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Takaki K, Kashio A, Nozaki E, Kanai T, Kamogashira T, Saze F, Uranaka T, Urata S, Koyama H, Kawahara Y, Yamasoba T. A Randomized Crossover Study in Single-Sided Deafness Comparing a Cartilage Conduction CROS System and an Air-Conduction CROS System. Otol Neurotol 2024:00129492-990000000-00549. [PMID: 38769110 DOI: 10.1097/mao.0000000000004199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
OBJECTIVE To investigate if cartilage conduction (CC) rerouting devices are noninferior to air-conduction (AC) rerouting devices for single-sided deafness (SSD) patients by measuring objective and subjective performance using speech-in-noise tests that resemble a realistic hearing environment, sound localization tests, and standardized questionnaires. STUDY DESIGN Prospective, single-subject randomized, crossover study. SETTING Anechoic room inside a university. PATIENTS Nine adults between 21 and 58 years of age with severe or profound unilateral sensorineural hearing loss. INTERVENTIONS Patients' baseline hearing was assessed; they then used both the cartilage conduction contralateral routing of signals device (CC-CROS) and an air-conduction CROS hearing aid (AC-CROS). Patients wore each device for 2 weeks in a randomly assigned order. MAIN OUTCOME MEASURES Three main outcome measures were 1) speech-in-noise tests, measuring speech reception thresholds; 2) proportion of correct sound localization responses; and 3) scores on the questionnaires, "Abbreviated Profile of Hearing Aid Benefit" (APHAB) and "Speech, Spatial, and Qualities of Hearing Scale" with 12 questions (SSQ-12). RESULTS Speech reception threshold improved significantly when noise was ambient, and speech was presented from the front or the poor-ear side with both CC-CROS and AC-CROS. When speech was delivered from the better-ear side, AC-CROS significantly improved performance, whereas CC-CROS had no significant effect. Both devices mainly worsened sound localization, whereas the APHAB and SSQ-12 scores showed benefits. CONCLUSION CC-CROS has noninferior hearing-in-noise performance except when the speech was presented to the better ear under ambient noise. Subjective measures showed that the patients realized the effectiveness of both devices.
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Affiliation(s)
- Ken Takaki
- Department of Electrical Engineering and Information Systems, Graduate School of Engineering, and
| | - Akinori Kashio
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo
| | - Etsushi Nozaki
- Department of Electrical Engineering and Information Systems, Graduate School of Engineering, and
| | - Tomomi Kanai
- Department of Electrical Engineering and Information Systems, Graduate School of Engineering, and
| | - Teru Kamogashira
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo
| | - Fumikazu Saze
- Department of Electrical Engineering and Computer Science, Graduate School of System Design, Tokyo Metropolitan University, Tokyo, Japan
| | - Tsukasa Uranaka
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo
| | - Shinji Urata
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo
| | - Hajime Koyama
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo
| | - Yoshihiro Kawahara
- Department of Electrical Engineering and Information Systems, Graduate School of Engineering, and
| | - Tatsuya Yamasoba
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo
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Costa JR, Costa S, Soares T, Feliciano T, Almeida e Sousa C, Coutinho MB. Skin and soft tissue complications of bone-anchored hearing aids: Introducing a new classification system. ACTA OTORRINOLARINGOLOGICA (ENGLISH EDITION) 2023; 74:85-92. [PMID: 37005042 DOI: 10.1016/j.otoeng.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 01/24/2022] [Indexed: 04/03/2023]
Abstract
OBJECTIVES There have been significant surgical and technological advances in bone-anchored hearing aid (BAHA) design, function, and implantation technique, but peri-implant skin complications remain the most frequent complication. The most important aspect in dealing with cutaneous complications is to identify the type of cutaneous lesion. Although Holger's Classification has been an extremely useful clinical tool, this grading system has been shown to be unsuitable for some cases. We therefore propose a new consistent and easy assessment classification of cutaneous complications associated with BAHA. METHODS A retrospective clinical study was carried out at a tertiary centre, between January 2008 and December 2014. All patients under 18 years old with a unilateral BAHA were included in the study. RESULTS A total of 53 children, with a BAHA, were included in the study. Post-operative skin complications were observed in 49.1% of the patients. Of the children, 28.3% presented with soft tissue hypertrophy, the most frequently reported skin complication, and grading according to the Holger's classification was not considered feasible. To overcome the difficulties we face in clinical practice, a new classification was developed and presented. CONCLUSION The new proposed classification - Coutinho Classification - aims to fill the gaps in the one used currently by introducing new clinical features, most importantly the presence/absence of tissue overgrowth, and by providing a better description of what each category encompasses. This is an inclusive and objective new classification system, maintaining applicability, and useful in guiding the treatment.
