Biomedical subjects

Lela Migirov

Publications and source records attributed to Lela Migirov.

At least 19 recordsLinked to original sources

PubMed2006

Revision surgeries in cochlear implant patients: a review of 45 cases.

The aim of this study was to analyze the causes for revision procedures, surgical findings and audiological outcome in reoperated cochlear implant patients. The medical records of 45 patients were reviewed retrospectively for age at the time of implantation, the implant was used for initial and revision surgeries, the duration of implant use before revision, surgical findings, and postoperative audiological results. Generally, children were reoperated more often than adults (12.5 vs. 6.9%) and, with one exception of improper electrode insertion, there were no major post-revision complications. Device failure (DF) was the main cause for revision surgery (23/45) followed by wound/flap problems, magnet/receiver-stimulator displacement, foreign body/allergic reaction, subperiosteal abscess, misplaced electrode, intractable vertigo, cholesteatoma and extrusion of the positioner. No significant difference was found in the rate of DF between children and adults for each implant separately (P = 0.289 for Nucleus 22, P = 0.355 for Nucleus 24, P = 0.683 for Clarion and P = 1.0 for Med-El). The failure rates of different implants did not differed significantly among adults. DF in the Clarion group was significantly higher compared to the Nucleus and Med-El combined for pediatric patients (P = 0.0218) and all CI recipients (adults + children; P = 0.0055). The post-revision audiological benefit was unchanged or improved compared to the initial implantation values in all reimplanted patients and was not influenced by minor surgical procedures (wound revision, drainage of any collection, magnet replacement, or relocation of receiver-stimulator). Since DF was found to be the most common cause for reoperation, improving device technology could prevent the vast majority of revision procedures.

Adult↗

PubMed2006

Surgical and medical complications following cochlear implantation: comparison of two surgical approaches.

Our study was designed to evaluate the complication rate of cochlear implantation (CI) and to compare two different surgical approaches that are currently being used for implantations in our department. This retrospective study was conducted on the patients who underwent CI in our center between 1989 and 2003 and who were followed-up for at least 18 months. The patients were divided into two groups according to the surgical technique that had been used for the implantation: the mastoidectomy with posterior tympanotomy approach and the suprameatal approach (without mastoidectomy). The incidence of complications following CI was compared between the two groups and between children and adults. Facial nerve paralysis, electrode misplacement, injury to the chorda tympani nerve and mastoiditis occurred only in the mastoidectomy with posterior tympanotomy approach group. Acute middle ear infection with or without mastoiditis emerged as the most common complication in both groups, followed by vestibular and wound problems. Disequilibrium was significantly more common among the adults than among the children (p < 0.0001). The suprameatal approach was demonstrated as being a good alternative technique to the classical surgery for CI.

Adolescent↗

PubMed2006

The influence of mastoidectomy on natural history of secretory otitis media in cochlear implant children.

Secretory otitis media (SOM) is a common childhood disease. The goal of the present study was to determine the influence of mastoidectomy on the incidence of postimplantation SOM in cochlear implant children. We conducted a retrospective study of all the children up to the age of 8 years, who underwent cochlear implantation from 1993 to 2001 in our department. The children were divided into two groups according to the surgical technique used for the implantation: 94 children underwent implantation with the posterior tympanotomy approach (including mastoidectomy) and 48 children were implanted with a suprameatal approach (without mastoidectomy). The incidence of SOM before and after the implantation was compared between the two groups. There were no significant differences between the two study groups in terms of age and the pre- and postimplantation incidence of SOM. Mastoidectomy failed to demonstrate any influence on the natural history of SOM.

Child↗

PubMed2006

A longitudinal study of electrical stimulation levels and electrode impedance in children using the Clarion cochlear implant.

