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Lela Migirov

Publications and source records attributed to Lela Migirov.

29 records · Page 2Linked to original sources
PubMed2004

The suprameatal approach: an alternative surgical approach to cochlear implantation.

The suprameatal approach is an alternative method for performing cochlear implantation developed in the Sheba Medical Center in 1999. This technique eliminates the need for mastoidectomy and posterior tympanotomy. The middle ear is entered through a retroauricular tympanotomy flap, and the electrode is introduced into the cochlea via a tunnel drilled in the suprameatal region superior to Henle's spine. The suprameatal approach is a simple and safe technique that does not endanger the facial nerve nor the chorda tympani. A wide exposure of the promontory enables exact determination of scala tympani and smooth introduction of the electrodes into the cochlea. This technique may also be used in malformed or ossified cochlea. Until now 140 patients were operated in our department and an additional 48 patients were operated on in the department of Otorhinolaryngology at the University of Vienna employing the suprameatal approach technique.

Adult↗
PubMed2004

NRT-based versus behavioral-based MAP: a comparison of parameters and speech perception in young children.

The present study was designed to evaluate the effect of neural response telemetry (NRT)-based cochlear implant (CI) programming versus behavioral-based programming on electrical stimulation parameters (MAP) threshold (T) and comfortable (C) levels and speech perception abilities in young children, during the first year of implant use. Ten congenitally deaf children at the age of 12-39 months (mean age: 25.2 months) implanted with the Nucleus 24R(CS) CI participated in the study. The group was randomly divided into two: (1) NRT-based MAP group (n = 5) consisted of children who were programmed using intra-operative NRT measurements; (2) behavioral-based MAP group (n = 5) consisted of children who were programmed using the behavioral responses of the patients. MAP parameters as well as sound-field aided thresholds and speech perception abilities were compared between the two groups at consecutive programming sessions: 1, 3, 6, and 12 months post initial stimulation. Results indicated no significant differences among NRT-based MAPs and behavioral-based MAPs. Although MAP profiles at initial stimulation differed in the apical region, these differences decreased with time. In addition, a gradual increase of T and C levels of NRT-based MAPs as well as those of behavioral-based MAPs was evident until the 1-month time point, thereafter stabilization occurred. Sound-field aided thresholds improved with time for both groups; however, they were found to be significantly better for the NRT-based MAP group. Despite these differences, speech perception abilities were comparable among groups at 12 months post initial stimulation. NRT-based programming was found to be significantly shorter than behavioral-based programming. In conclusion, for this small group of children, our findings support the use of NRT for programming of young children during the initial period after implantation.

Acoustic Stimulation↗
PubMed2003

Patulous internal auditory canal.

OBJECTIVE: To investigate a rare anomaly of the internal auditory canal known as a patulous canal and its relationship to hearing impairment. METHODS: High-resolution computed tomographic scans of the temporal bones of patients who presented between August 2001 and August 2002 were reviewed. The patients' medical charts were evaluated for age, sex, and hearing impairment, and the computed tomographic scans were examined for the presence of a patulous canal. RESULTS: The study group included 645 patients who underwent high-resolution computed tomography of the temporal bones for various reasons, including sensorineural hearing loss (50% of patients). A patulous canal without any associated anomaly of the labyrinth was the only finding in 2 patients. Both patients had chronic middle ear disease along with conductive hearing loss. CONCLUSION: Patulous canal is a rare anatomical variant of the internal auditory canal (0.3%), and its association with inflammatory ear disease accompanied by conductive hearing impairment appears to have been incidental in both cases in the present study.

Adolescent↗
PubMed2003

Cochlear implantation in a child with osteogenesis imperfecta.

Osteogenesis imperfecta (OI) is a hereditary disease of connective tissue and affects bone, dentine, sclera, joint, tendon, blood vessels, heart valves, and skin. Approximately 50% of the adult patients with OI have associated hearing impairment. To date, only three cases of cochlear implantation in adults with OI have been reported, but none in children. We present a case of cochlear implantation in a congenitally deaf 6-year-old boy with OI. The Nucleus 24 Contour device was successfully implanted using the suprameatal approach (SMA). At 6 months post-initial stimulation there was no evidence of non-acoustic nerve excitation (i.e. facial twitching) or discomfort, and significant progress in auditory abilities was manifested by open set word identification.

Audiometry↗
PubMed2003

The role of mastoidectomy in cochlear implant surgery.

