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Hearing Disorders: HELP
Articles by Jafri Kuthubutheen
Based on 17 articles published since 2010
(Why 17 articles?)
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Between 2010 and 2020, J. Kuthubutheen wrote the following 17 articles about Hearing Disorders.
 
+ Citations + Abstracts
1 Review Preoperative steroids for hearing preservation cochlear implantation: A review. 2016

Kuthubutheen, Jafri / Smith, Leah / Hwang, Euna / Lin, Vincent. ·a Department of Otolaryngology - Head and Neck Surgery , University of Toronto, Sunnybrook Health Sciences Centre , Ontario , Canada. · b Department of Otolaryngology - Head and Neck Surgery , School of Surgery, University of Western Australia , Perth , Australia. ·Cochlear Implants Int · Pubmed #26913646.

ABSTRACT: Preoperative steroids have been shown to be beneficial in reducing the hearing loss associated with cochlear implantation. This review article discusses the mechanism of action, effects of differing routes of administration, and side effects of steroids administered to the inner ear. Studies on the role of preoperative steroids in animal and human studies are also examined and future directions for research in this area are discussed.

2 Clinical Trial A case series of paediatric hearing preservation cochlear implantation: a new treatment modality for children with drug-induced or congenital partial deafness. 2012

Kuthubutheen, J / Hedne, C N / Krishnaswamy, J / Rajan, G P. ·Department of Otolaryngology, Head and Neck Surgery, Fremantle Hospital, Fremantle, W.A., Australia. ·Audiol Neurootol · Pubmed #22739546.

ABSTRACT: OBJECTIVE: To investigate the use of hearing preservation cochlear implantation in children with partial deafness. PATIENTS AND METHODS: Five children with either drug-induced or congenital partial deafness were enrolled in a pilot study. The patients ranged in age from 13 months to 14 years. Implantation was performed using a hearing preservation technique. A Flex EAS electrode (MED-EL, Innsbruck, Austria) was used in all full insertions. RESULTS: Low frequency hearing was preserved in all patients with postoperative bone conduction within 10 dB of the preoperative hearing levels. These changes were preserved over the follow-up period of 12 months. There were significant improvements in speech perception. CONCLUSION: Hearing preservation cochlear implantation is a new effective modality in children with partial deafness.

3 Clinical Trial The role of preoperative, intratympanic glucocorticoids for hearing preservation in cochlear implantation: a prospective clinical study. 2012

Rajan, Gunesh P / Kuthubutheen, Jafri / Hedne, Naveen / Krishnaswamy, Jay. ·Otolaryngology, Head & Neck Surgery Division, School of Surgery, Fremantle Hospital Campus, University of Western Australia, Fremantle, Australia. gunesh.rajan@health.wa.gov.au. ·Laryngoscope · Pubmed #22183635.

ABSTRACT: BACKGROUND: Hearing Preservation is becoming increasingly important in cochlear implantation as there is growing evidence that preserving the residual hearing, especially in the low frequencies in combination with the electric stimulation can significantly improve hearing and speech outcomes in noise. Besides the ongoing development of atraumatic implant electrodes and insertion techniques, the implementation of pharmacologic hair cell protection is thought to increase hearing preservation. This study investigates the effects of preoperative intratympanic glucocorticoid application on hearing preservation rates in cochlear implantation. STUDY DESIGN: Prospective interventional study. SETTING: Tertiary neurotology referral center. PATIENTS: Patients undergoing cochlear implantation with measurable preoperative hearing thresholds using either a Flex soft electrode or a Flex EAS electrode depending on the degree of residual low frequency hearing. INTERVENTION: Preoperative intratympanic steroid application during cochlear implantation via round window insertion. MAIN OUTCOME MEASURES: Level of hearing preservation after cochlear implantation; electrode- and frequency-specific hearing preservation rates. RESULTS: Preoperative hearing thresholds were comparable in the control group and the interventional Flex soft group (70.5 db±12.5 dB vs. 73.5 dB±10.5 dB, P=.27). As per selection criteria the low-frequency hearing thresholds were significantly lower in interventional Flex EAS groups when compared to the control group. Hearing preservation was significantly better in the interventional group with no case of complete hearing loss in this group (11 dB±2.5 dB vs. 19.5 dB 3.5 dB, P<.05). The interventional group displayed a higher stability of hearing preservation after implantation (r=.8, P=.03). Level of hearing preservation was higher when a specific hearing preservation electrode was used (r=.85, P<.05). Hearing preservation in the low frequencies was significantly higher than in the high frequencies. CONCLUSIONS: Our study suggests that the additional preoperative use of intratympanic glucocorticoids improves and stabilizes hearing preservations rates in round window cochlear implantation for adults and children with residual hearing.

