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PubMed2005

Preservation of residual hearing with cochlear implantation: how and why.

CONCLUSIONS: Hearing may be conserved in adults after implantation with the Nucleus Contour Advance perimodiolar electrode array. The degree of hearing preservation and the maximum insertion depth of the electrode array can vary considerably despite a defined surgical protocol. Residual hearing combined with electrical stimulation in the same ear can provide additional benefits even for conventional candidates for cochlear implantation. OBJECTIVES: We present preliminary results from a prospective multicentre study investigating the conservation of residual hearing after implantation with a standard-length Nucleus Contour Advance perimodiolar electrode array and the benefits of combined electrical and acoustic stimulation. MATERIAL AND METHODS: The subjects were 12 adult candidates for cochlear implantation recruited according to national selection criteria. A "soft" surgery protocol was defined, as follows: 1-1.2-mm cochleostomy hole anterior and inferior to the round window; Nucleus Contour Advance electrode array inserted using the "Advance-off-stylet" technique; and insertion depth controlled by means of three square marker ribs left outside the cochleostomy hole. These procedures had been shown to reduce insertion forces in temporal bone preparations. Variations in surgical techniques were monitored using a questionnaire. Pure-tone thresholds were measured pre- and postoperatively. Patients who still retained thresholds <90 dB HL for frequencies up to 500 Hz were re-fitted with an in-the-ear (ITE) hearing aid. Word recognition was tested in quiet and sentence perception in noise for the cochlear implant alone and in combination with an ipsilateral hearing aid. RESULTS: Hearing threshold level data were available for 12 patients recruited from 6 of the centres. Median increases in hearing threshold levels were 23, 27 and 33 dB for the frequencies 125, 250 and 500 Hz, respectively. These median increases include the data for two patients who had total loss of residual hearing due to difficulties encountered during surgery. "Cochlear view" X-ray images indicated that the depth of insertion varied between 300 and 430 degrees, despite modest variations in the length of the electrode inserted (17-19 mm). The insertion angle had some influence on the preservation of residual hearing at frequencies of 250-500 Hz. Six of the 12 patients retained sufficient hearing for effective use of an ipsilateral ITE hearing aid (< or = 80 dB HL at 125 and 250 Hz; < or = 90 dB HL at 500 Hz). Word recognition scores in quiet were improved from 10% to 30% with the cochlear implant plus ipsilateral hearing aid in 3 patients who had at least 3 months postoperative experience. Signal:noise ratio thresholds for sentence recognition were improved by up to 3 dB. Patients reported that they experienced greatly improved sound quality and preferred to use the two devices together.

Adult↗
PubMed1999

Control of hearing-aid saturated sound pressure level by frequency-shaped output compression limiting.

To fit a hearing aid successfully, it is important to set the Saturated Sound Pressure Level (SSPL) or Maximum Power Output (MPO) appropriately. The SSPL should be low enough to prevent sounds from being amplified to uncomfortable loudness, and yet high enough to maximize speech intelligibility and signal quality. To help attain an optimum SSPL setting, a novel output compression limiting scheme, with shapable MPO (ShaMPO), has been devised. In ShaMPO, the SSPL is shaped across frequencies in accordance with the individual user's loudness discomfort levels (LDLs). The contributions of different frequency regions to loudness are controlled by summing the amplified signal power relative to the LDLs across frequencies, and using this signal to control a wideband compressor. This scheme and a conventional output compression limiting (AGCo) scheme have been implemented in a digital hearing aid. Ten subjects, with moderately-severe to profound sensorineural hearing losses, participated in a study comparing speech intelligibility and listening comfort for the two schemes. Results showed that there were no significant differences in the speech perception scores between AGCo and ShaMPO, even when the speech was presented at 80 dBA, at which level both schemes were in compression much of the time. However, an examination of how subjects selected the SSPL for the two schemes revealed that, in many instances, AGCo would permit some sounds with compact spectra to be amplified above LDL, whereas ShaMPO would not. Thus the ShaMPO scheme can improve listening comfort for some intense sounds without a loss of speech intelligibility. In contrast, half the subjects found speech at 80 dBA to be uncomfortably loud when listening through their own aids.

