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Hearing Disorders: HELP
Articles by David S. Haynes
Based on 26 articles published since 2009
(Why 26 articles?)
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Between 2009 and 2019, David Haynes wrote the following 26 articles about Hearing Disorders.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Guideline Clinical practice guideline: Tympanostomy tubes in children. 2013

Rosenfeld, Richard M / Schwartz, Seth R / Pynnonen, Melissa A / Tunkel, David E / Hussey, Heather M / Fichera, Jeffrey S / Grimes, Alison M / Hackell, Jesse M / Harrison, Melody F / Haskell, Helen / Haynes, David S / Kim, Tae W / Lafreniere, Denis C / LeBlanc, Katie / Mackey, Wendy L / Netterville, James L / Pipan, Mary E / Raol, Nikhila P / Schellhase, Kenneth G. ·Department of Otolaryngology, State University of New York Downstate Medical Center, Brooklyn, New York 11201, USA. richrosenfeld@msn.com ·Otolaryngol Head Neck Surg · Pubmed #23818543.

ABSTRACT: OBJECTIVE: Insertion of tympanostomy tubes is the most common ambulatory surgery performed on children in the United States. Tympanostomy tubes are most often inserted because of persistent middle ear fluid, frequent ear infections, or ear infections that persist after antibiotic therapy. Despite the frequency of tympanostomy tube insertion, there are currently no clinical practice guidelines in the United States that address specific indications for surgery. This guideline is intended for any clinician involved in managing children, aged 6 months to 12 years, with tympanostomy tubes or being considered for tympanostomy tubes in any care setting, as an intervention for otitis media of any type. PURPOSE: The primary purpose of this clinical practice guideline is to provide clinicians with evidence-based recommendations on patient selection and surgical indications for and management of tympanostomy tubes in children. The development group broadly discussed indications for tube placement, perioperative management, care of children with indwelling tubes, and outcomes of tympanostomy tube surgery. Given the lack of current published guidance on surgical indications, the group focused on situations in which tube insertion would be optional, recommended, or not recommended. Additional emphasis was placed on opportunities for quality improvement, particularly regarding shared decision making and care of children with existing tubes. ACTION STATEMENTS: The development group made a strong recommendation that clinicians should prescribe topical antibiotic eardrops only, without oral antibiotics, for children with uncomplicated acute tympanostomy tube otorrhea. The panel made recommendations that (1) clinicians should not perform tympanostomy tube insertion in children with a single episode of otitis media with effusion (OME) of less than 3 months' duration; (2) clinicians should obtain an age-appropriate hearing test if OME persists for 3 months or longer (chronic OME) or prior to surgery when a child becomes a candidate for tympanostomy tube insertion; (3) clinicians should offer bilateral tympanostomy tube insertion to children with bilateral OME for 3 months or longer (chronic OME) and documented hearing difficulties; (4) clinicians should reevaluate, at 3- to 6-month intervals, children with chronic OME who did not receive tympanostomy tubes until the effusion is no longer present, significant hearing loss is detected, or structural abnormalities of the tympanic membrane or middle ear are suspected; (5) clinicians should not perform tympanostomy tube insertion in children with recurrent acute otitis media (AOM) who do not have middle ear effusion in either ear at the time of assessment for tube candidacy; (6) clinicians should offer bilateral tympanostomy tube insertion to children with recurrent AOM who have unilateral or bilateral middle ear effusion at the time of assessment for tube candidacy; (7) clinicians should determine if a child with recurrent AOM or with OME of any duration is at increased risk for speech, language, or learning problems from otitis media because of baseline sensory, physical, cognitive, or behavioral factors; (8) in the perioperative period, clinicians should educate caregivers of children with tympanostomy tubes regarding the expected duration of tube function, recommended follow-up schedule, and detection of complications; (9) clinicians should not encourage routine, prophylactic water precautions (use of earplugs, headbands; avoidance of swimming or water sports) for children with tympanostomy tubes. The development group provided the following options: (1) clinicians may perform tympanostomy tube insertion in children with unilateral or bilateral OME for 3 months or longer (chronic OME) and symptoms that are likely attributable to OME including, but not limited to, vestibular problems, poor school performance, behavioral problems, ear discomfort, or reduced quality of life and (2) clinicians may perform tympanostomy tube insertion in at-risk children with unilateral or bilateral OME that is unlikely to resolve quickly as reflected by a type B (flat) tympanogram or persistence of effusion for 3 months or longer (chronic OME).

2 Editorial Cochlear implants: an evolving technology. 2012

Roland, J Thomas / Haynes, David S. · ·Otolaryngol Clin North Am · Pubmed #22115693.

ABSTRACT: -- No abstract --

3 Review Current concepts in the management of idiopathic sudden sensorineural hearing loss. 2016

O'Connell, Brendan P / Hunter, Jacob B / Haynes, David S. ·Department of Otolaryngology, Head and Neck Surgery, The Otology Group, The Bill Wilkerson Center for Otolaryngology and Communication Sciences, Vanderbilt University, Nashville, Tennessee, USA. ·Curr Opin Otolaryngol Head Neck Surg · Pubmed #27348351.

ABSTRACT: PURPOSE OF REVIEW: The purpose of this manuscript is to review the initial management strategies for idiopathic sudden sensorineural hearing loss, with an emphasis on the role that steroids play in treatment of this condition, and discuss options for auditory rehabilitation of persistent unilateral hearing loss. RECENT FINDINGS: Recent data suggest that hearing improvement may be greater for patients initially treated with both systemic and intratympanic steroid when compared with those treated with systemic steroids alone. Salvage intratympanic steroids have been shown to confer hearing benefit if initial management fails. The ideal dosing regimen for intratympanic steroids has not been established, but evidence supports that higher dosing strategies are advantageous. Cochlear implantation has emerged as a strategy for auditory rehabilitation of persistent unilateral hearing loss. Recent studies have demonstrated high patient satisfaction, subjective improvement in tinnitus, and objective performance benefit after cochlear implantation for single-sided deafness. SUMMARY: Patients can be offered steroid therapy in the initial management of idiopathic sudden sensorineural hearing loss, but should be counseled that the efficacy of steroids remains unclear. If patients fail to improve with initial management, salvage intratympanic steroid administration should be considered. If hearing loss persists long term, options for auditory rehabilitation should be discussed.