4 Article Misplaced incus: an unusual complication of a temporal bone fracture. 2019

Pollaers, Katherine / Broadbent, Christopher / Kuthubutheen, Jafri. ·Ear Nose and Throat Department, Royal Perth Hospital, Perth, Western Australia, Australia. · Department of Otolaryngology Head Neck and Skull Base Surgery, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia. ·BMJ Case Rep · Pubmed #30898967.

ABSTRACT: A 24-year-old man sustained significant injuries as a result of a motor bicycle accident. CT scans demonstrated multiple intracranial injuries including bilateral temporal bone fractures. On emergence from sedation, the patient reported right-sided hearing loss which was attributed to ossicular chain disruption after the incus was found to be in the external auditory canal. Unexpectedly, the initial conductive hearing loss resolved with conservative management and an ossicular chain reconstruction was not required. This is an unusual case of impressive long-term good hearing outcomes following complete dislocation of the incus and extrusion from the middle ear.

5 Article Unusual case of unilateral conductive hearing loss: chronic lymphocytic leukaemia. 2018

Davis, Amelia Leigh / Gangatharan, Shane / Kuthubutheen, Jafri. ·School of Surgery, University of Western Australia, Crawley, Western Australia, Australia. · School of Pathology and Laboratory Medicine, University of Western Australia, Nedlands, Western Australia, Australia. · Australian Clinical Labs, Osborne Park, Western Australia, Australia. · Otolaryngology Head and Neck Surgery, Fiona Stanley Hospital, Perth, Western Australia, Australia. ·BMJ Case Rep · Pubmed #30317188.

ABSTRACT: This presentation reports a novel case of chronic lymphocytic leukaemia (CLL), presenting with an early cutaneous lesion within the external auditory canal, in a patient being assessed for conductive hearing loss. It has previously been reported that infiltrative CLL can involve the head and neck; however, isolated external ear canal involvement is rare. Given that the incidence of CLL in Australia is rising, this case highlights the importance of considering CLL as a differential diagnosis for presentations of unilateral conductive hearing loss.

6 Article The Role of Preoperative Steroids for Hearing Preservation Cochlear Implantation: Results of a Randomized Controlled Trial. 2017

Kuthubutheen, Jafri / Joglekar, Samidha / Smith, Leah / Friesen, Lendra / Smilsky, Kari / Millman, Tara / Ng, Amy / Shipp, David / Coates, Harvey / Arnoldner, Christoph / Nedzelski, Julian / Chen, Joseph / Lin, Vincent. ·Department of Otolaryngology - Head and Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada. ·Audiol Neurootol · Pubmed #29332068.

ABSTRACT: OBJECTIVES: To determine whether preoperative steroids can improve hearing outcomes in cochlear implantation (CI). METHODS: This is a randomized controlled trial involving 30 postlingual deaf CI patients. Subjects had preoperative thresholds of better than or equal to 80 dB at 125 and 250 Hz, and better than or equal to 90 dB at 500 and 1,000 Hz. The subjects were randomized to a control group, an oral steroid group (receiving 1 mg/kg/day of prednisolone for 6 days prior to surgery), or a transtympanic steroid group (receiving a single dose of 0.5 mL of 10 mg/mL dexamethasone at 24 h prior to surgery). RESULTS: The subjects receiving transtympanic steroids had a significant decrease in the pure tone average over 3 months compared to the control and oral steroid group, which persisted over 12 months (p < 0.05). CONCLUSION: A single dose of preoperative transtympanic steroids prior to CI appears to have a beneficial effect, at least in the short term, with minimal effects seen in the longer term.