Aged↗
PubMedDate not supplied

Auditory brainstem implant in posttraumatic cochlear nerve avulsion.

Patients aged over 12 years with neurofibromatosis type 2 are considered candidates for an auditory brainstem implant (ABI). This study extends the indication criteria of ABI to subjects with profound hearing loss due to damaged cochleas and/or cochlear nerves (CNs) following head injuries. In our department, over the period from April 1997 to November 2002, 32 patients, 23 adults and 9 children, were fitted with ABIs. Their ages ranged from 14 months to 70 years. These patients were suffering from a variety of tumor (13 subjects) and nontumor CN or cochlear diseases (19 subjects). Six patients, 5 adults and 1 child, had profound hearing loss following head injury. Their mean age was 25 years (range: 16-48 years). Five were male and 1 female. The retrosigmoid approach was used in all 6 patients. The electrode array was inserted into the lateral recess of the fourth ventricle and correct electrode positioning was monitored with the aid of electrically evoked auditory brainstem responses and neural response telemetry. Correct implantation was achieved in all patients. No complications were observed due to implantation surgery or related to ABI activation and stimulation of the cochlear nuclei. At activation, an average of 9.8 electrodes (range 5-13) were switched on without side effects. One to 6 electrodes were activated in the following sessions after time periods ranging from 2 to 16 months. All patients achieved auditory-alone-mode closed-set word recognition scores ranging from 40 to 100%; 3 had auditory-alone-mode open-set sentence recognition scores of 60-100%; 2 of these even had speech-tracking performance scores of 38 and 43 words, respectively, showing an ability to engage in normal conversation and converse over the phone. The present study demonstrates that the ABI is a useful rehabilitation instrument in subjects with damaged cochleas and/or CN avulsion following head injury who are unamenable or poorly responsive to auditory rehabilitation using cochlear implants.

Adolescent↗
PubMed1999

Use of a loudness model for hearing aid fitting: III. A general method for deriving initial fittings for hearing aids with multi-channel compression.

A model for predicting loudness for people with cochlear hearing loss is applied to the problem of the initial fitting of multi-channel fast-acting compression hearing aids. The fitting is based entirely on the pure tone audiogram, and does not require measures of loudness growth. One constraint is always applied: the specific loudness pattern evoked by speech of a moderate level (65 dB SPL) should be reasonably flat (equal loudness per critical band), and the overall loudness should be similar to that evoked in a normal listener by 65-dB speech. This is achieved using the 'Cambridge' formula. For hearing aids where the compression threshold in each channel can be set to a very low value, an additional constraint is used: speech with an overall level of 45 dB SPL should be audible over its entire dynamic range in all frequency channels from 500 Hz up to about 4 kHz. For hearing aids where the compression thresholds cannot be set to very low values, a different additional constraint is used: the specific loudness pattern evoked by speech of a high level (85 dB SPL, and with the spectral characteristics of shouted speech) should be reasonably flat, and the overall loudness should be similar to that evoked in a normal listener by 85-dB speech. For both cases, compression ratios are limited to values below 3. For each of these two cases, we show how to derive compression ratios and gains, and for the first case, compression thresholds, for each channel. The derivations apply to systems with any number of channels. A computer program implementing the derivations is described. The program also calculates target insertion gains at the centre frequency of each channel for input levels of 50, 65 and 80 dB SPL, and target gains at the eardrum measured relative to the level at the reference microphone of a probe microphone system.

Auditory Threshold↗
PubMed1999

Tolerable hearing aid delays. I. Estimation of limits imposed by the auditory path alone using simulated hearing losses.