4 Review Middle ear implants for rehabilitation of sensorineural hearing loss: a systematic review of FDA approved devices. 2014

Kahue, Charissa N / Carlson, Matthew L / Daugherty, Julie A / Haynes, David S / Glasscock, Michael E. ·Department of Otolaryngology-Head and Neck Surgery, The Bill Wilkerson Center for Otolaryngology and Communication Sciences, Vanderbilt University, Nashville, Tennessee, U.S.A. ·Otol Neurotol · Pubmed #24643033.

ABSTRACT: OBJECTIVE: To systematically review the safety and efficacy of the 3 Food and Drug Administration-approved middle ear implant (MEI) systems currently in use for the rehabilitation of sensorineural hearing loss. DATA SOURCES: MEDLINE and Cochrane Library databases were systematically searched by 2 independent reviewers. STUDY SELECTION: An initial search yielded 3,020 articles that were screened based on title and abstract. A full manuscript review of the remaining 80 articles was performed, of which 17 unique studies satisfied inclusion criteria and were evaluated. DATA EXTRACTION: Variables including functional gain, speech recognition score improvement, audiometric threshold shift following surgery, adverse events, and patient reported outcome measures were recorded. Study quality was appraised according to author conflict of interest, prospective or retrospective study design, inclusion criteria, number of patients, proper use of study controls, outcome measures reported, length of follow-up, and level of evidence. DATA SYNTHESIS: Heterogeneous outcome reporting precluded meta-analysis; instead a structured review was performed using best available data. CONCLUSION: The majority of studies evaluating the safety and efficacy of MEIs are retrospective in nature with limited follow-up. To date, no prospective randomized controlled trial exists comparing contemporary air conduction hearing aid performance and MEI outcomes. Based on available data for patients with sensorineural hearing loss, functional gain and word recognition improvement seems similar between conventional hearing aids and MEIs, whereas patient-perceived outcome measures suggest that MEIs provide enhanced sound quality and eliminate occlusion effect.

5 Review Bilateral cochlear implantation. 2012

Wanna, George B / Gifford, René H / McRackan, Theodore R / Rivas, Alejandro / Haynes, David S. ·Department of Otolaryngology-Head and Neck Surgery, Division of Otology-Neurotology and Skull Base Surgery, Vanderbilt University Medical Center, 1215 21st Avenue South, 7209 Medical Center East, South Tower, Nashville, TN 37232, USA. george.wanna@vanderbilt.edu ·Otolaryngol Clin North Am · Pubmed #22115683.

ABSTRACT: Cochlear implantation (CI) is the standard of care for the treatment of children and adults with bilateral severe-to-profound sensorineural hearing loss. Because the ultimate and continuous goal of CI teams is to improve patient performance, a potential method is bilateral CI. The potential benefits of bilateral CI include binaural summation, squelch, equivalent head shadow for each ear, improved hearing in noise, sound localization ability, and spatial release from masking. The potential disadvantages include additional or prolonged surgical procedure, unproven cost/benefit profile, and the elimination of the ability to use future technologies and/or medical therapies in the implanted ear.

6 Review Pediatric cochlear implantation: candidacy evaluation, medical and surgical considerations, and expanding criteria. 2012

Heman-Ackah, Selena E / Roland, J Thomas / Haynes, David S / Waltzman, Susan B. ·Department of Otolaryngology, New York University Cochlear Implant Center, New York University School of Medicine, 660 First Avenue, 7th Floor, New York, NY 10016, USA. ·Otolaryngol Clin North Am · Pubmed #22115681.

ABSTRACT: Since the first cochlear implant approved by the US Food and Drug Administration in the early 1980s, great advances have occurred in cochlear implant technology. With these advances, patient selection, preoperative evaluation, and rehabilitation consideration continue to evolve. This article describes the current practice in pediatric candidacy evaluation, reviews the medical and surgical considerations in pediatric cochlear implantation, and explores the expanding criteria for cochlear implantation within the pediatric population.

7 Review Middle ear implantable hearing devices: an overview. 2009

Haynes, David S / Young, Jadrien A / Wanna, George B / Glasscock, Michael E. ·From the Otology Group at Vanderbilt, Nashville, Tennessee. david.haynes@vanderbilt.edu ·Trends Amplif · Pubmed #19762429.

ABSTRACT: Hearing loss affects approximately 30 million people in the United States. It has been estimated that only approximately 20% of people with hearing loss significant enough to warrant amplification actually seek assistance for amplification. A significant interest in middle ear implants has emerged over the years to facilitate patients who are noncompliant with conventional hearing aides, do not receive significant benefit from conventional aides, or are not candidates for cochlear implants. From the initial studies in the 1930s, the technology has greatly evolved over the years with a wide array of devices and mechanisms employed in the development of implantable middle ear hearing devices. Currently, these devices are generally available in two broad categories: partially or totally implantable using either piezoelectric or electromagnetic systems. The authors present an up-to-date overview of the major implantable middle ear devices. Although the current devices are largely in their infancy, indications for middle ear implants are ever evolving as promising studies show good results. The totally implantable devices provide the user freedom from the social and practical difficulties of using conventional amplification.

8 Clinical Trial Evaluation of a revised indication for determining adult cochlear implant candidacy. 2017

Sladen, Douglas P / Gifford, René H / Haynes, David / Kelsall, David / Benson, Aaron / Lewis, Kristen / Zwolan, Teresa / Fu, Qian-Jie / Gantz, Bruce / Gilden, Jan / Westerberg, Brian / Gustin, Cindy / O'Neil, Lori / Driscoll, Colin L. ·Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota, U.S.A. · Department of Hearing and Speech Sciences, Vanderbilt University, Nashville, Tennessee, U.S.A. · Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee. · Rocky Mountain Ear Center, Englewood, Colorado, U.S.A. · Department of Otolaryngology, The Ohio State University Wexner Medical Center, Ohio, U.S.A. · Midwest Ear Institute, Kansas City, Missouri, U.S.A. · University of Michigan Cochlear Implant Program, Ann Arbor, Michigan, U.S.A. · Department of Head and Neck Surgery, University of California, Los Angeles, California, U.S.A. · Department of Otolaryngology, University of Iowa, Iowa City, Iowa, U.S.A. · Houston Ear Research Foundation, Houston, Texas. · Department of Otolaryngology - Head and Neck Surgery, Vancouver Children's Hospital, Vancouver, British Columbia, Canada. · Department of Otolaryngology, Vancouver Children's Hospital, Vancouver, British Columbia, Canada. · Cochlear Americas, Centennial, Colorado, U.S.A. ·Laryngoscope · Pubmed #28233910.

