| 1. |
- Knutsson, Johan, et al.
(författare)
-
A randomized study of four different types of tympanostomy ventilation tubes : Full-term follow-up
- 2018
-
Ingår i: International Journal of Pediatric Otorhinolaryngology. - : Elsevier BV. - 0165-5876 .- 1872-8464. ; 107, s. 140-144
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To evaluate the impact of tympanostomy ventilation tube material (silicone vs fluoroplastic) and shape (short vs long) regarding time to extrusion, occurrence of otorrhea, occlusion, tube removal and occurrence of persistent perforation.METHODS AND MATERIAL: Four different types of ventilation tubes were used; Long Armstrong tubes, Donaldson tubes, Shepard tubes and straight tubes, representing four specific combinations of VT material (silicone or fluoroplastic) and shape (short, double flanged or long, single flanged). Four hundred children scheduled for bilateral tube insertion were included in a randomized trial. The patients received one type of tube in the right ear and another type in the left ear. The incidence of tube extrusion and complications were monitored postoperatively every third month by an otolaryngologist.RESULTS: Twenty-two children were excluded during surgery. Out of the studied 378 children the mean age was 35.3 months. 63.8% were boys. Short tubes extruded earlier than long tubes; hazard ratio (HR) 4.84 (95% CI 3.50-6.69, p < 0.001). Long Armstrong tubes were least prone to extrude. Silicone tubes resulted in significantly longer time to first infection in a VT ear, HR 1.68 (95% CI 1.03-2.76, p = 0.039). Donaldson tubes rendered the longest mean time to first infection (p = 0.025). Infections did not affect tube extrusion rates significantly (p = 0.879). No significant differences were found regarding tube occlusion, tube extraction or persistent perforation.CONCLUSIONS: Long tubes are less prone to extrude early. Long Armstrong tubes have the least propensity to extrude early. Silicone tubes render significantly longer time to first infection. Donaldson tubes result in least infections. Infection does not affect extrusion rates significantly.LEVEL OF EVIDENCE: 1b.
|
|
| 2. |
- Priwin, Claudia, 1971, et al.
(författare)
-
Audiological evaluation and self-assessed hearing problems in subjects with single-sided congenital external ear malformations and associated conductive hearing loss
- 2007
-
Ingår i: Int J Audiol. - : Informa UK Limited. - 1499-2027 .- 1708-8186. ; 46:4, s. 162-71
-
Tidskriftsartikel (refereegranskat)abstract
- Previously, unilateral hearing impairment (UHI) has been considered of little consequence. However, a recent meta-analysis of children with UHI displayed educational and behavioural problems and possible delays of speech and language development. Further, patients with UHI consequently report hearing difficulties. Our study investigated hearing function, possible inner ear protection, and self-assessed hearing problems in 57 subjects aged between 3-80 years with single-sided congenital ear malformations and conductive UHI. Pure-tone thresholds and speech recognition (quiet, noise) were measured, and all patients completed a self-assessment questionnaire. Pure-tone thresholds corresponding to sensorineural function did not significantly differ between the normal (air conduction) and affected ear (bone conduction). However, speech recognition in both quiet and in noise was normal on the non-affected side but significantly worse on the malformed side. A moderate to high degree of self-assessed hearing problems were reported. In conclusion, hearing function in the affected ear was found to be subnormal in terms of supra threshold signal processing. Furthermore, a high degree of hearing difficulty was reported. Therefore, active treatment, surgery, or hearing amplification, might be considered.
|
|
| 3. |
- Priwin, Claudia, 1971, et al.
