RESUMEN
OBJECTIVE: Semi-structured interviews were conducted with sequentially implanted bilateral cochlear-implant (biCI) recipients to examine functional aspects of communication that are affected by listening with one versus two CIs. DESIGN: Participants were 15 adult biCI recipients and parents of 30 children (categorized into three groups by age) with biCIs. All CI users had sequential placement of biCIs with at least six months' experience with the first CI before activation of the second device, and at least three months' experience with both CIs prior to the interview. The parent/paediatric and adult interviews were all conducted by the same examiner. Electronic transcripts of the interview responses were coded for perceived changes or lack thereof in 23 behaviours following biCI. Extent of reported benefit was quantified for each subject within and across these behaviours and at the group level as a function of age. RESULTS: Most adults and parents of children reported multiple functional changes following biCI use, and changes often translated to enhanced social communication. Nearly all participants were consistent users of biCIs, and were satisfied with their perceived gains in communicating in everyday settings. Most reported ongoing challenges listening in noisy settings. Although many reports on children paralleled those of adults, developmental differences were apparent. Thirteen percent of adults and twenty percent of parents of children in each of the respective groups reported low levels of change. CONCLUSIONS: Results suggest that many biCI users experience meaningful functional benefits that may be underestimated by traditional outcome measures. We suggest the need to expand measurement approaches to better quantify the nature of these benefits.
Asunto(s)
Percepción Auditiva , Implantación Coclear/psicología , Implantes Cocleares , Pérdida Auditiva Bilateral/psicología , Medición de Resultados Informados por el Paciente , Adulto , Anciano , Niño , Preescolar , Implantación Coclear/métodos , Femenino , Pérdida Auditiva Bilateral/cirugía , Humanos , Masculino , Persona de Mediana Edad , Padres , Periodo Posoperatorio , Resultado del TratamientoRESUMEN
OBJECTIVE: Objectives were as follows: 1) to evaluate the incidence of abnormal cochlear implant electrode impedance intraoperatively and at the initial activation, 2) to identify the percentage of abnormalities that resolve by the initial activation, and 3) to determine the incidence of normal intraoperative impedances that present as abnormal at the initial activation. STUDY DESIGN: Retrospective records review of intraoperative and postoperative cochlear implant electrode impedances. SETTING: Tertiary referral center. PATIENTS: Records were examined for 194 devices implanted in 165 pediatric and adult patients. RESULTS: Results indicate at least 1 open (OC) or short circuit (SC) in 12.4% (24/194) of devices intraoperatively, decreasing to 8.2% (16/194) postoperatively. OCs were more prevalent than SCs for intraoperative (92% versus 8%) and postoperative (94% versus 6%) intervals. Of the 3,430 total electrodes, 78 had abnormal impedance intraoperatively. Sixty-four of those (82%) resolved by the postoperative interval (62 OC, 2 SC), whereas 18% (14/78) remained abnormal postoperatively (12 OC, 2 SC). Six (0.17%) of 3,430 electrodes had normal impedance intraoperatively but were abnormal postoperatively. CONCLUSION: The incidence of SCs in the present study is likely underestimated because of poor sensitivity of monopolar coupling for detecting SCs. Intraoperative OCs have a high probability of resolving by the initial activation, particularly when contiguous electrodes are affected and suggests limited need for the use of a backup device in these cases. Surgical technique and/or complications, such as explant/reimplant or perilymphatic gushers, may result in increased incidence of bubbles in the cochlea and may play a role in abnormal intraoperative impedance results.