ABSTRACT: OBJECTIVE: To evaluate the use of monosyllabic word recognition versus sentence recognition to determine candidacy and long-term benefit for cochlear implantation. STUDY DESIGN: Prospective multi-center single-subject design. METHODS: A total of 21 adults aged 18 years and older with bilateral moderate to profound sensorineural hearing loss and low monosyllabic word scores received unilateral cochlear implantation. The consonant-nucleus-consonant (CNC) word test was the central measure of pre- and postoperative performance. Additional speech understanding tests included the Hearing in Noise Test sentences in quiet and AzBio sentences in +5 dB signal-to-noise ratio (SNR). Quality of life (QoL) was measured using the Abbreviated Profile of Hearing Aid Benefit and Health Utilities Index. RESULTS: Performance on sentence recognition reached the ceiling of the test after only 3 months of implant use. In contrast, none of the participants in this study reached a score of 80% on CNC word recognition, even at the 12-month postoperative test interval. Measures of QoL related to hearing were also significantly improved following implantation. CONCLUSION: Results of this study demonstrate that monosyllabic words are appropriate for determining preoperative candidate and measuring long-term postoperative speech recognition performance. LEVEL OF EVIDENCE: 2c. Laryngoscope, 127:2368-2374, 2017.

9 Article Predictive factors for short- and long-term hearing preservation in cochlear implantation with conventional-length electrodes. 2018

Wanna, George B / O'Connell, Brendan P / Francis, David O / Gifford, Rene H / Hunter, Jacob B / Holder, Jourdan T / Bennett, Marc L / Rivas, Alejandro / Labadie, Robert F / Haynes, David S. ·Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University, Nashville, Tennessee, U.S.A. ·Laryngoscope · Pubmed #28643327.

ABSTRACT: OBJECTIVES/HYPOTHESIS: The aims of this study were to investigate short- and long-term rates of hearing preservation after cochlear implantation and identify factors that impact hearing preservation. STUDY DESIGN: Retrospective review. METHODS: Patients undergoing cochlear implantation with conventional-length electrodes and air-conduction thresholds ≤80 dB HL at 250 Hz preoperatively were included. Hearing preservation was defined as air-conduction thresholds ≤80 dB HL at 250 Hz. RESULTS: The sample included 196 patients (225 implants). Overall, the rate of short-term hearing preservation was 38% (84/225), with 18% (33/188) of patients preserving hearing long term. Multivariate analysis showed better preoperative hearing was predictive of hearing preservation at short (odds ratio [OR]: 0.93, 95% confidence interval [CI]: 0.91-0.95, P < .001) and long-term follow-up (OR: 0.94, 95% CI: 0.91-0.97, P < .001). Lateral wall electrodes and mid-scala electrodes had 3.4 (95% CI: 1.4-8.6, P = .009) and 5.6-times (95% CI: 1.8-17.3, P = .003) higher odds of hearing preservation than perimodiolar arrays at short-term follow-up, respectively. Long-term data revealed better hearing preservation for lateral wall (OR: 7.6, 95% CI: 1.6-36.1, P = .01), but not mid-scala (OR: 3.1, 95% CI: 0.4-23.1, P = .28), when compared to perimodiolar electrodes. Round window/extended round window (RW/ERW) approaches were associated with higher rates of long-term hearing preservation (21%) than cochleostomy approaches (0%) (P = 0.002) on univariate analysis. CONCLUSIONS: Better preoperative residual hearing, lateral wall electrodes, and RW/ERW approaches are predictive of higher rates of long-term functional hearing preservation. LEVEL OF EVIDENCE: 4. Laryngoscope, 128:482-489, 2018.

10 Article Insertion depth impacts speech perception and hearing preservation for lateral wall electrodes. 2017

O'Connell, Brendan P / Hunter, Jacob B / Haynes, David S / Holder, Jourdan T / Dedmon, Matt M / Noble, Jack H / Dawant, Benoit M / Wanna, George B. ·Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University, Nashville, Tennessee, U.S.A. · Department of Hearing and Speech Sciences, Vanderbilt University, Nashville, Tennessee, U.S.A. · Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, Tennessee, U.S.A. ·Laryngoscope · Pubmed #28304096.

ABSTRACT: OBJECTIVES: 1) Examine angular insertion depths (AID) and scalar location of Med-El (GmbH Innsbruck, Austria) electrodes; and 2) determine the relationship between AID and audiologic outcomes controlling for scalar position. STUDY DESIGN: Retrospective review. METHODS: Postlingually deafened adults undergoing cochlear implantation with Flex 24, Flex 28, and Standard electrode arrays (Med-El) were identified. Patients with preoperative and postoperative computed tomography scans were included so that electrode location and AID could be determined. Outcome measures were 1) speech perception in the cochlear implant (CI)-only condition, and 2) short-term hearing preservation. RESULTS: Forty-eight implants were included; all electrodes (48 of 48) were positioned entirely within the scala tympani. The median AID was 408° (interquartile [IQ] range 373°-449°) for Flex 24, 575° (IQ range 465°-584°) for Flex 28, and 584° (IQ range 368°-643°) for Standard electrodes (Med-El). The mean postoperative CNC score was 43.7% ± 21.9. A positive correlation was observed between greater AID and better CNC performance (r = 0.48, P < 0.001). Excluding patients with postoperative residual hearing, a strong correlation between AID and CNC persisted (r = 0.57, P < 0.001). In patients with preoperative residual hearing, mean low-frequency pure-tone average (PTA) shift was 27 dB ± 14. A correlation between AID and low-frequency PTA shift at activation was noted (r = 0.41, P = 0.04). CONCLUSION: Favorable rates of scala tympani insertion (100%) were observed. In the CI-only condition, a direct correlation between greater AID and CNC score was noted regardless of postoperative hearing status. Deeper insertions were, however, associated with worse short-term hearing preservation. When patients without postoperative residual hearing were analyzed independently, the relationship between greater insertion depth and better performance was strengthened. LEVEL OF EVIDENCE: 4. Laryngoscope, 127:2352-2357, 2017.