7 Article The role of extended preoperative steroids in hearing preservation cochlear implantation. 2015

Kuthubutheen, Jafri / Coates, Harvey / Rowsell, Corwyn / Nedzelski, Julian / Chen, Joseph M / Lin, Vincent. ·Department of Otolaryngology - Head and Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada; School of Surgery, University of Western Australia, Perth, Western Australia, Australia. Electronic address: jafri.kuth@gmail.com. · School of Surgery, University of Western Australia, Perth, Western Australia, Australia. · Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada. · Department of Otolaryngology - Head and Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada. ·Hear Res · Pubmed #26117408.

ABSTRACT: INTRODUCTION: Steroids have been shown to reduce the hearing threshold shifts associated with cochlear implantation. Previous studies have examined only the administration of steroids just prior to surgery. The aim of this study is to examine the role of extended preoperative systemic steroids in hearing preservation cochlear implantation. METHODS: An animal model of cochlear implantation was used. 24 Hartley strain guinea pigs with a mean weight of 768 g and normal hearing were randomised into a control group, a second group receiving a single dose of systemic dexamethasone one day prior to surgery, and a third group receiving a daily dose of systemic dexamethasone for 5 days prior to surgery. A specially designed cochlear implant electrode by Med-EL (Innsbruck) was inserted through a dorsolateral approach to an insertion depth of 5 mm and left in-situ. Auditory brain stem responses at 8 kHz, 16 kHz and 32 kHz were measured preoperatively, and 1 week, 1 month and 2 months postoperatively. Cochlear histopathology was examined at the conclusion of the study. RESULTS: At 1-week post operative, both groups receiving dexamethasone prior to implantation had smaller threshold shifts across all frequencies and which was significant at 32 kHz (p < 0.05). There were no differences among the three groups in the area of electrode related fibrosis. Spiral ganglion neuron (SGN) density was significantly higher in the group receiving steroids for 5 days, but only in the basal cochlear turn. DISCUSSION: This is study demonstrates the benefits of extended preoperative systemic steroids on hearing outcomes and SGN density in an animal model of cochlear implantation surgery.

8 Article Does Coupling and Positioning in Vibroplasty Matter? A Prospective Cohort Study. 2015

Marino, Roberta / Lampacher, Peter / Dittrich, Gregor / Tavora-Vieira, Dayse / Kuthubutheen, Jafri / Rajan, Gunesh P. ·*Otolaryngology, Head and Neck Surgery, School of Surgery, University of Western Australia, Perth; †Fiona Stanley Hospital, Murdoch, Western Australia; ‡Fremantle Hospital Campus, Fremantle, Western Australia, Australia; and §Med-EL, Innsbruck, Austria. ·Otol Neurotol · Pubmed #26075675.

ABSTRACT: OBJECTIVE: Vibroplasty has offered a new modality of hearing rehabilitation in patients with mixed, conductive, and sensorineural hearing loss who cannot wear hearing aids. Potentially, the positioning of the floating mass transducer (FMT) in vibroplasty surgery has a critical effect on hearing outputs. In this study, the impact on hearing outputs and coupling efficiency are evaluated by comparing various vibroplasty applications in the middle ear. No other study to date has examined the coupling efficiency of round window (RW) versus an ossicular vibroplasty application. STUDY DESIGN: Prospective cohort study of patients with underlying ear pathologies who were not able to wear hearing aids. METHODS: This is an ongoing prospective study of 16 patients. All patients had a standard audiological test battery. Direct drive transfer function analysis results were correlated with bone conduction thresholds to assess the efficiency of the FMT coupling. Speech perception in quiet and quality of life measure questionnaires were used to assess outcomes. Nine patients had round window vibroplasty, six patients had stapes vibroplasty, and one patient had traditional incus vibroplasty. RESULTS: Patients with a soft tissue coupler between the FMT and the RW had significantly reduced coupling efficiency. Patients who had direct RW contact had significantly improved coupling efficiency. Patients who underwent stapes or incus vibroplasty had the greatest coupling efficiency. CONCLUSION: This study demonstrates that attachment to the stapes or incus provides the best coupling when compared to round window vibroplasty. When applicable, stapes or incus coupling should be the first choice when implementing vibroplasty.