CONCLUSIONS: Electrical stimulation levels and electrode impedance values (EIVs) in children using the Clarion cochlear implant (CI) programmed with CIS strategy stabilized after 3 months of implant use. The data presented here may be useful as a general guideline for the programming of infants and young children and may further be of help for the identification of patients who fall outside the "average" range. OBJECTIVES: The purpose of the present study was to evaluate changes in electrical stimulation levels, i.e. threshold (T) levels, comfortable (M) levels, dynamic range (DR), and EIVs during the first 18 months of implant use, in children using the Clarion CI. MATERIALS AND METHODS: The maps of 18 pre-lingual children (mean age at implantation 4.2 years; range 1-8), using the Enhanced Bipolar 1.2 or Bipolar standard electrode with the S-Series speech processor programmed with CIS strategy, were examined at five time points: connection, and 3, 6, 12, and 18 months post-initial stimulation. T levels, M levels, DR and EIVs were analyzed according to four cochlear segments: apical, apical-medial, medial-basal, and basal. RESULTS: During the first 3 months of implant use T levels increased to some extent, whereas M levels and DR increased significantly. From 3 months and through the entire follow-up, T and M levels as well as DR were stable. EIVs of current carrying electrodes decreased significantly from connection to the 3-month visit; thereafter a stabilization of values was evident. Electrical stimulation levels and EIVs did not differ among the cochlear segments during the entire follow-up.

Adolescent↗

PubMed2006

Olfactory function in oncologic hospice patients.

INTRODUCTION: Normal sense of smell is important for well being. Although cancer is reported to be associated with impaired olfactory function, very few studies have directly evaluated this effect. PATIENTS AND METHODS: We performed a quantitative analysis of olfactory status in 42 hospice patients in a hospital-based hospice facility. Olfaction was assessed using the "Sniffin' Sticks" (Burghart Medical Technology, Tinsdaler, Germany) kit. RESULTS: Twenty-five patients (60%) were found to be hyposmic. CONCLUSION: Study results indicate the high incidence of decreased olfactory function among hospice patients.

Adult↗

PubMed2006

Radiology of the petromastoid canal.

OBJECTIVE: The petromastoid canal is a thin structure that connects the mastoid antrum with the posterior cranial fossa and houses subarcuate blood vessels and prolongation of the dura. The current retrospective study was designed to investigate radiology of the petromastoid canal in different age groups and to determine whether increasing the scanner's resolution could enhance the detection capability of this structure. METHODS: Axial sections of 504 high-resolution computed tomographic images obtained with 0.6-, 1.1-, or 1.3-mm-thick slices through the petrous bones were reviewed. Sixteen asymmetric images were excluded from the statistical analysis. Type I petromastoid canal was invisible; Type II and Type III appeared as thin channels less than 0.5 and 0.5 to 1 mm in width, respectively, and Type IV was greater than 1 mm wide. RESULTS: The petromastoid canal Type II was detected more frequently in patients older than 5 years (p<0.0001) and Type IV was demonstrated more often in children up to age 5 years (p<0.0001). The occurrence of a Type I petromastoid canal was not dependent on the age of the patients or the resolution of the images (p=0.82). Increasing the resolution failed to improve the visibility of the petromastoid canal or the ability to detect it. A wide petromastoid canal (>2 mm) was significantly more common in younger patients (22.2% versus 2.4% in the older group) (p<0.0001). A petromastoid canal beginning medially directly from the internal auditory canal was detected in 4 of 488 (0.8%) images. The lateral opening of the petromastoid canal can be found posteriorly to the medial orifice, anteriorly to it, or at the same level. The posterior lateral opening was demonstrated to be more common than the other two types in patients younger than 5 years, and the anterior opening was detected more frequently in older patients (p=0.0006). CONCLUSION: The shape and width of the petromastoid canal differ radiologically between populations younger and older than 5 years of age. The findings of the current study may be important for otolaryngologists engaged in cochlear implantation or involved in treating otogenic intracranial complications, especially in young children.

Adolescent↗

PubMed2006

[Facial nerve decompression].

