Publications by authors named "Mantokoudis G"
Objective: We aimed to investigate the effect of adding "rapid decelerations" and "vibrations" during a SemontPLUS maneuver on the dynamics of the inner ear and the success rate of canalolithiasis repositioning.
Methods: We used a previously described upscaled (5×) in vitro model of the posterior semicircular canal of the inner ear to analyze the trajectory of a single and clumped surrogate otolith particle (metallic sphere) during a SemontPLUS maneuver (-60 degrees below earth horizontal) on a repositioning chair (TRV). We compared the angular displacement of these particles with and without the application of "vibrations" or "rapid decelerations" using TRV.
Quantitative in-vitro assessment of a novel robot-assisted system for cochlear implant electrode insertion.
Int J Comput Assist Radiol Surg
October 2024
Article Synopsis
- This study focuses on improving cochlear implant procedures by testing a new robotic tool designed to minimize trauma during the insertion of electrodes, which is crucial for preserving hearing in patients with some remaining inner ear function.
- Using a validated model, the researchers conducted 60 insertions (30 manual and 30 robot-assisted) and found that the robotic method significantly reduced force variation and intracochlear pressure peaks compared to manual techniques.
- The findings suggest that robotic assistance allows for more controlled and consistent insertion speeds, potentially enhancing hearing preservation while indicating that further research is needed to address later stages of the surgery.
Background: Cochlear implants (CI) provide individuals with severe sensorineural hearing loss the opportunity for artificial auditory perception. The standardized documentation of speech intelligibility tests is widespread, while the systematic capture of patient-related outcome measures (PROMs) remains inconsistent.
Methodology: Relevant PROM instruments were evaluated and selected based on the criteria of dissemination, clarity, and relevance, integrated into routine clinical practice, and tested at longitudinal time points.
Article Synopsis
- Physicians can use nystagmus fixation suppression to help diagnose acute vestibular syndrome, but the accuracy of detecting this suppression using simulations by doctors is limited.
- In a study with 20 doctors, their ability to identify changes in nystagmus was tested under different conditions, revealing that both beginners and experienced physicians struggled similarly.
- The results showed that small changes in nystagmus velocity were difficult to detect, especially when the baseline nystagmus was strong, indicating that clinical tests for this condition may benefit from additional technology, like video-oculography.
Objectives: Electrocochleography (ECochG) is increasingly recognized as a biomarker for assessing inner ear function in cochlear implant patients. This study aimed to objectively determine intraoperative cochlear microphonic (CM) amplitude patterns and correlate them with residual hearing in cochlear implant recipients, addressing the limitations in current ECochG analysis that often depends on subjective visual assessment and overlook the intracochlear measurement location.
Design: In this prospective study, we investigated intraoperative pure-tone ECochG following complete electrode insertion in 31 patients.
Objective: Limitations in human kinematics during cochlear implantation induce pressure transients and increased forces on intracochlear structures. Herein, we present a novel head-mounted surgical tool designed for the motorized insertion of cochlear implant electrode arrays. The tool integrates a force measurement feature to overcome the lack of haptic feedback in current robotic solutions.
View Article and Find Full Text PDFBackground: The diagnosis of third window syndromes often poses a challenge in clinical practice.
Objective: This paper provides an up-to-date overview of diagnostic procedures in third window syndromes, with special emphasis on superior canal dehiscence syndrome (SCDS), large vestibular aqueduct syndrome (LVAS), and X-chromosomal malformation of the cochlea.
Materials And Methods: A literature search was performed in PubMed up to December 2023.
Objective: Evaluation at long term of the impact of the stereotactic surgery (SRS) on the vestibular function in vestibular schwannoma (VS) patients.
Study Design And Setting: Retrospective study in a tertiary referral center.
Patients: Fifty-one VS patients were included (34 females;17 males), aged from 41 to 78 years treated exclusively with SRS.
Objectives: The aim of this study is to improve our understanding of the mechanics involved in the insertion of lateral wall cochlear implant electrode arrays.
Design: A series of 30 insertion experiments were conducted by three experienced surgeons. The experiments were carried out in a previously validated artificial temporal bone model according to established soft surgery guidelines.
Article Synopsis
- A study involving 111 neurologists and ENT physicians in Switzerland sought to evaluate how specialists interact with generalists when diagnosing and treating dizzy patients, aiming to improve patient care and education.
- Results showed that specialists felt more confident diagnosing acute dizziness compared to episodic or chronic cases, with specific knowledge about timing and subtle signs aiding in diagnosis.
- Additional findings indicated that neurologists referred more acutely dizzy patients compared to ENT specialists, highlighting a disparity in the diagnostic process and revealing unmet needs in patient management.
Article Synopsis
- The study aimed to evaluate the effectiveness of the video Head Impulse Test (vHIT) in diagnosing vestibular strokes in patients presenting with acute vestibular syndrome in the emergency department.
- Out of 76 patients tested, 24 were confirmed to have vestibular strokes, with the vHIT showing an accuracy of 86.8% based on vestibulo-ocular reflex gain compared to lower accuracy from saccade metrics.
- While the vestibulo-ocular reflex gain proved to be the most accurate, saccade metrics still offered valuable diagnostic insights, though automated detection methods need improvement to match expert analysis.
Article Synopsis
- Vertigo and dizziness are common issues in emergency departments and outpatient centers, prompting consultations with specialists like neurologists and ENT physicians for better patient care.
- An online survey of 111 specialists in Switzerland revealed that both neurologists and ENT doctors often use specific tests for diagnosing common conditions like BPPV, but there are notable differences in their approaches, particularly in the use of brain MRIs and referrals for physical therapy.
