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Wener ER, McLennan JD, Papsin BC, Cushing SL, Stavropoulos DJ, Mendoza-Londono R, Quercia N, Gordon KA. Variants in Genes Associated with Hearing Loss in Children: Prevalence in a Large Canadian Cohort. Laryngoscope 2024. [PMID: 38426810 DOI: 10.1002/lary.31373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 01/17/2024] [Accepted: 02/02/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVE The objective of this study was to assess the prevalence of genetic variants associated with hearing loss in a large cohort of children in Canada using high throughput next generation sequencing (NGS). METHODS A total of 485 children with hearing loss underwent NGS testing with an 80 gene panel of syndromic and non-syndromic variants known to be associated with hearing loss. Genetic variants were classified as pathogenic, likely pathogenic, likely benign, benign, or variants of uncertain significance (VUS), according to the American College of Medical Genetics and Genomics guidelines. RESULTS Across the 80 genes tested, 923 variants, predominantly in 28 genes, were identified in 324 children. Pathogenic variants occurred in 19/80 (23.8%) of the hearing loss related genes tested and confirmed the etiology of hearing loss in 73/485 (15.1%) of children. GJB2 was the most prevalent gene, affecting 28/73 (38.4%) children with confirmed genetic hearing loss in our cohort. Most identified variants (748/923, 81.0%, in 76/80 genes) were of uncertain significance. CONCLUSION Genetic testing using NGS identified the etiology in approximately 15% of childhood hearing loss in a Canadian cohort which is lower than what is typically reported. GJB2 was the most common genetic cause of hearing loss. VUS are commonly identified, presenting clinical challenges for counseling. LEVEL OF EVIDENCE Level 4 Laryngoscope, 2024.
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Affiliation(s)
- Emily R Wener
- Archie's Cochlear Implant Laboratory, Neuroscience & Mental Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jacob D McLennan
- Archie's Cochlear Implant Laboratory, Neuroscience & Mental Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Blake C Papsin
- Archie's Cochlear Implant Laboratory, Neuroscience & Mental Health, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sharon L Cushing
- Archie's Cochlear Implant Laboratory, Neuroscience & Mental Health, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Dimitri James Stavropoulos
- Genome Diagnostics Paediatric Laboratory Medicine, Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Roberto Mendoza-Londono
- Genome Diagnostics Paediatric Laboratory Medicine, Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Nada Quercia
- Division of Clinical & Metabolic Genetics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Genetic Counselling, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Molecular Genetics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Karen A Gordon
- Archie's Cochlear Implant Laboratory, Neuroscience & Mental Health, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Hospital for Sick Children, Toronto, Ontario, Canada
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Benjamin RS, Cushing SL, Blakeman AW, Campos JL, Papsin BC, Gordon KA. Effects of the BalanCI on Working Memory and Balance in Children and Young Adults With Cochleovestibular Dysfunction. Ear Hear 2024; 45:378-389. [PMID: 37759357 DOI: 10.1097/aud.0000000000001433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
OBJECTIVES This study aimed to: (1) determine the interaction between cognitive load and balance in children and young adults with bilateral cochleovestibular dysfunction who use bilateral cochlear implants (CIs) and (2) determine the effect of an auditory balance prosthesis (the BalanCI) on this interaction. Many (20 to 70%) children with sensorineural hearing loss experience some degree of vestibular loss, leading to poorer balance. Poor balance could have effects on cognitive resource allocation which might be alleviated by the BalanCI as it translates head-referenced cues into electrical pulses delivered through the CI. It is hypothesized that children and young adults with cochleovestibular dysfunction will demonstrate greater dual-task costs than typically-developing children during dual balance-cognition tasks, and that BalanCI use will improve performance on these tasks. DESIGN Study participants were 15 typically-developing children (control group: mean age ± SD = 13.6 ± 2.75 years, 6 females) and 10 children and young adults who use bilateral CIs and have vestibular dysfunction (CI-V group: mean age ± SD=20.6 ± 5.36 years, 7 females). Participants completed two working memory tasks (backward auditory verbal digit span task and backward visuospatial dot matrix task) during three balance conditions: seated, standing in tandem stance with the BalanCI off, and standing in tandem stance with the BalanCI on. Working memory performance was quantified as total number of correct trials achieved. Postural stability was quantified as translational and rotational path length of motion capture markers worn on the head, upper body, pelvis, and feet, normalized by trial time. RESULTS Relative to the control group, children and young adults in the CI-V group exhibited poorer overall working memory across all balance conditions ( p = 0.03), poorer translational postural stability (larger translational path length) during both verbal and visuospatial working memory tasks ( p < 0.001), and poorer rotational stability (larger rotational path length) during the verbal working memory task ( p = 0.026). The CI-V group also exhibited poorer translational ( p = 0.004) and rotational ( p < 0.001) postural stability during the backward verbal digit span task than backward visuospatial dot matrix task; BalanCI use reduced this stability difference between verbal and visuospatial working memory tasks for translational stability overall ( p > 0.9), as well as for rotational stability during the maximum working memory span (highest load) participants achieved in each task ( p = 0.91). CONCLUSIONS Balance and working memory were impaired in the CI-V group compared with the control group. The BalanCI offered subtle improvements in stability in the CI-V group during a backward verbal working memory task, without producing a negative effect on working memory outcomes. This study supports the feasibility of the BalanCI as a balance prosthesis for individuals with cochleovestibular impairments.
