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Intraoperative electrocochleography (ECochG) has been proposed for cochlear monitoring to minimize trauma during the insertion of the electrode of a cochlear implant (CI). CI surgery is normally performed under general anesthesia, which is why intraoperative ECochG measurements have never been validated against the patient's subjective sound perception. The main objectives of this study were to investigate the feasibility of cochlear monitoring based on the patients hearing and to validate it against intraoperative ECochG measurements during CI surgery under local anesthesia.Prospective case series study.Tertiary referral center.Patients eligible for cochlear implantation with residual hearing (pure-tone threshold averages [PTA] 2501000 Hz ≤ 75 dB HL). Additionally, patients should be able to hear ECochG stimuli at 250, 500, or 1000 Hz at less than or equal to 100 dB (HL).Cochlear implantation under local anesthesia without conscious sedation. Intraoperative ECochG monitoring.The development of ECochG amplitudes and the patients' subjective perception to the sound stimuli.In all patients, monitoring based on their subjective sound perception was feasible, whereas, reliable ECochG responses could be measured in seven patients. Sixty percent of the registered declines in ECochG amplitude were associated with a concomitant attenuation of the subjectively perceived sound.The developments in the ECochG responses matched well with the changes of the sound stimulus perceived by the patients, which supports the applicability of ECochG for preventing insertion trauma. Monitoring of the patients subjective hearing appears to be more reliable than ECochG but requires surgery under local anesthesia without conscious sedation.

Precision medicine: Sensorineural hearing loss treatment Aarno Dietz, Professor of Otorhinolaryngology at Kuopio University Hospital, turns the spotlight on hospital precision medicine, focusing on the treatment of sensorineural hearing loss. Today, most medical treatments are designed for the average patient. This “one-size-fits-all-approach” may be effective for some patients but not others. Precision medicine refers to tailoring medical treatment to the individual characteristics of each patient, aiming to target the right treatments to the right patients at the right time. In general, a precision medicine approach does not mean unique treatments (e.g., drugs or medical devices) designed for each patient but rather the ability to classify individuals into subpopulations based on specific characteristics of the underlying disease or its response to a particular treatment. Advances in precision medicine have already led to new treatment strategies, e.g., in oncology, where tumour profiling is used to optimize adjuvant treatments, improving survival rates.

Purpose There is only limited data on the application of virtual reality (VR) for the evaluation of temporal bone anatomy. The aim of the present study was to compare the VR environment to traditional cross-sectional viewing of computed tomography images in a simulated preoperative planning setting in novice and expert surgeons. Methods A novice (n = 5) and an expert group (n = 5), based on their otosurgery experience, were created. The participants were asked to identify 24 anatomical landmarks, perform 11 distance measurements between surgically relevant anatomical structures and 10 fiducial markers on five cadaver temporal bones in both VR environment and cross-sectional viewings in PACS interface. The data on performance time and user-experience (i.e., subjective validation) were collected. Results The novice group made significantly more errors (p p = 0.001) in cross-sectional viewing than the expert group. In the VR environment, there was no significant differences (errors and time) between the groups. The performance of novices improved faster in the VR. The novices showed significantly faster task performance (p = 0.003) and a trend towards fewer errors (p = 0.054) in VR compared to cross-sectional viewing. No such difference between the methods were observed in the expert group. The mean overall scores of user-experience were significantly higher for VR than cross-sectional viewing in both groups (p Conclusion In the VR environment, novices performed the anatomical evaluation of temporal bone faster and with fewer errors than in the traditional cross-sectional viewing, which supports its efficiency for the evaluation of complex anatomy.