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Truong MT, Liu YCC, Kohn J, Chinnadurai S, Zopf DA, Tribble M, Tanner PB, Sie K, Chang KW. Integrated microtia and aural atresia management. Front Surg 2022; 9:944223. [PMID: 36636584 PMCID: PMC9831057 DOI: 10.3389/fsurg.2022.944223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 11/16/2022] [Indexed: 12/27/2022] Open
Abstract
Objectives To present recommendations for the coordinated evaluation and management of the hearing and reconstructive needs of patients with microtia and aural atresia. Methods A national working group of 9 experts on microtia and atresia evaluated a working document on the evaluation and treatment of patients. Treatment options for auricular reconstruction and hearing habilitation were reviewed and integrated into a coordinated care timeline. Results Recommendations were created for children with microtia and atresia, including diagnostic considerations, surgical and non-surgical options for hearing management and auricular reconstruction, and the treatment timeline for each option. These recommendations are based on the collective opinion of the group and are intended for otolaryngologists, audiologists, plastic surgeons, anaplastologists, and any provider caring for a patient with microtia and ear canal atresia. Close communication between atresia/hearing reconstruction surgeon and microtia repair surgeon is strongly recommended.
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Affiliation(s)
- Mai Thy Truong
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, CA
| | - Yi-Chun Carol Liu
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX,Division of Pediatric Otolaryngology, Texas Children's Hospital, Houston, TX
| | - Jocelyn Kohn
- Department of Otolaryngology-Head and Neck Surgery, Stanford Children's Hospital/Packard Children's Health Alliance, Walnut Creek, CA
| | - Sivakumar Chinnadurai
- Children's Minnesota Pediatric Otolaryngology and Facial Plastic Surgery, Minneapolis, MN,Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, MN
| | - David A. Zopf
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Melissa Tribble
- Department of Audiology, Lucile Packard Children's Hospital at Stanford University, Palo Alto, CA
| | - Paul B. Tanner
- Department of Surgery, University of Utah, Facial Prosthetics, Salt Lake City, UT, USA
| | - Kathleen Sie
- Department of Otolaryngology-Head and Neck Surgery, University of Washington/Seattle Children's Hospital, Seattle, WA
| | - Kay W. Chang
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, CA,Correspondence: Kay W. Chang
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Costa JR, Costa S, Soares T, Feliciano T, Almeida e Sousa C, Coutinho MB. Skin and soft tissue complications of bone-anchored hearing aids: Introducing a new classification system. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2022. [DOI: 10.1016/j.otorri.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Gardiner L, Lavallee M, Sima A, Coelho DH. Tobacco Use and Skin Reactivity in Patients With Percutaneous Auditory Osseointegrated Implants. Otol Neurotol 2021; 42:740-745. [PMID: 33967249 PMCID: PMC8387882 DOI: 10.1097/mao.0000000000003046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To determine if there is an association between tobacco use and the development of postoperative skin reactions in patients undergoing percutaneous osseointegrated auditory implant (pOAI) surgery. STUDY DESIGN Single surgeon retrospective cohort study. SETTING Academic medical center. SUBJECTS AND METHODS Retrospective chart review was performed on all patients who underwent pOAI. Smoking status (current and former users versus never-users) was recorded as were numerous demographic and surgical variables. The primary outcome measure was skin reactivity as measured by Holgers score. Secondary outcomes studied included total number of problem visits, minor interventions, and major interventions. RESULTS 126 patients, 73 with no tobacco history (NT) and 53 with a positive smoking tobacco history (T) underwent pOAI surgery in this study. The T group was found to have higher rates of first postoperative visit soft tissue reactions compared with the NT group (24.5% versus 6.8%, p 1/4 0.011, odds ratio [OR] 4.42, 95% confidence interval [CI]: 1.5, 13.3), but not at long-term follow-up. When former smokers were eliminated from analysis, differences were also found at long- term follow-up (40.9% versus 19.2%, p 1/4 0.037, OR 2.92, 95% CI [1.0 - 8.1]). There were no differences in total number of problem visits or total number of minor or major interventions. CONCLUSIONS Patients with a history of tobacco use have a significantly higher rates of skin reactivity compared with patients without, though smoking cessation may partially mitigate long-term risks. Surgeons should be aware of the risks of early skin reactivity and should counsel patients accordingly.