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Affiliation(s)
- Rebecca S Benjamin
- Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
- Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sharon L Cushing
- Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
- Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Otolaryngology, Head and Neck Surgery, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Otolaryngology, Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Alan W Blakeman
- Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jennifer L Campos
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Blake C Papsin
- Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
- Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Otolaryngology, Head and Neck Surgery, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Otolaryngology, Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Karen A Gordon
- Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
- Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Otolaryngology, Head and Neck Surgery, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Otolaryngology, Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- Department of Communication Disorders, Hospital for Sick Children, Toronto, Ontario, Canada
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Alemu RZ, Papsin BC, Harrison RV, Blakeman A, Gordon KA. Head and Eye Movements Reveal Compensatory Strategies for Acute Binaural Deficits During Sound Localization. Trends Hear 2024; 28:23312165231217910. [PMID: 38297817 PMCID: PMC10832417 DOI: 10.1177/23312165231217910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 10/17/2023] [Accepted: 11/14/2023] [Indexed: 02/02/2024] Open
Abstract
The present study aimed to define use of head and eye movements during sound localization in children and adults to: (1) assess effects of stationary versus moving sound and (2) define effects of binaural cues degraded through acute monaural ear plugging. Thirty-three youth (MAge = 12.9 years) and seventeen adults (MAge = 24.6 years) with typical hearing were recruited and asked to localize white noise anywhere within a horizontal arc from -60° (left) to +60° (right) azimuth in two conditions (typical binaural and right ear plugged). In each trial, sound was presented at an initial stationary position (L1) and then while moving at ∼4°/s until reaching a second position (L2). Sound moved in five conditions (±40°, ±20°, or 0°). Participants adjusted a laser pointer to indicate L1 and L2 positions. Unrestricted head and eye movements were collected with gyroscopic sensors on the head and eye-tracking glasses, respectively. Results confirmed that accurate sound localization of both stationary and moving sound is disrupted by acute monaural ear plugging. Eye movements preceded head movements for sound localization in normal binaural listening and head movements were larger than eye movements during monaural plugging. Head movements favored the unplugged left ear when stationary sounds were presented in the right hemifield and during sound motion in both hemifields regardless of the movement direction. Disrupted binaural cues have greater effects on localization of moving than stationary sound. Head movements reveal preferential use of the better-hearing ear and relatively stable eye positions likely reflect normal vestibular-ocular reflexes.
