Conclusion. Our study results confirm that it is possible to preserve preoperative hearing levels in the majority of subjects when using the Nucleus 24 Contour Advance provided that there is adherence to the major principles of ‘soft surgery’. Our study group demonstrated that 71–86% of subjects showed preservation of preoperative hearing thresholds at 6 months to varying degree. Objectives. The aim of the study was to assess the degree of residual hearing preserved postoperatively in a group of standard cochlear implant (CI) candidates following implantation via soft surgery with a Nucleus® 24 Contour Advance™ CI. Surgical technique variations from the soft surgery guidelines provided were assessed and their potential impact upon the conservation of residual hearing was examined. Subjects and methods. A prospective multicentre study involving a within-subject repeated measures design with each subject acting as their own control was performed. Pure-tone audiometric thresholds were assessed and compared i...

An evaluation of the preservation of residual hearing with the Nucleus Contour Advance electrode.

Limitierend fur eine optimale funktionelle Intigritat von Kochleaimplantaten sind der richtige Sitz und die Position der Elektrode, welche masgeblich von der Kochleostomie beeinflusst werden. Lokalisation und Form des Bohrkanals werden bislang ausschlieslich vom Operateur bestimmt, wobei haufig intraoperativ nachkorrigiert werden muss. In einer Kadaverstudie haben wir untersucht, inwieweit durch Einsatz der computerassistierten Chirurgie der in der Computertomographie festgelegte Zielpunkt auch reproduzierbar erreicht wird. Fur die Referenzierung haben wir Titanschraubmarker als derzeitigen Goldstandard gewahlt. Am Zielpunkt wurde eine reale Abweichung von 1,6 mm festgestellt. Bei einer Kochleostomie von 0,5 mm Durchmesser wird damit jedoch der Zielpunkt nicht eindeutig reproduzierbar erreicht. Andererseits wird bei dieser Abweichung ein Zielfeld von 2,56 mm2 umschrieben. Ein solches navigiert angesteuertes Zielfeld ist jedoch hinsichtlich Reproduzierbarkeit und Genauigkeit besser als ohne Einsatz der Navigation. Bei Weiterentwicklung der Technik ist eine navigierte Kochleostomie grundsatzlich moglich.

Navigiert-kontrollierte Kochleostomie

Objective In the long term it is desirable for CI users to control their device via brain signals. A possible strategy is the use of auditory evoked potentials (AEPs). Several studies have shown the suitability of auditory paradigms for such an approach. However, these investigations are based on non-invasive recordings. When thinking about everyday life applications, it would be more convenient to use implanted electrodes for signal acquisition. Ideally, the electrodes would be directly integrated into the CI. Further it is to be expected that invasively recorded signals have higher signal quality and are less affected by artifacts. Approach In this project we investigated the feasibility of implanting epidural electrodes temporarily during CI surgery and the possibility to record AEPs in the course of several days after implantation. Intraoperatively, auditory brainstem responses were recorded, whereas various kinds of AEPs were recorded postoperatively. After a few days the epidural electrodes were removed. Main results Data sets of ten subjects were obtained. Invasively recorded potentials were compared subjectively and objectively to clinical standard recordings using surface electrodes. Especially the cortical evoked response audiometry depicted clearer N1 waves for the epidural electrodes which were also visible at lower stimulation intensities compared to scalp electrodes. Furthermore the signal was less disturbed by artifacts. The objective quality measure (based on data sets of six patients) showed a significant better signal quality for the epidural compared to the scalp recordings. Significance Altogether the approach revealed to be feasible and well tolerated by the patients. The epidural recordings showed a clearly better signal quality than the scalp recordings with AEPs being clearer recognizable. The results of the present study suggest that including epidural recording electrodes in future CI systems will improve the everyday life applicability of auditory closed loop systems for CI subjects.

https://iopscience.iop.org/article/10.1088/1741-2552/ab1e80/pdf

Epidural recordings in cochlear implant users.