Purpose To report the outcomes and the patients’ subjective experience of cochlear implantation (CI) performed under local anesthesia (LA). To describe a new form of intraoperative cochlear monitoring based on the patients subjective sound perception during CI. Methods In this retrospective case–cohort study, 117 patients underwent CI under LA with (n = 58) or without conscious sedation (n = 59). Included were primarily elderly patients with elevated risks for general anesthesia and recently patients with residual hearing eligible for electro-acoustic stimulation (EAS) (n = 27), in whom hearing could be monitored during the electrode insertion. A 500 Hz test tone was presented and the patient reported of subjective changes in loudness, leading to a modification of the insertion. A questionnaire was sent to all patients in which they assessed their subjective experience. Results All patients were successfully operated under LA without the need to intraoperatively convert to general anesthesia. 90% of the patients reported that the surgery was a positive experience. The vast majority, 90% of patients were satisfied with the overall treatment and with intraoperative pain management and 84% of the patients would opt for local anesthesia again. Cochlear monitoring by the patients’ subjective sound perception enabled for atraumatic insertions as all EAS patients could hear the test tone up to the end of the surgery. Conclusions CI under LA was well tolerated and recommended by the vast majority of patients. In addition, it offers the possibility to monitor the patients’ hearing during the electrode insertion, which may help to prevent insertion trauma.

Purpose Consumer-grade virtual reality (VR) has recently enabled various medical applications, but more evidence supporting their validity is needed. We investigated the accuracy of simulated surgical planning in a VR environment (VR) with temporal bones and compared it to conventional cross-sectional image viewing in picture archiving and communication system (PACS) interface. Methods Five experienced otologic surgeons measured significant anatomic structures and fiducials on five fresh-frozen cadaveric temporal bones in VR and cross-sectional viewing. Primary image data were acquired by computed tomography. In total, 275 anatomical landmark measurements and 250 measurements of the distance between fiducials were obtained with both methods. Distance measurements between the fiducials were confirmed by physical measurement obtained by Vernier caliper. The experts evaluated the subjective validity of both methods on a 5-point Likert scale qualitative survey. Results A strong correlation based on intraclass coefficient was found between the methods on both the anatomical (r > 0.900) and fiducial measurements (r > 0.916). Two-tailed paired t-test and Bland–Altman plots demonstrated high equivalences between the VR and cross-sectional viewing with mean differences of 1.9% (p = 0.396) and 0.472 mm (p = 0.065) for anatomical and fiducial measurements, respectively. Gross measurement errors due to the misidentification of fiducials occurred more frequently in the cross-sectional viewing. The mean face and content validity rating for VR were significantly better compared to cross-sectional viewing (total mean score 4.11 vs 3.39, p Conclusion Our study supports good accuracy and reliability of VR environment for simulated surgical planning in temporal bones compared to conventional cross-sectional visualization.

Objectives: To investigate the effect of fixed and adaptive microphone directionality on speech reception threshold (SRT) in noise when compared to omnidirectional mode in unilateral cochlear-impla...

Objectives To investigate the benefits of the image fusion technique for precise postoperative assessment of intracochlear placement with six different electrode arrays. Study design Consecutive retrospective case study. Settings Tertiary referral center. Patients Analyses of imaging data of 30 patients implanted with six different electrode arrays. Interventions Electrode reconstructions obtained from postoperative cone-beam computed tomography (CBCT) were overlaid onto preoperative magnetic resonance imaging (MRI) and/or high-resolution computed tomography (HRCT) registrations to create artefact-free images. Main outcome measures Each electrode's intracochlear position was analyzed with the image fusion reconstructions and compared with the results obtained by CBCT alone. The electrode location was classified according to its position in relation to the basal membrane at four different insertion angles. Results In 40 out of 151 measurements (26.5%), the location grading obtained by CBCT alone changed after the assessment with the image fusion reconstructions. A significant association was found between deep insertions (over 360 degrees) and the effectiveness of image fusion (p = 0.019). The difference between the impact of the fusion technique for the basal turn versus the apical part was highly significant (p = 0.001). There was no significant difference between the effectiveness of the image fusion and the different electrodes. Conclusions By utilizing an image fusion technique, a more accurate assessment of electrode placement could be achieved for all types of electrodes. Image fusion was especially beneficial for insertions beyond 360 degrees.

