Development and Validation of the Cochlear Implant Surgical Competency Assessment Instrument.

Objective: We present a new instrument for evaluation of cochlear implant (CI) surgical skills and review its validation process.

Methods: An instrument to assess CI surgical competency incorporated results of structured surveys of comprehensiveness sent to 30 international CI experts and US trainees. One-hundred evaluations of 28 residents, fellows, and practicing CI surgeons were completed.

Acetaminophen and NAPQI are toxic to auditory cells via oxidative and endoplasmic reticulum stress-dependent pathways.

Pain relievers containing N-acetyl-para-aminophenol, also called APAP, acetaminophen or paracetamol, in combination with opioid narcotics are top-selling pharmaceuticals in the U.S. Individuals who abuse these drugs for as little as sixty days can develop tinnitus and progressive bilateral sensorineural hearing loss.

Dietary modification as adjunct treatment in Ménière's disease: patient willingness and ability to comply.

Objective: To evaluate ease of use and compliance with dietary modification in the treatment of vertigo in patients with Ménière's disease.

Study Design: Mailed patient retrospective questionnaire and chart review.

Setting: Tertiary referral neurotologic private practice.

In vitro and in vivo models of drug ototoxicity: studying the mechanisms of a clinical problem.

Introduction: Drug ototoxicity represents one of the main preventable causes of deafness. Ototoxicity is a trait shared by aminoglycoside and macrolide antibiotics, antimalarial medications, loop diuretics, platinum-based chemotherapeutic agents, some NSAIDs and most recently described, acetaminophen when abused with narcotic medication. These medications are prescribed despite their side effects, which includes inner ear toxicity, because they are life-saving drugs or there is a lack of better treatment.

Evaluation of a customized acoustical stimulus system in the treatment of chronic tinnitus.

Objective: The purpose of this study is to evaluate the efficacy of a customized acoustical stimulus (Neuromonics) system in the treatment of chronic tinnitus.

Study Design: Multi-institutional prospective.

Setting: Nine U.

Acetaminophen ototoxicity after acetaminophen/hydrocodone abuse: evidence from two parallel in vitro mouse models.

Objective: Acetaminophen/hydrocodone, a commonly used analgesic preparation, has been linked to rapidly progressing sensorineural hearing loss in human patients. The cellular and molecular mechanisms underlying the ototoxic effects of this drug combination are currently unknown, but are usually associated with high doses of hydrocodone. This study was aimed at identifying the specific agent responsible for hearing loss from toxic killing of cochlear sensory cells.

Single vertical incision for Baha implant surgery: preliminary results.

Objectives: A single vertical skin incision with subcutaneous tissue removal is a cosmetic alternative for Baha implant placement. We aimed to determine the preliminary complication rate using a 4-cm vertical skin incision.

Study Design: Retrospective review.

Recent experience with the neuromonics tinnitus treatment.

This study examines the outcomes of patients undergoing the Neuromonics tinnitus treatment protocol at a single, tertiary referral center over a 2-year period. A retrospective review of patient records was performed with the objective of collecting demographic and au-diological information and identifying changes in score on an established tinnitus questionnaire (Tinnitus Reaction Questionnaire [TRQ]) after treatment. Forty-seven patients initiated reatment with the Neuromonics device during the study period.

Cochlear and brainstem implantation. 2002.

Cochlear and auditory brainstem implants offer safe and effective hearing habilitation and rehabilitation for profoundly deafened adults and children. Brainstem implant technology is currently approved for use in patients with type 2 Neurofibromatosis, who have lost integrity of auditory nerves following vestibular schwannoma removal. An update on implant devices, speech processing strategies, candidacy criteria, and perceptual performance are provided in this article.

Revision cochlear implant surgery in children.

Objective: To determine the incidence of revision cochlear implant (CI) surgery in children and the indications for revision surgery and to examine the pattern of events that lead to revision CI surgery.

Study Design: Retrospective case review.

Setting: Two tertiary pediatric CI centers.