9 Article The role of a new contralateral routing of signal microphone in established unilateral cochlear implant recipients. 2015

Grewal, Amandeep S / Kuthubutheen, Jafri / Smilsky, Kari / Nedzelski, Julian M / Chen, Joseph M / Friesen, Lendra / Lin, Vincent Y W. ·Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Sunnybrook Cochlear Implant Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. ·Laryngoscope · Pubmed #25224587.

ABSTRACT: OBJECTIVES/HYPOTHESIS: To investigate whether a contralateral routing of signal (CROS) microphone combined with a unilateral cochlear implant (CI) results in hearing improvement after a prolonged trial period. STUDY DESIGN: A prospective experimental trial was undertaken on a group of 10 postlingually deafened adults who are experienced CI users. METHODS: Participants completed audiometric testing and validated questionnaires with their unilateral CI alone, followed by addition of a CROS microphone (CI-CROS). This was worn daily for the 2-week trial, after which hearing performance was reevaluated using the same measures. Objective tests included AzBio sentences in quiet and noise and consonant-vowel nucleus-consonant (CNC) words. Subjective measures included the Abbreviated Profile of Hearing Aid Benefit (APHAB); Speech, Spatial, Qualities of Hearing Index (SSQ); Hearing Implant Sound Quality Index; an institutional questionnaire; and a daily log sheet. RESULTS: There is statistically significant enhanced speech discrimination with the CI-CROS when speech is presented on the CROS side. However, scores are markedly diminished when background noise is introduced, particularly to the CROS side. Subjective results indicate lower satisfaction scores for the global and ease of communication subdomains of the APHAB with the CI-CROS, but increased scores on the spatial hearing subdomain of the SSQ (P < 0.05). CONCLUSION: The CI-CROS provides significant benefit in certain situations, particularly speech recognition in quiet. CI-CROS performance with background noise is poor, leading to low satisfaction scores. Further refinement of the device may yield a useful tool for unilateral CI users in the future.

10 Article The effect of different utility measures on the cost-effectiveness of bilateral cochlear implantation. 2015

Kuthubutheen, Jafri / Mittmann, Nicole / Amoodi, Hosam / Qian, Wei / Chen, Joseph M. ·Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; School of Surgery, University of Western Australia, Perth, Western Australia, Australia. ·Laryngoscope · Pubmed #25169819.

ABSTRACT: OBJECTIVES/HYPOTHESIS: To determine if the choice of health utility measure affects the incremental cost-utility ratio (ICUR) when assessing the cost-effectiveness of bilateral cochlear implantation (CI). STUDY DESIGN: A scenario-based estimate with three scenarios: 1) a patient with severe to profound sensorineural hearing loss with no intervention, 2) the same patient with a unilateral CI with average or better performance, and 3) the same patient with bilateral CIs with average or better performance. METHODS: One hundred and forty-two subjects comprising preimplantees (n = 30), unilateral cochlear implantees (n = 30), bilateral implantees (n = 30), and healthcare professionals (n = 52). The four health utility instruments applied were the Health Utility Index Mark 3 (HUI3), European Quality of Life Questionnaire in 5 Domains (EQ5D), visual analog scale (VAS), and time trade-off (TTO). Cost for each implant was based on a 25-year time horizon, 50% discount for the second implant, and a 15% failure rate. RESULTS: Using the HUI3, the utility gain from unilateral to bilateral implantation was 0.035 or 11.5% of the total utility gain. This ratio was higher using the other instruments: EQ5D (22.2%), VAS (35.0%), and TTO (41.4%). For the scenario of bilateral CI compared to no intervention, HUI3 ICUR estimates were the lowest, and for bilateral CI compared to unilateral CI, HUI3 ICUR estimates were the highest. CONCLUSIONS: The choice of utility instrument in cost-utility analysis of bilateral CI heavily influences whether the second implant is deemed cost-effective. The HUI3 is the utility of choice in CI studies and is the most conservative. LEVEL OF EVIDENCE: 4.

