| 11. |
- Calon, T. G. A., et al.
(författare)
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Minimally Invasive Ponto Surgery Versus the Linear Incision Technique With Soft Tissue Preservation for Bone Conduction Hearing Implants: A Multicenter Randomized Controlled Trial
- 2018
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Ingår i: Otology & Neurotology. - : Ovid Technologies (Wolters Kluwer Health). - 1531-7129 .- 1537-4505. ; 39:7, s. 882-893
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Tidskriftsartikel (refereegranskat)abstract
- Objective:To compare the surgical outcomes of the Minimally Invasive Ponto Surgery (MIPS) technique with those of the linear incision technique with soft-tissue preservation for bone-anchored hearing systems (BAHS).Design:Sponsor-initiated multicenter, open, randomized, controlled clinical trial.Setting:Maastricht University Medical Centre, Ziekenhuisgroep Twente and Medisch Centrum Leeuwarden, all situated in The Netherlands.Participants:Sixty-four adult patients eligible for unilateral BAHS surgery.Interventions Single-stage BAHS surgery with 1:1 randomization to the linear incision technique with soft-tissue preservation (control) or the MIPS (test) group.Primary and Secondary Outcome Measurements:Primary objective: compare the incidence of inflammation (Holgers Index 2) during 12 weeks' follow-up after surgery. Secondary objectives: skin dehiscence, pain scores, loss of sensibility around the implant, soft-tissue overgrowth, skin sagging, implant extrusion, cosmetic results, surgical time, wound healing and Implant Stability Quotient measurements.Results:Sixty-three subjects were analyzed in the intention-to-treat population. No significant difference was found for the incidence of inflammation between groups. Loss of skin sensibility, cosmetic outcomes, skin sagging, and surgical time were significantly better in the test group. No statistically significant differences were found for dehiscence, pain, and soft-tissue overgrowth. A nonsignificant difference in extrusion was found for the test group. The Implant Stability Quotient was statistically influenced by the surgical technique, abutment length, and time.Conclusion:No significant differences between the MIPS and the linear incision techniques were observed regarding skin inflammation. MIPS results in a statistically significant reduction in the loss of skin sensibility, less skin sagging, improved cosmetic results, and reduced surgical time. Although nonsignificant, the implant extrusion rate warrants further research.
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| 12. |
- Counter, S. Allen, et al.
(författare)
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Ultra-high-field (9.4 T) MRI Analysis of Contrast Agent Transport Across the Blood-Perilymph Barrier and Intrastrial Fluid-Blood Barrier in the Mouse Inner Ear
- 2017
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Ingår i: Otology and Neurotology. - 1531-7129 .- 1537-4505. ; 38:7, s. 1052-1059
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Tidskriftsartikel (refereegranskat)abstract
- Hypothesis: Effective paramagnetic contrast agent for the penetration of the perilymphatic spaces of the scala tympani, scala vestibuli, and scala media of the mouse inner ear can be determined using intravenous injection of various gadolinium (Gd) complexes and ultra-high-field magnetic resonance imaging (MRI) at 9.4 Tesla.Background: A number of contrast agents have been explored in experimental high-field MRI to determine the most effective Gd complex for ideal signal-to-noise ratio and maximal visualization of the in vivo mammalian inner ear in analyzing the temporal and spatial parameters involved in drug penetration of the blood-perilymph barrier and intrastrial fluid-blood barrier in the mouse model using MRI.Methods: Gadoteric acid (Dotarem), Gadobutrol (Gadovist), Gadodiamide (Omniscan), Gadopent acid (Magnevist), and Mangafodipir (Teslascan) were administered intravenously using the tail vein of 60 Balb/C mice. High-resolution T1 images of drug penetration were acquired with a horizontal 9.4 T Agilent magnet after intravenously injection. Signal intensity was used as a metric of temporal and spatial parameters of drug delivery and penetration of the perilymphatic and endolymphatic spaces.Results: ANOVA analysis of the area under the curve of intensity enhancement in perilymph revealed a significant difference (p < 0.05) in the scalae uptake using different contrast agents (F (3,25) = 3.54, p = 0.029). The Gadoteric acid complex Dotarem was found to be the most effective Gd compound in terms of rapid, morphological enhancement for analysis of the temporal, and spatial distribution in the perilymphatic space of the inner ear.Conclusion: Gadoteric acid (Dotarem) demonstrated efficacy as a contrast agent for enhanced visualization of the perilymphatic spaces of the inner ear labyrinthine in the mouse, including the scala tympani and scala vestibuli of the cochlea, and the semicircular canals of the vestibular apparatus. These findings may inform the clinical application of Gd compounds in patients with inner ear fluid disorders and vertigo.