OBJECTIVE Balloon dilation (BD) is a controversial alternative to conventional sinus surgery. The role of industry on practice patterns remains unknown. The aim of this study was to determine whether industry payments from BD manufacturers influence practice patterns for otolaryngologists and evaluate how these payments change over time. METHODS Retrospective cohort study using Medicare Provider Utilization and Payment (PUP) Data and Center for Medicare and Medicaid Services Open Payments (OP) general payment datasets. A total of 294 otolaryngologists identified in the PUP dataset who performed BD procedures from January 1, 2013, to December 31, 2015, were cross-referenced in the OP dataset from January 1, 2014, to December 31, 2016, for BD manufacturer payments. Payments to surgeons performing BD stratified by amount, type, and number of procedures performed were primary outcome measures. RESULTS Of the 294 otolaryngologists reporting BD procedures, 223 (76%) received payments from a company that manufactures BD devices. Receipt of $2,500 in BD payments was associated with performance of one additional BD procedure, and consulting fees were most positively associated with performing additional BD procedures (P = 0.006). The providers receiving the most in BD payments were more likely to continue to receive the most in payments, regardless of number of BD procedures performed. Performing more BD procedures did not correlate with decrease in other sinus procedures. CONCLUSION Payments to otolaryngologists from manufacturers of sinus BD devices are associated with the performance of an increased number of such procedures. Surgeons should consider the impact of interactions with industry when evaluating patients for BD procedures. LEVEL OF EVIDENCE 4. Laryngoscope, 128:1540-1545, 2018.

The role of industry influence in sinus balloon dilation: Trends over time.

Persistierende Schwindelbeschwerden nach Cochleaimplantation sind bekannte Einflussfaktoren auf die Lebensqualitat. Mit in diesen Patientenkollektiven bisher nur teilweise eingesetzten Fragebogeninstrumenten werden die Effekte einer bilateralen Versorgung mit einem Cochleaimplantat (CI) auf die Lebensqualitat sowie subjektive Schwindelbeschwerden analysiert. Es sollte untersucht werden, ob Fragebogeninstrumente eine erfolgreiche Methode zur Dokumentation von Schwindelbeschwerden und der Lebensqualitat im Rahmen der Qualitatssicherung darstellen. Es wurden 32 bilateral versorgte CI-Patienten bezuglich ihrer Schwindelsymptomatik und Lebensqualitat befragt. Dabei kam der Nijmegen-Cochlear-Implant-Fragebogen (NCIQ) zum Einsatz. Bei berichteten, regelmasigen Schwindelbeschwerden wurden zusatzlich der Schwindel-Handicap-Fragebogen (VHQ) und der Vertigo-Symptom-Scale(VSS)-Fragebogen erhoben. Acht von 32 Patienten zeigten persistierende Schwindelbeschwerden. Die Lebensqualitat, gemessen mit dem NCIQ, verbesserte sich signifikant (p < 0,001) um 23,7 % durch eine Versorgung mit dem zweiten CI. Die Schwindelbeschwerden veranderten sich geringfugig (VHQ –11,2 %; VSS +16,4%) nach der zweiten Implantation. Die Ergebnisse zeigen, dass mit den Fragebogen praktikable Instrumente vorliegen, mit denen sich Lebensqualitat und Schwindelbeschwerden zur Qualitatssicherung dokumentieren lassen und die moglicherweise erganzend oder alternativ zur apparativen Schwindeldiagnostik sinnvoll angewendet werden konnen.