Asunto(s)
Implantación Coclear/métodos , Implantes Cocleares , Monitoreo Intraoperatorio/métodos , Potenciales de Acción/fisiología , Adolescente , Adulto , Niño , Preescolar , Implantación Coclear/economía , Implantes Cocleares/economía , Impedancia Eléctrica , Electrodos , Falla de Equipo , Humanos , Lactante , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Resultado del Tratamiento , Adulto JovenRESUMEN
Under the Health Information Technology for Economic and Clinical Health (HITECH) Act, passed as a part of the American Recovery and Reinvestment Act of 2009, the US Congress implemented new regulations to encourage the adoption of electronic health records (EHRs). The federal government will expend up to $27 billion in incentive payments to physicians and hospitals to increase adoption and implement "meaningful use" of EHRs. Otolaryngologists may receive as much as $44,000 under Medicare or $63,750 under Medicaid as part of this law. In July 2010, the US Department of Health and Human Services announced final rules to support "meaningful use." This commentary discusses recommendations from the American Academy of Otolaryngology--Head and Neck Surgery Medical Informatics Committee for implementing "meaningful use" of EHRs to improve safety, quality, and efficiency of patient care and receiving incentive payments as defined by these new regulations.
Asunto(s)
Registros Electrónicos de Salud/estadística & datos numéricos , Informática Médica/organización & administración , Otolaringología/estadística & datos numéricos , Guías de Práctica Clínica como Asunto , Sociedades Médicas , Humanos , Estados UnidosRESUMEN
OBJECTIVES/HYPOTHESIS: Although the overall incidence of perilymphatic gushers is approximately 1%, patients with inner ear anomalies are at an increased risk for development of perilymphatic gushers. As cochlear implantation becomes more common in patients with inner ear anomalies (e.g., Mondini defect or common cavity defect), the ability to successfully seal such leaks becomes of paramount importance to reduce the risk of subsequent meningitis. METHODS: A 1.0-mm and a 1.5-mm cochleostomy were placed superior to the round window in two respective temporal bones. Cochlear implant electrodes (Cochlear [Lane Cove NSW, Australia], Med-El [Insbruck, Austria] and Advanced Bionics [Valencia, CA]) were placed in the cochleostomy and sealed with porcine periosteum. A fixed amount of pressure was applied to the inner ear, and the presence or absence of a leak was recorded for 10 different packings of each cochleostomy diameter at 0, 10, 15, 20, and 30 cm H(2)O. RESULTS: For the Cochlear, Med-El, and Advanced Bionics electrode, no statistically significant difference was noted between the 1.0-mm and the 1.5-mm cochleostomy at 0, 10, 15, and 20 cm H(2)O. At 30 cm H(2)O, no leaks were noted with the 1.5-mm cochleostomy for any brand. For the 1.0-mm cochleostomy at 30 cm H(2)O, 6/10 of the Cochlear trials leaked (P = .004), 2/10 of the Med-El trials leaked (P = .24), and 5/10 of the Advanced Bionics trials leaked (P = .03). CONCLUSIONS: The 1.5-mm cochleostomies are associated with a decreased risk of perilymphatic fistula as compared to 1.0-mm cochleostomies at 30 cm H(2)O; this likely represents a phenomenon of packing adequacy.
Asunto(s)
Cóclea/cirugía , Implantación Coclear/métodos , Perilinfa , Implantación Coclear/efectos adversos , Implantes Cocleares , Fístula/etiología , Fístula/prevención & control , Humanos , Enfermedades del Laberinto/etiología , Enfermedades del Laberinto/prevención & controlRESUMEN
Chronic rhinosinusitis (CRS) is characterized by mucosal inflammation affecting both the nasal cavity and paranasal sinuses; its causes are potentially numerous, disparate, and frequently overlapping. The more common conditions that are associated with CRS are perennial allergic and nonallergic rhinitis, nasal polyps, and anatomical mechanical obstruction (septum/turbinate issues). Other less common etiologies include inflammation (eg, from superantigens), fungal sinusitis or bacterial sinusitis with or without associated biofilm formation, gastroesophageal reflux, smoke and other environmental exposures, immune deficiencies, genetics, and aspirin-exacerbated respiratory disease. A diagnosis of CRS is strongly suggested by a history of symptoms (eg, congestion and/or fullness; nasal obstruction, blockage, discharge, and/or purulence; discolored postnasal discharge; hyposmia/anosmia; facial pain and/or pressure) and their duration for > 3 months. A definitive diagnosis requires physical evidence of mucosal swelling or discharge appreciated during physical examination coupled with CT imaging if inflammation does not involve the middle meatus or ethmoid bulla. Multivariant causation makes the diagnosis of CRS and selection of treatment complex. Furthermore, various types of health care providers including ear, nose, and throat (ENT) specialists, allergists, primary care physicians, and pulmonologists treat CRS, and each is likely to have a different approach. A structured approach to the diagnosis and management of CRS can help streamline and standardize care no matter where patients present for evaluation and treatment. A 2008 Working Group on CRS in Adults, supported by the American Academy of Otolaryngic Allergy (AAOA), developed a series of algorithms for the differential diagnosis and treatment of CRS in adults, based on the evolving understanding of CRS as an inflammatory disease. The algorithms presented in this paper address an approach for all CRS patients as well as approaches for those with nasal polyps, edema observed on nasal endoscopy, purulence observed on nasal endoscopy, an abnormal history and physical examination, and an abnormal history and normal physical examination.