11 Article Durability of Hearing Preservation after Cochlear Implantation with Conventional-Length Electrodes and Scala Tympani Insertion. 2016

Sweeney, Alex D / Hunter, Jacob B / Carlson, Matthew L / Rivas, Alejandro / Bennett, Marc L / Gifford, Rene H / Noble, Jack H / Haynes, David S / Labadie, Robert F / Wanna, George B. ·Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA. · Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA. · Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA. · Department of Electrical Engineering and Computer Science, Vanderbilt University Medical Center, Nashville, Tennessee, USA. · Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA george.wanna@vanderbilt.edu. ·Otolaryngol Head Neck Surg · Pubmed #26908553.

ABSTRACT: OBJECTIVES: To analyze factors that influence hearing preservation over time in cochlear implant recipients with conventional-length electrode arrays located entirely within the scala tympani. STUDY DESIGN: Case series with planned chart review. SETTING: Single tertiary academic referral center. SUBJECTS AND METHODS: A retrospective review was performed to analyze a subgroup of cochlear implant recipients with residual acoustic hearing. Patients were included in the study only if their electrode arrays remained fully in the scala tympani after insertion and serviceable acoustic hearing (≤80 dB at 250 Hz) was preserved. Electrode array location was verified through a validated radiographic assessment tool. Patients with <6 months of audiologic follow-up were excluded. The main outcome measure was change in acoustic hearing thresholds from implant activation to the last available follow-up. RESULTS: A total of 16 cases met inclusion criteria (median age, 70.6 years; range, 29.4-82.2; 50% female). The average follow-up was 18.0 months (median, 16.1; range, 6.2-36.4). Patients with a lateral wall electrode array were more likely to have stable acoustic thresholds over time (P < .05). Positive correlations were seen between continued hearing loss following activation and larger initial postoperative acoustic threshold shifts, though statistical significance was not achieved. Age, sex, and noise exposure had no significant influence on continued hearing preservation over time. CONCLUSIONS: To control for hearing loss associated with interscalar excursion during cochlear implantation, the present study evaluated patients only with conventional electrode arrays located entirely within the scala tympani. In this group, the style of electrode array may influence residual hearing preservation over time.

12 Article Impact of Perioperative Oral Steroid Use on Low-frequency Hearing Preservation After Cochlear Implantation. 2015

Sweeney, Alex D / Carlson, Matthew L / Zuniga, M Geraldine / Bennett, Marc L / Wanna, George B / Haynes, David S / Rivas, Alejandro. ·The Otology Group of Vanderbilt University, Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A. ·Otol Neurotol · Pubmed #26375969.

ABSTRACT: OBJECTIVE: To investigate the efficacy of a perioperative oral steroid taper on low-frequency hearing preservation after cochlear implantation. STUDY DESIGN: Retrospective case series. SETTING: Tertiary referral center. PATIENTS: Consecutive cochlear implant recipients between January 2012 and December 2014 who were candidates for a hearing preservation approach based on preoperative pure tone thresholds were identified. INTERVENTIONS: A subgroup of patients received a 2-week oral corticosteroid taper beginning 3 days before surgery. All patients were implanted using standard length electrodes. MAIN OUTCOME MEASURES: The preservation of low-frequency pure tone thresholds on the first postoperative audiogram was assessed. Secondary outcome measures included the respective impacts of age, diabetes, and electrode array type on hearing preservation, the durability of hearing preservation over time, and the development of medical complications related to steroid use. RESULTS: Twenty-seven ears met inclusion criterion, and the mean age at implantation was 49.8 years (median 62 yr, range 2-81 yr). Twenty patients (74.1%, mean age 48.7 yr) received an oral corticosteroid taper, whereas 7 (25.9%, mean age 53.1 yr) did not. The rate (p < 0.01) and degree (p < 0.01) of hearing preservation as measured at implant activation was greater for patients who received an oral steroid taper than those who did not. There were no medical complications related to steroid use. CONCLUSION: A 2-week oral prednisone taper beginning before surgery may positively affect the incidence and degree of low-frequency hearing preservation after cochlear implantation.

13 Article Availability of binaural cues for pediatric bilateral cochlear implant recipients. 2015

Sheffield, Sterling W / Haynes, David S / Wanna, George B / Labadie, Robert F / Gifford, René H. ·Department of Hearing and Speech Sciences, Vanderbilt University, Nashville, TN. · Department of Otolaryngology, Vanderbilt University, Nashville, TN. ·J Am Acad Audiol · Pubmed #25751696.

ABSTRACT: BACKGROUND: Bilateral implant recipients theoretically have access to binaural cues. Research in postlingually deafened adults with cochlear implants (CIs) indicates minimal evidence for true binaural hearing. Congenitally deafened children who experience spatial hearing with bilateral CIs, however, might perceive binaural cues in the CI signal differently. There is limited research examining binaural hearing in children with CIs, and the few published studies are limited by the use of unrealistic speech stimuli and background noise. PURPOSE: The purposes of this study were to (1) replicate our previous study of binaural hearing in postlingually deafened adults with AzBio sentences in prelingually deafened children with the pediatric version of the AzBio sentences, and (2) replicate previous studies of binaural hearing in children with CIs using more open-set sentences and more realistic background noise (i.e., multitalker babble). RESEARCH DESIGN: The study was a within-participant, repeated-measures design. STUDY SAMPLE: The study sample consisted of 14 children with bilateral CIs with at least 25 mo of listening experience. DATA COLLECTION AND ANALYSIS: Speech recognition was assessed using sentences presented in multitalker babble at a fixed signal-to-noise ratio. Test conditions included speech at 0° with noise presented at 0° (S0N0), on the side of the first CI (90° or 270°) (S0N1stCI), and on the side of the second CI (S0N2ndCI) as well as speech presented at 0° with noise presented semidiffusely from eight speakers at 45° intervals. Estimates of summation, head shadow, squelch, and spatial release from masking were calculated. RESULTS: Results of test conditions commonly reported in the literature (S0N0, S0N1stCI, S0N2ndCI) are consistent with results from previous research in adults and children with bilateral CIs, showing minimal summation and squelch but typical head shadow and spatial release from masking. However, bilateral benefit over the better CI with speech at 0° was much larger with semidiffuse noise. CONCLUSIONS: Congenitally deafened children with CIs have similar availability of binaural hearing cues to postlingually deafened adults with CIs within the same experimental design. It is possible that the use of realistic listening environments, such as semidiffuse background noise as in Experiment II, would reveal greater binaural hearing benefit for bilateral CI recipients. Future research is needed to determine whether (1) availability of binaural cues for children correlates with interaural time and level differences, (2) different listening environments are more sensitive to binaural hearing benefits, and (3) differences exist between pediatric bilateral recipients receiving implants in the same or sequential surgeries.