Objectives Temporal bone (TB) studies are essential during the development of new arrays. Postoperative cochlear histology is still regarded as golden standard for the assessment of electrode localization and trauma though it is time consuming, expensive and technically very demanding. The aim of this study is to investigate whether pre-operative evacuation of perilymph improve the assessment of electrode localization and insertion trauma in TBs applying fusion imaging. The results were compared to a prior validated image fusion technique based on the quantification of the electrode placement. Materials and methods 12 prototype electrodes were implanted in fresh frozen TBs. The perilymph was evacuated from the scale prior to pre-operative cone-beam computer tomography (CBCT). The TB were then immersed in Ringer solution to rehydrated both scalae. After electrode insertion post-operative CBCT were obtained. 3D fusions of the pre- and postoperative registration were reconstructed. The electrode localization with respect to the basilar membrane was visually assessed. Results The visualization of the BM on the pre-operative scans was achieved beyond the second turn in all TBs. The visual assessment was found to be as accurate as the previously validated fusion technique. There was no statistically significant difference between the methods (p=0.564). The image reconstructions and evaluations, however, were faster to perform and the insertion results are immediately available. Conclusion CBCT in combination with pre- and postoperative image fusion is an accurate method for the post-operative assessment of insertion trauma in TBs. This new application facilitates the identification of the BM and allows for a visual assessment of insertion trauma.

Background: A large number of different speech-in-noise (SIN) tests are available for testing cochlear implant (CI) recipients, but few studies have compared the different tests in the same patient population to assess how well their results correlate. Methods: A clinically representative group of 80 CI users conducted the Finnish versions of the matrix sentence test, the simplified matrix sentence test, and the digit triplet test. The results were analyzed for correlations between the different tests and for differences among the participants, including age and device modality. Results: Strong and statistically significant correlations were observed between all of the tests. No floor or ceiling effects were observed with any of the tests when using the adaptive test procedure. Age or the length of device use showed no correlation to SIN perception, but bilateral CI users showed slightly better results in comparison to unilateral or bimodal users. Conclusions: Three SIN tests that differ in length and complexity of the test material provided comparable results in a diverse CI user group.

Purpose To evaluate the insertion results and hearing preservation of a novel slim modiolar electrode (SME) in patients with residual hearing. Methods We retrospectively collected the data from the medical files of 17 patients (18 ears) implanted with a SME. All patients had functional low frequency hearing (PTA (0.125–0.5 kHz) ≤ 80 dB HL). The insertion results were re-examined from the postoperative cone-beam computed tomography scans. Postoperative thresholds were obtained at the time of switch-on of the sound processors (mean 43 days) and at latest follow-up (mean 582 days). The speech recognition in noise was measured with the Finnish matrix sentence test preoperatively and at follow-up. Results The mean insertion depth angle (IDA) was 395°. Neither scala dislocations nor tip fold over were detected. There were no total hearing losses. Functional low-frequency hearing was preserved in 15/18 (83%) ears at switch-on and in 14/17 (82%) ears at follow-up. According to HEARRING classification, 55% (10/18) had complete HP at switch-on and 41% (7/17) still at follow-up. Thirteen patients (14 ears) were initially fitted with electric–acoustic stimulation and seven patients (8 ears) continued to use it after follow-up. Conclusions The preliminary hearing preservation results with the SME were more favorable than reported for other perimodiolar electrodes. The results show that the array may also be feasible for electro-acoustic stimulation; it is beneficial in that it provides adequate cochlear coverage for pure electrical stimulation in the event of postoperative or progressive hearing loss.

Bilateral cochlear implantation is increasing worldwide. In adults, bilateral cochlear implants (BICI) are often performed sequentially with a time delay between the first (CI1) and the second (CI2) implant. The benefits of BICI have been reported for well over a decade. This study aimed at investigating these benefits for a consecutive sample of adult patients. Improvements in speech-in-noise recognition after CI2 were followed up longitudinally for 12 months with the internationally comparable Finnish matrix sentence test. The test scores were statistically significantly better for BICI than for either CI alone in all assessments during the 12-month period. At the end of the follow-up period, the bilateral benefit for co-located speech and noise was 1.4 dB over CI1 and 1.7 dB over CI2, and when the noise was moved from the front to 90 degrees on the side, spatial release from masking amounted to an improvement of 2.5 dB in signal-to-noise ratio. To assess subjective improvements in hearing and in quality of life, two questionnaires were used. Both questionnaires revealed statistically significant improvements due to CI2 and BICI. The association between speech recognition in noise and background factors (duration of hearing loss/deafness, time between implants) or subjective improvements was markedly smaller than what has been previously reported on sequential BICI in adults. Despite the relatively heterogeneous sample, BICI improved hearing and quality of life.

