with the Nucleus® CI24R (CS) (Contour) cochlear Implant: its characteristics, differences compared with the previous generation of devices, the perimodiolar electrode, and the surgical technique used for safe insertion. We also discuss the rationale behind perimodiolar electrodes in general, as well as the results of laboratory studies validating the design and safety of this particular electrode array. The differences in surgical technique between this device and prior Nucleus cochlear implants are as follows: the incision and the size of the well, or recess, for the electronics are smaller; the cochleostomy is larger; the posterior portion is placed in a subpericranial pocket, not tied down, before electrode insertion; and the insertion process itself is quite different, due to the nature of the electrode, its size, shape, and stylet. The technique described is that used by one experienced cochlear implant center, and reflect the authors' practice. Clearly, there are other possible variations on this theme, which may be equally satisfactory in other hands. Most surgeons find this device to be easier to place than previous generations: complications to date have been uncommon.

A 39-year-old patient was admitted to our hospital for 10 days fever (up to 40°C) with pain in the right hypochondrium. Abdominal echography performed at the onset of symptoms was normal. Blood tests showed C-reactive protein 311 mg/L, leucocytes count 24x109 /L (neutrophils count at 19, 29x109/L), bilirubin 1.1 mg/dL, lactate dehydrogenase (LDH) 254 U/L, aspartate aminotransferase (ASAT) 67 U/L, alanin aminotransferase (ALAT) 66 U/L, gammaGlutamyltransferase (gGT) 79 U/L and alkaline phosphatase 221 U/L. Chest X-ray showed an infiltrate in the right …

Objective The preferential delayed enhancement of the perilymphatic space enables detection of the non-enhancing endolymphatic hydrops present in patients with Meniere's disease. The aim of this study was to evaluate the diagnostic utility of delayed postcontrast 3D FLAIR images and a color map of fused postcontrast FLAIR and constructive interference steady state (CISS) images in the identification of endolymphatic hydrops in patients with clinically diagnosed Meniere's disease. Study design Case control, blinded study. Setting Tertiary referral center. Patients Ten patients with Meniere's disease and five volunteer controls. Intervention Diagnostic. Main outcome measure Two neuroradiologists blinded to the clinical history independently evaluated for the presence of endolymphatic hydrops on the images of both inner ears for test and control subjects. Both the standard gray-scale FLAIR images and the fused color map images were independently reviewed. Results The gray-scale 3D FLAIR images demonstrated 68.2% sensitivity and 97.4% specificity, and the fused color map images demonstrated 85.0% sensitivity and 88.9% specificity in the identification of endolymphatic hydrops in Meniere's disease. There was significant correlation between the gray-scale 3D FLAIR images and fused color map images with the categorization of involvement (p = 0.002). Inter-evaluator reliability was excellent (kappa = 0.83 for gray-scale images, kappa = 0.81 for fused color map). Conclusion Delayed 3D FLAIR and fused 3D FLAIR-CISS color map images of the inner ears after intravenous contrast administration are potentially useful diagnostic tools in the evaluation of patients with suspected Meniere's disease.

Objective Is conscious sedation an effective, safe, and efficient anesthetic choice in patients undergoing select neurotologic and otologic procedures? Study design Retrospective case review. Setting Tertiary referral center. Patients Six patients underwent eight neurotologic procedures including cerebrospinal fluid leak and encephalocele repair, and primary and revision cochlear implant surgery. Patients were deemed poor candidates for general anesthesia secondary to medical comorbidities. These were compared to 11 control patients who underwent same procedures under general anesthesia with intubation. Intervention Dexmedetomidine infusion was utilized as the primary agent for conscious sedation in this high-risk patient population because, unlike other commonly used sedatives, it preserves normal respirations while providing adequate analgesia. Main outcome measures Preoperative Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (P-POSSUM) scores were calculated for the study group. We measured total anesthesia, and perioperative and recovery times. Cost of anesthetic agents was considered and any adverse effects were noted. Patient satisfaction with the operative experience was assessed with telephone surveys. Results P-POSSUM scores were high for the study group. Postoperative anesthesia was shorter for the study patients undergoing conscious sedation. Difference in cost of anesthetic agents was negligible. The adverse effects were few and as expected for the type of procedure. Patients reported satisfaction and comfort with their operative experience. Conclusion Select neurotologic and otologic procedures can be safely, effectively, and efficiently performed under conscious sedation with dexmedetomidine infusion as the primary anesthetic choice for patients who are deemed poor medical candidates for general endotracheal anesthesia.