14 Article 228 cases of cochlear implant receiver-stimulator placement in a tight subperiosteal pocket without fixation. 2015

Sweeney, Alex D / Carlson, Matthew L / Valenzuela, Carla V / Wanna, George B / Rivas, Alejandro / Bennett, Marc L / Haynes, David S. ·The Otology Group, Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA. · The Otology Group, Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA david.haynes@vanderbilt.edu. ·Otolaryngol Head Neck Surg · Pubmed #25605691.

ABSTRACT: OBJECTIVES: (1) To investigate the outcomes of cochlear implant receiver-stimulator (RS) placement using a tight subperiosteal pocket technique without device fixation and (2) to compare the efficiency of this approach with the traditional bony well and trough technique. STUDY DESIGN: Case series with planned chart review. SETTING: Single tertiary academic referral center. SUBJECTS AND METHODS: All cochlear implant surgeries utilizing a tight subperiosteal pocket without additional fixation or use of a bone well were identified retrospectively. Revision cases were only included if the tight subperiosteal pocket technique was used during the initial surgery. Patients with less than 6 months of postoperative follow-up were excluded. Primary outcome measures included RS migration, flap complications, device failure, and percentage reduction in operative time. RESULTS: Two hundred twenty-eight cases (average age 45.3 years) met inclusion criterion and were analyzed. At a mean follow-up of 18.1 months, no patient experienced RS migration. One patient experienced a postoperative hematoma that was managed with observation. One patient developed a surgical site infection that resolved following exploration and intravenous antibiotics. The subperiosteal pocket technique resulted in an 18.9% reduction in total operative time compared to a more conventional RS placement method (P < .01). CONCLUSIONS: The tight subperiosteal pocket without fixation is a safe, durable, and time-saving technique for RS placement during cochlear implantation. Notably, device migration and flap complications are very uncommon.

15 Article Evidence for the expansion of pediatric cochlear implant candidacy. 2015

Carlson, Matthew L / Sladen, Douglas P / Haynes, David S / Driscoll, Colin L / DeJong, Melissa D / Erickson, Hannah C / Sunderhaus, Linsey W / Hedley-Williams, Andrea / Rosenzweig, Elizabeth A / Davis, Timothy J / Gifford, René H. ·*Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, U.S.A.; and †Departments of Otolaryngology-Head and Neck Surgery and ‡Hearing and Speech Sciences, Vanderbilt Bill Wilkerson Center, Vanderbilt University, Nashville, Tennessee, U.S.A. ·Otol Neurotol · Pubmed #25275867.

ABSTRACT: OBJECTIVE: To test the hypothesis that children who are non-traditional cochlear implant candidates, but are not making progress with appropriately fitted hearing aids and intervention, will demonstrate significant benefit from cochlear implantation as defined by improvement in (1) speech perception, (2) auditory skills development, and/or (3) progress on standardized measures of receptive and expressive language. STUDY DESIGN: Retrospective case series. SETTING: Two tertiary academic cochlear implant centers. PATIENTS: All pediatric patients that underwent cochlear implantation were reviewed. Only those meeting one or both of the following criteria were included: (1) less severe hearing loss than specified in the current indications and (2) open-set word and/or sentence recognition scores greater than 30% for children who are able to participate in speech perception testing. Patients with auditory neuropathy were excluded. INTERVENTION(S): Cochlear implantation. MAIN OUTCOME MEASURES: Pre- and postoperative results of age appropriate speech recognition tests, auditory questionnaires, and standardized norm-referenced estimates of speech and language development. RESULTS: A total of 51 patients met study criteria. The mean age at time of surgery was 8.3 years and 24% underwent bilateral sequential implantation. Overall, the mean speech recognition improvement was 63 percentage points in the implanted ear (p < 0.001) and 40 percentage points in the bimodal condition (p < 0.001). Results of auditory and language development measures revealed significant improvement after implantation (p < 0.05). CONCLUSION: Non-traditional pediatric implant recipients derive significant benefit from cochlear implantation. A large-scale reassessment of pediatric cochlear implant candidacy, including less severe hearing losses and higher preoperative speech recognition, is warranted to allow more children access to the benefits of cochlear implantation.

16 Article Historical development of active middle ear implants. 2014

Carlson, Matthew L / Pelosi, Stanley / Haynes, David S. ·Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. · Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, PA, USA. · Department of Otolaryngology-Head and Neck Surgery, The Bill Wilkerson Center for Otolaryngology & Communication Sciences, 7209 Medical Center East, South Tower, 1215 21st Avenue South, Nashville, TN 37232-8605. Electronic address: david.haynes@vanderbilt.edu. ·Otolaryngol Clin North Am · Pubmed #25282038.

ABSTRACT: Active middle ear implants (AMEIs) are sophisticated technologies designed to overcome many of the shortcomings of conventional hearing aids, including feedback, distortion, and occlusion effect. Three AMEIs are currently approved by the US Food and Drug Administration for implantation in patients with sensorineural hearing loss. In this article, the history of AMEI technologies is reviewed, individual component development is outlined, past and current implant systems are described, and design and implementation successes and dead ends are highlighted. Past and ongoing challenges facing AMEI development are reviewed.

17 Article Impact of electrode design and surgical approach on scalar location and cochlear implant outcomes. 2014

Wanna, George B / Noble, Jack H / Carlson, Matthew L / Gifford, René H / Dietrich, Mary S / Haynes, David S / Dawant, Benoit M / Labadie, Robert F. ·Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University, Nashville, Tennessee, U.S.A. ·Laryngoscope · Pubmed #24764083.

ABSTRACT: OBJECTIVES/HYPOTHESIS: Three surgical approaches: cochleostomy (C), round window (RW), and extended round window (ERW); and two electrodes types: lateral wall (LW) and perimodiolar (PM), account for the vast majority of cochlear implantations. The goal of this study was to analyze the relationship between surgical approach and electrode type with final intracochlear position of the electrode array and subsequent hearing outcomes. STUDY DESIGN: Comparative longitudinal study. METHODS: One hundred postlingually implanted adult patients were enrolled in the study. From the postoperative scan, intracochlear electrode location was determined and using rigid registration, transformed back to the preoperative computed tomography which had intracochlear anatomy (scala tympani and scala vestibuli) specified using a statistical shape model based on 10 microCT scans of human cadaveric cochleae. Likelihood ratio chi-square statistics were used to evaluate for differences in electrode placement with respect to surgical approach (C, RW, ERW) and type of electrode (LW, PM). RESULTS: Electrode placement completely within the scala tympani (ST) was more common for LW than were PM designs (89% vs. 58%; P < 0.001). RW and ERW approaches were associated with lower rates of electrode placement outside the ST than was the cochleostomy approach (9%, 16%, and 63%, respectively; P < 0.001). This pattern held true regardless of whether the implant was LW or PM. When examining electrode placement and hearing outcome, those with electrode residing completely within the ST had better consonant-nucleus-consonant word scores than did patients with any number of electrodes located outside the ST (P = 0.045). CONCLUSION: These data suggest that RW and ERW approaches and LW electrodes are associated with an increased likelihood of successful ST placement. Furthermore, electrode position entirely within the ST confers superior audiological outcomes. LEVEL OF EVIDENCE: 2b.