OBJECTIVE: When people who wear hearing aids speak, there are three paths by which they hear their own voices: 1) through the air and leakage around the earmold; 2) via the solid structures of their head; 3) through the air to the hearing aid microphone, and then through the aid circuitry. These paths involve different time delays. Digital processing introduces delays in path 3 from a few to several tens of milliseconds, which could lead to a range of disturbing effects. We examined one purely auditory effect, namely hearing speech through all three of these paths. Subjective disturbance was measured as a function of delay in path 3 using simulations of hearing loss and a simulated hearing aid. With increasing hearing loss, the loudness of sound heard via paths 1 and 2 decreases, and the aid user relies more on path 3. The disturbance produced by the delay then might be less perceptible. To test this idea, four different hearing losses were simulated, varying from mild to moderately severe. DESIGN: Each of two talkers was fitted with a closed earmold, and simultaneous above-ear and in-ear recordings were made of each talker reading prose. The above-ear signal was amplified using a simulated hearing aid with 4-channel full dynamic range compression; compression ratios and gains were selected using an algorithm based on the absolute thresholds used in the simulations of hearing loss. The resultant output was then mixed with the in-ear signal with one of five values of delay, and the combined signal was processed using the four simulations of hearing loss. The resulting stimuli simulated for normal-hearing listeners the experience of having a hearing impairment and listening through a hearing aid while talking, except that the talker's voice was not that of the listener. Twenty normally hearing subjects gave subjective ratings of the disturbance of the echo for each delay and each simulated hearing loss. RESULTS: Disturbance ratings generally increased monotonically with increasing delay. Average results show that delays are rated as "disturbing" for values between 20 and 30 msec for mild to moderate losses. For a moderately severe loss, the rating "disturbing" was not quite achieved at 40 msec. For moderate losses, a speaker with low fundamental frequency (f0)(70 to 140 Hz) was less disturbing than a speaker with a medium f0, (100 to 180 Hz). This effect reversed for the mildest loss for low values of delay. CONCLUSIONS: The auditory effects of delays between bone-conducted sound and aid-conducted sound are likely to become disturbing for delays exceeding 20 msec. Somewhat longer delays may be tolerable for moderate to severe hearing losses. These delays are smaller than the delays at which audio-visual integration is disrupted.

Adult↗
PubMed1998

A comparison of threshold-based fitting strategies for nonlinear hearing aids.

OBJECTIVE: In recent years, wide dynamic range compression (WDRC) has been used with increasing success. To optimize the fit with this type of hearing aid circuitry, subjective measures of loudness growth often are used. Unfortunately, these type of measures cannot be performed with infants, young children, and some elderly individuals. The primary purpose of this study was to compare the fitting recommendations of two recently described threshold-based procedures for fitting nonlinear hearing aids (DSL 4.0 and FIG6) to the use gain settings of satisfied adult hearing aid users for whom the fitting was based on subjective measures of loudness growth. Because it cannot be assumed that the use settings for adults will be appropriate for young children, a secondary goal was to quantify the audibility of speech at the use settings derived from loudness growth measures. DESIGN: Forty-nine adult hearing aid users with mild to severe sensorineural hearing loss participated in this study. For all subjects, loudness growth measures were used to optimize the fit of a 2-channel WDRC hearing aid. The use gain at 50 and 80 dB SPL was compared with the gain recommended by DSL, FIG6, and the manufacturer's threshold-based fitting algorithm. RESULTS: In general, both DSL and FIG6 prescribed more gain than actually was used by these hearing aid wearers. These discrepancies increased as a function of frequency, and differences in excess of 20 dB were observed in some cases. The manufacturer's algorithm provided a closer approximation to the use gain than either DSL or FIG6. Utilizing these use gain values, an Aided Audibility Index (AAI) was calculated for soft, average, and loud speech across four degrees of hearing loss, ranging from mild to severe (12 conditions). Transfer functions for continuous discourse and nonsense syllables were applied to yield estimated intelligibility scores. For the higher context speech materials, estimated intelligibility was > or = 85% for nine of the 12 conditions. For low-context speech materials, estimated intelligibility was > or = 85% for only three of the 12 conditions. CONCLUSIONS: Results suggest that the gain recommendations provided by both DSL and FIG6 exceeded the gain actually used by the adult hearing-impaired subjects in this study. Gain recommendations from the manufacturer's algorithm provided a closer approximation to the use gain values of these subjects. These findings suggest that, for adult hearing aid users who cannot perform loudness judgments reliably, the manufacturer's algorithm would be expected to provide a closer approximation to loudness-based use gain values than either DSL or FIG6. However, AAI calculations revealed that the gain recommendations from this algorithm produce adequate audibility of speech only if one assumes linguistic competence. When AAI values are transformed to predict the intelligibility of low-context speech materials, it appears that the degree of audibility may not be appropriate for prelingually hearing-impaired children with more than a moderate hearing loss.