Asunto(s)
Rinitis/diagnóstico , Rinitis/terapia , Sinusitis/diagnóstico , Sinusitis/terapia , Adulto , Algoritmos , Enfermedad Crónica , Humanos , Rinitis/etiología , Sinusitis/etiologíaRESUMEN
OBJECTIVES/HYPOTHESIS: The goal of this study is to retrospectively compare the long-term, 10 year, outcomes of surgical versus medical management of young children with chronic rhinosinusitis. STUDY DESIGN: This is a retrospective, age-matched, cohort outcome study performed at a tertiary-care hospital. METHODS: Two groups of young children (2-5 yr old) with chronic rhinosinusitis were treated with endoscopic sinus surgery or medically managed and evaluated 10 years after their initial therapy. Of the 131 eligible patients, 67 could be located and consented to participate in the study. Six symptoms (day cough, night cough, irritability or crankiness, headaches, nasal airway obstruction, and purulent rhinorrhea) were used to assess the outcome of their treatment. RESULTS: Children undergoing endoscopic sinus surgery had more significant disease as noted on the computed tomography (CT) scans. Their symptom severity, however, was similar. When individual symptoms were compared, there were no statistically significant differences between the surgically and medically managed groups. When the mean was controlled for baseline symptom severity and CT severity, there was statistical improvement in nasal airway obstruction and decreased rhinorrhea. There was a trend toward improvement in cough, but this was not statistically significant. Parenteral assessment of improvement (change) in symptoms (P = .001) and their degree of satisfaction with treatment (P = .005) was significantly higher in the surgically managed group. CONCLUSIONS: Children who have chronic rhinosinusitis improve in their symptoms of nasal airway obstruction and purulent discharge if they undergo surgery. Parents of young children with chronic rhinosinusitis appear to be more satisfied with the outcome of surgical management than medical management when assessed 10 years later.
Asunto(s)
Rinitis/cirugía , Sinusitis/cirugía , Preescolar , Enfermedad Crónica , Femenino , Estudios de Seguimiento , Humanos , Lactante , Masculino , Estudios Retrospectivos , Rinitis/diagnóstico por imagen , Índice de Severidad de la Enfermedad , Sinusitis/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
Rhinosinusitis and asthma are common conditions associated with significant morbidity and health care costs. Recent studies in adults have suggested that rhinosinusitis and asthma may be manifestations of an inflammatory process within a continuous airway rather than fully separate diseases that only act locally; and, in fact, the presence of upper airway disease may influence lower airway disease. Controlling upper airway infection, inflammation, and symptoms may improve signs and symptoms of asthma. Pediatric studies regarding this matter are few, but the impact of rhinosinusitis and asthma is still immense and significant in children. This article discusses several pediatric studies regarding medical or surgical management of sinusitis and asthma outcome. These studies show that aggressive treatment of sinusitis when present can significantly improve asthma symptoms and quality of life in children, indicating that sinusitis may play an important role in initiating or exacerbating asthma. These findings have important implications for the physician treating a child with chronic asthma.