Objectives:Describe the surgical technique and outcome in a series of patients who underwent revision cochlear implantation using a double-array or split electrode device. All patients had an ossified cochlea due to meningitis and were functioning poorly with a standard electrode cochlear implant.Methods:Four patients between the ages of 4-15 years underwent revision with 5 double-array cochlear implant devices in our center during the years 2010-2012. One patient underwent bilateral revision surgery. All patients suffered from meningitis with computed tomography and magnetic resonance imaging studies that demonstrated an ossified cochlea. The time interval between the disease and initial cochlear implantation was 4 months to 4 years. Patients data were retrospectively analyzed with emphasis on the surgical technique, number of electrodes inserted, and number of active electrodes at follow-up. In addition, pre and post revision surgery function was compared.Results:The revision surgery was carried out 4 t...

Program Description:The single-sided deafness (SSD) handicap has been underestimated. The purpose of this miniseminar is to present the latest research on the benefits of binaural hearing (Sig Soli, PhD), and the impact of SSD on childhood development and school performance (Nancy Young, MD). The different rehabilitation methods available will be presented, including osseointegrated bone conduction technologies (Jack J. Wazen, MD) and nonsurgical options (John Goddard, MD). Future trends and clinical research on the use of cochlear implants in SSD will be presented (Bruce Gantz, MD, and Tom Roland, MD). Open discussion, questions, and audience participation will follow the presentations.Educational Objectives:(1) Recognize the benefits of binaural hearing in children and adults and the potential deficits imposed by SSD. (2) Differentiate between surgical and nonsurgical options in the rehabilitation of SSD. (3) Use developing technologies and clinical research in the rehabilitation of SSD, including the u...

Objectives:(1) Develop a multidimensional metric for assessing quality of life (QoL) in patients with NF2. (2) Compare NF2 results with reference values for the general population and patients with head and neck or brain cancer.Methods:Structured interviews with NF2 providers and patients identified relevant domains. Items in these domains were extracted from validated EORTC modules, combined with items unique to NF2 and pre-tested on NF2 providers and patients (N = 118). The questionnaire included 61 items assessing overall QoL and 10 additional domains including hearing, balance, facial function, vision, oral intake, future uncertainty, psychosocial, cognition, sexual activity, pain and vocal communication. Responses were compared to reference values for the general population and head and neck cancer and brain cancer patients.Results:QoL in NF2 patients was lower than that of the general population (P < .01) and similar to that of patients with cancer. NF2 patients whose treatment included radiation th...

Trauma to intracochlear structures during cochlear implant insertion is associated with poorer hearing outcomes. One way surgeons can influence insertion trauma is by choosing the surgical approach. We seek to compare cochleostomy (CO), peri-round window (PRW), and round window (RW) approaches using a fresh frozen temporal bone model.Experiments using fresh frozen temporal bones.Cochlear implant insertions using the three aforementioned approaches were performed on 15 fresh frozen human temporal bones using a Cochlear 422 electrode. Insertions were evaluated by examining fluoroscopic recordings of histologic sections.Five cochlear implant insertions were performed using each of the three aforementioned approaches. Fluoroscopic examination revealed that none of the CO or PRW insertions contacted the modiolus during insertion, whereas three of five RW insertions did. RW insertions were less linear during insertion when compared to CO and PRW insertions (P .05). CO insertions had significantly larger angular depth of insertion (487°) when compared to PRW (413°) and RW (375°) (P .05). Histologic examination revealed one RW insertion resulted in osseous spiral lamina fracture, whereas the remaining insertions had no evidence of trauma. In the damaged specimen, the inserted electrode was observed to rest in the scala vestibuli, whereas the remaining electrodes rested in the scala tympani.Due to variability in RW anatomy, a CO or PRW window surgical approach appears to minimize the risk for insertion trauma. However, with favorable anatomy, a Cochlear 422 electrode can be inserted with any of the three approaches.