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Affiliation(s)
- Robel Z. Alemu
- Archie's Cochlear Implant Laboratory, The Hospital for Sick Children, Toronto, ON, Canada
- Institute of Medical Science, The University of Toronto, Toronto, ON, Canada
| | - Blake C. Papsin
- Archie's Cochlear Implant Laboratory, The Hospital for Sick Children, Toronto, ON, Canada
- Institute of Medical Science, The University of Toronto, Toronto, ON, Canada
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
- Department of Otolaryngology, The Hospital for Sick Children, Toronto, ON, Canada
- Program in Neuroscience and Mental Health, Research Institute, Toronto, ON, Canada
| | - Robert V. Harrison
- Institute of Medical Science, The University of Toronto, Toronto, ON, Canada
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
- Program in Neuroscience and Mental Health, Research Institute, Toronto, ON, Canada
| | - Al Blakeman
- Archie's Cochlear Implant Laboratory, The Hospital for Sick Children, Toronto, ON, Canada
| | - Karen A. Gordon
- Archie's Cochlear Implant Laboratory, The Hospital for Sick Children, Toronto, ON, Canada
- Institute of Medical Science, The University of Toronto, Toronto, ON, Canada
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
- Program in Neuroscience and Mental Health, Research Institute, Toronto, ON, Canada
- Department of Communication Disorders, The Hospital for Sick Children, Toronto, ON, Canada
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Chen T, Papaioannou V, Liberman G, Gordon KA, Papsin BC, Cushing SL. Importance of early objective auditory testing in the presentation of sudden sensorineural hearing loss in children. Am J Otolaryngol 2024; 45:104087. [PMID: 37839178 DOI: 10.1016/j.amjoto.2023.104087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 10/01/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND Functional hearing loss can be due to an auditory manifestation of functional neurological disorder, previously known as conversion disorder. METHODS This is a case series of 3 pediatric patients with a diagnosis of idiopathic SSNHL who ultimately were found to have functional neurological disorder. RESULTS Average age was 12.7 years at presentation (range 10-14 years). All three patients underwent invasive interventions prior to their initial clinic visit. All patients demonstrated profound SNHL on behavioural audiogram, but normal otoacoustic emissions (OAE) and auditory brainstem response testing. With counselling, both patients demonstrated significant hearing improvement. CONCLUSIONS Early use of OAE's in the workup of SSNHL can avoid unnecessary and potentially harmful therapies and expedite access to counselling services which may help lead to symptom resolution.
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Affiliation(s)
- Tanya Chen
- Department of Otolaryngology, Head & Neck Surgery, Hospital for Sick Children, Toronto, Canada; Department of Otolaryngology, Head & Neck Surgery, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Vicky Papaioannou
- Department of Otolaryngology, Head & Neck Surgery, Hospital for Sick Children, Toronto, Canada; Department of Otolaryngology, Head & Neck Surgery, Faculty of Medicine, University of Toronto, Toronto, Canada; Department of Communication Disorders, Hospital for Sick Children, Toronto, Canada
| | - Gillian Liberman
- Social Work Department, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Karen A Gordon
- Department of Otolaryngology, Head & Neck Surgery, Hospital for Sick Children, Toronto, Canada; Department of Otolaryngology, Head & Neck Surgery, Faculty of Medicine, University of Toronto, Toronto, Canada; Department of Communication Disorders, Hospital for Sick Children, Toronto, Canada; Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Blake C Papsin
- Department of Otolaryngology, Head & Neck Surgery, Hospital for Sick Children, Toronto, Canada; Department of Otolaryngology, Head & Neck Surgery, Faculty of Medicine, University of Toronto, Toronto, Canada; Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Sharon L Cushing
- Department of Otolaryngology, Head & Neck Surgery, Hospital for Sick Children, Toronto, Canada; Department of Otolaryngology, Head & Neck Surgery, Faculty of Medicine, University of Toronto, Toronto, Canada; Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada.