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Asma/complicaciones , Asma/terapia , Rinitis/complicaciones , Rinitis/terapia , Sinusitis/complicaciones , Sinusitis/terapia , Corticoesteroides/uso terapéutico , Antibacterianos/uso terapéutico , Niño , Enfermedad Crónica , Endoscopía , Humanos , Descongestionantes Nasales/uso terapéutico , Rinitis/fisiopatología , Sinusitis/fisiopatologíaRESUMEN
OBJECTIVE: We sought to assess the clinical status of pediatric sinusitis patients after a minimum of 2 years follow-up and to evaluate relative treatment effectiveness. Study design We conducted a medical record review of 308 patients, with a 2-year follow-up questionnaire. RESULTS: Overall, 55% of children were "much improved." A 4-stage prognostic system was developed and used to compare results in 133 patients who had not responded to medical treatment and who had positive sinus computed tomography scans. Endoscopic sinus surgery (ESS) had no apparent advantages in stages I and IV, but in stages II and III, rates of "much improved" for ESS versus medical therapy were 79% versus 54% and 68% versus 42%, respectively. CONCLUSION: These results suggest that ESS may be particularly effective for patients from intermediate prognostic stages. SIGNIFICANCE: This type of prognostic staging and evaluation of treatment effectiveness is necessary and important in chronic sinusitis, where randomized trials are unlikely to be performed.
Asunto(s)
Sinusitis/diagnóstico , Sinusitis/cirugía , Preescolar , Enfermedad Crónica , Endoscopía/métodos , Femenino , Estudios de Seguimiento , Humanos , Masculino , Registros Médicos , Pronóstico , Recurrencia , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
OBJECTIVES: To evaluate and report the outcome of costal cartilage tracheoplasty for the treatment of congenital long-segment tracheal stenosis. DESIGN: Retrospective chart review. SETTING: Academic tertiary care children's hospital. PATIENTS: Consecutive series of 10 patients who presented with congenital long-segment tracheal stenosis. INTERVENTION: All patients underwent costal cartilage tracheoplasty while receiving cardiopulmonary bypass. MEASUREMENTS: Age at repair, weight at repair, length of stenosis, minimal diameter of stenosis, postoperative days receiving ventilator support, postoperative days until discharge, postoperative bronchoscopies, postoperative complications, associated anomalies, survival rate, and current status. RESULTS: There were 8 males and 2 females with an average age at repair of 18 weeks. Average weight was 5.2 kg. Average length of stenosis was 3.2 cm, and average minimal diameter was 1.9 mm. Average postoperative days receiving ventilator support was 17 with a median of 9.5. Average postoperative days until discharge was 35.2 with a median of 17. Average postoperative bronchoscopies was 18 with a median of 4.5. There was a 40% major postoperative complication rate. Seven of the patients had associated anomalies. No patient died from an inadequate tracheal airway, though 2 patients ultimately died from other cardiopulmonary complications for a survival rate of 80%. Average time since surgery for survivors is 8.0 years. Two patients still require treatment. Seven of the original 10 patients are fully active without tracheostomy. CONCLUSION: We report one of the largest series of costal cartilage tracheoplasty for congenital long-segment tracheal stenosis and one that has met with a relatively high success rate.
Asunto(s)
Cartílago/cirugía , Evaluación de Resultado en la Atención de Salud , Tráquea/cirugía , Estenosis Traqueal/congénito , Estenosis Traqueal/cirugía , Peso Corporal , Puente Cardiopulmonar , Cartílago/patología , Femenino , Humanos , Lactante , Recién Nacido , Tiempo de Internación , Masculino , Estudios Retrospectivos , Tasa de Supervivencia , Tráquea/patología , Estenosis Traqueal/mortalidadRESUMEN
The presence of coagulation pathology in children who are candidates for adenotonsillectomy (AT) is a challenge to the otolaryngologist. von Willebrand's disease (vWD) is the most common hereditary coagulopathy and is due to a quantitative and/or qualitative deficiency of von Willebrand's factor (vWF). In recent years, the administration of 1-deamino-8-D-arginine vasopressin (DDAVP) has been recommended as coadjuvant therapy for surgical procedure. This synthetic hormone promotes the release of vWF and factor VIII from endothelial cells. In this report, the authors describe the history of a child with vWD undergoing successful AT after administration of DDAVP. Furthermore, a review of the literature with particular emphasis on the use of DDAVP is made.