Objective Speech-in-noise tests are widely used in hearing diagnostics but typically without reverberation, although reverberation is an inextricable part of everyday listening conditions. To support the development of more real-life-like test paradigms, the objective of this study was to explore how spatially reproduced reverberation affects speech recognition thresholds in normal-hearing and hearing-impaired listeners. Design Thresholds were measured with a Finnish speech-in-noise test without reverberation and with two test conditions with reverberation times of similar to 0.9 and 1.8 s. Reverberant conditions were produced with a multichannel auralisation technique not used before in this context. Study sample Thirty-four normal-hearing and 14 hearing-impaired listeners participated in this study. Five people were tested with and without hearing aids. Results No significant differences between test conditions were found for the normal-hearing listeners. Results for the hearing-impaired listeners indicated better performance for the 0.9 s reverberation time compared to the reference and the 1.8 s conditions. Benefit from hearing aid use varied between individuals; for one person, an advantage was observed only with reverberation. Conclusions Auralisations may offer information on speech recognition performance that is not obtained with a test without reverberation. However, more complex stimuli and/or higher signal-to-noise ratios should be used in the future.

Objective: A simplified version of the Finnish matrix sentence test (FMST) was developed to improve the reliability of hearing diagnostic for children and for patients with limited working memory c...

OBJECTIVE: The aim of this study was to evaluate and compare myringoplasty results from two different consecutive series conducted at the Kuopio University Hospital during a four-decade period. MATERIALS AND METHODS: We reviewed 315 patients (a total of 338 ears) who underwent myringoplasty at Kuopio University Hospital between the years 1986 and 2012. The results from this series were compared with those form a previously published series of 404 patients who underwent myringoplasty between 1970 and 1985 at the same institution. RESULTS: Myringoplasty was considered to be successful whenever the tympanic membrane remained closed without atelectasis. The results were analyzed at the 1- and 3-year follow-up. The overall success rate after 1 year was 82.8% compared with 88% in the previous series. The success rate after 3 years was 87.4%. The best closure rate after 1 year (85.7%) was achieved with fascia grafts (n=272) and perichondrium (85.7%, n=14). The closure rate of 61.9% with the perichondrium/cartilage graft (n=21) and 71.0% with the fat graft (n=31) was statistically significantly lower (p

The aim of this study was to evaluate the insertion results and placement of the new Advanced Bionics HiFocus Mid-Scala (HFms) electrode array, inserted through the round window membrane, in eight fresh human temporal bones using cone beam computed tomography (CBCT). Pre- and post-insertion CBCT scans were registered to create a 3D reconstruction of the cochlea with the array inserted. With an image fusion technique both the bony edges of the cochlea and the electrode array in situ could accurately be determined, thus enabling to identify the exact position of the electrode array within the scala tympani. Vertical and horizontal scalar location was measured at four points along the cochlea base at an angular insertion depth of 90°, 180° and 270° and at electrode 16, the most basal electrode. Smooth insertion through the round window membrane was possible in all temporal bones. The imaging results showed that there were no dislocations from the scala tympani into the scala vestibule. The HFms electrode was positioned in the middle of the scala along the whole electrode array in three out of the eight bones and in 62 % of the individual locations measured along the base of the cochlea. In only one cochlea a close proximity of the electrode with the basilar membrane was observed, indicating possible contact with the basilar membrane. The results and assessments presented in this study appear to be highly accurate. Although a further validation including histopathology is needed, the image fusion technique described in this study represents currently the most accurate method for intracochlear electrode assessment obtainable with CBCT.