Objective To examine the relationship between histopathology, immunohistochemistry, and clinical behavior in atypical and low-grade malignant vestibular schwannomas. Study Design The study design was a retrospective case review in conjunction with a histopathologic and immunohistochemical proliferation marker study of archival specimens. Data Sources A tertiary referral center's anatomic pathology and vestibular schwannoma computerized databases. Methods The diagnosis of atypical or low-grade malignant vestibular schwannoma was based on the number of mitotic figures present per tumor slide. MIB1 labeling indices were used to compare the proliferative activity of the atypical and low-grade malignant groups with that in an age-matched and size-matched control group. Results Eight cases of atypical and six cases of low-grade malignant vestibular schwannoma were diagnosed from 1990 to 1998. In the atypical and low-grade malignant groups, respectively, the average patient age was 54.3 years (range, 38–74 yr) and 50 years (range, 38–72 yr), and the average total tumor size was 1.53 cm (range, 0.7–3.5 cm) and 1.55 cm (range, 1.5–2 cm). Two recurrences were identified from the low-grade malignant group, and there was one postoperative House-Brackmann Grade III facial weakness. There were no recurrences or facial palsies in the atypical group. No distant metastasis or aggressive local invasion was observed in either group. MIB1 labeling indices were significantly (p ≤ 0.001) higher in the atypical (4.69%) and low-grade malignant (5.23%) groups than in the control group (1.99%). Conclusions These findings suggest a tendency for recurrence in proliferative tumors; however, the designation of malignancy should be reconsidered.

Objectives/Hypothesis The most common indication for cochlear reimplantation is device failure. Other, less frequent indications consist of “upgrades” (e.g., single to multichannel), infection, and flap breakdown. Although the percentage of failures has decreased over time, an occasional patient requires reimplantation because of device malfunction. The varying designs of internal receiver/stimulators and electrode arrays mandate an examination of the nature and effects of reimplantation for the individual designs. The purpose of the current study was to investigate the reimplantation of several implant designs and to determine whether differences in surgical technique, anatomical findings, and postoperative performance exist. Study Design Retrospective chart review. Methods The subjects were 33 of 618 severely to profoundly deaf adults and children who had implantation at the New York University Medical Center (New York, NY) between February 1984 and December 2000. The subjects had previously had implantation with either a single-channel 3M/House (House Ear Institute, Los Angeles, CA) or 3M/Vienna (Technical University of Vienna, Vienna, Austria) device or with one of the multichannel Clarion (Advanced Bionics, Sylmar, CA), Ineraid (Smith & Nephew Richards, TN), or Nucleus (including the Contour) devices (Cochlear Corp., Englewood, CO) before reimplantation. Results Length of use before reimplantation ranged from 1 month to 13 years and included traumatic and atraumatic (electronic) failures, as well as device extrusion or infection. Results indicated that postoperative performance was either equal to or better than scores before failure. None of the devices explanted caused damage that precluded the implantation of the same or an upgraded device. These findings support the efficacy and safety of internal implant designs as related to the maintenance of a functional cochlea for the purpose of reimplantation. Conclusions Cochlear reimplantation can be performed safely and without decrement to performance. The number of implanted electrodes at reinsertion were either the same or greater in all cases.