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Wener E, Booth L, Bensky H, Desai V, Negandhi J, Cushing SL, Papsin BC, Gordon KA. Exposure to Spoken Communication During the COVID-19 Pandemic Among Children With Cochlear Implants. JAMA Netw Open 2023; 6:e2339042. [PMID: 37889489 PMCID: PMC10611997 DOI: 10.1001/jamanetworkopen.2023.39042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 09/07/2023] [Indexed: 10/28/2023] Open
Abstract
Importance School closures and other COVID-19-related restrictions could decrease children's exposure to speech during important stages of development. Objective To assess whether significant decreases in exposure to spoken communication found during the initial phase of the COVID-19 pandemic among children using cochlear implants are confirmed for a larger cohort of children and were sustained over the first years of the COVID-19 pandemic. Design, Setting, and Participants This cohort study used datalogs collected from children with cochlear implants during clinical visits to a tertiary pediatric hospital in Toronto, Ontario, Canada, from January 1, 2018, to November 11, 2021. Children with severe to profound hearing loss using cochlear implants were studied because their devices monitored and cataloged levels and types of sounds during hourly use per day (datalogs) and because their hearing and spoken language development was particularly vulnerable to reduced sound exposure. Statistical analyses were conducted between January 2022 and August 2023. Main Outcomes and Measures Daily hours of sound were captured by the cochlear implant datalogging system and categorized into 6 auditory scene categories, including speech and speech-in-noise. Time exposed to speech was calculated as the sum of daily hours in speech and daily hours in speech-in-noise. Residual hearing in the ear without an implant of children with unilateral cochlear implants was measured by pure tone audiometry. Mixed-model regression analyses revealed main effects with post hoc adjustment of 95% CIs using the Satterthwaite method. Results Datalogs (n = 2746) from 262 children (137 with simultaneous bilateral cochlear implants [74 boys (54.0%); mean (SD) age, 5.8 (3.5 years)], 38 with sequential bilateral cochlear implants [24 boys (63.2%); mean (SD) age, 9.1 (4.2) years], and 87 with unilateral cochlear implants [40 boys (46.0%); mean (SD) age, 7.9 (4.6) years]) who were preschool aged (n = 103) and school aged (n = 159) before the COVID-19 pandemic were included in analyses. There was a slight increase in use among preschool-aged bilateral cochlear implant users through the pandemic (early pandemic, 1.4 h/d [95% CI, 0.3-2.5 h/d]; late pandemic, 2.3 h/d [95% CI, 0.6-4.0 h/d]) and little change in use among school-aged bilateral cochlear implant users (early pandemic, -0.6 h/d [95% CI, -1.1 to -0.05 h/d]; late pandemic, -0.3 h/d [95% CI, -0.9 to 0.4 h/d]). However, use decreased during the late pandemic period among school-aged children with unilateral cochlear implants (-1.8 h/d [95% CI,-3.0 to -0.6 h/d]), particularly among children with good residual hearing in the ear without an implant. Prior to the pandemic, children were exposed to speech for approximately 50% of the time they used their cochlear implants (preschool-aged children: bilateral cochlear implants, 46.6% [95% CI, 46.5%-47.2%] and unilateral cochlear implants, 52.1% [95% CI, 50.7%-53.5%]; school-aged children: bilateral cochlear implants, 47.6% [95% CI, 46.8%-48.4%] and unilateral cochlear implants, 51.0% [95% CI, 49.4%-52.6%]). School-aged children in both groups experienced significantly decreased speech exposure in the early pandemic period (bilateral cochlear implants, -12.1% [-14.6% to -9.4%]; unilateral cochlear implants, -15.5% [-20.4% to -10.7%]) and late pandemic periods (bilateral cochlear implants, -5.3% [-8.0% to -2.6%]; unilateral cochlear implants, -11.2% [-15.3% to -7.1%]) compared with the prepandemic baseline. Conclusions and Relevance This cohort study using datalogs from children using cochlear implants suggests that a sustained reduction in children's access to spoken communication was found during more than 2 years of COVID-19 pandemic-related lockdowns and school closures.