11 Article Quality of life in cochlear implantees: comparing utility values obtained through the Medical Outcome Study Short-Form Survey-6D and the Health Utility Index Mark 3. 2014

Arnoldner, Christoph / Lin, Vincent Y / Bresler, Richard / Kaider, Alexandra / Kuthubutheen, Jafri / Shipp, David / Chen, Joseph M. ·Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada. ·Laryngoscope · Pubmed #24536018.

ABSTRACT: OBJECTIVES/HYPOTHESIS: To evaluate the changes in health-related quality of life in unilateral adult cochlear implant patients using the Medical Outcome Study Short-Form Survey-36 (SF-36) and the Health Utility Index Mark 3 (HUI-3). To do so, a health utility index was obtained by converting the SF-36 to the Medical Outcome Study Short-Form Survey-6D (SF-6D) to permit comparison with HUI-3 scores in the context of health preference as measured by quality-adjusted life years. STUDY DESIGN: Prospective cohort study. METHODS: Eighty-one postlingually deaf adult patients undergoing cochlear implantation completed the SF-36 and HUI-3 preoperatively and at a median of 1.4 years (range, 11 months-5 years) after cochlear implantation. RESULTS: The SF-36 improvement was statistically significant in two domains. The SF-36 data were converted to SF-6D. Preoperatively, the mean SF-6D utility score was 0.575 ± 0.056. One year postoperatively this score increased to 0.590 ± 0.064. The improvement of 0.015 ± 0.082 was not statistically significant (P = .1118). Of the HUI-3 attributes, two showed improvement between preoperative and postoperative evaluations. The overall HUI-3 score increased from 0.464 ± 0.207 preoperatively to 0.611 ± 0.190 postoperatively. The gain of 0.146 ± 0.19 was statistically significant (P < .0001). The intraclass correlation coefficient between the SF-6D and HUI-3 showed a very small correlation, both pre- and postoperatively. CONCLUSIONS: Against the backdrop of diminishing resources for healthcare, cost-effective analysis is fast becoming an important tool. There remains a strong need for health-related quality-of-life instruments that can truly reflect the benefit of cochlear implantation, in which utility estimates are fundamentally important. The SF-36 scores, when converted to SF-6D, do not correlate well with HUI-3 scores in a cohort of adult cochlear implant recipients. The HUI-3 remains the most appropriate tool for this patient group. LEVEL OF EVIDENCE: 4

12 Article Standards of practice in the field of hearing implants. 2013

Van de Heyning, P / Adunka, O / Arauz, S L / Atlas, M / Baumgartner, W-D / Brill, S / Bruce, I / Buchman, C / Caversaccio, M / Dillon, M / Eikelboom, R / Eskilsson, G / Gavilan, J / Godey, B / Green, K / Gstoettner, W / Hagen, R / Han, D / Iwasaki, S / Kameswaran, M / Karltorp, E / Kleine Punte, A / Kompis, M / Kuthubutheen, J / Kuzovkov, V / Lassaletta, L / Li, Y / Lorens, A / Manikoth, M / Martin, J / Mlynski, R / Mueller, J / O'Driscoll, M / Parnes, L / Pillsbury, H / Prentiss, S / Pulibalathingal, S / Raine, C H / Rajan, G / Rajeswaran, R / Riechelmann, H / Rivas, A / Rivas, J A / Senn, P / Skarzynski, P H / Sprinzl, G / Staecker, H / Stephan, K / Sugarova, S / Usami, S-I / Wolf-Magele, A / Yanov, Y / Zernotti, M E / Zimmerman, K / Zorowka, P / Skarzynski, H. ·Antwerp University Hospital, University Department of Otorhinolaryngology, Wilrijkstraat 10, BE-2650 Antwerp, Belgium. Paul.van.de.heyning@uza.be ·Cochlear Implants Int · Pubmed #23764325.