18 Article Cochlear implantation in Ménière's disease patients. 2014

McRackan, Theodore Richardson / Gifford, Rene H / Kahue, Charissa N / Dwyer, Robert / Labadie, Robert F / Wanna, George B / Haynes, David S / Bennett, Marc L. ·*Department of Otolaryngology-Head and Neck Surgery, and †Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A. ·Otol Neurotol · Pubmed #24492131.

ABSTRACT: OBJECTIVE: A significant portion of the Ménière's disease (MD) population will ultimately have severe-to-profound hearing loss in their affected ear. When this occurs bilaterally or when a patient has poor hearing in the contralateral ear, these patients may meet criteria for cochlear implantation (CI). Here, we describe our institution's CI outcomes in MD patients. STUDY DESIGN: Retrospective chart and literature review. SETTING: Tertiary referral center. PATIENTS: Twenty-one patients with either bilateral MD or unilateral MD who underwent CI in their ear affected with MD. INTERVENTION(S): Cochlear implantation. MAIN OUTCOME MEASURE(S): Postoperative speech perception. RESULTS: Results for the MD patients were also compared with a standard sample of 178 adult recipients implanted with newest generation technology. Collapsing across status of MD activity, there was a significant difference between the MD CNC word recognition scores and that of the standard sample (43.2 versus 59.1%, p = 0.02). When separating the MD patients into groups according to the status of disease activity, those with active MD achieved scores that were not significantly different from the standard sample (55.7 versus 59.1%, p = 0.94), although those without active MD were significantly different from the standard group (38.2 versus, p = 0.002). Patients undergoing surgical or ablative procedures for their MD symptoms had statistically significant improvement in their CI hearing outcomes compared with those who did not (CNC words: p = 0.014; CNC phonemes: p = 0.035). Six patients had persistent vertiginous symptoms of MD before CI. After CI, 2 had complete resolution of vertigo, 3 had subjective improvement in their symptoms, and 1 noticed no change. CONCLUSION: Ménière's disease patients' hearing outcomes seem to be worse than the general CI population. However, those with active MD perform similarly to the general CI population.

19 Article Evolving considerations in the surgical management of cholesteatoma in the only hearing ear. 2014

Carlson, Matthew L / Latuska, Richard F / Pelosi, Stanley / Wanna, George B / Bennett, Marc L / Rivas, Alejandro / Glasscock, Michael E / Haynes, David S. ·Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University, Nashville, Tennessee, U.S.A. ·Otol Neurotol · Pubmed #24270720.

ABSTRACT: OBJECTIVE: To describe a contemporary, pragmatic approach to managing cholesteatoma in the only hearing ear. STUDY DESIGN: Retrospective case series. SETTING: Single tertiary referral center. PATIENTS: All patients that underwent cholesteatoma surgery, having profound hearing loss in the contralateral ear. INTERVENTION(S): Cholesteatoma surgery. MAIN OUTCOME MEASURE(S): Surgical strategy, preoperative and postoperative audiometric outcomes, short- and long-term complications, recidivism. RESULTS: Twenty-eight patients met criteria, representing 0.25% of all chronic ear surgeries performed between 1970 and 2012. Patients undergoing surgery in the latter half of the study underwent intact canal wall procedures and ossicular chain reconstruction more frequently despite having similar severities of disease. All patients with inner ear fistula underwent an open-cavity operation. In the early postoperative period, 86% of ears had stable or improved hearing levels, and all patients maintained preoperative bone conduction thresholds. At a mean follow-up of 48 months, 79% of patients maintained stable or improved pure tone thresholds, whereas 2 subjects experienced delayed sensorineural hearing loss and 2 experienced isolated declining speech discrimination. Notably, 3 of the latter 4 patients were diagnosed with labyrinthine fistula and had undergone radical mastoidectomy. None of the patients who received an intact canal wall tympanomastoidectomy experienced worsening bone conduction thresholds, whereas 1 subject demonstrated a delayed decline in speech discrimination and another recurred. CONCLUSION: It is commonly held that the radical or classic modified radical mastoidectomy is the procedure of choice when managing cholesteatoma in the only hearing ear while intact canal wall techniques are contraindicated. Over the last 20 years, we have adopted a less-rigid, functional approach favoring intact canal wall procedures in the absence of inner ear fistula rather than unequivocally committing to an open cavity. This strategy has been influenced by advancements in preoperative evaluation, increasing familiarity and refinement of closed-cavity techniques, postoperative imaging surveillance options, and the potential for cochlear implant "salvage" in the rare case of profound hearing loss. Based on the current series, this approach appears safe when performed by an experienced surgeon, and reliable long-term patient follow-up is maintained.

20 Article Unilateral auditory performance before and after bilateral sequential cochlear implantation. 2013

Pelosi, Stanley / Wanna, George B / Gifford, Rene H / Sisler-Dinwiddie, Allyson / Bom Braga, Gabriela P / Bennett, Marc L / Labadie, Robert F / Rivas, Alejandro / Haynes, David S. ·*Department of Otolaryngology, and †Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A.; and ‡Universidade de São Paulo, São Paulo, Brazil. ·Otol Neurotol · Pubmed #24136307.