Facial nerve palsy is usually managed conservatively, but in some cases may require surgical intervention. In cases in which the continuity of the nerve is not disrupted, decompression is the procedure of choice. No reports were found in the literature addressing this group separately. We report the results of 33 facial nerve decompressions conducted in the Sheba Medical Center through the years 1985-2002. Fifteen of our patients were operated on using the middle cranial fossa approach, 12 underwent mastoidectomy and 6 were treated using the combined middle cranial fossa mastoidectomy approach. Twenty-four (72.7%) underwent surgery for temporal bone fracture and the rest (27.3%) due to other reasons (iatrogenic injury, infection). The postoperative results were determined using the House-Brackmann (HB) scale. Patients who were operated on more than 30 days after complete palsy achieved better results than those operated on earlier than 30 days. The total average HB score was 3.2. The followup results are significantly worse in patients after less than 3 months, as compared to those with 3 to 12 months followup. On the basis of our experience, facial nerve decompression achieves good functional results. We found no advantage in early vs. late intervention with regard to results. The final results can be determined only a year after surgery.

Bell Palsy↗

PubMed2005

Acute otitis media and mastoiditis following cochlear implantation.

OBJECTIVE: To examine the incidence of acute otitis media (AOM) and mastoiditis in children after cochlear implantation (CI) and to evaluate the role of mastoidectomy in decreasing the rate of AOM in implanted children by comparing two surgical techniques: the Posterior tympanotomy approach (MPTA, with mastoidectomy) and the Suprameatal approach (SMA, without mastoidectomy). METHODS: A retrospective study was conducted on 234 children up to 16 years of age who underwent CI between 1993 and 2003 in our department. The children were divided into two groups according to the surgical technique that had been used for the implantation: the MPTA group and the SMA group. RESULTS: Part of the children with a history of pre-implantation AOM (22 of 29 in MPTA group and 26 of 38 in SMA group) did not suffer from AOM post-CI (p=0.59), and an incidence of AOM after CI in children who did not have history of AOM prior to implantation (13 patients of MPTA group and 15 patients of SMA group) was unrelated to surgical approach (p=0.65). The incidence of pre-implantation AOM was similar for the two groups and declined after CI unrelated to performing of mastoidectomy in surgical technique. Overall, 47 children (20.1%) had post-CI AOM compared to 67 children (28.6%) who had pre-CI AOM. Mastoiditis developed in 11 children (4.7%), all 11 in the MPTA group. A subperiosteal abscess was incised and drained with the retroauricular approach in three of these children and the others were managed with intravenously administered ceftriaxone 50mg/kg/day for 3-5 consecutive days, followed by a course of oral cephalexin until there is complete clinical resolution of the effusion in the middle ear. The implants were preserved in all cases. Seven out of 11 children with mastoiditis had no history of AOM prior to implantation. CONCLUSIONS: AOM and mastoiditis represent common complications of CI that can be successfully treated with the prompt use of antibiotics. However, the subperiosteal abscess could require surgical drainage. In our opinion, the decrease of incidence of AOM in implanted children is the result of natural history of otitis media and is unrelated to the surgical approach.

Abscess↗

PubMed2005

Mastoid subperiosteal abscess: a review of 51 cases.

OBJECTIVE: To present a large study on subperiosteal abscess (SA) that represents the most frequent complication of acute mastoiditis. METHOD: A retrospective study was conducted on 49 patients who underwent mastoidectomy for SA. RESULTS: The patients ranged in age from 8 months to 21 years. Two patients were re operated on the same side due to recurrent abscess. Forty-five percent of the patients were treated using antibiotics at home and 58.8% of patients had no history of middle ear infection prior to admission. CT underestimated abscess in two patients who were operated on based on their clinical signs. Perisinus abscess was drained during mastoidectomy in one child. Purulent discharge was obtained from the abscess in 41 cases. The most common isolated pathogens were Streptococcus pyogenes and Staphylococcus aureus. Cholesteatoma was found during mastoidectomy in six patients (11.3%). Twenty-four patients (49%) developed postoperative sequela including various middle ear infections, mastoiditis, recurrent SA and impaired hearing. CONCLUSIONS: Mastoid SA is a unilateral mainly children's disease that can recur. Cholesteatoma can associate the abscess and could be found in older children and recurrent abscess. High morbidity rate requires long-term follow-up for these patients.

Abscess↗

PubMed2005

Cochlear implantation in Waardenburg's syndrome.