- The findings emphasize the need for standardized guidelines for diagnosing and treating dizziness across specialties, alongside the importance of training neurologists in specific repositioning techniques for better patient management.
The acute vestibular syndrome: prevalence of new hearing loss and its diagnostic value.
Eur Arch Otorhinolaryngol
April 2024
Objectives: To assess the prevalence of new hearing losses in patients with acute vestibular syndrome (AVS) and to start to evaluate its diagnostic value for the differentiation between peripheral and central causes.
Design: We performed a cross-sectional prospective study in AVS patients presenting to our Emergency Department (ED) from February 2015 to November 2020. All patients received an MRI, Head-impulse test, Nystagmus test and Test of skew ('HINTS'), caloric testing and a pure-tone audiometry.
Background: Vestibular function (VF) in patients with cochlear implantation (CI) performed during childhood is underinvestigated.
Objective: To study VF in patients receiving CI during childhood.
Material & Methods: Sixty patients (22 females) from 7-34 years old, unilaterally ( = 21) and bilaterally ( = 39) implanted, were included.
Objective: The transmastoid plugging of a superior semicircular canal is considered a safe and effective technique for the management of superior semicircular canal dehiscence (SSCD). The aim of this meta-analysis is to assess the postoperative hearing outcomes after the transmastoid plugging of the superior semicircular canal. Search method and data sources: A systematic database search was performed on the following databases until 30 January 2023: MEDLINE, Embase, Cochrane Library, Web of Science, CINAHL, ICTRP, and clinicaltrials.
View Article and Find Full Text PDFBackground: Vertigo and dizziness are among the most frequent presenting symptoms in the primary care physicians' (PCPs) office. With patients facing difficulties in describing their complaints and clinical findings often being subtle and transient, the diagnostic workup of the dizzy patient remains challenging. We aimed to gain more insights into the current state of practice in order to identify the limitations and needs of the PCPs and define strategies to continuously improve their knowledge in the care of the dizzy patient.
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- - This study compared two methods—auditory brainstem response (ABR) and extracochlear electrocochleography (ECochG)—to evaluate the effectiveness of floating mass transducer (FMT) placement in active middle ear implant (AMEI) surgery for patients with mixed hearing loss.
- - 15 patients underwent AMEI implantation, and results showed that ABR successfully assessed coupling efficiency in all cases, whereas ECochG was effective in only eight, indicating that ABR is more reliable and robust.
- - The research concluded that ABR provides more accurate predictions of coupling efficiency and is preferable for optimizing FMT placement during surgery, offering useful data for future clinical applications.
Article Synopsis
- Vestibular symptoms in emergency department patients can signal serious conditions like stroke, and accurate identification is critical for effective treatment.
- A study from 2015 to 2019 examined 1647 ED patients with these symptoms, leading to a focus on 122 confirmed stroke cases through MRI scans.
- Findings revealed that 13% of dizzy patients had strokes, predominantly in the posterior circulation, with nystagmus present in half of the stroke cases, yet many stroke patients lacked this symptom, making diagnosis challenging.
Article Synopsis
- The study identifies challenges primary care physicians face in diagnosing and treating dizziness due to diverse causes and limited time.
- An online survey of 152 Swiss PCPs revealed higher confidence in managing acute dizziness compared to chronic cases, with younger physicians needing more support.
- Recommendations include improving communication with specialists, reducing referral waiting times, and developing practical educational tools like workshops and digital resources for better management of dizzy patients.
Article Synopsis
- The study evaluates the importance of bedside oculomotor exams in differentiating between peripheral and central causes of acute vestibular syndrome (AVS), focusing on patterns of spontaneous nystagmus (SN).* ! -
- An analysis of 39 studies was conducted, involving 1,599 patients predominantly with ischemic strokes and acute unilateral vestibulopathy, highlighting significant differences in SN patterns between peripheral AVS (pAVS) and central AVS (cAVS).* ! -
- Results show that horizontal SN patterns are common in pAVS, while vertical and torsional patterns indicate cAVS; the specificity for diagnosing a central origin through isolated vertical or torsional SN is high, but sensitivity is low
Background: With the advent of cochlear implants, tactile aids for the profoundly deaf became obsolete decades ago. Nevertheless, they might still be useful in rare cases. We report the case of a 25-year-old woman with Bosley-Salih-Alorainy Syndrome and bilateral cochlear aplasia.
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- The study aims to validate an impedance-based method for estimating cochlear implant electrode positions as a safer and cost-effective alternative to traditional radiography.
- Data from 56 postoperative CT scans and impedance telemetry records were used to assess the effectiveness and accuracy of this new estimation method.
- Findings indicate that the method provides reliable estimates of electrode insertion depths over time, with an average error margin of 0.9 mm and 22° angle, showing stable tissue resistances except for the most basal electrodes.
Objective: Acute dizziness/vertigo is usually due to benign inner-ear causes but is occasionally due to dangerous neurologic ones, particularly stroke. Because symptoms and signs overlap, misdiagnosis is frequent and overuse of neuroimaging is common. We assessed the accuracy of bedside findings to differentiate peripheral vestibular from central neurologic causes.
View Article and Find Full Text PDFObjectives: We aimed to determine the frequency of vestibular syndromes, diagnoses, diagnostic errors and resources used in patients with dizziness in the emergency department (ED).
Design: Retrospective cross-sectional study.
Setting: Tertiary referral hospital.
Electrocochleography (ECochG) measures electrophysiological inner ear potentials in response to acoustic stimulation. These potentials reflect the state of the inner ear and provide important information about its residual function. For cochlear implant (CI) recipients, we can measure ECochG signals directly within the cochlea using the implant electrode.
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