To investigate the results of clinical surgical insertions with a Mid-scala array (HIFocus Mid-Scala Electrode, HFms).Consecutive retrospective case study.Tertiary referral center.Analyses of imaging data of 26 consecutive patients (31 insertions) implanted with the HFms.The evaluation of insertion trauma evoked by a previously validated image fusion technique. Electrode reconstructions from postoperative cone-beam computed tomography (CBCT) were overlaid onto preoperative magnetic resonance imaging (MRI) scans to create artifact-free images.The electrode position was quantified in relation to the basilar membrane. Trauma scaling adopted from Eshraghi was used for evaluating insertion trauma. The results of the visual assessment of the postoperative CBCT were compared to those obtained with the fusion technique.Three insertions had to be excluded due to incompatibility of the imaging data with the fusion software. We found consistent peri- to mid-modiolar placement of the HFms with a mean insertion depth angle of 376°. According to the medical records, a visual examination of the postoperative CBCT indicated that there had been no scala dislocations but when assessed by the image fusion technique, five scala dislocations (17.8%) were found. Additionally, one tip fold-over was detected in the postoperative CBCT even though this was not evident in any intraoperative measurements.HFms showed atraumatic surgical insertion results with consistent mid-modiolar placement. Image fusion enhances the accuracy of the insertion trauma assessment. Routine postoperative imaging is recommended for identifying tip fold-over as well as for quality control and documentation.

Hypothesis To evaluate the insertion results of a novel straight array (EVO) by detailed imaging and subsequent histology in human temporal bones (TB). Background The main focuses of modern cochlear implant surgery are to prevent damage to the intracochlear structures and to preserve residual hearing. This is often achievable with new atraumatic electrode arrays in combination with meticulous surgical techniques. Methods Twenty fresh-frozen TBs were implanted with the EVO. Pre- and postoperative cone beam computed tomography scans were reconstructed and fused for an artifact-free representation of the electrode. The array's vertical position was quantified in relation to the basilar membrane on basis of which trauma was classified (Grades 0-4). The basilar membrane location was modeled from previous histologic data. The TBs underwent subsequent histologic examination. Results The EVOs were successfully inserted in all TBs. Atraumatic insertion (Grades 0-1) were accomplished in 14 of 20 TBs (70%). There were three apical translocations, and two basal translocations due to electrode bulging. One TB had multiple translocations. The sensitivity and specificity of imaging for detecting insertion trauma (Grades 2-4) was 87.5% and 97.3.0%, respectively. Conclusion Comparable insertion results as reported for other arrays were also found for the EVO. Insertion trauma can be mostly avoided with meticulous insertion techniques to prevent bulging and by limiting the insertion depth angle to 360 degrees. The image fusion technique is a reliable tool for evaluating electrode placement and is feasible for trauma grading.

To evaluate the insertion characteristics and trauma of a new slim lateral wall electrode (SlimJ) in human temporal bones (TB). Pre- and postoperative assessment was performed using cone beam computed tomography (CBCT) and image fusion in 11 human TB. The position of the array in each cochlea was analyzed and described using a vertical scaling factor, calculated by dividing the distance of the scala tympani floor to the centre of the electrode by the duct height. Insertion trauma was scaled according to the presumed localization of the basilar membrane, which was modeled from histologic sections of 20 TBs. The insertion trauma was described by the adaptation of the Eshragi trauma grading. A full electrode insertion, via the round window, was achieved in all TBs. Surgical handling was good, with a favorable compromise between high flexibility but sufficient stiffness to facilitate smooth insertions. The median angular insertion depth was 368° (range 330°–430°). Scala tympani placement was achieved in ten out of eleven TBs; in one TB a scala translocation was observed, occurring at approximately 180°. The SlimJ showed atraumatic insertion characteristics. The CBCT fusion technique provides an accurate and reliable assessment of the electrode position and allows for grading insertion trauma without histology. The SlimJ true potential for structure and hearing preservation needs to be further assessed in vivo.

