Device fixation and small incision access for pediatric cochlear implants.

Objective: Small incision cochlear implant surgery has been advocated to improve cosmesis and reduce post-operative morbidity. However, with standard small incision techniques, it is not possible to securely fix the device in place. This risks displacement of the device, particularly in active children.

Facial nerve palsy: a complication following anaesthesia in a child with Treacher Collins syndrome.

We report a case of facial nerve palsy following anaesthesia in a child with Treacher Collins syndrome. Children in whom intubation is difficult may be at increased risk of this complication.

Button batteries in the ear, nose and upper aerodigestive tract.

Objectives: With the miniaturization of electronic devices, the demand and usage of button batteries has risen. As a result, button batteries are more readily available for young children to handle and potentially mishandle. They are frequently inadvertently placed by children in their ears or noses.

Misfolding diverts CFTR from recycling to degradation: quality control at early endosomes.

To investigate the degradation mechanism of misfolded membrane proteins from the cell surface, we used mutant cystic fibrosis transmembrane conductance regulators (CFTRs) exhibiting conformational defects in post-Golgi compartments. Here, we show that the folding state of CFTR determines the post-endocytic trafficking of the channel. Although native CFTR recycled from early endosomes back to the cell surface, misfolding prevented recycling and facilitated lysosomal targeting by promoting the ubiquitination of the channel.

Activity-dependent developmental plasticity of the auditory brain stem in children who use cochlear implants.

Objectives: 1) To determine if a period of early auditory deprivation influences neural activity patterns as revealed by human auditory brain stem potentials evoked by electrical stimulation from a cochlear implant. 2) To examine the potential for plasticity in the human auditory brain stem. Specifically, we asked if electrically evoked auditory potentials from the auditory nerve and brain stem in children show evidence of development as a result of implant use.

Saline nasal irrigation: Its role as an adjunct treatment.

Objective: To review clinical evidence on the efficacy of saline nasal irrigation for treatment of sinonasal conditions and to explore its potential benefits.

Quality Of Evidence: Clinical trials, reviews, and treatment guidelines discussing nasal irrigation were obtained through a MEDLINE search from January 1980 to December 2001. Most trials were small and some were not controlled; evidence, therefore, is level II, or fair.

Establishment of a bone-anchored auricular prosthesis (BAAP) program.

Objective: Bone-anchored auricular prostheses (BAAPs) are indicated for treatment of congenital or acquired microtia in children. This paper reports on our experience in establishing a BAAP program, including treatment algorithms, protocols and a discussion of the methodology, complications and patient satisfaction.

Methods: Eleven consecutive children using BAAPs were reviewed.

A comparison of the audiometric performance of bone anchored hearing aids and air conduction hearing aids.

Objective: To compare the function of bone anchored hearing aids (BAHA) with conventional air conduction hearing aids (ACHA) by means of objective audiometric tests focusing on temporal acuity and consonant discrimination in quiet and noise, as well as subjective quality-of-life questionnaires.

Setting: Tertiary referral center.

Study Design: Prospective.

Heterotopic gastric mucosa of the oral cavity: a rare entity.

Objective: Heterotopic gastric mucosa found within the oral cavity has been reported as a rare occurrence with less than 30 cases in the English literature. We propose that this entity may not be as rare as originally described.

Method: Five cases of heterotopic gastric mucosa in the oral cavity were collected from three institutions.

Nasal nitric oxide in children: a novel measurement technique and normal values.

Objectives: To develop and standardize a technique for measuring nasal nitric oxide (NO) output in children and to determine normal values in this population.

Study Design: Prospective study evaluating a new technique for measuring nasal nitric oxide in a cohort of normal patients and a cohort of patients with nasal disease.

Methods: Nasal NO was measured using an aspiration technique, aspirating room air through the nasal cavities by means of a Teflon nozzle placed in one nasal vestibule while maintaining velopharyngeal closure using a party "blow-out" toyRESULTS Nasal NO measurements were performed in 45 children (mean age, 11.

The effect of blindness on horizontal plane sound source identification.

The effect of blindness on sound source identification was studied. Four groups of normally-hearing adults, two sighted and two blind, participated. Subjects were tested using arrays of four and eight loudspeakers, surrounding them in the horizontal plane.

Auditory brain stem and midbrain development after cochlear implantation in children.

Input to the central auditory system through a cochlear implant promotes psychophysical improvement of auditory skills. However, the developmental changes along the pathways have never been characterized in children with hearing loss who use implants. We aimed to measure auditory development in such children by using the electrically evoked auditory brain stem response (EABR).