CONCLUSIONS: Children with Waardenburg's syndrome (WS) derive significant benefit from cochlear implantation (CI) and do so to an extent that is comparable to that of the general population of implanted children. Although we report on a relatively small cohort, our data are useful for counseling the parents of children with WS considering CI. OBJECTIVE: To present our experience with CI in patients with WS. MATERIAL AND METHODS: A retrospective record review was conducted for five children who underwent CI in our department between 1993 and 2004. RESULTS: Children with WS comprised 1.9% of our entire pediatric CI population: four girls had a familial history of WS and the phenotype of WS Type I, and one boy met the criteria for WS Type II. They were all diagnosed as having bilateral profound sensorineural hearing loss 4-24 weeks after birth. Rehabilitation was initiated immediately and included bilateral fitting of hearing aids and intensive speech and language therapy. Otoscopic and temporal bone high-resolution CT findings were normal in all patients. At surgery, all children were found to have a patent cochlea, and the electrodes were implanted into the scala tympani without difficulty. After 1.3-10.2 years of implant use all children achieved open-set recognition of 2-syllable words, with an average score of 81%. Four of the 5 children achieved open-set recognition of monosyllabic words (average score 40%) and 3 achieved open-set recognition of words in sentences (average score 81%).

Adolescent↗

PubMed2005

Otogenic intracranial complications: a review of 28 cases.

CONCLUSIONS: Antibiotic treatment does not absolutely prevent the development of otogenic intracranial complications (ICC); however, their incidence is relatively low (0.36%). Various pathogens can be isolated in cultures of patients with these complications, but combinations of third- or fourth-generation cephalosporins with chloramphenicol, vancomycin, metronidazole or aminoglycosides can provide good results. Underlying cholesteatoma is common and is usually associated with intracranial abscess or sinus thrombosis. High morbidity rates warrant long-term follow-up. OBJECTIVE: To evaluate the cause and nature of otogenic ICC in patients treated at 1 medical center over an 18-year period. MATERIAL AND METHODS: This was a retrospective chart review of 28 patients admitted to Sheba Medical Center, Israel with otogenic ICC between 1984 and 2002. RESULTS: Meningitis was the commonest complication (46.4%), followed by brain abscess, epidural abscess, sigmoid sinus thrombosis, subdural empyema, perisinus abscess and transverse and cavernous sinus thrombosis. Twelve patients (42.9%) had received antibiotic treatment prior to admission. Chronic otitis media, cholesteatoma and brain abscess were diagnosed mainly in adults, while acute otitis media and epidural abscess were more frequent in children. Twenty-one patients underwent mastoidectomy to eradicate the source of infection. The commonest finding at surgery was granulations (81%). Cholesteatoma was seen in 38.1% of cases. Cholesteatoma and brain abscess were usually associated with Gram-negative bacterial infection. Meningitis, however, was caused by Streptococcus pneumoniae in 40% of cases. CT showed a sensitivity of 92.75% for diagnosing otogenic ICC. There was no mortality. The morbidity rate was high (71.4%) and included hearing impairment, hemiparesis, hydrocephalus, mental retardation, polyneuropathy and epilepsy.

Adolescent↗

PubMed2005

Magnet displacement following cochlear implantation.

OBJECTIVE: To describe a rare complication of cochlear implantation, such as magnet displacement. STUDY DESIGN: Retrospective case review. SETTING: The study was conducted at the Sheba Medical Center, Tel-Aviv, Israel. PATIENTS: One child presented with an external coil attached to the skin anteriorly to the receiver/stimulator site (20 months after implantation) and another child was seen with a displaced magnet under the skin a few days after a head trauma (28 months after implantation). Both children were implanted with the Nucleus 24 device at the age of 2 years. INTERVENTION: Plain skull radiographs showed the dislocated magnet in both cases. Surgery for each child was limited to revision of the receiver/stimulator site and reinsertion of the magnet to its pocket. RESULTS: Intraoperative Neural Response Telemetry well displayed the responses of evoked potentials of the auditory nerve within the cochlea in both children. Postoperative auditory responses were as good as those measured before the complication. CONCLUSION: The displaced magnet can be successfully managed by a simple revision procedure. The possibility of magnet migration should be considered in cases of device malfunction. Two cases of magnet migration from its pocket after cochlear implantation are presented. The diagnostic and surgical method used for resolving this condition are described.

