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Retrospective analysis of 1650 permanent pacemaker implantations experience over two different consecutive time periods in a single cardiology clinic  [cached]
Serdar Bayata,Murat Ye?il,Erdin? Ar?kan,Nur?en Postac?
Anadolu Kardiyoloji Dergisi , 2010,
Abstract: Objective: Indications for pacing, pacing modes, and demographics of patients who underwent pacemaker implantation between two different time periods were compared in this study.Methods: Pacemaker registry of our cardiology department was used to evaluate these changes from 1986 to 2007 (First period: 1986-1996, second period: 1997-2007) retrospectively. Results: Registry revealed 776 implantations in the first and 874 implantations in the second period. The percentages of first implantation were 89% and 70.1% respectively. Nearly 50% of the patients in both periods were female. Main indications for pacing were atrioventricular (AV) block, sick sinus syndrome (SSS) and slow ventricular rate during atrial fibrillation in both periods. Implantation of VVI-AAI pacemakers have decreased (77.8%/1.5% to 51%/0.3%, p<0.05) and implantation of DDD-VDD pacemakers have increased (19.3%/1.3% to 42.3%/6.3%, p<0.05) during the second period compared to the first period. Permanent pacemaker implantation for SSS has decreased significantly from 31.1% in the first period to 12.0% (p<0.05) in the second period. Implantation for AV block has increased significantly from 63.3% to 79.7% (p<0.05) in the second period.Conclusion: Our data revealed temporal changes in pacemaker implantation practice during last twenty years in the cardiology department of a teaching hospital. Implantation of VVI-AAI pacemakers have decreased significantly during the second period. Permanent pacemaker implantation for AV block has also decreased during the last period.
Cochlear Implantation after Bacterial Meningitis in Infants Younger Than 9 Months  [PDF]
B. Y. Roukema,M. C. Van Loon,C. Smits,C. F. Smit,S. T. Goverts,P. Merkus,E. F. Hensen
International Journal of Otolaryngology , 2011, DOI: 10.1155/2011/845879
Abstract: Objective. To describe the audiological, anesthesiological, and surgical key points of cochlear implantation after bacterial meningitis in very young infants. Material and Methods. Between 2005 and 2010, 4 patients received 7 cochlear implants before the age of 9 months (range 4–8 months) because of profound hearing loss after pneumococcal meningitis. Results. Full electrode insertions were achieved in all operated ears. The audiological and linguistic outcome varied considerably, with categories of auditory performance (CAP) scores between 3 and 6, and speech intelligibility rating (SIR) scores between 0 and 5. The audiological, anesthesiological, and surgical issues that apply in this patient group are discussed. Conclusion. Cochlear implantation in very young postmeningitic infants is challenging due to their young age, sequelae of meningitis, and the risk of cochlear obliteration. A swift diagnostic workup is essential, specific audiological, anesthesiological, and surgical considerations apply, and the outcome is variable even in successful implantations.
New Criteria of Indication and Selection of Patients to Cochlear Implant  [PDF]
André L. L. Sampaio,Mercêdes F. S. Araújo,Carlos A. C. P. Oliveira
International Journal of Otolaryngology , 2011, DOI: 10.1155/2011/573968
Abstract: Numerous changes continue to occur in cochlear implant candidacy. In general, these have been accompanied by concomitant and satisfactory changes in surgical techniques. Together, this has advanced the utility and safety of cochlear implantation. Most devices are now approved for use in patients with severe to profound unilateral hearing loss rather then the prior requirement of a bilateral profound loss. Furthermore, studies have begun utilizing short electrode arrays for shallow insertion in patients with considerable low-frequency residual hearing. This technique will allow the recipient to continue to use acoustically amplified hearing for the low frequencies simultaneously with a cochlear implant for the high frequencies. The advances in design of, and indications for, cochlear implants have been matched by improvements in surgical techniques and decrease in complications. The resulting improvements in safety and efficacy have further encouraged the use of these devices. This paper will review the new concepts in the candidacy of cochlear implant. Medline data base was used to search articles dealing with the following topics: cochlear implant in younger children, cochlear implant and hearing preservation, cochlear implant for unilateral deafness and tinnitus, genetic hearing loss and cochlear implant, bilateral cochlear implant, neuropathy and cochlear implant and neural plasticity, and the selection of patients for cochlear implant. 1. Introduction The first pediatric cochlear implant program was established at the House Ear Institute in 1980. Incredible as it may seem from the current perspective, the primary issue in that era was whether to consider implanting children at all. In 1980, the first child (a 9-year-old boy) was implanted, and by 1982, 12 children with age ranges from 3.5 to 17 years had been implanted in their program [1, 2] The House/3M device obtained Food and Drug Administration (FDA) approval for implantation in adults in 1984 and in children in 1986. In June 1990, the Nucleus-22 channel implant received FDA approval for implantation in children aged 2 years and older. Shortly thereafter, momentum gained rapidly, and by the mid-1990s, more children were being implanted than adults [2]. In the USA, the Food and Drug Administration, a consumer protection and healthy agency, has historically had great influence on cochlear implant candidacy. Numerous clinical trials have been conducted by the FDA since cochlear implants were first introduced, and numerous supplements have been submitted to the FDA as these devices have undergone
The Modified Transcanal Approach for Cochlear Implantation: Technique and Results  [PDF]
Badr Eldin Mostafa,Walid Farag Ezzat,Abdel Monem El Mogui
Advances in Otolaryngology , 2014, DOI: 10.1155/2014/509703