Asunto(s)
Adenoidectomía , Tonsilectomía , Enfermedades de von Willebrand/complicaciones , Pérdida de Sangre Quirúrgica/prevención & control , Quimioterapia Adyuvante , Preescolar , Desamino Arginina Vasopresina/uso terapéutico , Hemostáticos/uso terapéutico , Humanos , Masculino , Hemorragia Posoperatoria/prevención & control , Factores de Tiempo , Enfermedades de von Willebrand/tratamiento farmacológicoRESUMEN
OBJECTIVE: To explore the anomalies of the temporal bone found on radiologic examination, technical challenges in cochlear implantation, and audiologic benefit derived from cochlear implantation in a series of children with CHARGE association. DESIGN: Case series report. SETTING: Tertiary referral children's hospital pediatric cochlear implant program. PATIENTS: Six children with CHARGE association and sensorineural hearing loss. INTERVENTION: All patients were evaluated and followed up by the cochlear implant team. Cochlear implantation was attempted in all 6 children. MAIN OUTCOME MEASURES: Computed tomographic scans and cochlear implantation operative records were reviewed, and their findings were correlated. Audiometric and speech perception data before and after cochlear implantation were compared. RESULTS: Five children with CHARGE association received implants. A sixth child did not because of an aberrant course to the facial nerve. The 5 children receiving implants obtained varying degrees of measurable benefit from their implants. All 6 children had temporal bone abnormalities seen on their computed tomographic scans and documented at the time of surgery. CONCLUSIONS: Variations in the temporal bone anatomy of patients with CHARGE association can lead to increased technical challenges and risk to the facial nerve during cochlear implantation. Individual outcomes after implantation may vary; our patients receiving implants obtained benefit. Parents should be counseled thoroughly and have appropriate expectations before proceeding with implantation.
Asunto(s)
Anomalías Múltiples/cirugía , Implantación Coclear , Pérdida Auditiva Sensorineural/congénito , Pérdida Auditiva Sensorineural/cirugía , Evaluación de Resultado en la Atención de Salud , Hueso Temporal/anomalías , Hueso Temporal/cirugía , Anomalías Múltiples/diagnóstico por imagen , Audiometría , Niño , Preescolar , Estudios de Factibilidad , Femenino , Estudios de Seguimiento , Pérdida Auditiva Sensorineural/diagnóstico por imagen , Humanos , Lactante , Masculino , Síndrome , Hueso Temporal/diagnóstico por imagen , Factores de Tiempo , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVE: We sought to determine whether functional endoscopic sinus (FES) surgery performed in children with chronic rhinosinusitis alters facial growth. STUDY DESIGN AND SETTING: This was a retrospective age-matched cohort outcome study performed at a tertiary care hospital. RESULTS: Sixty-seven children participated. There were 46 boys and 21 girls, and the mean age was 3.1 years at presentation and 13.2 years at follow-up. There were 46 children who underwent FES surgery and 21 children who did not undergo FES surgery. Quantitative anthropomorphic analysis was performed using 12 standard facial measurements. A facial plastic expert performed qualitative facial analysis. Both quantitative and qualitative analyses showed no statistical significance in facial growth between children who underwent FES surgery and those who did not undergo FES surgery. CONCLUSIONS: In this study, there was no evidence that FES surgery affected facial growth. SIGNIFICANCE: These results will aid physicians when discussing with parents the risks of FES surgery.