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Affiliation(s)
- Emily Wener
- Archie’s Cochlear Implant Laboratory, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Lindsay Booth
- Archie’s Cochlear Implant Laboratory, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Hailey Bensky
- Archie’s Cochlear Implant Laboratory, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Veeral Desai
- Archie’s Cochlear Implant Laboratory, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jaina Negandhi
- Archie’s Cochlear Implant Laboratory, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sharon L. Cushing
- Archie’s Cochlear Implant Laboratory, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Otolaryngology–Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- Department of Otolaryngology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Blake C. Papsin
- Archie’s Cochlear Implant Laboratory, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Otolaryngology–Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- Department of Otolaryngology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Karen A. Gordon
- Archie’s Cochlear Implant Laboratory, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Otolaryngology–Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- Department of Communication Disorders, The Hospital for Sick Children, Toronto, Ontario, Canada
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Gordon KA, Papsin BC, Cushing SL. Long-term Language, Educational, and Quality-of-Life Outcomes in Adolescents After Childhood Cochlear Implantation. JAMA Otolaryngol Head Neck Surg 2023; 149:715-716. [PMID: 37382947 DOI: 10.1001/jamaoto.2023.1329] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Affiliation(s)
- Karen A Gordon
- Archie's Cochlear Implant Laboratory, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Ontario, Canada
| | - Blake C Papsin
- Archie's Cochlear Implant Laboratory, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Ontario, Canada
| | - Sharon L Cushing
- Archie's Cochlear Implant Laboratory, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Ontario, Canada
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Benjamin RS, Cushing SL, Blakeman AW, Campos JL, Papsin BC, Gordon KA. Evaluating the use of a balance prosthesis during balance perturbations in children and young adults with cochleovestibular dysfunction. Sci Rep 2023; 13:9721. [PMID: 37322114 PMCID: PMC10272120 DOI: 10.1038/s41598-023-36613-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 06/07/2023] [Indexed: 06/17/2023] Open
Abstract
Study objectives were to: (1) quantify stability in children and young adults using cochlear implants with concurrent cochleovestibular dysfunction (CI-V) during balance perturbations and (2) to assess effects of an auditory head-referencing device (BalanCI) on their stability. The BalanCI provides auditory feedback via cochlear implants to cue posture and potentially avoid falling in children with CI-V. It was hypothesized that children and young adults with CI-V respond with larger movements to floor perturbations than typically-developing peers (controls) and that BalanCI use decreases these movements. Motion in response to treadmill perturbations was captured by markers on the head, torso, and feet in eight CI-V and 15 control participants. Stability (area under the curve of motion displacement) and peak displacement latencies were measured. The CI-V group demonstrated less stability and slower responses than the control group during medium and large backwards perturbations (p's < 0.01). In the CI-V group, BalanCI use improved stability during large backwards perturbations (p < 0.001), but worsened stability during large sideways perturbations (p's < 0.001). Children and young adults with CI-V move more to remain upright during perturbations than typically-developing peers. The BalanCI has potential to aid physical/vestibular therapy in children with CIs who have poor balance.
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Affiliation(s)
- Rebecca S Benjamin
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
- Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, ON, Canada
| | - Sharon L Cushing
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
- Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, ON, Canada
- Department of Otolaryngology, Head and Neck Surgery, Hospital for Sick Children, Toronto, ON, Canada
- Department of Otolaryngology, Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Alan W Blakeman
- Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, ON, Canada
| | - Jennifer L Campos
- Department of Psychology, University of Toronto, Toronto, ON, Canada
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Blake C Papsin
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
- Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, ON, Canada
- Department of Otolaryngology, Head and Neck Surgery, Hospital for Sick Children, Toronto, ON, Canada
- Department of Otolaryngology, Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Karen A Gordon
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada.
- Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, ON, Canada.
- Department of Otolaryngology, Head and Neck Surgery, Hospital for Sick Children, Toronto, ON, Canada.
- Department of Otolaryngology, Head and Neck Surgery, University of Toronto, Toronto, ON, Canada.
- Department of Communication Disorders, Hospital for Sick Children, Toronto, ON, Canada.