Abstract: The aim of this work is to present a modified transcanal technique for cochlear implantation. It was a prospective study on 125 cochlear implant patients presenting to two tertiary referral hospitals between January 2010 and January 2013 and followed up for 6–30 months. Their age range was 2–56 (mean 3.4 years) and the male: female ratio was of 2.1?:?1. A modified transcanal technique was adopted through a small postauricular incision. A tympanomeatal flap is elevated, the middle ear is exposed, and the round window membrane is exposed by drilling the overhanging niche. The electrode is channeled in an open trough along the posterosuperior meatal wall, which is reconstructed by autologous cartilage. The round window was used for insertion in 110 patients and a cochleostomy in 15. The main outcome measures were technical steps, operative time, and ease and completeness of electrode insertion. The actual surgical time (excluding device testing) ranged between 25 and 40 minutes (mean 30.1?min). There were 115 complete insertions and 10 partials. There were 6 chorda tympani injuries, 2 electrode exposures with 1 requiring revision, and 2 cases with a tympanic membrane perforation which were grafted uneventfully. One case had severe infection with extrusion of the device 1 year after successful implantation. 1. Introduction Cochlear implants have a well-established field track of hearing rehabilitation. In addition to severe and profound sensorineural hearing loss, the indications for cochlear implants have been extended over the past few years (younger age at implantation, bilateral implantations, single sided deafness, hearing preserving techniques, and electroacoustic devices) [1–4]. The number of cochlear implant candidates has thus grown tremendously [5, 6]. This will naturally lead to the need for more trained surgeons in more centers to be able to cope with this increasing workload. The standard mastoidectomy-posterior tympanotomy has been the gold standard for cochlear implantation for decades. However it does have its disadvantages and complications [7–11]. This stimulated many workers to modify their approach to a more “surgeon-friendly” approach which is adaptable to most of the possible situations with minimal morbidity, comparable efficiency, and shorter operative time [12–21]. We present our modification of the transcanal approach outlining the technique, its advantages, and our results. 2. Patients and Methods This study includes 125 cochlear implant patients who were implanted between January 2010 and January 2013 and followed up from 18 to
Cochlear Implantation after Bacterial Meningitis in Infants Younger Than 9 Months  [PDF]
B. Y. Roukema,M. C. Van Loon,C. Smits,C. F. Smit,S. T. Goverts,P. Merkus,E. F. Hensen
International Journal of Otolaryngology , 2011, DOI: 10.1155/2011/845879
Abstract: Objective. To describe the audiological, anesthesiological, and surgical key points of cochlear implantation after bacterial meningitis in very young infants. Material and Methods. Between 2005 and 2010, 4 patients received 7 cochlear implants before the age of 9 months (range 4–8 months) because of profound hearing loss after pneumococcal meningitis. Results. Full electrode insertions were achieved in all operated ears. The audiological and linguistic outcome varied considerably, with categories of auditory performance (CAP) scores between 3 and 6, and speech intelligibility rating (SIR) scores between 0 and 5. The audiological, anesthesiological, and surgical issues that apply in this patient group are discussed. Conclusion. Cochlear implantation in very young postmeningitic infants is challenging due to their young age, sequelae of meningitis, and the risk of cochlear obliteration. A swift diagnostic workup is essential, specific audiological, anesthesiological, and surgical considerations apply, and the outcome is variable even in successful implantations. 1. Introduction Current standards for cochlear implantation in infants with severe congenital sensorineural hearing loss (SNHL) advocate an age at implantation between 9 and 12 months. On the one hand, a growing body of evidence indicates that hearing rehabilitation is more effective when the patient is implanted at a young age [1–4]. On the other hand, a certain period of time is needed to determine a reliable hearing threshold, to allow for improvement of hearing due to maturation of the auditory system after birth, and to test the performance of the patient with hearing aids [5]. Furthermore, the benefits of cochlear implantation before the age of 9 months should be weighed against the higher risk of anesthesia at this young age [5]. In case of sensorineural hearing loss caused by acute bacterial meningitis, different considerations apply. A swift diagnostic workup is imperative because of the risk of cochlear fibrosis and subsequent obliteration of the cochlear lumen, which may occur within weeks after the onset of meningitis, especially if the meningitis is caused by pneumococci [6, 7]. This diagnostic workup should include a thorough evaluation of the hearing as well as adequate imaging of the cochlea in order to assess the need and feasibility of cochlear implantation. In infants that suffer from postmeningitic SNHL, this may lead to an indication for cochlear implantation at an age younger than 9 months. If so, this patient group presents the cochlear implant (CI) team with a very specific
Cochlear Implant
Mehrnaz Karimi
Audiology , 1992,
Abstract: People with profound hearing loss are not able to use some kinds of conventional amplifiers due to the nature of their loss . In these people, hearing sense is stimulated only when the auditory nerve is activated via electrical stimulation. This stimulation is possible through cochlear implant. In fact, for the deaf people who have good mental health and can not use surgical and medical treatment and also can not benefit from air and bone conduction hearing aids, this device is used if they have normal central auditory system. The basic parts of the device included: Microphone, speech processor, transmitter, stimulator and receiver, and electrode array.
Cochlear Implant
Mehrnaz Karimi
Audiology , 1993,
Abstract: People with profound hearing loss are not able to use some kinds of conventional amplifiers due to the nature of their loss. In these people, hearing sense is stimulated only when the auditory nerve is activated via electrical stimulation. This stimulation is possible through cochlear implant. In fact, for the deaf people who have good mental health and can not use surgical and medical treatment and also can not benefit from air and bone conduction hearing aids, this device is used if they have normal central auditory system. The basic parts of the device included: Microphone, speech processor, transmitter, stimulator and receiver, and electrode array.
Cochlear implantation at the ear, nose and throat clinic of the Clinical center of Vojvodina  [PDF]
Komazec Zoran,Dankuc Dragan,Vla?ki Ljiljana,Lemaji?-Komazec Slobodanka
Medicinski Pregled , 2007, DOI: 10.2298/mpns0712643k
Abstract: Introduction. A cochlear implant is a small electronic device that can provide a sense of sound to a person who is profoundly deaf or severely hard-of-hearing. Cochlear implants bypass the damaged hearing systems and directly stimulate the auditory nerve. Signals generated by the implant are sent by way of the auditory nerve to the brain, which recognizes the signals as sound. Hearing through a cochlear implant differs from normal hearing and takes time to learn or relearn. Cochlear implantations have been performed at the ENT Clinic in Novi Sad since 2002. The aim of this retrospective investigation was to evaluate performance of cochlear implanted patients in regard to the age of hearing loss identification, age at implantation, as well as complications. Material and Methods. During a 5-year period (2002-2007), 45 patients underwent cochlear implantation (46 implants) at the ENT Clinic in Novi Sad. Only four patients were postlingually deaf adults. Forty-one implanted patients were children with a mean age at implantation of 42.2 months (range: 2 to 8 years). Out of these patients, 28 (68.2%) had congenital deafness of unknown cause. The commonest known cause was meningitis, found in 4 (9.7%) patients, followed by use of ototoxic drugs and hereditary deafness. Etiological factors included: postnatal hypoxia, intracranial hemorrhage, pre term birth, cytomegalovirus infection during pregnancy, middle ear cholesteatoma, as well as sudden bilateral deafness. The time span between diagnosis of hearing loss and implantation was 34.6 months in 2002 and only 10 months in 2007. Results. 6 (13%) patients presented with complications. There were 4 major, and two minor complications. The following complications were noted: ossified cochlea which required reoperation, unsuccessful operation in a patient with Down syndrome, facial tics, temporary facial weakness and ataxia. Five out of six complications were successfully resolved. Conclusion. New, more sophisticated audiological evaluation is essential to shorten the time for diagnosing hearing impairment. The results of the investigation performed at the Cochlear Implantation Center of the ENT Clinic in Novi Sad show that cochlear implantation is an effective procedure which should be continued.
Neuron Types Of Cochlear Nucleus  [cached]
Levent Tumkaya,Adnan Korkmaz
Arsiv Kaynak Tarama Dergisi , 2010,
Abstract: The cochlear nuclei, located at the border between the medulla oblongata and pons around the point of entrance of acoustic nerve root, are the first neuronal centres to receive synaptic terminals from the acoustic nerve. The cochlear nucleus is the first relay station of the ascending auditory pathway that receives all efferent output coming from the cochlea. The cochlear nucleus is divided into a ventral part and a dorsal part, consisting of morphologically and physiology distinct types of neurons. Because the cochlear nucleus is related to hearing, it is also associated with language development and learning, therefore many morphological and physiological studies have been done in this nucleus. [Archives Medical Review Journal 2010; 19(2.000): 57-71]
Complications of cochlear implant surgery  [PDF]
Kosanovi? Rade,Ivankovi? Zoran,Stojanovi? Sandra
Srpski Arhiv za Celokupno Lekarstvo , 2004, DOI: 10.2298/sarh0410302k
Abstract: During the last several decades, cochlear implant has been fully recognized in treatment of severe hearing loss. Development of modern technology enabled inconceivable possibilities of technical qualities of the device as well as development of usable coding strategies, which led to extraordinary results in patient rehabilitation. Although cochlear implantation has become one of the routine operative procedures throughout the world nowadays, it gives rise to certain complications. These complications, though rare, can sometimes be very serious, even with fatal outcome. If cochlear implantation is performed by experienced and well-educated team of experts, the possibility of complications is minimal and is certainly not the argument against cochlear implantation as a method of treatment of severe hearing impairments.
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