Lebensqualität und Schwindel bei bilateraler Cochleaimplantation

Die CI-Versorgung im Erwachsenenalter stellt nach dem heutigen Stand der Technik ein Routineverfahren fur die betroffenen Patienten dar. Pra- und postoperatives Vorgehen, Operationstechnik und Rehabilitation sind weitgehend standardisiert, sodass bei grundsatzlich geeigneten Patienten die Implantation mit dem ublichen Risiko einer normalen Mittelohroperation durchgefuhrt werden kann. Die modernen Kochleaimplantate (CI) sind technisch sehr zuverlassig, bieten dem Patienten verschiedene Sprachkodierungsstrategien, lassen sich individuell programmieren und konnen wahlweise auch mit einem HdO-Prozessor betrieben werden. Der standig weiterfuhrende technische Fortschritt kann oftmals uber die Weiterentwicklung der Software und den Austausch externer Komponenten fur den Patienten nutzbar gemacht werden. Insgesamt ergeben sich somit nur verhaltnismasig wenige Kontraindikationen, die gegen eine CI-Versorgung im Erwachsenenalter sprechen. Potenziell geeignete Patienten sollten vom betreuenden HNO-Arzt in einem versorgenden Zentrum vorgestellt werden, damit dann je nach Horvermogen und Motivation sowie nach Abschluss der notwendigen Voruntersuchungen die Entscheidung zur Implantation getroffen werden kann.

Kochleaimplantat bei Erwachsenen: Indikation und Durchführung : Teil I: Diagnostik, Operationsverfahren und Ergebnisse.

Twenty years ago, cochlear implants (CI) were indicated only in cases of profound hearing loss or complete deafness. While from today's perspective the technology was clumsy and provided patients with only limited speech comprehension in quiet scenarios, successive advances in CI technology and the consequent substantial hearing improvements over time have since then resulted in continuous relaxation of indication criteria toward residual hearing. While achievements in implant and processor electronics have been one key factor for the ever-improving hearing performance, development of electro-acoustic CI systems-together with atraumatic implantation concepts-has led to enormous improvements in patients with low-frequency residual hearing. Manufactures have designed special processors with integrated hearing aid components for this patient group, which are capable of conveying acoustic and electric stimulation. A further milestone in improvement of hearing in challenging listening environments was the adoption of signal enhancement algorithms and assistive listening devices from the hearing aid industry. This article gives an overview of the current state of the art in the abovementioned areas of CI technology.

[Technical advancements in cochlear implants : State of the art].

From the technical point of view, cochlear implant (CI) surgery in adults is a well established procedure. Pre- and postoperative evaluation, surgical approach and rehabilitation programs acre standardized, presenting CI as a low risk procedure with rare complications similar to those of middle ear surgery. Part 1 described the diagnostics, surgical procedures and possible complications. The second part will cover the contraindications, special cases as well as the technical parameters of the modern implantation system.

[Cochlear implants in adults: indications and realization. Special cases and technical parameters of the implantation systems].

Hintergrund
Der standardisierte Freiburger Sprachtest wird in der klinischen Praxis sowohl uber Kopfhorer als auch uber Lautsprecher dargeboten. Fur eine Vergleichbarkeit beider Darbietungsarten wird die Kopfhorermessung auf ein aquivalentes Freifeldubertragungsmas bezogen. Dieses wird auf Basis eines subjektiven Lautheitsabgleichs ermittelt und durch ein Freifeldentzerrungsnetzwerk sowie eine breitbandige Pegelkorrektur bei der Kopfhorerkalibrierung realisiert. In dieser Studie wurde anhand des Freiburger Sprachtests die Vergleichbarkeit der Freifeldmessung und der HDA200-Kopfhorermessung gepruft.

Überprüfung der Vergleichbarkeit von Freifeld- und HDA200-Kopfhörermessungen für den Freiburger Sprachtest

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Kochleaimplantat bei Erwachsenen: Indikation und Durchführung : Teil I: Diagnostik, Operationsverfahren und Ergebnisse.

[Technical advancements in cochlear implants : State of the art].

[Cochlear implants in adults: indications and realization. Special cases and technical parameters of the implantation systems].

Überprüfung der Vergleichbarkeit von Freifeld- und HDA200-Kopfhörermessungen für den Freiburger Sprachtest