ABSTRACT: OBJECTIVE: The relationship between unilateral preimplantation and postimplantation auditory performance in patients undergoing sequential cochlear implantation (SCI) has not been clearly defined. A greater understanding of this relationship could affect preoperative counseling to patients regarding choice of initial side to implant. STUDY DESIGN: Retrospective case series. SETTING: Tertiary otologic practice. PATIENTS: Adult/pediatric SCI recipients. OUTCOME MEASURES: Unilateral auditory performance preimplantation and postimplantation was assessed. To compare interaural preimplantation performance, we defined a "better-hearing ear" as better pure tone average or speech awareness/reception threshold by at least 10 dB or open/closed-set speech perception score at least 10 percentage points higher. RESULTS: Ninety patients underwent SCI from 1997 to 2011; 34 children and 22 adults with at least 6 months of bilateral implant use underwent further analysis. Preoperatively, the first-implanted ear was better hearing in 6 cases, poorer hearing in 15 cases, and equal hearing in 35 individuals. The proportion of SCI recipients exhibiting better long-term performance of the first-implanted ear was not significantly different from the proportion exhibiting equal or better performance of the second-implanted ear (p = 0.79, χ²), irrespective of preoperative hearing status. The first-implanted ear exhibited better closed/open-set speech perception scores in 41% (9/22) adult and 59% (20/34) pediatric patients at a mean most recent test point of 25 and 39 months, respectively. CONCLUSION: Preimplantation unilateral hearing status was not found to influence relative interaural performance differences after SCI. This finding highlights the relative unimportance of preoperative audiometry and speech recognition scores for guiding clinical decisions regarding implant ear selection.

21 Article Cochlear implantation versus hearing amplification in patients with auditory neuropathy spectrum disorder. 2013

Pelosi, Stanley / Wanna, George / Hayes, Cathrine / Sunderhaus, Linsey / Haynes, David S / Bennett, Marc L / Labadie, Robert F / Rivas, Alejandro. ·Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee 37232, USA. stanley.pelosi@vanderbilt.edu ·Otolaryngol Head Neck Surg · Pubmed #23426710.

ABSTRACT: OBJECTIVE: Patients with auditory neuropathy spectrum disorder (ANSD) exhibit altered neural synchrony in response to auditory stimuli. Cochlear implantation (CI) is thought to improve neural synchrony in response to auditory stimuli and improve speech perception relative to conventional hearing amplification (HA). STUDY DESIGN: Retrospective review. SETTING: Tertiary otologic practice. SUBJECTS AND METHODS: Subjects included patients with ANSD treated at Vanderbilt University from 1999 to 2011. Sixteen patients underwent CI, and 10 received binaural HAs. Pretreatment performance was assessed through speech reception thresholds and parent questionnaire (Infant-Toddler Meaningful Auditory Integration Scale [IT-MAIS]). Posttreatment outcomes were assessed using IT-MAIS and closed-/open-set speech perception scores. RESULTS: Two HA users underwent neuromaturation and were excluded from further analysis. For the remaining patients, median duration of device use was 48 months. All CI patients had a prior binaural HA trial with failure of auditory skills development. Median available pretreatment IT-MAIS score was 13 and 30 for CI and HA groups, respectively (rank sum test, P = .32). Posttreatment, 6 of 16 CI patients and 4 of 8 HA patients achieved open-set speech perception scores ≥ 60%. No differences between groups were found in posttreatment IT-MAIS scores (rank sum test, P = .11) or the percentage of patients achieving the above levels of open-set speech perception (Fisher exact test, P = .67). CONCLUSIONS: A wide range of speech perception outcomes are observed in ANSD patients. In our ANSD population, patients who exhibited failure of auditory skills development with HAs were able to achieve comparable overall speech perception outcomes after CI relative to those who continued to make appropriate auditory progress with HAs alone.

22 Article Outcomes comparing primary pediatric stapedectomy for congenital stapes footplate fixation and juvenile otosclerosis. 2013

Carlson, Matthew L / Van Abel, Kathryn M / Pelosi, Stanley / Beatty, Charles W / Haynes, David S / Wanna, George B / Bennett, Marc L / Driscoll, Colin L. ·Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA. ·Otol Neurotol · Pubmed #23370553.

ABSTRACT: OBJECTIVE: To compare presentation, operative findings, and outcomes among pediatric patients undergoing primary stapedectomy for congenital stapes footplate fixation (CSFF) and juvenile otosclerosis (JO). STUDY DESIGN: Retrospective review. SETTING: Combined experience from 2 tertiary academic referral centers. PATIENTS: Pediatric patients with CSFF and JO. INTERVENTION: Primary stapedectomy. MAIN OUTCOME MEASURE(S): 1) Preoperative and postoperative audiometric data using the 1995 AAO-HNS reporting guidelines; 2) Notable operative findings, and postoperative complications. RESULTS: Forty-four pediatric ears met inclusion criteria (27 CSFF, 17 JO). Patients with CSFF presented with a more significant hearing loss (mean PTA 52 dB versus 42 dB; p = 0.04), underwent surgery at a younger age (12.2 versus 16.3 yr; p < 0.001), and more commonly had coincident ossicular malformations (37% versus 0%; p = 0.004). Subjects with JO demonstrated a smaller postoperative ABG (mean 8.8 dB versus 17.2 dB; p = 0.04), although both groups experienced a statistically significant improvement following surgery. Mean bone conduction thresholds remained stable for both groups. There were no instances of profound sensorineural hearing loss, perilymph gusher, facial nerve paresis, or tympanic membrane perforation. CONCLUSION: When performed by an experienced surgeon, stapedectomy is safe and effective in managing carefully selected pediatric patients with CSFF and JO. CSFF is associated with a more severe hearing loss at presentation and concurrent ossicular anomalies are common. Both groups experience substantial benefit from stapedectomy, although ABG closure rates are superior in patients with JO. These data may be helpful in preoperative assessment and patient counseling.

23 Article Stimulation rate reduction and auditory development in poorly performing cochlear implant users with auditory neuropathy. 2012

Pelosi, Stanley / Rivas, Alejandro / Haynes, David S / Bennett, Marc L / Labadie, Robert F / Hedley-Williams, Andrea / Wanna, George B. ·Department of OtolaryngologyYHead and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee 37232, USA. stanley.pelosi@gmail.com ·Otol Neurotol · Pubmed #22972423.