Child, Preschool↗

PubMed2005

Limited use of complementary and alternative medicine in Israeli head and neck cancer patients.

HYPOTHESIS/OBJECTIVE: The use of complementary or alternative medicine (CAM) is growing among cancer patients. A Medline search failed to reveal any dedicated report of CAM use specifically in patients with head and neck cancer (HNC). STUDY DESIGN: Use of CAM was evaluated in a cohort of treated HNC patients. METHODS: Patients treated for HNC were asked if they had used CAM since their diagnosis. Demographic data and data pertaining to mode of CAM, duration of treatment and effects were obtained. RESULTS: One hundred forty-three patients (mean age 61 years) were included. Only nine patients (6.3%) reported using disease related CAM. This included acupuncture (4), Reiki (2), naturopathy (2), hypnosis (1), shiatsu (1), chiropractic treatment (1), homeopathy (1), and selenium (1). CONCLUSION: Contrary to the reported use, few of our HNC patients used CAM. Although this could be related to good caregiver-patient relationship, further studies in comparable populations are warranted to evaluate if this is a local or a pervading finding in head and neck cancer patients.

Adolescent↗

PubMed2005

Radiology of the cochlear aqueduct.

OBJECTIVES: We sought to determine normative data for the radiologic presentation of the cochlear aqueduct (CA), hypothesizing that increasing the scanner's resolution could enhance detection capability. METHODS: Axial sections of 502 high-resolution computed tomography (CT) images of temporal bones (488 patients) were reviewed. A type 1 CA was visualized on CT scans up to the vestibule, and its portion in the otic capsule segment could be seen as a thin (<1 mm) streak. In type 2, we were able to detect the medial two thirds of the structure, but we failed to see the whole otic capsule portion. In type 3, only the external aperture of the aqueduct and/or the medial third was seen. We defined undetectable CAs as type 4. RESULTS: We obtained CT scans with 0.6-, 1.1-, or 1.3-mm-thick slices through the petrous bones in 9.5%, 58.8%, and 31.7% of cases, respectively. The CA was visible and bilaterally symmetric in 49% of the images, and type 2 was the most commonly detected CA type (36%). The CA was invisible on either side in 21.9% of scans, irrespective of CT resolution, and was asymmetric in 53 of the 502 images. The CA types varied with changes in resolution, although type 3 appeared unchanged independent of alterations in resolution in most cases. CONCLUSIONS: There was no significant difference in CT detection capability between CA types at different resolutions. Computed tomography failed to demonstrate any CAs > or =1 mm in width in the otic capsule segment.

Adolescent↗

PubMed2005

Electrical stimulation levels and electrode impedance values in children using the Med-El Combi 40+ cochlear implant: a one year follow-up.

The present study was designed to follow changes in electrical stimulation levels and electrode impedance values (EIV) in children using the Med-El Combi 40+ cochlear implant (CI) during the first 12 months of implant use. The maps of 24 prelingually deaf children implanted at a mean age of 5.9 years (range 1-15.9 years) using the TEMPO+ speech processor programmed with CIS+ strategy were examined at five time points: initial stimulation, and 1, 3, 6, and 12 months post-initial stimulation. Most comfortable levels (M) and electrode impedance values (EIV) were analyzed according to three cochlear segments: apical, medial, and basal. Results indicated a significant increase in M levels until the 3-month time point, thereafter stabilization was evident. Furthermore, M levels in the apical segment were lower than those in the medial and basal segments. EIV decreased from initial stimulation to the 3-month time point and was then stable through the study follow up. Interestingly, the finding of higher EIV in the apical segment may be attributed to the physical characteristics of the Med-El electrode. In conclusion, the pattern of stabilization of M levels found in the present study is similar to that reported for children using other devices. The data presented here may be useful as a guideline for programming M levels and monitoring EIV in infants and young children. They may further help clinicians to identify those children that fall outside the 'typical' range.