Background. Comorbid conditions have a significant impact on the actuarial survival of patients with head and neck cancer. However, no studies have evaluated the impact of comorbidity on tumor- and treatment-specific outcomes. This study was performed to evaluate the impact of comorbidity, graded by the Kaplan-Feinstein comorbidity index (KFI) on the incidence and severity of complications, disease-free interval, and tumor-specific survival in patients undergoing curative treatment for head and neck cancer. Methods. A multi-institutional, retrospective cohort of 70 patients 45 years of age and under with head and neck squamous cell carcinoma (SCC) presenting over an 11-year period was studied. Results. Advanced comorbidity (KFI grade 2 or 3) was present in 21 patients (30%). Patients with advanced comorbidity did not differ from patients with low-level comorbidity (KFI grades 0 or 1) in sex distribution, race, presence of human immunodeficiency virus (HIV) infection, tobacco use, location of primary lesion, stage at presentation, pathologic differentiation of the tumor, or type of initial treatment. The overall incidence of treatment-associated complications was similar between the groups (57% versus 49%; p > 0.05), but a higher proportion of patients with advanced comorbidity developed high-grade complications (24% versus 6%; p =.04). The median disease-free interval (11.1 months versus 21.6 months; p =.045) and tumor-specific survival (13.7 months versus 57.6 months; p =.03) was poorer for patients with advanced comorbidity. The effects of comorbidity on survival remained significant even after adjusting for the confounding effects of HIV status and tumor stage (p =.05). Conclusions. The presence of comorbid conditions has a significant impact on tumor- and treatment-specific outcomes. Although the presence of advanced comorbid conditions is not associated with an increase in the rate of treatment-associated complications, complications tend to be more severe in this population. More importantly, advanced comorbidity has a detrimental effect on the disease-free interval and tumor-specific survival in patients with head and neck cancer, independent of other factors. This suggests that comorbidity may impact on tumor behavior, presumably by altering the host's response to cancer. Accordingly, to be more predictive and reliable, the current staging system for head and neck cancer should include a description of the patient's comorbidity.

Program Description:The purpose of this course is to educate our otolaryngology community about how best to provide the widest array of surgical technologies to the largest populations of patients with hearing loss. Traditionally, technologic advancement has driven the field forward, though recent attention has also focused on expanding eligibility criteria for existing technology. The format will be a panel of experts with proposed topics organized by patient population (rather than by technology), including patients with moderate to severe hearing loss and significant residual hearing, single sided-deafness, tinnitus, children, age extremes, the multi-handicapped, cochlear nerve deficiency, and others.Educational Objectives:1) Recognize the most current surgical technologies available to patients with hearing loss. 2) Articulate the rationale for expanding inclusion criteria for existing technologies to patients previously considered ineligible. 3) Evaluate how promising preliminary outcomes data suppor...

To analyze the effects of residual hearing on postoperative speech performance in traditional cochlear implant (CI) patients implanted with a conventional electrode.Retrospective review.Academic tertiary referral center.A total of 129 adults implanted by a single surgeon at a tertiary care facility between June 2005 and November 2010 with measurable preoperative pure tone thresholds at any frequency were included.Cochlear implantation with a conventional electrode via an anterior inferior cochleostomy.Speech perception using monosyllabic word scores in quiet and sentences in quiet and noise in the electric (CI-only) condition of the implanted ear. Preservation of hearing was defined as complete for postoperative thresholds within 10 dB of preimplant values and partial if greater than 11 dB. Pure tone audiometry and speech perception testing were performed preoperatively and at regular intervals postoperatively, with the 1-year evaluation being the final outcome period.Preservation at any frequency or level was not a factor in speech perception outcome, although preservation was more common in low frequencies. Hearing preservation was correlated with younger age at implantation, but was not related to length of hearing loss, cause of deafness, device type, sex, preoperative speech performance, or low-frequency pure-tone average.Hearing can be preserved in traditional CI patients implanted with a conventional electrode. Although preservation of hearing may have implications for future technology, it is not currently correlated with speech performance in the CI-only condition.

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Cochlear implantation has significantly positively, impacted the lives of deaf individuals internationally. The device that converts acoustic energy into electrical stimulation bypassing endogenous...

OBJECTIVES AND IMPORTANCE: Children with certain congenital malformations of the inner ear, including those with a common cavity defect, have a higher incidence of spontaneous cerebrospinal fluid (CSF) leak and resulting meningitis. However, they may also benefit from cochlear implantation. We suggest that surgical management may be possible that both prevents meningitis and provides hearing rehabilitation during the same procedure.A 2-year-old girl with bilateral common cavity defects who had previously undergone cochlear implantation developed contralateral CSF leak resulting in meningitis.After resolution of the infection, cochlear implantation was performed at the same time as definitive CSF leak repair. Simultaneous cochlear implantation and repair of the CSF leak successfully decreased the chance of recurrent meningitis in this case. She has been deriving hearing benefit from the bilateral implants.This case suggests a role for cochlear implantation to be combined with simultaneous CSF leak repair in children with a cochlear malformation. Furthermore, bilateral cochlear implantation at an early age may be warranted in these patients before CSF leaks and meningitis have occurred.