Search

Objective: To identify risk factors for postoperative complications in patients undergoing diverticulectomy and cricopharyngeal (CP) myotomy for Zenker's diverticulum.Study Design: Retrospective.Materials and Methods: A chart review was conducted of all patients with a Zenker's diverticulum who were treated with diverticulectomy and cricopharyngeal myotomy at three tertiary care centers in central Indiana between 1988 and 1998.Results: Of the 24 patients identified, 9 developed postoperative complications (2 medical and 7 surgical). Statistical analysis of multiple potential risk factors revealed that only diverticulum size greater than 10 cm2 at surgery placed the patient at increased risk for postoperative surgical complications. To our knowledge, this is the first report that has specifically addressed diverticulum size as an independent risk factor for postoperative surgical complications following diverticulectomy and CP myotomy.Conclusions: Given our findings, we recommend considering diverticulopexy rather than diverticulectomy in a patient with a Zenker's diverticulum greater than 10 cm2 in size if a cervical approach is the selected treatment. [ABSTRACT FROM AUTHOR]

Brachytherapy can be employed in the primary or salvage treatment of head and neck cancer. The advantage of brachytherapy is the stereotactic limitation of radiation exposure to noninvolved tissues. Wound complications associated with brachytherapy have been discussed only sporadically in the literature. This retrospective study examines 28 patients, 20 for initial treatment and eight for salvage, with varying site and stage head and neck cancer treated with brachytherapy in addition to external beam radiation therapy and/or surgery. The overall complication rate was 50% (14/28), with infection and minor flap breakdown being the most common problems. Tumor site in the primary treatment group was the only significant factor in wound complications. In the salvage group complications were minor and primarily related to flap coverage of brachytherapy catheters. [ABSTRACT FROM AUTHOR]

Objective: Otoacoustic emissions (OAEs) are low-level acoustic signals which emanate from the cochlea and can be recorded in the ear canal. The two types of OAEs are spontaneous and evoked otoacoustic emissions., Methods: In this retrospective study, transient-evoked otoacoustic emissions (TEOAEs) were measured in 385 ears from 204 children with normal hearing and tympanostomy tubes., Results: The results indicate that, when using the Quick Screen option on the Oto-Dynamics ILO88 Otoacoustic Emission Analyzer, postoperative TEOAEs were present at all measured frequencies in 81% of the ears. The remaining 19% of ears showed the absence of an observable emission at one or more of the measured response frequencies. The overwhelming factor contributing to an absent emission was insufficient stimulus energy at 4 kHz. The use of T-type tympanostomy tubes also appeared to decrease the probabilities obtaining normal TEOAEs in ears with normal peripheral auditory function. The use of grommet-type tympanostomy tubes, the type of middle ear effusion, the age and gender of the child, and the physical volume of the ear canal as measured by tympanometry with the tympanostomy tube patent and in place had negligible effects on the measurement of TEOAEs., Conclusions: Clinicians must be cautious when interpreting click-evoked TEAOEs if the patient has a T-tube in place and may need to modify this testing to rule out high-frequency hearing loss when using TEOAEs with these patients. For those patients who have tympanostomy tubes and fail to meet the "pass criteria" for TEOAEs at 4 kHz in the Quick Screen option, TEOAE should be repeated either in the Diagnostic mode or by using a 4 kHz tone-burst stimulus centered at 4 kHz to recover the loss of energy in this region due to the high-frequency roll-off of the stimuli used in the Quick Screen option.