The overall complication rate of cochlear implant surgery is low and so-called electrode failures (electrode migration, misplacement, etc.,) account for only a minority of all complications. The aim of this study was to explore the prevalence of electrode migration as the cause for increased impedance values and non-auditory stimulation in the basal channels. Within the scope of a quality control process, the cochlear implant database of the Kuopio University Hospital (Finland) was reviewed. Patients with gradual elevation of impedance values and/or non-auditory stimulation of the basal electrode channels were re-examined and cone-beam computed tomography was administered. There were 162 cochlear implant recipients and 201 implanted devices registered in the database. A total of 18 patients (18 devices) were identified having significantly increased impedance values or non-auditory stimulation of the basal electrodes. Cone-beam computed tomography revealed extra-cochlear electrodes in 12 of these patients due to the migration of the electrode array. All extruded electrodes were lateral wall electrodes, i.e., straight electrode arrays (Cochlear CI422 and Med-El devices). The most common feature of electrode migration was the gradual increase of the impedance values in the basal electrodes, even though telemetry could also be unsuspicious. Electrode migration after cochlear implant surgery may be more common than previously reported. At surgery, special attention should be paid to the reliable fixation of the electrode array. This study underlines the importance of postoperative imaging after cochlear implant surgery.

HYPOTHESIS To explore the results of a new slim modiolar electrode array (SMA) with respect to intracochlear placement and trauma evaluated by detailed radiologic imaging and histology. BACKGROUND Hearing and structure preservation is the goal of cochlear implantation for advanced hearing outcomes. Currently, this is most consistently achieved with thin lateral wall electrodes. Modiolar electrodes are located nearer the modiolus and may provide some electrophysiological advantages, but have a greater tendency for causing insertion trauma. METHODS The SMA was implanted in 20 fresh-frozen human temporal bones (TB). All TBs were scanned pre- and postoperatively with cone beam computed tomography. For atraumatic insertion, the round window approach was preferred. Scalar localization and trauma were analyzed by three-dimensional image fusion reconstructions of the pre- and postimplant scans. The TBs underwent histologic examination to validate the radiologic findings. RESULTS Insertion through the round window was performed in 19 TBs and through a cochleostomy in one TB. In one TB trauma in the form of scala translocation was identified radiologically and histologically. In the remaining TBs there was no insertion trauma. Adequate modiolar localization of the SMA was found in 19 of 20 TBs. The mean angular insertion depth was 400 degrees without correlation to cochlea size. There was no significant statistical difference between the radiological and histological measurements of electrode localization. CONCLUSION The SMA showed consistent and atraumatic insertion results in TBs. Pre- and postimplant cone beam computed tomography with image fusion was shown to be very accurate for the assessment of electrode position and insertion trauma.

The Finnish Matrix Test is the first sentence test in noise for the Finnish language. It was developed according to the HearCom standards and provides reliable speech intelligibility measurements with highly comparable results with the other international matrix tests.The aim of the study was to develop an accurate speech intelligibility test in noise for the Finnish language that is comparable across different languages.We chose a matrix sentence test, which comprises a base matrix of 10 names, verbs, numerals, adjectives and nouns. Test lists were formed from this matrix quasi randomly, providing test sentences of the same syntactical structure. The speech material corresponds to everyday spoken language and the phoneme distribution is representative of the Finnish language. The test was optimized by determining the speech recognition thresholds of the individual words and subsequently by applying level corrections of up to ±3 dB. Evaluation measurements were performed to check the equivalence of the different test lists with respect to speech intelligibility and to provide reference values for further clinical applications.After training, the mean speech recognition threshold (SRT) and the slope of the final test lists were -10.1 ± 0.1 dB signal-to-noise-ratio (SNR)and 16.7 ± 1.2%/dB, respectively (measurements at constant level; inter-list variability). The mean SRT and the slope of the test subjects were -10.1 ± 0.7 dB SNR and 17.5 ± 2.2%/dB (measurements at constant level; inter-subject variability). The expected SRT range for normal-hearing young adults for adaptive measurements is -9.7 ± 0.7 dB SNR.