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| 13. |
- Eeg-Olofsson, Måns, 1967, et al.
(författare)
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Implications for contralateral bone-conducted transmission as measured by cochlear vibrations.
- 2011
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Ingår i: Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology. - : LWW. - 1537-4505 .- 1531-7129. ; 32:2, s. 192-8
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Tidskriftsartikel (refereegranskat)abstract
- The velocity response at the contralateral cochlea from bone-conducted (BC) stimulation depends on the stimulation position.
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| 14. |
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| 15. |
- Enghag, Sara, et al.
(författare)
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Incus Necrosis and Blood Supply : A Micro-CT and Synchrotron Imaging Study
- 2019
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Ingår i: Otology and Neurotology. - : LIPPINCOTT WILLIAMS & WILKINS. - 1531-7129 .- 1537-4505. ; 40:7, s. E713-E722
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Tidskriftsartikel (refereegranskat)abstract
- Background: Incus necrosis is a common complication following stapes surgery and is associated with impaired microcirculation. The objective of this study was to investigate the vascular anatomy of the human incus by using light microscopy, micro-computed tomography (micro-CT), and synchrotron phase-contrast imaging (SR-PCI) for a novel three-dimensional (3D) analysis of the middle ear, mucosal folds, major vascular pathways, and intraosseous vascular bone channels. Methods: One-hundred-and-fifty temporal bones from the Uppsala collection were analyzed under light microscopy. Twenty temporal bones underwent high-resolution micro-CT scanning, and an additional seven specimens underwent SR-PCI at the Canadian Lightsource in Saskatoon, Canada. One of these specimens was from an individual who had undergone stapes surgery. Data were processed with volume-rendering software to create 3D reconstructions using scalar opacity mapping for bone transparency, cropping, and soft tissue analyses. Results: Micro-CT and SR-PCI with 3D rendering revealed the extensive vascular plexus within the un-decalcified incus bone communicating with the exterior surface. The relationship between the vessels, lenticular process, and incudostape-dial joint were clearly observed. SR-PCI allowed for histologic-level detail while preserving the specimen and its 3D relationships. Conclusion: SR-PCI with 3D reconstructions confirmed the main vascular supply to the lenticular process along the intraosseous lenticular vessels. This is the first synchrotron analysis of a patient having undergone stapes surgery, and it suggests that incus necrosis associated with stapes surgery may be caused by a disruption of the lenticular blood flow induced by the prosthesis loop, and not by strangulation of mucosal vessels as has been previously described.
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| 16. |
- Erixon, Elsa, et al.