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Gordon KA, Alemu R, Papsin BC, Negandhi J, Cushing SL. Effects of Age at Implantation on Outcomes of Cochlear Implantation in Children with Short Durations of Single-Sided Deafness. Otol Neurotol 2023; 44:233-240. [PMID: 36728258 PMCID: PMC9924958 DOI: 10.1097/mao.0000000000003811] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Children with single-sided deafness (SSD) show reduced language and academic development and report hearing challenges. We aim to improve outcomes in children with SSD by providing bilateral hearing through cochlear implantation of the deaf ear with minimal delay. STUDY DESIGN Prospective cohort study of 57 children with SSD provided with cochlear implant (CI) between May 13, 2013, and June 25, 2021. SETTING Tertiary children's hospital. PARTICIPANTS Children with early onset (n = 40) or later onset of SSD (n = 17) received CIs at ages 2.47 ± 1.58 years (early onset group) and 11.67 ± 3.91 years (late onset group) (mean ± SD). Duration of unilateral deafness was limited (mean ± SD = 1.93 ± 1.56 yr). INTERVENTION Cochlear implantation of the deaf ear. MAIN OUTCOMES/MEASURES Evaluations of device use (data logging) and hearing (speech perception, effects of spatial release from masking on speech detection, localization of stationary and moving sound, self-reported hearing questionnaires). RESULTS Results indicated that daily device use is variable (mean ± SD = 5.60 ± 2.97, range = 0.0-14.7 h/d) with particular challenges during extended COVID-19 lockdowns, including school closures (daily use reduced by mean 1.73 h). Speech perception with the CI alone improved (mean ± SD = 65.7 ± 26.4 RAU) but, in the late onset group, remained poorer than in the normal hearing ear. Measures of spatial release from masking also showed asymmetric hearing in the late onset group ( t13 = 5.14, p = 0.001). Localization of both stationary and moving sound was poor (mean ± SD error = 34.6° ± 16.7°) but slightly improved on the deaf side with CI use ( F1,36 = 3.95, p = 0.05). Decreased sound localization significantly correlated with poorer self-reported hearing. CONCLUSIONS AND RELEVANCE Benefits of CI in children with limited durations of SSD may be more restricted for older children/adolescents. Spatial hearing challenges remain. Efforts to increase CI acceptance and consistent use are needed.
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Affiliation(s)
- Karen A. Gordon
- Department of Otolaryngology–Head and Neck Surgery, University of Toronto
- Archie’s Cochlear Implant Laboratory, The Hospital for Sick Children
- Department of Communication Disorders, The Hospital for Sick Children
| | - Robel Alemu
- Archie’s Cochlear Implant Laboratory, The Hospital for Sick Children
| | - Blake C. Papsin
- Department of Otolaryngology–Head and Neck Surgery, University of Toronto
- Archie’s Cochlear Implant Laboratory, The Hospital for Sick Children
- Department of Otolaryngology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jaina Negandhi
- Archie’s Cochlear Implant Laboratory, The Hospital for Sick Children
| | - Sharon L. Cushing
- Department of Otolaryngology–Head and Neck Surgery, University of Toronto
- Archie’s Cochlear Implant Laboratory, The Hospital for Sick Children
- Department of Otolaryngology, The Hospital for Sick Children, Toronto, ON, Canada
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Zawawi F, Dell S, Wolter NE, Papsin BC, Propst EJ. Olfaction and Gustation in Children With Primary Ciliary Dyskinesia. OTO Open 2023; 7:e28. [PMID: 36998551 PMCID: PMC10046730 DOI: 10.1002/oto2.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 12/07/2022] [Accepted: 12/19/2022] [Indexed: 02/19/2023] Open
Abstract
Objective Primary ciliary dyskinesia (PCD) is a rare autosomal recessive disorder whereby abnormal cilia cause a wide array of respiratory tract manifestations including chronic rhinosinusitis. The purpose of this study was to determine whether olfaction and gustation are impaired in children with PCD. Study Design Cross-sectional study. Setting Tertiary pediatric academic hospital. Methods Children with confirmed PCD based on having at least 1 of 3 approved diagnostic criteria as per The American Thoracic Society guidelines were recruited from The PCD Clinic in our tertiary care pediatric hospital. Odor identification ability was tested using the Universal Sniff (U-Sniff) test and taste threshold was measured using an electrogustometer. The main outcome of this study is to determine the incidence of olfactory dysfunction in children with PCD and investigate if there is an associated gustatory dysfunction. Results Twenty-five children participated (14 male, 11 female), The median age was 10.8 years (range: 4.1-17.9 years). Only 4/25 (16%) complained of olfactory dysfunction prior to testing. None of the patients complained of dysgeusia. However, 48% (12/25) scored less than 7 on the U-Sniff, signifying hyposmia or anosmia. In contrast, scores obtained by electrogustometry were in the normal range. There was no correlation between performance on the U-Sniff and electrogustometry testing. Conclusion Olfactory impairment in children with PCD is common but underrecognized by patients. This is not associated with abnormal gustation. Among other, this places children with PCD at an increased risk with respect to smelling a fire or detecting spoiled or poisonous food.