Objectives: The aim of the study was to develop a reliable and easily accessible screening test for primary detection of hearing impairment.Methods: Digits 0-9 were used to form quasirandom digit triplets. First, digit specific intelligibility functions and speech recognition thresholds (SRTs) were determined. To homogenize the test material digits with steep intelligibility function slopes were chosen and level correction up to 2dB were applied to the digits as needed. Evaluation measurements were performed to check for systematic differences in intelligibility between the test lists and to obtain normative reference function for normal-hearing listeners.Results: The mean SRT and the final slope of the test lists were -10.8 +/- 0.1dB signal-to-noise ratio (SNR) and 21.7 +/- 1.8%/dB, respectively (measurements at constant level; inter-list variability). The mean SRT and slope of the test subjects were -10.8 +/- 0.5dB SNR and 23.4 +/- 5.2%/dB (measurements at constant level; inter-subject variability). The mean SRT for normal-hearing young adults for a single adaptive measurement is -9.8 +/- 0.9dB SNR.Conclusion: The Finnish digit triplet test is the first self-screening hearing test in the Finnish language. It was developed according to current standards, and it provides reliable and internationally comparable speech intelligibility measurements.

Objective Although cochlear implantation is a relatively safe procedure, there is some reticence to subject elderly people, especially those with significant comorbidity, to the risks of general anesthesia. The purpose of the study was to explore the feasibility of cochlear implant surgery under local anesthesia and sedation in elderly people. Study design Case report study (Clinical Capsule Report). Setting Single tertiary academic referral center. Patients Seven elderly subjects with severe or severe-to-profound sensorineural hearing impairment underwent cochlear implantation under local anesthesia and sedation. All subjects had significant comorbidities with an American Society of Anesthesiologists (ASA) classification 3 to 4 and explicitly expressed their concerns regarding general anesthesia. The subjects were implanted with 24 mm straight electrode array devices via a modified suprameatal approach. Interventions Therapeutic. Main outcome measure The evaluation of a modified suprameatal approach for cochlear implant surgery under local anesthesia and sedation with respect to patient safety and compliance. Results Cochlear implantation under local anesthesia and sedation was successful and well tolerated in all subjects. No intra- or postoperative complications occurred. Recovery was quick and all subjects were discharged on the first postoperative day. All subjects would opt again for the procedure under local anesthesia. Conclusion Cochlear implantation under local anesthesia and sedation was found to be feasible. The modified suprameatal approach lends itself for procedures under local anesthesia, because only minimal drilling is required. The application of this technique provides a safe alternative especially for the elderly with significant comorbidity and increased risks for general anesthesia.

Objective The purpose of this study was to determine the prevalence and etiology of congenital or early acquired bilateral sensorineural hearing impairment (SNHI) in children born from 1988 to 2002 in the district of Kuopio University Hospital, Finland, and to compare the results with those from an earlier 14-year period in the same region and similar population. Methods The data were collected retrospectively from Hospital Records. The degree of hearing impairment was based on average air conduction threshold calculated over the frequencies 0.5, 1, 2 and 4 kHz in the better hearing ear. Hearing impairment was classified as mild (≥20–39 dB), moderate (40–69 dB), severe (70–95 dB) and profound (>95 dB). Results We identified 92 children with bilateral SNHI diagnosed before the age of 7 years. The overall prevalence and the prevalence for at least moderate SNHI was 2.1 per 1000 live births and 1.2 per 1000 live births, respectively. We found no differences in the prevalence of SNHI during both study periods. Etiology was genetic in 46%, acquired in 14% and unknown in 40%. Out of the genetic cases 74% were non-syndromic and 26% were syndromic. In comparison to the previous study there was a decline in the proportion of acquired SNHI and the proportion of genetic and unknown cause had increased. Six children in five families had homozygous 35delG mutation and six children in four families presented with a homozygous M34T mutation. Conclusions The prevalence of congenital or early acquired SNHI in the Kuopio University Hospital district area has not changed during a period of 29 years. Despite possibility to test the GBJ2 gene, the proportion of hearing impairment of unknown etiology remained high.