ABSTRACT: -- No abstract --

13 Article Hearing preservation after cochlear reimplantation. 2013

Helbig, Silke / Rajan, Gunesh P / Stöver, Timo / Lockley, Morag / Kuthubutheen, Jafri / Green, Kevin M. ·Department of Otorhinolaryngology, Goethe University, Frankfurt, Germany. silke.helbig@kgu.de ·Otol Neurotol · Pubmed #23202149.

ABSTRACT: OBJECTIVE: The combination of electrical and acoustical hearing (EAS) is the aim of successful hearing preservation in patients with low-frequency residual hearing who receive a cochlear implant. With adequate surgical treatment and electrode arrays designed for hearing preservation, partial hearing preservation can nowadays be achieved in the majority of patients. Over recent years, the number of patients with EAS has increased, and device failures within this group are a problem that will need to be addressed. It remains unclear how reliably hearing can be preserved during revision surgery. The outcome of 3 subjects requiring cochlear reimplantation after surgery for hearing preservation is presented and discussed. Our aim was to investigate the influence of electrode reinsertion on hearing preservation. PATIENTS: Three patients with measurable residual hearing were implanted with a flexible, free-fitting electrode array in 3 different centers. INTERVENTIONS: Two subjects received a 31.5-mm array inserted 24 mm into the cochlea, whereas a third was treated with a 24-mm array, which was inserted 21 mm into the cochlea. In all cases, hearing was preserved at the initial operation. All of these subjects subsequently represented with device problems, and reimplantation was performed. MAIN OUTCOME MEASURES: Hearing preservation was measured using preoperative and postoperative pure tone audiograms. In addition, speech perception with the implant was evaluated before and after reimplantation surgery. RESULTS: Reimplantation was feasible in all subjects also in cases where a slightly deeper reinsertion was performed. Speech understanding scores after reimplantation were comparable to those seen after the first intervention. CONCLUSION: Revision surgery in patients with preserved hearing after cochlear implantation does not necessarily lead to loss of natural residual hearing, and patients can continue to benefit from the combination of electric and acoustic hearing. Even deeper insertion is possible without hearing loss within residual frequencies.

14 Article The effects of insertion speed on inner ear function during cochlear implantation: a comparison study. 2013

Rajan, Gunesh P / Kontorinis, Georgios / Kuthubutheen, Jafri. ·Otolaryngology, Head and Neck Surgery, School of Surgery, University of Western Australia, Perth, W.A., Australia. Gunesh.Rajan@health.wa.gov.au ·Audiol Neurootol · Pubmed #23006502.

ABSTRACT: OBJECTIVE: To investigate the insertion speed and its impact on electrode insertion characteristics, hearing preservation and clinical vestibular function in a prospective cohort study with a retrospective control group at a tertiary otology/neurotology centre. INTERVENTIONS: Hearing-preserving cochlear implantation using systemic and topical steroids in conjunction with a round-window approach, a complete cochlear coverage electrode and two different electrode insertion speeds [60 mm/min (n = 18) vs. 15 mm/min (n = 22)] was performed. RESULTS: The insertion speed had a significant impact on various insertion characteristics as well as hearing preservation and vestibular function. In conclusion, a slow electrode insertion speed appears to facilitate full electrode insertion, reduce the occurrence of insertion resistance as well as promote preservation of residual hearing and vestibular function after cochlear implantation.

15 Article Hearing preservation and hearing improvement after reimplantation of pediatric and adult patients with partial deafness: a retrospective case series review. 2012

Jayawardena, Janitha / Kuthubutheen, Jafri / Rajan, Gunesh. ·Division of Otolaryngology, Head and Neck Surgery, School of Surgery, University of Western Australia, Perth, Australia. janithami6@gmail.com ·Otol Neurotol · Pubmed #22699985.