(författare)
-
BAHA in children and adolescents with unilateral or bilateral conductive hearing loss: a study of outcome
- 2007
-
Ingår i: Int J Pediatr Otorhinolaryngol. - : Elsevier BV. - 0165-5876. ; 71:1, s. 135-45
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: Bilateral BAHAs in adults with bilateral hearing loss (BHL) have proven to be superior to unilateral fitting, in both audiologically measurements and in overall patient satisfaction. There have been no similar studies in children. Furthermore, a recent meta-analysis of children with unilateral hearing loss (UHL) has shown numerous negative consequences. The objectives of the study were to investigate whether fitting of bilateral BAHAs in children with conductive BHL give additional hearing benefits, to investigate the effects of unilateral hearing aids in children with conductive UHL, and to identify different aspects of auditory problems in children with conductive UHL or BHL. STUDY DESIGN: This was a prospective study involving 22 children with either conductive UHL (unaided or with unilateral hearing aid) or conductive BHL (with unilateral or bilateral BAHAs) and 15 controls. METHODS: Baseline audiometry, tone thresholds in a sound field, speech recognition in noise and sound localization were tested without, and with unilateral and bilateral hearing aids. Two questionnaires, MAIS & MUSS and IOI-HA, were completed. RESULTS: Two problem areas were identified in the children with hearing impairment: in reactions to sounds and in intelligibility of speech. An additional BAHA in the children with BHL resulted in a tendency to have improved hearing in terms of better sound localization and speech recognition in noise. Fitting of unilateral hearing aids in the children with UHL gave some supplementary benefit in terms of better speech recognition in noise but no positive effect on ability to localize sound could be detected. Even so, all children fitted with hearing aids - either unilaterally or bilaterally - reported a positive outcome with their devices in the self-assessment questionnaire. CONCLUSIONS: Children with either UHL or BHL displayed several problems within the hearing domain. Fitting of bilateral BAHAs in children with BHL and of a single-sided hearing aid in children with UHL appears to have some supplementary audiological benefits and also renders high patient satisfaction. In order to investigate the possible supplementary effects of hearing aids, a 3-month trial of BAHA on Softband, either unilaterally or bilaterally, may be of value in children with conductive UHL or BHL, respectively.
|
|
| 4. |
- Priwin, Claudia, 1971, et al.
(författare)
-
Bilateral bone-anchored hearing aids (BAHAs): an audiometric evaluation
- 2004
-
Ingår i: Laryngoscope. - : Laryngoscope. - 0023-852X .- 1531-4995. ; 114:1, s. 77-84
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: Since the technique to implant bone-anchored hearing aids (BAHAs) with the use of osseointegrated implants was developed in 1977, more than 15,000 patients have been fitted with BAHAs worldwide. Although the majority have bilateral hearing loss, they are primarily fitted unilaterally. The main objective of this study was to reveal benefits and drawbacks of bilateral fitting of BAHAs in patients with symmetric or slight asymmetric bone-conduction thresholds. The possible effects were divided into three categories: hearing thresholds, directional hearing, and binaural hearing. STUDY DESIGN: Prospective study of 12 patients with bilateral BAHAs. METHODS: Baseline audiometry, directional hearing, speech reception thresholds in quiet and in noise, and binaural masking level difference were tested when BAHAs were fitted unilaterally and bilaterally. RESULTS: Eleven of the 12 patients used bilateral BAHAs on a daily basis. Tests performed in the study show a significant improvement in sound localization with bilateral BAHAs; the results with unilateral fitting were close to the chance level. Furthermore, with bilateral application, the improvement of the speech reception threshold in quiet was 5.4 dB. An improvement with bilateral fitting was also found for speech reception in noise. CONCLUSIONS: Overall, the results with bilateral fitted BAHAs were better than with unilaterally fitted BAHA; the benefit is not only caused simply by bilateral stimulation but also, to some extent, by binaural hearing. Bilateral BAHAs should be considered for patients with bilateral hearing loss otherwise suitable for BAHAs.
|
|
| 5. |
- Priwin, Claudia
(författare)
-
Bone anchored hearing aids 'BAHAs' in children
- 2006
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- BACKGROUND: The technique for applying bone-anchored hearing aids (BAHAs) by the use of osseointegration is today widely established for both adults and children. The BAHA concept is suitable for patients with recurrent ear infections or car malformations who cannot use conventional hearing aids, which are placed altogether or partially in the ear canal. Long-term results are well documented in adults but are lacking in children. Most patients are fitted with unilateral BAHA even though they have bilateral hearing loss. However, recent studies in adults with bilateral hearing loss have shown better hearing results with bilateral BAHA fitting compared to unilateral. Moreover, a recently published metaanalysis on the consequences of unilateral hearing loss in children has implied that educational and behavioural problems as well as delayed speech and language development can occur. Improved hearing outcomes have lately been presented in adults with single-sided deafness and unilateral conductive