(författare)
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Variational anatomy of the human cochlea : implications for cochlear implantation
- 2009
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Ingår i: Otology and Neurotology. - 1531-7129 .- 1537-4505. ; 30:1, s. 14-22
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Tidskriftsartikel (refereegranskat)abstract
- HYPOTHESIS: To study variations in human cochlea anatomy with potential implications for cochlear implantation surgery. BACKGROUND: A comprehension of the anatomic variations of the human cochlea is essential for understanding the degree of surgical trauma induced by inserting various electrode arrays in cochlear implantation surgery. Variations in anatomy may also limit the potential for performing hearing preservation. METHODS: We studied 73 archival, nonselected, adult, corrosion casts of human inner ears. Anatomic reference points were constructed from photographic reproductions taken at different angles, and various dimensions were assessed using planimetry. Anatomic variants with particular clinical/surgical interests were pinpointed. RESULTS: Results showed that the human cochlea is individually shaped, varying greatly in dimensions ("fingerprint"). The outer cochlear wall length ranged from 38.6 to 45.6 mm with a mean length of 42.0 mm. The first turn represented 53% of the total length and ranged from 20.3 to 24.3 mm. The number of quadrants varied from slightly more than 8 to 12. The facial nerve canal ran in close proximity to the upper first turn explaining facial nerve excitement during stimulation of electrodes in this region in some instances. The internal diameter (height) of the cochlear tube in the first turn varied broadly (1.6-2.6 mm), occasionally with limited space for conventional implants. CONCLUSION: The human cochlea exhibits extensive anatomic variations. These variations will influence the location of cochlear implant arrays and affect the potential of hearing preservation surgery. Our results may explain the surgeon's difficulties sometimes to insert electrode arrays even in so-called "normal" cochleae.
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| 17. |
- Fogels, Jonas, et al.
(författare)
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Single-Sided Deafness-Outcomes of Three Interventions for Profound Unilateral Sensorineural Hearing Loss: A Randomized Clinical Trial
- 2020
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Ingår i: Otology & Neurotology. - : Ovid Technologies (Wolters Kluwer Health). - 1531-7129 .- 1537-4505. ; 41:6, s. 736-744
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Tidskriftsartikel (refereegranskat)abstract
- Objective:A comparison of three interventions for profound unilateral sensorineural hearing loss.Study Design:Prospective, crossover randomized clinical trial.Participants:Fifteen participants with profound unilateral sensorineural hearing loss.Interventions:Three potential technical interventions were compared: Bone Conduction Device on softband, Contralateral Routing of Signal (CROS), and Remote Microphone . Each intervention was randomly trialed for a period of 3 weeks, separated by a 1 week washout period.Outcome Measures:Speech in noise recognition test performed under four conditions (lateral noise poorer ear, lateral noise better ear, speech poorer ear, speech better ear). Standardized questionnaires (Abbreviated Profile of Hearing Aid Benefit, Bern Benefit in Single Sided Deafness Questionnaire, and Speech, Spatial, and Other Qualities 12) were used to evaluate amplification benefit at baseline and following each intervention.Results:The use of remote microphone provided the best results in the speech recognition in noise test. A benefit in some signal-to-noise ratios was presented of the CROS over bone conduction device on softband in the Speech Poor Ear condition. On questionnaires of benefit, participants did not rate a particular intervention as significantly better than any other. Following the study, CROS was the intervention preferred by the 8 of 15 participants (53%). The majority of participants (80%) chose to continue with an intervention rather than no treatment.Conclusion:The use of all interventions resulted in increased performance in speech recognition in noise and rated higher on subjective benefits in comparison with baseline. People with SSD are a heterogeneous population when considering perceived difficulties. Future research should focus on segmenting the population of SSD depending on factors such as etiology, high frequency loss in the better ear, and age of acquired loss for the poorer ear. This stratification may possibly increase the benefit for the patient in terms of more individual-based clinical routines.
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| 18. |
- Frodlund, Jonas, et al.
(författare)
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Vestibular Function After Cochlear Implantation: A Comparison of Three Types of Electrodes
- 2016
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Ingår i: Otology and Neurotology. - : LIPPINCOTT WILLIAMS & WILKINS. - 1531-7129 .- 1537-4505. ; 37:10, s. 1535-1540
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To investigate the vestibular function after cochlear implantation with different types of electrode arrays. Study Design: Retrospective cohort study. Setting: Academic tertiary referral center. Materials and Methods: Forty three adults underwent first cochlear implantation. Three consecutive series of patients: Group 1 (n = 13) implanted with a precurved electrode, Group 2 (n = 15) implanted with a straight electrode, Group 3 (n = 15) implanted with a flexible electrode. Patients vestibular functions were assessed with pre-and postoperative caloric testing using videonystagmography (VNG). The postoperative reduction of the maximum slow phase velocity (MSPV) in the implanted ear was evaluated. Medical charts were reviewed to evaluate the occurrence of late onset of postoperative vestibular symptoms. Results: Mean reduction of MSPV was 7.6/s (standard deviation [SD] 8.0) in Group 1, 23.1/s (SD 16.6) in Group 2, and 0.1/s (SD 18.5) in Group 3. Significant difference was found between Group 1 and 2 (p amp;lt; 0.030) and between Group 2 and 3 (p amp;lt; 0.001). Group 2 showed a higher prevalence of late onset of clinical vertigo (28.6%) than Group 1 (7.7%) and 3 (6.7%). Conclusion: In this prospective study, significantly larger reductions of caloric responses were found in subjects implanted with a straight electrode compared with subjects implanted with a precurved or flexible electrode. These findings seem to correlate to a higher prevalence of postoperative vertigo.