Objectives: The role of tympanostomy in the treatment of otitis media with effusion (OME) in children with palate cleft with regard to the otologic and audiologic outcome is controversial. Little is known about the development of the mastoid air cell system (MACS) in these children. Study Design: Controlled, prospective. Methods: All children born in the hospital district area of the Central Hospital of Central Finland during the years 1983 to 1993 with palate cleft were reviewed at the age of 6 months. A total of 39 patients were followed up for 6 years after primary tympanostomy. Otologic and audiologic data were collected, and the MACS size was planimetrically measured. The control group consisted of age-matched children without palate cleft suffering from OME and were identically reviewed. Results: The otologic outcome was similar in the study group, 64.1%, and among the controls, 60.6% were healed. There were no serious otologic complications in the study group. The audiologic outcome was also similar, with a mean pure-tone average (0.5–2 kHz) of 10.5 dB and 10.9 dB for the corresponding groups. The initial size and growth of the MACS did not significantly differ between the groups. Conclusions: The prognosis of children with palate cleft treated with early tympanostomy is favorable and does not differ from children without palate cleft. Active treatment ensures normal hearing during the critical years of language, speech, and cognitive development and maintains the development of an aerated mastoid. We believe that early tympanostomy is the treatment of choice of OME in palate cleft children.

Objectives/Hypothesis: Although most studies have agreed that small mastoid air cell systems correlate with long-standing otitis media, the extent to which the environmental factors affect the development of MACS remains undetermined. We investigated the radiographic development of mastoid air cell systems in children with recurrent acute otitis media or otitis media with effusion who were treated with ventilation tubes early in life. Study Design: Prospective follow-up. Methods: Of 305 consecutive patients aged less than 17 months with recurrent acute otitis media or otitis media with effusion who received primary tympanostomy in the Central Hospital of Central Finland, 281 (92.1%) were followed for 5 years. Mastoid radiographic films were obtained preoperatively and at the 5-year end-point examination. Mastoid air cell system size was planimetrically measured. Results: Small baseline mastoid air cell system size was associated with young age at the time of first diagnosis of otitis media and small size of the child. Slow growth and small final size of mastoid air cell system related significantly with female gender and with slow overall growth of the child. Slow mastoid air cell system growth was observed in children who required several ventilation tubes during the follow-up period. Small final mastoid air cell system size correlated significantly with unfavorable otological outcome. Conclusion: The genetically determined development of mastoid air cell system is arrested in varying degree by environmental factors, particularly by an early onset of otitis media, a long-standing disease, and an unfavorable otological outcome. On the other hand, poor pneumatization seems to be a risk factor for chronic and recurrent infections and, ultimately, for a deficient otological outcome. However, in a vast majority of patients, this untoward development may be reversed by an early and, if needed, repeated tympanostomy.

Mucormycosis of the nose and paranasal sinuses is a rare invasive fungal infection, which often has a very fulminant course and characteristic clinical findings. The patients are usually immunocompromised, with diabetic ketoacidosis being the commonest underlying disorder. In some immunocompetent patients, the disease is associated with local predisposing factors, such as chronic sinusitis. Although the prognosis has improved in recent decades, the disease can still be fatal. The underlying disease is an important determinant of prognosis and correction of the metabolic disorder, if present, is essential. Herein we report two cases: one of our patients was immunocompetent but had earlier suffered from polypous rhinosinusitis whereas the other had mild adult-type diabetes. Both patients were successfully treated with surgical debridement and amphotericin B.

The suspicion of a hearing defect is nowadays raised during auditory screening, which is performed on all newborn immediately after birth. Final diagnosis requires several examination visits, during which clinical examinations are combined with electrical examinations of auditory responses. Auditory rehabilitation is executed with hearing aids applied in both ears. If conventional auditory rehabilitation with hearing aids does not ensure sufficient hearing for the development of speech, the child can be provided with a cochlear implant. Children with a hearing defect should regularly be monitored. A multiprofessional team participates in the rehabilitation.