RESUMEN
OBJECTIVES/HYPOTHESIS: Cochlear implantation is an established method of auditory rehabilitation for severely and profoundly hearing impaired individuals. Although numerous studies have examined communication outcomes in pediatric cochlear implant (CI) recipients, data concerning the benefits of cochlear implantation in children who speak Mandarin Chinese are lacking. This study examined communication outcomes in 29 Mandarin-speaking children implanted at Chung Gung Memorial Hospital. DESIGN: A prospective between-groups design was used to compare communication outcomes as a function of age at time of implantation. METHODS: Children in the Younger group were implanted before 3 years of age, whereas children in the Older group were implanted after 3 years of age. Outcome measures assessed auditory thresholds, speech perception, speech intelligibility, receptive and expressive language skills, communication barriers, and communication mode. Correlation analysis was used to examine the relationship between communication outcome and age at implantation. RESULTS: Children in the Younger group demonstrated a significant level of difference on Mandarin vowels, consonants, tones, and open-set speech perception compared with the children in the Older group. Between-group differences were also shown on receptive and expressive language skills. But, no significant differences were noted on speech intelligibility or in self-ratings of communication barriers. A larger proportion of children in the Younger group used oral communication and were educated in mainstream classrooms. Communication mode change of the Younger group reached a significant level after cochlear implant. Speech perception performance was negatively correlated with age at implantation as well as chronological age. Mandarin-speaking children can obtain substantial communication benefits from cochlear implantation, with earlier implantation yielding superior results.
Asunto(s)
Implantación Coclear/estadística & datos numéricos , Trastornos de la Comunicación/diagnóstico , Trastornos de la Comunicación/epidemiología , Sordera/epidemiología , Sordera/cirugía , Adolescente , Umbral Auditivo/fisiología , Niño , Preescolar , Trastornos de la Comunicación/terapia , Métodos de Comunicación Total , Sordera/diagnóstico , Educación Especial/estadística & datos numéricos , Femenino , Humanos , Integración Escolar/estadística & datos numéricos , Masculino , Inteligibilidad del Habla , Percepción del Habla/fisiología , Medición de la Producción del Habla , Taiwán/epidemiología , Resultado del TratamientoRESUMEN
The foregoing discussion has attempted to substantiate and clarify the six propositions outlined at the outset in light of the author's personal experience. In sum, the following points are emphasized: Employment of ESS for treatment of intractable Meniere's disease in cases where the sac is definitively delineated, the real sac lumen entered, the sac's integrity preserved, and sac enlargement technique is employed has an approximate 90% chance of achieving complete or substantial control of vertigo in the short run (2-3 years). Although there seems to be little likelihood of pushing the short-term rate of vertigo control obtainable with ESS significantly beyond the 90% mark, there is still room for improvement of longer-term control of Meniere's disease symptoms, either through modification of surgical procedure or, as the author recommends, through treatment at an early stage of the disease. The efficacy of ESS almost certainly has a definite, although presently ill-understood, pathophysiologic basis and cannot be purely attributable to a placebo effect. Regardless of limitations and uncertainties surrounding Meniere's disease and treatment of it, ESS is indisputably both safe and highly effective and, in the author's opinion, continues to be the preferred treatment for medically refractory Meniere's symptom-complex.
Asunto(s)
Saco Endolinfático/cirugía , Enfermedad de Meniere/cirugía , Audiometría de Respuesta Evocada , Enfermedad Crónica , Interpretación Estadística de Datos , Saco Endolinfático/fisiopatología , Estudios de Seguimiento , Audición , Humanos , Enfermedad de Meniere/fisiopatología , Monitoreo Intraoperatorio , Otitis Media/cirugía , Placebos , Pronóstico , Prótesis e Implantes , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Timpanoplastia , VértigoRESUMEN
OBJECTIVE: To determine whether intraoperative topical application of the drug mitomycin C to the endolymphatic sac area in conjunction with endolymphatic sac ballooning surgery (ESBS) can safely achieve longer-lasting relief from incapacitating, medically intractable Meniere symptom-complex than ESBS alone. STUDY DESIGN/METHOD: A retrospective study is presented of 142 cases of ESBS performed by the author between May 1998 and November 1999, in which a solution of mitomycin C diluted to 1 mg/mL of physiological saline was applied to the sac area for 5 minutes followed by irrigation with a cephalosporin antibiotic solution. The results of the 103 of 142 cases diagnosed as classic Meniere's disease or endolymphatic hydrops are given special attention, comparing them with the results of an earlier-reported series of 109 cases of ESBS sharing the same diagnostic and result evaluation criteria but not using mitomycin C. RESULTS: In terms of vertigo control, the comparative short-term rates (<3 y) of complete/substantial control for the aforementioned 103-case series and earlier 109-case series are similar: respectively, 90.3% (after 1.5--3 years' follow-up) versus 91.7% (after 2.5-3 years' follow-up). In the 103-case series, to date, there has been no recurrence of incapacitating vertiginous symptoms necessitating revision surgery, whereas in the 109-case series, although there were likewise no cases necessitating revision surgery during the reported 2.5-to 3-year follow-up period, at least 8 patients in that series are known to have undergone revision surgery at later dates. Hearing results were significantly better (P =.004) in the 103-case series than the 109-case series: respectively, 30.0% versus 12.8% hearing improvement. CONCLUSIONS: Preliminarily, the superior hearing results in the present series indicate that possible adverse effects of mitomycin C on the inner ear and endolymphatic system have been averted; and no recurrence of incapacitating symptoms to date offers hope that longer-term efficacy of endolymphatic sac surgery using mitomycin C can be maintained.