Objectives: In this investigation, we report the outcomes of 14 adults (age >18 y) and 9 children (age <18 y) with radiographically proven large vestibular aqueduct syndrome (LVAS) who received cochlear implants at Indiana University School of Medicine., Study Design: This is a retrospective case-control study detailing the outcomes of 23 patients with LVAS and 46 control patients implanted with Nucleus (Cochlear Corp., Englewood, CO), Clarion (Advanced Bionics Corp., Sylmar, CA), or Med-El (MED-EL Corp., Innsbruck, Austria) cochlear implants., Methods: Performance data on pure-tone averages, speech detection thresholds, and a variety of auditory and speech recognition tasks from these patients with LVAS were compared with performance data obtained from a matched group of 46 cochlear implant users who did not have LVAS. Specific patient characteristics used in matching included the age of the patient, the age at implant of the patient, and whether the patient was pre- or postlingually deafened. Data for the adult group was analyzed using the Student t test, and data for the pediatric patient group was compared using a chi2 test., Results: The results indicated positive outcomes for both pediatric and adult groups. With both adult and pediatric groups, auditory and speech recognition performance did not differ significantly between those patients with LVAS and control subjects., Conclusions: This study adds further support for the use of cochlear implantation in patients with LVAS. Cochlear implantation is beneficial and can be offered as an eventual treatment of LVAS if hearing loss progresses to profound levels in these patients.

Objective: A group of 20 patients with large vestibular aqueduct syndrome was identified at the Indiana University School of Medicine. The major objective of this study was to explore the improvements in quality of life associated with cochlear implantation in patients with large vestibular aqueduct syndrome, as well as the cost-utility of cochlear implantation in this group., Setting: A total of 70 patients were identified with large vestibular aqueduct syndrome through analysis of thin-section computed tomography of the temporal bone over the past 6 years at this medical center. Data collected from the medical records for each patient included demographic data, hearing-related statistics, implantation data, and audiometric data. Sixteen children and adults with large vestibular aqueduct syndrome had undergone cochlear implantation before the beginning of this study, and the remaining 54 children and adults were identified as undergoing treatment of progressive or fluctuant sensorineural hearing loss. Health utility indexes used in this analysis were taken through the use of the Ontario Health Utility Index, Mark III. The range of costs used for cost-utility analysis was derived from the costs of cochlear implantation at this medical center, as well as from costs associated with implantation published in the medical literature., Methods: Participants were selected from the total population of patients with large vestibular aqueduct syndrome at this center who were postlingually deafened and who currently had severe hearing loss. Two groups were formed. These groups comprised either cochlear implant patients with large vestibular aqueduct syndrome or patients with large vestibular aqueduct syndrome currently using hearing aids. Ten of the 16 cochlear implant patients and 10 of the remaining 54 patients with large vestibular aqueduct syndrome met these criteria. Mark III health utility indexes were distributed to patients in each group and scored. Those health utility indexes not completed by the patients were scored by proxy, using the audiologist at this center who was the most familiar with the patient. Changes in quality of life associated with cochlear implantation were derived by comparison of the health utility index results of the two groups. Cost-utility measures were then made using discounted costs per quality-of-life years (QALYs) (5%), and a sensitivity analysis was performed that evaluated changes in scoring done by proxy. The cost-utility results were then compared with the cost-utilities derived from similar studies and associated with other disease states., Results: Although both groups of patients had significant hearing loss, the hearing aid group had a better mean pure-tone average. The mean pure-tone average for the hearing aid group was 70.8 dB (SD 24.4), and the mean pure-tone average for the cochlear implant group was 107.0 dB (SD 21.7). Seven of the 20 health utility indexes were scored by proxy. Results from the base case indicate a 0.20 gain in health utility from cochlear implantation (hearing aid = 0.62, cochlear implant = 0.82, p = 0.037), resulting in a discounted cost per QALY of $12,774. Sensitivity analysis of the proxy scoring indicated that decreasing the hearing score one level on the health utility index resulted in a gain in health utility with cochlear implantation of 0.15, resulting in a discounted cost per QALY of $17,832. A decrease of the hearing score by two levels on the health utility survey resulted in no significant gain in quality of life with cochlear implantation., Conclusion: This study found an improvement in quality of life associated with cochlear implantation in postlingually deafened patients with large vestibular aqueduct syndrome. By weighing this improvement in quality of life against the significant difference noted between the pure-tone averages of each group, further strength can be given to this conclusion. This gain in quality of life, as well as the results derived for the cost-utility of cochlear implantation, was similar to that in previous published studies of cochlear implantation in all types of patients. These results also indicate a favorable cost-utility when compared with published data about other disease states. As patients with large vestibular aqueduct syndrome progress to profound levels of hearing loss, these results indicate that cochlear implantation can be offered as a beneficial, life-improving therapy.