OBJECTIVE: The classical technique for cochlear implantation (CI) involves mastoidectomy and posterior tympanotomy. The question raised in this work is whether mastoidectomy is indispensable in CI surgery. MATERIAL AND METHODS: The advantages and disadvantages of performing mastoidectomy during CI surgery were weighed, in particular the effect of mastoidectomy on chronic secretory otitis media (SOM) and the ability of the electrode to expand in the mastoid during skull growth. RESULTS: No effect of mastoidectomy on chronic SOM was found and the assumption that the electrode in the mastoid cavity has the ability to expand during skull growth was not proven. Eliminating mastoidectomy in CI surgery simplifies the procedure, shortens the duration of surgery, minimizes the amount of drilling and provides broader, better exposure of the middle ear and promontory. Mastoidectomy was found not to be obligatory in CI surgery and in fact may have more disadvantages than advantages. CONCLUSION: The development of alternative CT techniques which eliminate the need for mastoidectomy is justified.

Adolescent↗
PubMed2003

Computed tomographic versus surgical findings in complicated acute otomastoiditis.

Computed tomography (CT) plays an important role in planning surgery in cases of complicated middle ear infection. The purpose of this study was to determine, by comparison of radiologic and surgical findings, the diagnostic value of CT in complicated acute otomastoiditis. The study group consisted of 37 patients without a history of chronic ear disease. In this study, CT enabled correct diagnosis of 26 of 27 cases (96%) of subperiosteal abscess, 17 of 18 cases (94%) of mastoid cortex erosion in patients with subperiosteal abscess, and several intracranial complications, including epidural abscess, subdural empyema, and perisinus abscess. The CT scan produced overdiagnosis in some cases: sigmoid sinus thrombosis in 1 patient, mastoid cortex erosion in 2 children with subperiosteal abscess, and bone erosion toward the posterior cranial fossa in 1 patient with meningitis. My findings suggest that subperiosteal abscess is a disease of young children; however, when it develops in an older child, cholesteatoma should be suspected. Furthermore, acute mastoiditis complicated with facial nerve paralysis may be associated with cholesteatoma in 66% of cases. My experience showed that CT had a sensitivity of 97% and a positive predictive value of 94% in the diagnosis of complicated acute otomastoiditis.

Abscess↗
PubMed2003

Methodology for studying the effects of topically applied ear drops on otoacoustic emissions in guinea pigs.

Testing of otoacoustic emissions (OAE) has been successfully applied to study outer hair cell function. We used this methodology to evaluate and compare the effect of topically applied normal saline, and gentamicin- and ciprofloxacin-containing drops into the middle ear of guinea pigs. All three solutions similarly decreased the distortion product OAE (DPOAE) and all three caused an inflammatory reaction in the guinea pig's middle-ear. OAE failed to detect adequately the ototoxicity of topically administered drops in this animal model because the opening of the bulla affected DPOAE, and both inflamed middle-ear mucosa and osteoneogenesis caused a decrease in DPOAE amplitude. This is the first report examining the influence of topically used otic drops on inner ear function as demonstrated by OAE.

Administration, Topical↗
PubMedDate not supplied

The suprameatal approach in cochlear implant surgery: our experience with 80 patients.

The suprameatal approach (SMA) was first performed in 1999. It was developed for cochlear implantation as an alternative to the classic technique of transmastoid posterior tympanotomy approach. In the course of SMA the middle ear is exposed from the external auditory canal and the electrodes are inserted into the cochlea through a suprameatal tunnel bypassing the mastoid cavity. The goal of developing the SMA was to simplify the surgical technique, shorten the duration of surgery, enable wide exposure of the middle ear during the procedure, and avoid possible damage to the facial nerve and chorda tympani. We report here the results of 80 patients who were operated on using the SMA technique.

Adolescent↗
PubMedDate not supplied

Intracranial complications following mastoidectomy.

Mastoidectomy is a common surgical procedure in otology. However, postoperative complications of various degrees of severity may occur. We present 4 children who underwent mastoidectomy for middle ear and mastoid disease and developed postoperative intracranial complications. One child was operated on for brain abscess 1 week after the initial mastoidectomy. Another child appeared with seizures 5 days after the initial mastoidectomy and a subdural empyema was drained during revision surgery. Large bone defects with exposed middle cranial fossa dura were found at revision surgery in both cases and Proteus vulgaris and methicillin-resistant Staphylococcus aureus were isolated from the mastoid and abscess cavities in these children. A small epidural collection was diagnosed in the third patient 2 days after initial mastoid surgery and was managed with intravenous antibiotics only. The other child was found to have sigmoid sinus thrombosis the day after mastoidectomy that was performed for nonresponsive acute mastoiditis. This child received both intravenous antibiotics and anticoagulants. Timely revision surgery, combinations of third- or fourth-generation cephalosporins with vancomycin or metronidazole and the addition of anticoagulants in cases of sinus thrombosis can lead to full recovery.

Adolescent↗