ABSTRACT: OBJECTIVE: Patients with auditory neuropathy spectrum disorder (ANSD) exhibit altered neural synchrony in response to auditory stimuli. It has been hypothesized that a slower rate of electrical stimulation in programming strategies for cochlear implant (CI) users with ANSD may enhance development of neural synchrony and speech perception abilities. STUDY DESIGN: Retrospective case series. SETTING: Tertiary otologic practice. PATIENTS: Twenty-two patients with ANSD underwent CI. Patients with complete postoperative audiometric data and at least 2 years of follow-up were included in further analysis. INTERVENTION: Thirteen patients patients met inclusion criteria. Five "poorly performing" CI recipients with ANSD who had not developed closed-set speech perception abilities despite at least 2 years of implant use underwent implant programming to lower the neural stimulation rate. MAIN OUTCOME MEASURES: Speech perception abilities over time using parent questionnaire, closed-set testing, and open-set measures. RESULTS: A high incidence of comorbid conditions was present in the poor performers, including cognitive delay (n = 2), motor delay (n = 3), and autism spectrum disorder (n = 1). The median time to rate slowing in 5 poor performers was 29 months after implant activation. Three of 5 patients achieved closed-set speech perception scores higher than 60% after 6 to 16 months of implant use at the slower rates. At last follow-up (median, 42 mo), no poor performer had yet achieved open-set speech perception abilities. Of all CI recipients with ANSD included in analysis, open-set speech perception abilities developed in 46% (6/13). CONCLUSION: In CI recipients with ANSD who demonstrate limited auditory skills development despite prolonged implant use, lowering the stimulation rate may facilitate acquisition of closed-set speech perception abilities. Further efforts on the study of programming parameters in ANSD patients with CIs are necessary to maximize auditory development in this patient population.

24 Article Horizontal plane localization in single-sided deaf adults fitted with a bone-anchored hearing aid (Baha). 2012

Grantham, D Wesley / Ashmead, Daniel H / Haynes, David S / Hornsby, Benjamin W Y / Labadie, Robert F / Ricketts, Todd A. ·Department of Hearing and Speech Sciences, Vanderbilt University School of Medicine, Nashville, Tennessee 37232, USA. d.wesley.grantham@vanderbilt.edu ·Ear Hear · Pubmed #22588268.

ABSTRACT: OBJECTIVES: : One purpose of this investigation was to evaluate the effect of a unilateral bone-anchored hearing aid (Baha) on horizontal plane localization performance in single-sided deaf adults who had either a conductive or sensorineural hearing loss in their impaired ear. The use of a 33-loudspeaker array allowed for a finer response measure than has previously been used to investigate localization in this population. In addition, a detailed analysis of error patterns allowed an evaluation of the contribution of random error and bias error to the total rms error computed in the various conditions studied. A second purpose was to investigate the effect of stimulus duration and head-turning on localization performance. DESIGN: : Two groups of single-sided deaf adults were tested in a localization task in which they had to identify the direction of a spoken phrase on each trial. One group had a sensorineural hearing loss (SNHL group; N = 7), and the other group had a conductive hearing loss (CHL group; N = 5). In addition, a control group of four normal-hearing adults was tested. The spoken phrase was either 1250 msec in duration (a male saying "Where am I coming from now?") or 341 msec in duration (the same male saying "Where?"). For the longer-duration phrase, subjects were tested in conditions in which they either were or were not allowed to move their heads before the termination of the phrase. The source came from one of nine positions in the front horizontal plane (from -79° to +79°). The response range included 33 choices (from -90° to +90°, separated by 5.6°). Subjects were tested in all stimulus conditions, both with and without the Baha device. Overall rms error was computed for each condition. Contributions of random error and bias error to the overall error were also computed. RESULTS: : There was considerable intersubject variability in all conditions. However, for the CHL group, the average overall error was significantly smaller when the Baha was on than when it was off. Further analysis of error patterns indicated that this improvement was primarily based on reduced response bias when the device was on; that is, the average response azimuth was nearer to the source azimuth when the device was on than when it was off. The SNHL group, on the other hand, had significantly greater overall error when the Baha was on than when it was off. Collapsed across listening conditions and groups, localization performance was significantly better with the 1250 msec stimulus than with the 341 msec stimulus. However, for the longer-duration stimulus, there was no significant beneficial effect of head-turning. Error scores in all conditions for both groups were considerably larger than those in the normal-hearing control group. CONCLUSIONS: : On average, single-sided deaf adults with CHL showed improved localization ability when using the Baha, whereas single-sided deaf adults with SNHL showed a decrement in performance when using the device. These results may have implications for clinical counseling for patients with unilateral hearing impairment.

25 Article Time of cochlear implant surgery in academic settings. 2010

Majdani, Omid / Schuman, Theodore A / Haynes, David S / Dietrich, Mary S / Leinung, Martin / Lenarz, Thomas / Labadie, Robert F. ·Department of Otolaryngology, Medical University of Hannover, Hannover, Germany. ·Otolaryngol Head Neck Surg · Pubmed #20115984.

ABSTRACT: OBJECTIVE: Establish the time required to perform cochlear implantation (CI) in academic settings. STUDY DESIGN: Historical cohort study. SETTING: German and American academic centers. PATIENTS: A total of 2639 patients underwent CI (1997-2007). We excluded patients receiving an experimental device or technique and those with abnormal cochlear anatomy or incomplete charts, leaving 2253 for analysis. INTERVENTION: Unilateral, bilateral, and revision CI with devices approved in the U.S. and Europe. MAIN OUTCOME MEASURES: Mean surgical time (ST) and total operating room time (TORT). RESULTS: Mixed model analysis was used; estimated marginal means were calculated in minutes after adjusting for random effect of individual surgeon. There were no differences between unilateral (ST = 171, TORT = 245) and revision CI (ST = 160, TORT = 232), but bilateral procedures were longer (ST = 295, TORT = 377, P < 0.001). In unilateral surgeries, Cochlear Limited (CL) devices were implanted faster (ST = 165, TORT = 225) than Advanced Bionics (ABC) (ST = 183, P = 0.001; TORT = 240, P = 0.023) or MedEl (ST = 193, P < 0.001; TORT = 253, P = 0.002) devices. There were no differences for unilateral CI between ABC and MedEl devices. For revision CI, ABC devices (ST = 141, TORT = 219) were implanted faster than CL devices (ST = 181, P = 0.001; TORT = 266, P < 0.001). There were no differences by age group or between Germany and the U.S. ST and TORT were shorter for 575 CIs performed in the final two years of the study (unilateral CI: ST = 145, TORT = 209; bilateral CI: ST = 259, TORT = 330; revision CI: ST = 138, TORT = 205). For unilateral CI, ST and TORT decreased yearly (linear regression, P < 0.001) and inversely correlated with surgeon experience (linear regression, P < 0.01). CONCLUSIONS: We report the time required to perform CI in academic settings-data that are vital for cost-benefit analyses and assessing new CI techniques.

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