Objective: To discuss the various symptoms and causes of objective tinnitus in children., Study Design: Retrospective case review., Patients: Five children who had audible signals emanating from their ears caused by audible spontaneous otoacoustic emissions, palatal myoclonus, arteriovenous malformation, and acoustic trauma., Main Outcome Measure: The tinnitus reported by the patients was linked to acoustic signals that could be measured objectively or heard by the examiner., Results: Four of the five children had essentially normal hearing. The one child who demonstrated a hearing loss audiometrically was thought to have normal hearing sensitivity, but his intense roaring objective tinnitus appeared to mask his low-frequency thresholds. All five patients had measurable acoustic signals in the ear canal that matched the patients' descriptions of their tinnitus., Conclusion: The cases illustrate how the objective tinnitus was diagnosed and measured, how a treatment algorithm was applied, and the expected results of treatment. In addition, the cases provide support for the use of psychologic counseling throughout the examination and treatment of objective tinnitus in children.

When taking an impression of the external ear canal and ear, the audiologist is engaged in an invasive procedure whereby a foreign body is first placed into the ear canal and then removed. There is always an element of risk for significant medical problems when a clinician is performing an invasive procedure. Although some minor patient discomfort and, at times, some slight trauma to the ear canal occur when taking ear impressions, the incidence of significant trauma to the external or middle ear appears to be low. The purpose of this report is to provide some illustrative cases of significant external and middle ear trauma as a result of taking impressions of the external ear. Audiologists are advised to develop and implement an appropriate risk management program for taking ear impressions to reduce the potential risks associated with this procedure to their patients and to their practices.

The use of directional microphones is one of the few methods available for hearing aids to increase the signal-to-noise ratio. The smaller microphones available with today's technology have increased the viability of their application for in-the-ear (ITE) hearing aids. This study evaluated an ITE hearing aid containing two nondirectional microphones that provides wearer-selectable omnidirectional/directional operating modes. Ten sensorineural hearing-impaired patients were fitted binaurally. During the first trial period, the low-frequency gain decrease produced by the directional mode was not compensated for. The frequency responses were matched during the second trial period. For both trial periods, Hearing in Noise Test results using two uncorrelated noise sources indicated significant speech recognition improvements for the directional mode relative to the omnidirectional mode. Responses on Abbreviated Profile of Hearing Aid Benefit questionnaires, paired-comparison judgments, and interview data revealed that most subjects preferred the directional mode in noisier environments, but many also preferred the omnidirectional mode in quiet listening.

Differences in performance were evaluated between binaural fittings of the Oticon MultiFocus (MF) and ReSound BT2-E on 25 hearing-impaired subjects across two sites. Subjects were initially fit using each manufacturer's algorithm and adjustments were made at 1 week based on subjects' responses to diary questions. Performance was assessed after a 4- to 6-week trial period with each hearing aid set using the Speech Perception in Noise (SPIN) test administered at 50, 65, and 80 dB SPL, the Abbreviated Profile of Hearing Aid Benefit (APHAB) questionnaire, loudness judgments of female connected discourse at 65 and 80 dB SPL, and an overall preference selection. The MF yielded significantly better SPIN scores at 50 and 65 dB SPL, while the BT2-E yielded a significantly better score at 80 dB SPL. No statistically significant differences were found in the APHAB benefit scores between the hearing aid sets, but both sets were significantly better than the subjects' own hearing aids on three of the four subscales. The MF produced slightly higher mean loudness judgments at both input levels than the BT2-E. Finally, 12 subjects preferred the BT2-E, 10 subjects preferred the MF, and three subjects stated no preference. The results are discussed in terms of audiogram effects on preference and effects of differences in signal processing approaches between the devices.