Aged↗
PubMed2001

[Status of hearing aid use by children in schools for the hearing impaired and deaf].

To evaluate and possibly improve the hearing aid fittings of children attending the Westphalian School for the Hearing Impaired or the Westphalian School for the Deaf, regular pedaudiologic consulting hours were established at both schools. During a 2-year period, 115 children were examined once, 35 children twice, and 5 children three times. The examinations comprised ear microscopy, audiometry, and a check of the hearing aids with a 0.6-cm3 coupler (children up to 7 years) or 2-cm3 coupler, respectively. The following criteria were used to assess the quality of the hearing aid setting: status of the external auditory canal and middle ear, acceptance of wearing the hearing aid, status of the ear mold, technical status of the hearing aid, and its setting. The results were related to four variables: gender, type of school, age, and mean hearing loss. Overall, just 40.9% of all children showed satisfactory hearing aid performance at the first examination and just 37.1% at the second. A significant influence of the variables on the hearing aid performance was documented for hearing loss only. The higher the hearing loss, the more likely the children were to have good hearing aid status. Analysis of the different parameters revealed that an incorrect setting was the main problem, with a rate of 20.9%; the rate of the other parameters varied from 6.1% to 15.7%. Thus, no parameter was of major relevance to the results. The results of the second examination were poorer in most parameters than those of the first. These alarming results, which are probably not only of regional significance, demonstrate that the hearing aid status of children attending schools for the hearing impaired or for the deaf is in urgent need of improvement.

Adolescent↗
PubMed2000

Fibular hemimelia: comparison of outcome measurments after amputation and lengthening.

BACKGROUND: Treatment of fibular hemimelia includes either Syme or Boyd amputation with early prosthetic fitting or tibial lengthening. Numerous studies have documented the success of both procedures. The purpose of our study was to compare the outcome after amputation with that after tibial lengthening, specifically with regard to activity restrictions, pain, satisfaction, complications, number of procedures, and cost, in children with fibular hemimelia. METHODS: Thirty limbs in twenty-five patients treated with either an amputation or a lengthening procedure and followed for at least two years were studied. Fifteen patients underwent amputation, and ten patients underwent lengthening of the tibia. The mean age was 1.2 years at the time of amputation and 9.7 years at the time of initial lengthening. The mean duration of follow-up was 6.9 years after the amputations and 7.1 years after the lengthening procedures. RESULTS: The patients who underwent amputation were able to perform more activities than those who had a lengthening (mean activity score, 0 compared with 1.2 points; p<0.05), and they had less pain (mean pain score, 0.2 compared with 1.2 points; p = 0.091), were more satisfied and had a lower complication rate (0.37 compared with 1.91; p<0.05). The patients who underwent amputation also had fewer procedures (1.9 compared with 7.0; p<0.05), at a lower cost ($7016 compared with $26,900; p<0.05), than those who had a lengthening. Lengthening was successful in equalizing limb lengths; the mean limb-length discrepancy, assessed in nine of eleven limbs, was 0.7 centimeter. CONCLUSIONS: This study demonstrated that children who undergo early amputation are more active, have less pain, are more satisfied, have fewer complications, undergo fewer procedures, and incur less cost than those who undergo lengthening. This was true even though good results were obtained with the lengthening procedures and most patients achieved limb-length equality, were able to walk, had minimal pain, and were quite active.

Adolescent↗
PubMed2004

Pseudomonas aeruginosa corneal binding after 24-hour orthokeratology lens wear.