Influence of age at implantation and of residual hearing on speech outcome measures after cochlear implantation: binary partitioning analysis.

The goal of this study was to evaluate speech understanding outcomes in prelingually deaf children who use a cochlear implant device. Specifically, we discuss investigations on 2 prognostic variables--age at implantation and degree of residual hearing--and use a novel method: binary partitioning analysis. Our outcome measures are standard speech perception evaluations, including the Word Intelligibility by Picture Identification (WIPI) test, the Phonetically Balanced-Kindergarten (PBK) test, and the Glendonald Auditory Screening Procedure (GASP).

Congenital conductive hearing loss.

Congenital conductive hearing loss due to ossicular deformities can be treated by either rehabilitation with a hearing aid or surgical reconstruction. We present the results of exploratory tympanotomy performed in a large paediatric otolaryngology centre in 67 patients with non-serous congenital conductive hearing loss. Forty-two children had malformation of one or more ossicles without fixation of the stapes, and 19 had fixed stapes.

Effect of residual hearing prior to cochlear implantation on speech perception in children.

We examined the impact of residual hearing prior to cochlear implantation on pre- and postimplantation speech perception outcomes in children. Stimulation of the auditory system prior to implantation because of the presence of residual hearing is important for development of the central auditory pathways, whereas, in the absence of such stimulation, the pathways show less development. We hypothesized that children who had some degree of residual hearing preimplantation achieve better speech perception skills than their peers with poorer hearing.

The effect of the audallion BEAMformer noise reduction preprocessor on sound localization for cochlear implant users.

Objective: To assess the effect of the Audallion BEAMformer noise reduction preprocessor on the sound localization ability of children fitted unilaterally with the Nucleus 22-channel cochlear implant.

Design: Eight children aged 11 to 14 yr participated. Using three arrays of six loudspeakers, each child was tested in a semi-reverberant sound proof booth representative of a small office environment.

Assessment of vocabulary development in children after cochlear implantation.

Objectives: To assess vocabulary development in children following cochlear implantation and to evaluate the effect of age at implantation on performance.

Design: Retrospective study (mean follow-up, 3(1/2) years).

Setting: Tertiary center.

The effects of age of cochlear implantation on speech perception outcomes in prelingually deaf children.

We have made a retrospective analysis on 70 prelingually deaf children (78% congenital; age range 2-15 years) followed for up to 5 years post-implant during which both closed set speech perception tests (TAC, WIPI) and open set tasks (PBK, GASP) were administered. We used a binary partitioning algorithm to optimally divide our dataset on the basis of age at implantation This technique achieves an optimal split when the heterogeneity of the data is most reduced (maximal drop in deviance). For the closed set speech perception tests (TAC and WIPI) partitioning best divided-out data at age 4.

Vocabulary acquisition rate after pediatric cochlear implantation and the impact of age at implantation.

Objective: studies of early vocabulary development after pediatric cochlear implantation show growth rates that approach normality. Do these growth rates continue to rise over time and, therefore, allow a 'catch up' with ideal scores for age, or do they decline after an initial peak. Could age at implantation be a decisive factor in that process?

Design: retrospective study (mean follow-up 4 years).

Thyroid ala cartilage reconstruction in neonatal subglottic stenosis as a replacement for the anterior cricoid split.

Cricoid split is the procedure of choice in neonatal subglottic stenosis in many paediatric institutions. However, the post-operative care of these patients is a concern given the potentially lethal complications which can occur, in particular, self-extubation. We have been using the thyroid ala cartilage (TAC) reconstruction, a proven technique, as an alternative treatment for this disorder to avoid these complications.

Disordered breathing during sleep in patients with mucopolysaccharidoses.

Objective: Obstructive sleep apnoea (OSA) has been reported as a feature of children with mucopolysaccharidoses (MPS). However, the incidence and severity of OSA with respect to disease type is poorly defined. The aim of the present study was to measure objectively the degree of OSA in a group of children with a range of MPS syndromes.

Utilization of bone-anchored hearing aids in children.

Objective: Bone-anchored hearing aids (BAHAs) are indicated for use in children with bilateral microtia or chronic suppurative otitis media, which precludes the use of conventional hearing aids.

Methods: Nineteen consecutive children using BAHAs were reviewed retrospectively. Outcome measures included the long-term stability of BAHAs, frequency of adverse dermatological reactions at the implant site, and audiologic thresholds.