ABSTRACT: OBJECTIVE: To report and review the clinical experiences of patients who required reimplantation from an ongoing trial of patients with partial deafness who were treated with electroacoustic stimulation (EAS) cochlear implantation. STUDY DESIGN: Retrospective case series review. SETTING: Tertiary referral center. PATIENTS: Two patients with partial deafness, 1 child and 1 adult, who required reimplantation because of device failure occurring 12 to 18 months after hearing preservation cochlear implantation with a Med-El Sonata Flex-EAS electrode array. INTERVENTION: Reimplantation (with full insertion) of a Med-El Sonata Flex-EAS array (child) and the new complete cochlear coverage Med-El Sonata Flex-28 electrode array (adult). Surgical techniques used include round window insertion with slow insertion speed and the use of preoperative systemic steroids and preoperative, perioperative, and postimplantation intratympanic steroids. MAIN OUTCOME MEASURE: Preservation of residual hearing. RESULTS: Both patients had complete preservation of residual hearing after reimplantation. The adult patient had stable improvement in hearing from 750 to 2,000 Hz of 5 to 10 dB. Both patients reported increased benefit after reimplantation. CONCLUSION: We report a case series of successful pediatric and adult EAS reimplantation, in the adult hearing improvement after reimplantation with a deep insertion electrode was observed. Reimplantation with preservation of residual hearing in patients with EAS is possible with current surgical hearing preserving techniques and atraumatic electrode arrays of variable length.

16 Article Impact of floating mass transducer coupling and positioning in round window vibroplasty. 2011

Rajan, Gunesh P / Lampacher, Peter / Ambett, Ranjeeta / Dittrich, Gregor / Kuthubutheen, Jafri / Wood, Bradley / McArthur, Anne / Marino, Roberta. ·Otolaryngology, Head & Neck Surgery Unit, School of Surgery, University of Western Australia, Australia. Gunesh.Rajan@health.wa.gov.au ·Otol Neurotol · Pubmed #21206391.

ABSTRACT: OBJECTIVE: The round window application of the Vibrant Sound bridge, the so-called round window vibroplasty, is gaining increasing popularity for hearing rehabilitation of patients with mixed hearing loss or conductive hearing loss. In these patients, conventional hearing amplification and/or surgical restoration is either not possible or has failed because of chronic ear disease, extensive otosclerosis, or malformations. The exact mechanisms of direct cochlear stimulation via the round window membrane are not yet completely understood. It is unclear what kind and what degree of contact is required between the floating mass transducer (FMT) and the round window membrane (RWM) to elicit a functional hearing perception with the implant. We investigated the coupling efficiency between the FMT and the RWM and how the efficiency is altered by the FMT position, the degree of FMT-RWM contact, and the use of a soft tissue coupler. STUDY DESIGN: Prospective cohort study. SETTING: Tertiary referral center in Western Australia. PATIENTS: Patients undergoing round window vibroplasty for a mixed or conductive hearing loss otherwise not aidable. INTERVENTION: Patients underwent round window vibroplasty and received audiological and coupling analysis in the follow-up. These data were then correlated with FMT positioning and the extent of FMT-RWM interface as determined by postoperative high-resolution temporal bone computed tomography. MAIN OUTCOME MEASURES: Coupling and hearing levels in relation to FMT positioning and degree of FMT-RWM contact. RESULTS: Of 10 patients, 8 were available for vibroplasty behavioral threshold testing. In 2 patients, testing could not be done because of wound breakdown requiring device explantation in 1 case, and in the other case, the bone conduction thresholds dropped 2 months after implantation, thus falling out of the performance range of the device. Postoperative FMT migration occurred in 50% of the patients (3/6) with recurrent chronic ear disease and status after multiple previous ear operations. All patients, including the 3 patients requiring surgical repositioning of the FMT, attained significantly improved speech in quiet and speech in noise when compared with the preoperatively best aided performance. All patients showed significantly improved average Abbreviated Profile of Hearing Benefit scores with the use of the FMT. Direct (partial or complete) contact with the RWM resulted in good coupling efficiency; soft tissue coupling resulted in a reduced coupling efficiency.

17 Minor Comment on the Paper by Weder et al. Entitled 'Benefit of a Contralateral Routing of Signal Device for Unilateral Cochlear Implant Users. 2015

Kuthubutheen, Jafri / Lin, Vincent / Chen, Joseph. · ·Audiol Neurootol · Pubmed #26329636.

ABSTRACT: -- No abstract --