PURPOSE: To examine the effect of short-term 24-hr orthokeratology lens (OKL) wear on Pseudomonas aeruginosa binding, epithelial surface cell morphology, epithelial sheet thickness, and stromal thickness in a rabbit model. METHODS: Seventeen New Zealand white rabbits were treated according to the Association for Research in Vision and Ophthalmology Statement for the Use of Animals in Ophthalmic and Vision Research. Partial membranectomy was performed on all rabbits 1 week before the experiments. Baseline values for epithelial and stromal thickness and epithelial surface cell size were determined by in vivo confocal microscopy in one randomly chosen eye (n = 6). One week later, rabbits were fitted in the same eye with a hyper oxygen-transmissible OKL. Twenty-four hours later, confocal microscopy was repeated. The second group of rabbits (n = 6) was fitted with an OKL in one randomly chosen eye for 24 hr. P. aeruginosa binding to the corneal epithelium was assessed for the control corneas and those exposed to the test lens. Scanning electron microscopy was performed on a third group of rabbits to assess epithelial surface damage (n = 5). RESULTS: There was a statistically significant difference (P<0.001) in P. aeruginosa binding between the control (1.11 +/- 0.74 x 10(5) colony-forming units per cornea) and the OKL-wearing eyes (2.74 +/- 0.69 x 10(5) colony-forming units per cornea). The central epithelium thinned by 6.5% after lens wear (48.2 +/- 1.9 microm to 45 +/- 1.7 microm, P=0.005); however, central stromal thickness increased by 7.3% (322 +/- 22 microm to 345 +/- 29 microm, P=0.006). Compared with the baseline value, central epithelial cell size increased significantly from 1,253 +/- 140 mm(2) to 1,627 +/- 393 mm(2) (29.4%, P=0.02). Scanning electron microscopy showed increased surface epithelial damage associated with OKL wear. CONCLUSIONS: This prospective, masked, pilot study showed that 24-hr hyper oxygen-transmissible OKL wear induced a statistically significant increase in P. aeruginosa binding to the epithelium of the rabbit cornea, accompanied by central epithelial thinning, stromal thickening, and surface cell damage assessed by scanning electron microscopy. Collectively, the data suggest that despite adequate lens oxygen transmissibility, the mechanical pressure inherent in the OKL design exerted on the corneal surface appears to be associated with increased adherence of P. aeruginosa to surface corneal epithelial cells, which may pose an increased risk for lens-related microbial keratitis, especially in overnight (i.e., closed-eye) wearing conditions. Future studies are needed to determine whether these results are similar in human wear and how P. aeruginosa binding during OKL wear compares with other lens-wearing modalities, such as daily or continuous soft lens wear.

Animals↗
PubMed2001

Effects of rigid and soft contact lens daily wear on corneal epithelium, tear lactate dehydrogenase, and bacterial binding to exfoliated epithelial cells.

OBJECTIVE: To determine the effects of lens type and oxygen transmissibility on human corneal epithelium during daily lens wear (DW). DESIGN: Prospective, randomized, double-masked, single-center, parallel treatment groups clinical trial. PARTICIPANTS: Two hundred forty-six patients fitted with: (1) high oxygen-transmissible soft lenses (n = 36), (2) hyper oxygen-transmissible soft lenses (n = 135), and (3) hyper oxygen-transmissible rigid gas-permeable (RGP) lenses (n = 75). INTERVENTION: Irrigation chamber to collect exfoliated epithelial surface cells, confocal microscopy, and tear collection at baseline, 2 weeks, and 4 weeks of DW. MAIN OUTCOME MEASURES: (1) Pseudomonas aeruginosa (PA) binding to exfoliated corneal epithelial surface cells, (2) central epithelial thickness, (3) superficial epithelial cell area, (4) epithelial surface cell exfoliation, and (5) tear lactate dehydrogenase (LDH). RESULTS: Four weeks of DW with the high oxygen-transmissible soft lens significantly increased PA binding from baseline 6.55 +/- 3.01 to 8.75 +/- 3.05 bacteria per epithelial cell (P < 0.01). By contrast, hyper oxygen-transmissible soft lens wear increased binding significantly less (6.13 +/- 2.45 to 7.62 +/- 3.06; P < 0.01), whereas hyper oxygen-transmissible RGP lens wear demonstrated no significant changes (5.91 +/- 2.40 to 6.13 +/- 2.17; P = 0.533). No significant change in central epithelial thickness was found after 4 weeks of DW in either soft lens; however, the epithelial thickness decreased by 9.8% (P < 0.001) with RGP lens wear. Epithelial cell surface area increased 3.3% and 4.1% with the high and hyper oxygen-transmissible soft lenses, respectively, and 10.5% with the hyper oxygen-transmissible RGP lens (P < 0.001). Epithelial desquamation significantly decreased in all groups (P < 0.001). Tear LDH levels increased for all test lenses (P < 0.001). CONCLUSIONS: Increased PA binding induced by wear of a conventional soft lens material is significantly greater than that induced by the new hyper oxygen-transmissible soft silicone hydrogel lens during DW. However, both soft materials showed significant increases in PA binding as compared with baseline controls. By contrast, hyper oxygen-transmissible RGP lens DW did not increase PA binding significantly. Taken together, these findings suggest for the first time both an oxygen effect as well as a difference between soft and rigid lens types on PA binding in DW.