Acoustic Impedance Tests↗

PubMed2005

Is mastoidectomy indispensable in cochlear implant surgery?

OBJECTIVE: To challenge the need for mastoidectomy in cochlear implant (CI) surgery by comparing the advantages and disadvantages of the classic technique for CI, the mastoidectomy posterior tympanotomy approach (MPTA), with the suprameatal approach (SMA), a nonmastoidectomy approach. STUDY DESIGN AND SETTING: A retrospective study of 290 patients who underwent cochlear implantation in our department between 1989 and 2002. One hundred fifty-seven of them underwent the MPTA and 133 underwent the SMA. The ability of the electrode to expand in the MPTA patients who were reoperated on was examined, as was the influence of mastoidectomy on the course of chronic secretory otitis media (SOM) in a group of 56 children who suffered from chronic SOM prior to implantation. RESULTS: In all 4 reoperated children, in whom the MPTA was used, the mastoid was completely closed by bony regrowth on the cortical portion of the mastoid and the mastoid cavity was obliterated. The electrode had been embedded in dense fibrous tissue and bony spicule, preventing electrode expansion. Mastoidectomy was found to have no influence on the course of chronic SOM. The rate of postoperative SOM was found to be equal in 40 children who were operated on using the MPTA compared with 16 operated on using the SMA. CONCLUSION: Using a nonmastoidectomy approach, such as the SMA, provides a wide exposure of the middle ear and promontory and thus enables a well-controlled cochleostomy site and safe insertion of the electrode into the cochlea. Mastoidectomy in CI surgery is not indispensable; it may cause more disadvantages than advantages.

Adolescent↗

PubMed2005

Mastoidectomy for acute otomastoiditis: our experience.

We conducted a retrospective study of 53 mastoidectomies in 51 patients with acute otomastoiditis. In 26 cases (49.1%), surgery had been performed within 48 hours of the development of symptoms. The most common complication of acute otomastoiditis was subperiosteal abscess, which occurred in 37 cases (69.8%). Intracranial complications were seen in 6 cases (11.3%). The most common pathogens isolated from subperiosteal abscesses, the mastoid cavity, and intracranial collections were Streptococcus spp and Staphylococcus aureus. In 14 cases (26.4%), conservative treatment failed to cure acute otomastoiditis; such cases should raise a suspicion of a subperiosteal abscess, an underlying cholesteatoma, or an infection caused by gram-negative bacteria. Upon hospital admission, patients should receive antibiotics that are effective against both gram-positive and gram-negative organisms. Patients with intracranial complications or facial nerve paralysis may require a combination of two or more antibiotics. Long-term follow-up is highly recommended.

Acute Disease↗

PubMed2004

Bacteriology of mastoid subperiosteal abscess in children.

OBJECTIVE: Subperiosteal abscess (SA) is the most frequent complication of acute mastoiditis (AM). Of pathogens cultured from the external auditory canal or middle ear during myringotomy, 15% may be different from microorganisms isolated from the SA. We suggest, therefore, that only cultures obtained from the abscess cavity can truly reflect the bacteriology of this complication of AM. The purpose of our study was to analyze the infectious agents which cause SA and mastoid cortex erosion in children. MATERIAL AND METHODS: The medical records of 35 children who underwent mastoidectomy for SA between May 1984 and April 2002 were evaluated. RESULTS: Mastoid cortex erosion was found at surgery in 72.7% of abscesses Purulent discharge was obtained from the SA cavity in 28 cases. The commonest pathogens isolated in these cases, as well as in 18 cases of mastoid cortex erosion, were Staphylococcus aureus and Streptococcus pyogenes, followed by Streptococcus pneumoniae. Hemophilus influenzae, Pseudomonas aeruginosa, Escherichia coli and Klebsiella pneumoniae. Sterile culture was found in 25% of cases. CONCLUSIONS: Mastoid SA is a unilateral disease that can recur. Early administration of anti-Staphylococcus medications should be considered for patients with SA as a complication of AM.

Abscess↗