Evaluation of facial function with a questionnaire: reliability and validity.

Objectives: To analyze the validity and reliability of assigning House-Brackmann facial nerve grade based on a patient-administered questionnaire. Specifically, the use of a questionnaire was studied for evaluation of the long-term facial function after microsurgical resection of vestibular schwannoma (VS).

Study Design: Three neurotologists with more than 25 years of experience and 3 neurotology clinical fellows rated facial nerve grade in a blinded fashion based on the questionnaire.

Nucleus Freedom North American clinical trial.

Objective: To evaluate hearing outcomes and effects of stimulation rate on performance with the Nucleus Freedom cochlear implant (Cochlear Americas, Denver, CO).

Study Design And Setting: Randomized, controlled, prospective, single-blind clinical study using single-subject repeated measures (A-B-A-B) design at 14 academic centers in the United States and Canada and comparison with outcomes of a prior device by the same manufacturer.

Patients: Seventy-one severely/profoundly hearing impaired adults.

Clinical performance of children following revision surgery for a cochlear implant.

Objectives: The purpose of this study was to describe the causes for revision surgery and to compare clinical performance before and after surgery in children who required electrode reinsertion.

Study Design And Settings: Soundfield thresholds and speech recognition scores were compared before device failure and following electrode reinsertion. Temporal bones from a deceased adult implant user who underwent bilateral revision implantation were analyzed.

A temporal bone study of insertion trauma and intracochlear position of cochlear implant electrodes. II: Comparison of Spiral Clarion and HiFocus II electrodes.

In recent years, several new designs of cochlear implant electrodes have been introduced clinically with the goal of optimizing perimodiolar placement of stimulation sites. Previous studies suggest that perimodiolar electrodes may increase both the efficiency and performance of a cochlear implant. This is the second of two studies designed to examine the positioning of electrodes and the occurrence of insertion-related injury with these newer designs and to directly compare two perimodiolar electrodes to their predecessors.

A temporal bone study of insertion trauma and intracochlear position of cochlear implant electrodes. I: Comparison of Nucleus banded and Nucleus Contour electrodes.

In recent years, new designs of cochlear implant electrodes have been introduced in an attempt to improve efficiency and performance by locating stimulation sites closer to spiral ganglion neurons and deeper into the scala tympani. The goal of this study was to document insertion depth, intracochlear position and insertion trauma with the Nucleus Contour electrode and to compare results to those observed with the earlier generation Nucleus banded electrode. For this comparison eight Nuclears banded electrodes and 18 Contour electrodes were implanted in cadaver temporal bones using a realistic surgical exposure.

Surgical outcomes in patients with endolymphatic sac tumors.

Objective: To determine the surgical outcomes in patients with endolymphatic sac tumors (ELSTs).

Study Design: Retrospective review of patients at a referral-based otology-neurotology practice.

Methods: A review of the records from the House Ear Clinic revealed 16 patients treated for ELSTs from 1971 to 2002.

Postoperative infection in cochlear implant patients.

Objective: Recently, the association of meningitis with cochlear implants has raised concern over the safety of these devices. We examined the incidence of all postoperative infections in patients undergoing cochlear implant surgery. Study design and settings A retrospective chart review of all patients undergoing cochlear implants at a private tertiary referral center from 1993 to 2002 was performed.

Management of cholesteatoma: status of the canal wall.

Objective/hypothesis: Management of chronic otitis media with cholesteatoma remains controversial. The purpose of the study is to examine factors associated with the surgical approach to manage cholesteatoma.

Study Design: A retrospective review.

Cochlear and brainstem implantation.

Cochlear implantation is an established habilitative and rehabilitative option for profoundly deafened individuals over 1 year of age who derive limited benefit from conventional hearing aids. Auditory performance varies among individuals and is determined primarily by age at implantation, pre-existence of speech and language skills, and the time interval between onset of deafness and implantation. Successful implant users generally demonstrate improved auditory abilities and speech production skills beyond those achieved with hearing aids.