Adult↗
PubMed2000

Comparison of the NAL(R) and Cambridge formulae for the fitting of linear hearing aids.

This paper describes a laboratory-based comparison of the effectiveness of two formulae for fitting linear hearing aids, the NAL(R) formula and the Cambridge formula. The formulae prescribe the desired insertion gain as a function of frequency, based on the audiometric threshold. The two formulae have a similar rationale; both are based on the goal that, for speech with a moderate level, all frequency bands should be equally loud (equal loudness per critical band) over the frequency range important for speech (400-5000 Hz), and the overall loudness should be comfortable. However, the formulae differ; generally the Cambridge formula leads to slightly more high-frequency gain (above 2 kHz) and slightly less mid-frequency gain (between 500 Hz and 2000 Hz) than the NAL(R) formula. The two formulae were implemented using an experimental digital hearing aid whose frequency-gain characteristic could be controlled very precisely. A loudness model (Moore and Glasberg, 1997) was used to adjust the overall gains for each subject and each formula so that a speech-shaped noise with an overall level of 65 dB SPL would give the same loudness as for a normally hearing person (according to the model). The adjustments were, on average, smaller for the Cambridge than for the NAL(R) formula. A condition was also used with all insertion gains set to zero, simulating unaided listening. Evaluation was based on: (1) subjective ratings of the loudness, intelligibility and quality of continuous discourse presented in quiet at levels of 45, 55, 65 and 75 dB SPL and in babble at an 0-dB speech-to-babble ratio, using speech levels of 55, 65 and 75 dB SPL; (2) measures of the speech reception threshold (SRT) in background noise for two noise levels (65 and 75 dB SPL) and four types of background noise. Neither the subjective ratings nor the measures of the SRTs revealed any consistent difference between the results obtained using the two formulae, although both formulae led to lower (better) SRTs than for simulated unaided listening. It is concluded that the differences between the NAL(R) formula and the Cambridge formula are too small to have measurable effects, at least in a laboratory setting.

Aged↗
PubMed1994

The relationship between the design, position, and articular wear of acetabular components inserted without cement and the development of pelvic osteolysis.

Between 1983 and 1987, an acetabular component with a unique chamfered-cylinder design was inserted without cement in 134 hips. With use of this design, initial stability is achieved through a cylindrical interference fit with the peripheral rim of the acetabulum, without the need for pegs, spikes, or screws. At an average of sixty-four months (range, forty to ninety-six months) after implantation, follow-up data were available for 113 hips (ninety-three patients). No component had been revised for loosening or was radiographically loose. However, the prevalence of balloon-like osteolysis of the pelvis was 17 per cent (nineteen hips). This bone loss was generally not associated with pain or other symptoms. Ten of the nineteen hips that were associated with pelvic osteolysis (including six of the nine that were associated with osteolysis of the ilium) had been reconstructed with use of an acetabular component that had no holes in the shell (that is, the shell was completely solid). This finding indicates that, while elimination of holes through the acetabular shell may have advantages, it will not prevent pelvic osteolysis. The osteolysis of the ilium was associated with a lateral opening of the acetabular component of more than 50 degrees (p < 0.0001). All of the hips in this series had insertion of a porous-ingrowth femoral resurfacing component made of titanium alloy. These components are no longer used. Revision of the femoral side due to osteolysis provided a unique opportunity to inspect directly forty-two clinically well functioning acetabular components. All of the polyethylene liners and acetabular shells were found to be rigidly fixed. Inflammatory tissue at the periphery of the implant-bone interface resulted in circumferential resorption of periacetabular bone despite rigid fixation of the component. This is direct evidence that a process of bone resorption similar to that reported at the cement-bone interface of cemented acetabular components can occur at the implant-bone interface of components inserted without cement. At the reoperation, a communication that had led to the pelvic osteolysis was found through areas of bone resorption at the periphery of the implant-bone interface. These areas were essentially cystic and were filled with a mixture of fluid and friable, yellow-tan tissue. It appeared that the osteolytic process had expanded into the soft cancellous bone and marrow while being contained by the denser cortical shell of the pelvic bones.(ABSTRACT TRUNCATED AT 250 WORDS)

Acetabulum↗
PubMed2003

Prosthetic rehabilitation of an amputated thumb.