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| 19. |
- Frykholm, Carina, et al.
(författare)
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Familial Meniere's disease in five generations
- 2006
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Ingår i: Otology and Neurotology. - : Ovid Technologies (Wolters Kluwer Health). - 1531-7129 .- 1537-4505. ; 27:5, s. 681-686
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Clinical characterization of a Swedish family followed for five generations. Several members of each generation had Meniere's disease (MD). Possible modes of genetic transmission were assessed. Study Design: Retrospective family survey. Setting: University hospital. Tertiary referral center. Patients: Members of a large family in which several members in each generation were affected by MD. Interventions: Hearing levels were assessed, and the patients were asked to complete a questionnaire regarding age at onset, hearing loss, tinnitus, aural fullness, vertigo, and if MD was unilateral or bilateral. Glycerol tests were performed in a few cases. For deceased relatives, information was obtained from patient charts and interviews with relatives. Genetic studies with linkage analysis was performed for the loci DFNA 1, DFNA6/14, DFNA9, and DFNA 15. Results: One member of Generation I and, according to patient charts, two members of Generation 11 could have suffered from MD. In Generations III to V, 9 of 25 members developed inner ear dysfunction. Six of these individuals developed MD that was strictly in accordance with American Academy of Otolaryngology and Head and Neck Surgery, 1995 guidelines criteria, whereas three individuals had unilateral or bilateral hearing impairment, one in combination with benign paroxysmal positioning vertigo, which could represent an incomplete expression of the disease. ne mean age at disease onset was 64.5 years in Generation 111, 43 years in Generation W, and 25 years in Generation V. In the genetic studies, none of the regions investigated showed linkage to the disease gene with a significant calculated log of odds ratio (LOD) score above three. Conclusion: The pattern of inheritance suggested that familial MD was autosomal dominant and exhibited incomplete expression of inner ear symptoms in some affected members. The decreasing age at onset of disease with succeeding generations could indicate anticipation. None of the hitherto-known DFNA loci, which has phenotypes hearing some resemblance to MD, had haplotypes in common with this large family affected by MD.
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| 20. |
- Giese, Dina, et al.
(författare)
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Carotid Artery Compression Caused by the Cochlea
- 2015
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Ingår i: Otology and Neurotology. - 1531-7129 .- 1537-4505. ; 36:7, s. 1275-1278
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Tidskriftsartikel (refereegranskat)abstract
- Hypothesis We investigated the possible interference between the human internal carotid artery and the cochlea. Background The cochlea and the internal carotid artery (ICA) are anatomically closely related in the human temporal bone. The intimacy may even result in functional interferences. Methods Here, we analyzed 324 human plastic inner ear corrosion casts including the ICA canal and jugular bulb. Results Results showed that in 23% (14 cases), the cochlea caused physical impression in the carotid canal (CA) with luminal restriction. In one case, there was no separation between the CC and the basal turn of the cochlea. The distance between the CC and the cochlea varied between 0 and 1 mm among these 14 specimens. The lumen restriction of the CC in the pyramid-axial projection varied between 39% and 79%. Conclusion We speculate that the reduction in ICA canal lumen size caused by the cochlea may form a predilection site for intratemporal ICA plaque formation and therefore be clinically relevant.
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