hearing loss fitted with unilateral BAHA why unilateral BAHA ought to be explored also in children. AIMS: The study was performed with the aim to increase our knowledge of long-term results and new areas of use of BAHA in children with either uni- or bilateral conductive hearing loss. A further objective was to evaluate the influence of single-sided congenital conductive hearing loss on hearing function and to investigate perceived problems in patients with congenital ear malformation where no hearing intervention has been performed. MATERIAL AND METHODS: Altogether 127 patients and 15 controls, mainly children were enrolled in the present study. The included subjects had either uni-or bilateral conductive hearing loss. The patients with bilateral hearing loss were fitted with BAHAs uni-or bilaterally whereas the patients with unilateral hearing loss were predominantly untreated or fitted with unilateral BAHA. Medical records were examined. Psychoacoustic tests including tone and speech audiometry, sound localizations tasks, as well as satisfactory measurements were employed. RESULTS AND CONCLUSION: Long-term results in children concerning implant failure rate, adverse skin reactions and function pattern of the BAHA were in parity with previous measured outcomes in adults. Furthermore, bilateral BAHAs in patients, both children and adults gave additional hearing effects such as improved speech reception/recognition and sound localization ability as well as binaural hearing to some extent. Unilateral hearing aid fitting in children gave some supplementary benefit in terms of improved speech recognition in noise but no positive influence on sound localization ability was recorded. Nevertheless, all children fitted with hearing aids, either uni-or bilaterally reported positive outcome with their devices. Two problem areas were identified in the hearing impaired children: in reaction to sounds and with speech intelligibility. Finally, in patients with single-sided congenital external ear malformations and associated hearing loss, a deprived auditory function was noticed. This patient cohort also reported a high degree of hearing related problems. In conclusion, BAHA is a good amplification alternative in children with conductive hearing loss. Bilateral BAHAs resulted in supplementary hearing gain compared to one BAHA in both adults and children why bilateral BAHAs could be considered in patients with bilateral conductive hearing loss. Unilateral hearing aid, mainly BAHA might also be beneficial to some extent in children with conductive unilateral hearing loss and a trial with BAHA on Softband could be considered. Complementary intervention should also focus on the alleviation of the high degree of self and guardian reported problems in audition and communication.
|
|
| 6. |
- Priwin, Claudia, 1971, et al.
(författare)
-
The bone-anchored hearing aid in children: a surgical and questionnaire follow-up study
- 2005
-
Ingår i: Otolaryngol Head Neck Surg. - : Wiley. - 0194-5998. ; 132:4, s. 559-65
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: The main objectives were to evaluate the surgical techniques and problems seen in children with bone-anchored hearing aids (BAHA) as well as to determine the children's attitudes toward BAHA. STUDY DESIGN: A retrospective study of 41 children with unilateral BAHA was conducted. Surgical recordings were investigated and a questionnaire was distributed. RESULTS: Surgery was performed as a 2-stage procedure. Available bone thickness was measured in 29 patients and found to be on average 2.5 mm. Thin temporal bone necessitated bone augmentation in 8 patients. Of the implants, 70.5% were installed in contact with the dura or the sigmoid sinus. Implant failures were seen in 9.1% and adverse skin reactions appeared in 7.6% of the patients. Twenty-seven patients responded to the questionnaire, 19 were still BAHA users. Overall, these patients were very content with their BAHAs. CONCLUSION: BAHA is a good alternative in children despite limited thickness of the temporal bone.
|
|
| 7. |
|
|
| 8. |
- Söderman, Anne-Charlotte Hessén, et al.
(författare)
-
A randomized study of four different types of tympanostomy ventilation tubes - One-year follow-up
- 2016
-
Ingår i: International Journal of Pediatric Otorhinolaryngology. - : Elsevier BV. - 0165-5876 .- 1872-8464. ; 89, s. 159-163
-
Tidskriftsartikel (refereegranskat)abstract
- Objective: To compare four different types of tympanostomy ventilation tubes (VT); long-shaft and short-shaft silicone tubes and long-shaft and short-shaft fluoroplastic tubes, regarding time to extrusion and events of otorrhea. Methods: A prospective randomized controlled trial in children with bilateral recurrent acute otitis media or secretory otitis media; four hundred children were randomized to receive one type of VT in the right ear and another type in the left ear. Postoperatively the children were assessed every third month by an otolaryngologist to monitor the incidence of otorrhea and tube extrusion. Results: Out of the 400 children, 22 were excluded during surgery. Mean age was 35.3 months. A majority (63.8%) were boys. Forty-eight children were lost to follow up during the first year. Significantly more short-shaft VTs were extruded after 12 months compared to long-shaft VTs, regardless of material. Significantly higher incidence of otorrhea was found in the fluoroplastic VT ears compared to the silicone ones, regardless of length of tube. Conclusion: Long-shaft VTs last longer in the eardrum during the first year of treatment. Silicone tubes render a reduced risk of otorrhea during the first year of treatment.
|
|