Prosthetic rehabilitation of any defect or abnormality of any part of the body must be as indiscernible as possible from the surrounding natural tissues in terms of cosmesis as well as function. Surgical procedures are more likely to meet the requirements of absolute function but the patients' involvement and willingness to undergo extensive and costly procedures like micro-surgical grafting and implants may preclude these procedures. This paper presents an alternative method of prosthetic rehabilitation of an amputated thumb with a heat cured silicone material.

Adolescent↗
PubMed2006

Revision cochlear implantation for facial nerve stimulation in otosclerosis.

OBJECTIVE: To find if patients experiencing postsurgical facial nerve stimulation caused by underlying disease process (ie, otosclerosis) can improve their hearing performance with their cochlear implant by reimplantation and by an optimal programming strategy. DESIGN: Retrospective analysis. SETTING: Academic tertiary referral center. PATIENTS: Two cochlear otosclerosis patients with resistant facial nerve stimulation (FNS). Both patients were initially implanted with Nucleus 22 devices (Cochlear Corporation, Englewood, Colo) and they developed FNS after a period of use. Owing to the decreasing number of active electrodes, concurrent decreases in speech understanding occurred. INTERVENTIONS: Various programming approaches were used to address the FNS. Both subjects ultimately received Nucleus 24 devices. One was reimplanted in the same ear, and the other was implanted in the opposite ear. Both have been followed up for 8 months following the reimplantation. MAIN OUTCOME MEASURES: Cochlear implant programming levels, cochlear implant performance, and facial nerve stimulation. RESULTS: The FNS was managed for more than 3 years through optimized programming. However, the FNS progressed until performance dropped below acceptable levels. Reimplantation was believed to be the only option for improvement. After reimplantation and programming, both subjects showed immediate improvement in speech discrimination. One user increased his consonant-nucleus-consonant word score from 12% preoperatively to 42%, and the other's performance increased from 0% to 86%. CONCLUSIONS: Our results suggest that having more programming options with newer devices is critical in otosclerotic or ossified users who experience FNS. Also, reimplantation may be a useful tool to improve performance.

Cochlear Implantation↗
PubMedDate not supplied

Rotationplasty.

Partial limb salvage by a rotationplasty procedure is possible in patients suffering from malignant tumors of the lower extremity. Upon diagnosis of a malignant tumor of the distal femur or proximal tibia, resection of the tumor is performed with wide margins, including the knee joint. The sciatic nerve is preserved, and the lower part of the leg is retransplanted to the thigh, observing a rotation of 180 degrees. This procedure results in a shortened leg with the ankle joint at the position of the former knee joint. The resulting stump is able to bear a prosthesis. The ankle rotated at 180 degrees serves as a substitute knee joint capable of moving a shank prosthesis, an ability which would have been lost with high amputation of the leg. The foot is able to carry load via the sole skin. There is no phantom pain. Experience with 40 cases is reported.

Adolescent↗
PubMed1994

Laparoscopic prosthesis fixation rectopexy for complete rectal prolapse.

Five women aged 64-81 years with complete rectal prolapse and incontinence were treated by laparoscopic mobilization of the rectum and posterior fixation to the presacral fascia using Marlex mesh. Mobilization was carried out with standard straight laparoscopic instruments in the first two patients (operating times 3.5 and 4.5 h) and with coaxial curved instruments and ultrasonic dissection in the succeeding three (operating times 2.5, 2.0 and 2.5 h). Restoration to full continence (grade 1) was observed in two patients and to grade 2 in a further two. No recurrence of the prolapse occurred during follow-up of 4-27 months.

Aged↗