Electrical suppression of tinnitus via a cochlear implant is a secondary benefit for many cochlear implant recipients. In this study, a sample of 78 adult cochlear implant users were surveyed. Data was compiled from 64 completed questionnaires. A high prevalence of preoperative tinnitus was documented in profoundly deaf adult cochlear implant users. Although only a few subjects reported that their tinnitus was totally eliminated after implantation, many users reported improvement or stabilization. Duration of tinnitus appeared to be a significant factor as all subjects who reported a significant improvement had less than a 20-year history of tinnitus.

The purpose of this study was to determine whether brief duration samples of noise dose measurements could predict the noise exposure levels of employees as measured by 8-hour dosimetry. Sampled noise dose measurements were obtained for 1, 5, 10, 15, and 20 minutes and 8 hours for four workers at each of four industrial sites. Statistical analyses indicated no significant differences or interactions among trials and sample durations. A simple linear prediction model provided the best fit for the four shortest of the five abbreviated sample durations, whereas an exponential regression model provided the best predictions using the 20-minute sample duration. The high variance and low correlations across all measures permitted only poor predictions from these abbreviated sample data. Based on these results, sampled noise measurements of short duration (1 to 20 minutes) do not appear to be a valid means for predicting the amount of noise exposure during an 8-hour shift.

The frequency contribution to the click-evoked ABR wave V was examined in adults and 3-month-old infants through the use of notch-filtered broadband noise. Notch center frequencies were set at 1.0, 4.0, and 8.0 kHz. Responses were obtained at 20, 40, and 60 dBnHL during the simultaneous presentation of each notched-noise masker as well as in an unmasked condition. The ABR wave V was analyzed for absolute latency and amplitude, as well as latency and amplitude changes resulting from the introduction of masking. Analyses showed wave V latency and amplitude values to be similar for adults and infants within the 1.0-kHz notch. Differences between adult and infant groups were observed as the notch was shifted to the high frequencies. Further, latency and amplitude shifts resulting from the introduction of masking noise produced differential effects on infant responses when compared to adults.

Decrement in ABR wave V amplitude was measured in the presence of simultaneous tonal maskers. Probe stimuli were 1.0, 4.0, and 8.0-kHz third-octave-filtered clicks. Adults and 3-month-old infants served as subjects. The resultant amplitude-decrement functions for each tonal masker were fit with regression lines. The sound pressure level (SPL) required to reduce wave V to 50% of the unmasked probe amplitude was plotted for each masker to develop tuning curves. The tuning curves were quantified by calculations of tip-to-tail difference, Q 10, and SPL at maximum masker frequency (MMF). Tuning curves for adult and infant subjects were similar for the 1.0-kHz probe. For the high-frequency probes (4.0 and 8.0 kHz), smaller tip-to-tail differences and lower Q 10 values were observed for the infant subjects. Ranges of MMF level were similar across adult and infant subjects. For the 8.0-kHz probe, tuning curves from infant subjects consistently showed maximum masker frequencies which were lower than the probe.

The Synthetic Sentence Identification - Ipsilateral Competing Message (SSI-ICM) test at a -20-dB message-to-competition ratio was used to investigate central auditory function of fluent and disfluent, normally speaking, male college students. The disfluent group consisted of 10 subjects who demonstrated part-word repetitions while speaking extemporaneously. The matched fluent group of 10 subjects had extemporaneous speech containing no part-word repetitions and with speaking times matched to those of the disfluent group. All subjects had intact peripheral hearing skills and no known history of stuttering. As hypothesized, the disfluent normal speakers had lower scores on the SSI-ICM test than did the fluent normal speakers. It was suggested that a central auditory variable may be one of the factors contributing to the production of disfluent speech at the level of syllable production. It was further suggested that this relationship is not one limited to the clinical or stuttering population as suggested by the design of previous research.