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Functional Hearing Preservation in Cochlear Implantation: The Miami Cocktail Effect.
Angeli, Simon Ignacio; Brown, C Scott; Holcomb, Meredith A; Velandia, Sandra L; Eshraghi, Adrien A; Chiossone-Kerdel, Juan Armando; Hoffer, Michael E; Sanchez, Chrisanda; Telischi, Fred F.
Afiliación
  • Brown CS; Atlanta Institute for ENT, Atlanta, Georgia.
  • Holcomb MA; Department of Otolaryngology-Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, Florida.
  • Velandia SL; Department of Otolaryngology-Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, Florida.
  • Eshraghi AA; Department of Otolaryngology-Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, Florida.
  • Chiossone-Kerdel JA; Department of Otolaryngology-Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, Florida.
  • Sanchez C; Department of Otolaryngology-Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, Florida.
  • Telischi FF; Department of Otolaryngology-Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, Florida.
Otol Neurotol ; 45(4): 376-385, 2024 Apr 01.
Article en En | MEDLINE | ID: mdl-38361325
ABSTRACT

OBJECTIVE:

To investigate if pharmacological treatment with prednisone and L-N-acetylcysteine (STE + NAC) influence functional hearing preservation in cochlear implant (CI) surgery. STUDY DESIGNS Preimplantation and postimplantation longitudinal case-control study.

SETTING:

Tertiary referral center. PATIENTS Pediatric and adult recipients of CI with preimplantation functional hearing defined as an average of air-conducted thresholds at 125, 250, and 500 Hz (low-frequency pure-tone average [LFPTA]) <80 dB.

INTERVENTIONS:

Preimplantation and postimplantation audiometry. Weight-adjusted oral prednisone and L-N-acetylcysteine starting 2 days before surgery (Miami cocktail). Prednisone was continued for 3 days and L-N-acetylcysteine for 12 days after surgery, respectively. Cochlear implantation with conventional length electrodes. MAIN OUTCOME

MEASURES:

Proportion of patients with LFPTA <80 dB, and LFPTA change at 1-year postimplantation.

RESULTS:

All 61 patients received intratympanic and intravenous dexamethasone intraoperatively, with 41 patients receiving STE + NAC and 20 patients not receiving STE + NAC. At 1-year postimplantation, the proportion of functional hearing preservation was 83% in the STE + NAC group compared with 55% of subjects who did not receive STE + NAC ( p = 0.0302). The median LFPTA change for STE + NAC-treated and not treated subjects was 8.33 dB (mean, 13.82 ± 17.4 dB) and 18.34 dB (mean, 26.5 ± 23.4 dB), respectively ( p = 0.0401, Wilcoxon rank test). Perioperative STE + NAC treatment resulted in 10 dB of LFPTA better hearing than when not receiving this treatment. Better low-frequency preimplantation hearing thresholds were predictive of postimplantation functional hearing. No serious side effects were reported.

CONCLUSION:

Perioperative STE + NAC, "The Miami Cocktail," was safe and superior to intraoperative steroids alone in functional hearing preservation 1-year after cochlear implantation.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Implantes Cocleares / Implantación Coclear Tipo de estudio: Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Adult / Child / Humans Idioma: En Revista: Otol Neurotol Asunto de la revista: NEUROLOGIA / OTORRINOLARINGOLOGIA Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Implantes Cocleares / Implantación Coclear Tipo de estudio: Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Adult / Child / Humans Idioma: En Revista: Otol Neurotol Asunto de la revista: NEUROLOGIA / OTORRINOLARINGOLOGIA Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos