RESUMEN
OBJECTIVE: To review the clinical features, radiographic findings, and programming strategies used in our population of patients who developed facial nerve stimulation after cochlear implantation. STUDY DESIGN AND SETTING: Patients referred to our nonprofit, outpatient facility were studied prospectively. PATIENTS: The study consisted of 14 patients with facial nerve stimulation after placement of the Nucleus 22-channel cochlear implant. INTERVENTIONS: Records were reviewed retrospectively, and patients were studied with three-dimensional computed tomographic scanning techniques. Electrical testing was performed, and various cochlear implant programming strategies were evaluated. MAIN OUTCOME MEASURES: Important clinical features were reviewed. The radiographic and anatomical relationships of the facial nerve to the cochlea were evaluated, and the programming strategies used to effectively control facial nerve stimulation were reviewed. RESULTS: Prevalence of facial nerve stimulation in our population was 7%. The most common cause was otosclerosis. Anatomical data confirmed the close proximity of the basal turn of the cochlea and the labyrinthine segment of the facial nerve. There was a high correlation between the electrodes causing symptoms and those found radiographically to be closest to the labyrinthine segment of the facial nerve. We were able to control facial nerve stimulation in all patients through programming mode changes. CONCLUSIONS: Otosclerosis appears to be a risk factor for developing facial nerve stimulation after cochlear implantation, and the site of stimulation appears to be the labyrinthine segment of the facial nerve. Familiarity with more elaborate programming techniques is critical to managing patients with this complication.
Asunto(s)
Implantes Cocleares/efectos adversos , Enfermedades de los Nervios Craneales/etiología , Nervio Facial , Adulto , Anciano , Sordera/rehabilitación , Sordera/cirugía , Nervio Facial/diagnóstico por imagen , Femenino , Humanos , Masculino , Enfermedad de Meniere/complicaciones , Persona de Mediana Edad , Otosclerosis/complicaciones , Estudios Prospectivos , Tomografía Computarizada por Rayos XRESUMEN
The purpose of this study was to compare the audiologic and surgical results of elderly patients receiving cochlear implants with other adult patients, and to evaluate the benefit of cochlear implantation in the geriatric population. Twenty-eight patients, aged 60 to 80 years, who received the Nucleus 22 channel cochlear implant were studied retrospectively. Mean audiologic test scores increased significantly after implantation. Postoperative audiologic test scores of this elderly population are comparable to those of a matched group of younger adult patients. The surgical procedure was well tolerated in all elderly patients, and there were two postoperative complications requiring revision procedures. A questionnaire was used to assess implant use and the impact of cochlear implantation on the quality of life in this elderly population. Average implant use per day was 13.8 hours, and 65% of patients were able to recognize voices over the telephone. More than 80% of patients believed that their quality of life had improved significantly, that their self-confidence had increased, and that their decision regarding implantation was correct. The results of this study indicate that elderly patients with bilateral, profound, sensorineural hearing loss should not be denied consideration for cochlear implantation based on age alone.
Asunto(s)
Implantes Cocleares , Pérdida Auditiva Sensorineural/cirugía , Satisfacción del Paciente , Anciano , Anciano de 80 o más Años , Audiometría de Tonos Puros , Femenino , Humanos , Masculino , Persona de Mediana Edad , Percepción de la Altura Tonal , Complicaciones Posoperatorias , Calidad de Vida , Estudios Retrospectivos , Encuestas y Cuestionarios , Resultado del TratamientoAsunto(s)
Implantes Cocleares , Electrodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Falla de Prótesis , Percepción del HablaRESUMEN
Murine monoclonal antibodies to human cytomegalovirus (CMV) strain AD169 were selected that neutralized virus infectivity. One monoclonal antibody-producing hybridoma, 1G6, was used to produce ascites fluid from which immunoglobulin was isolated. This antibody efficiently neutralized CMV AD169, other laboratory strains (Towne, Davis), and clinical isolates of CMV in early tissue culture passage (less than 10) in the absence of complement. The antibody immunoprecipitated a single 86,000-dalton protein from both laboratory and clinical strains. This viral protein was demonstrated by indirect immunofluorescence to be localized in the cytoplasm of CMV-infected cells.