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Affiliation(s)
- Lauren Gardiner
- Department of Otolaryngology–Head and Neck Surgery;
Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Martin Lavallee
- Department of Biostatistics, Virginia Commonwealth
University School of Medicine, Richmond, Virginia
| | - Adam Sima
- Department of Biostatistics, Virginia Commonwealth
University School of Medicine, Richmond, Virginia
| | - Daniel H. Coelho
- Department of Otolaryngology–Head and Neck Surgery;
Virginia Commonwealth University School of Medicine, Richmond, Virginia
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Xiao Q, Gong F, Wang N, Hu W. Punch vs open surgical techniques for placement of bone-anchored hearing implants: a systematic review and meta-analysis of skin reactions and operating time. Eur Arch Otorhinolaryngol 2021; 278:3171-3180. [PMID: 33389004 DOI: 10.1007/s00405-020-06511-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 11/19/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Several authors have reported their experience with the punch technique as compared to open surgical methods for bone-anchored hearing implants (BAHI). However, no study has attempted to aggregate current evidence. We aimed to compare post-operative skin complications and operating time between punch and open surgical techniques of BAHI via a systematic review and meta-analysis. METHODS Databases of PubMed, Embase, Scopus, BioMed Central, Ovoid, and CENTRAL were screened up to 15th February 2020 to include studies comparing punch and open surgical technique for BAHI. RESULTS Eight studies were included. Punch technique was compared with dermatome and linear incision techniques with and without soft tissue reduction. There was no difference in normal-to-moderate skin reaction between the punch and open surgical techniques (OR: 0.86 95% CI 0.23, 3.28 I2 = 0%). The incidence of adverse skin reactions were also not different between the two groups. Meta-regression for different follow-up periods did not demonstrate any statistically significant results. Our results also indicated that punch technique requires less operating time, however, the inter-study heterogeneity in the analysis was very high. Similar results were seen on sub-group analysis based on the type of open surgical technique. CONCLUSION There may be no difference in skin tolerance between the punch technique and open surgical techniques. Operating time may be significantly reduced with the punch technique. Strong conclusions cannot be drawn owing to a limited number of studies. Further large-scale randomized trials are required.
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Affiliation(s)
- Qianyu Xiao
- Department of Nursing, Hunan Provincial People's Hospital, the First-Affiliated Hospital of Hunan Normal University, 61 Jiefang West Road, Changsha, Hunan, China.
| | - Fanghua Gong
- Department of Nursing, Hunan Provincial People's Hospital, the First-Affiliated Hospital of Hunan Normal University, 61 Jiefang West Road, Changsha, Hunan, China
| | - Ning Wang
- Department of ENT & HN Surgery, Hunan Provincial People's Hospital, the First-Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Weihua Hu
- Department of Nursing, Hunan Provincial People's Hospital, the First-Affiliated Hospital of Hunan Normal University, 61 Jiefang West Road, Changsha, Hunan, China
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The Potential Added Value of Novel Hearing Therapeutics: An Early Health Economic Model for Hearing Loss. Otol Neurotol 2020; 41:1033-1041. [PMID: 33169949 DOI: 10.1097/mao.0000000000002744] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To construct an early health economic model to assess the potential added value of novel hearing therapeutics, compared with the current standard of care. We use idiopathic sudden sensorineural hearing loss (ISSNHL) as a case example, because it is a lead indication for several emerging hearing therapeutics. METHODS A decision analytic model was developed to assess the costs and effects of using novel hearing therapeutics for patients with ISSNHL. This was compared to the current standard of care. Input data were derived from literature searches and expert opinion. The study adopted a healthcare perspective of the UK National Health Service. Four analyses were conducted: 1) headroom, 2) scenario, 3) threshold, 4) sensitivity. RESULTS The decision analytic model showed that novel therapeutics for ISSNHL have potential value both in terms of improved patient outcomes, as well as incremental net monetary benefit (iNMB). The base case analysis revealed an iNMB of £39,032 for novel therapeutics compared with the current standard of care. Results of the threshold and scenario analysis revealed that age of treatment and severity of ISSNHL are major determinants of iNMB for novel therapeutics. CONCLUSION This article describes the first health economic model for novel therapeutics for hearing loss; and shows that novel hearing therapeutics can be cost-effective under NICE's cost-effectiveness threshold, with considerable room for improvement in the current standard of care. Our model can be used to inform the development of cost-effective hearing therapeutics; and help decision makers decide which therapeutics represent value for money.
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Alves F, Ribeiro JC, Alves M, Gonçalo M. Titanium allergy as a possible cause of extrusion of a bone conduction ear implant. Contact Dermatitis 2020; 83:148-149. [PMID: 32311757 DOI: 10.1111/cod.13566] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 04/17/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Francisca Alves
- Department of Dermatology, Coimbra University Hospital, Coimbra, Portugal
| | - João Carlos Ribeiro
- Department of Otorhinolaryngology, Coimbra University Hospital, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Marta Alves
- Allergy and Clinical Immunology Unit, Coimbra University Hospital, Coimbra, Portugal
| | - Margarida Gonçalo
- Department of Dermatology, Coimbra University Hospital, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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Inter-rater Reliability and Validity of Holgers Scores for the Assessment of Bone-anchored Hearing Implant Images. Otol Neurotol 2019; 40:200-203. [DOI: 10.1097/mao.0000000000002100] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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