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Affiliation(s)
- Faisal Zawawi
- Department of Otolaryngology–Head and Neck Surgery Hospital for Sick Children Toronto Ontario Canada
- Department of Otolaryngology–Head and Neck Surgery King Abdulaziz University Jeddah Saudi Arabia
| | - Sharon Dell
- Department of Pediatrics, Division of Respiratory Medicine, BC Children's Hospital University of British Columbia Vancouver British Columbia Canada
| | - Nikolaus E. Wolter
- Department of Otolaryngology–Head and Neck Surgery Hospital for Sick Children Toronto Ontario Canada
| | - Blake C. Papsin
- Department of Otolaryngology–Head and Neck Surgery Hospital for Sick Children Toronto Ontario Canada
| | - Evan J. Propst
- Department of Otolaryngology–Head and Neck Surgery Hospital for Sick Children Toronto Ontario Canada
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10
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James AL, Papsin BC. Endoscopic Repair of Round Window Cochleocele. Otol Neurotol 2022; 43:e1136-e1139. [PMID: 36156534 DOI: 10.1097/mao.0000000000003695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To describe the novel presentation, implications, and endoscopic management of a congenital round window cochleocele. PATIENT A 16-month old girl with profound hearing loss from bilateral incomplete partition type 1 (IP1) anomaly of the cochlea plus left-sided cochlear nerve aplasia and cochleocele. INTERVENTION Anomalies were identified with computed tomographic scanning and magnetic resonance imaging during cochlear implant candidacy assessment. While under general anesthesia for right-sided cochlear implantation, the cochleocele was removed and packed with temporalis fascia using transcanal endoscopic ear surgery. The endoscope was held by an assistant while the surgeon packed the round window using a two-handed technique to counter the gush of cerebrospinal fluid. RESULTS The child made an uneventful recovery with no cerebrospinal fluid leak or meningitis. CONCLUSIONS Cochleocele can protrude through the round window of a cochlea with incomplete partition type 1 anomaly. An increased risk of meningitis secondary to acute otitis media is expected given the known risk from cochleocele arising through a stapes footplate fistula. Care should be taken to check for the presence of a cochleocele in hearing loss from congenital malformations involving the basal turn of the cochlea on imaging and also at the time of cochlear implant surgery. Repair should be considered at the first opportunity to prevent meningitis. If early cochlear implant surgery is not feasible or appropriate (as, for example, with cochlear nerve aplasia), transcanal endoscopic ear surgery provides good access for a low-morbidity approach.
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Affiliation(s)
- Adrian L James
- Department of Otolaryngology Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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11
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Wolter NE, Wolter JK, James AL, Ostrow O, McKinnon NK, Everett T, Papsin BC, Propst EJ. Button battery taping prevents oesophageal injury. J Paediatr Child Health 2022; 58:1337-1344. [PMID: 35445484 DOI: 10.1111/jpc.15978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 03/30/2022] [Indexed: 01/23/2023]
Abstract
AIM Most button battery (BB) ingestions in children are unwitnessed leading to prolonged exposures and severe complications. One third of ingestions occur from free BB, that are stored or awaiting disposal. Recommendations have been made to cover the terminals of discarded BB with adhesive tape; however, it is unclear if this practice prevents injury. Our aim was to determine if tape could prevent oesophageal injury in a cadaveric porcine model. METHODS Electrical, masking, packing and duct tape were compared. One BB was left untaped. Taped BBs were placed in a cadaveric porcine oesophagus controlled for temperature and humidification. Specimens were assessed at 0, 0.5, and hourly for 6 h by visual inspection, temperature and pH. BB voltage was measured before and after testing. All tests were repeated in triplicate. RESULTS Oesophageal specimens demonstrated burn prevention in the packing and duct tape trials. Burns were seen in 2/3 trials with electrical tape and 3/3 trials with masking tape. pH remained neutral throughout the study for all packing and duct tape specimens. pH remained neutral initially for masking tape but increased rapidly to 12 by 2 h. There was no change in battery voltage for the packing tape and duct tape trials. There was a 16.3% reduction in voltage for masking tape which was similar to controls. CONCLUSIONS Taping BB with packing tape and duct tape prevented oesophageal burns. This may provide a novel method of burn prevention for loose BB intended for disposal.
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Affiliation(s)
- Nikolaus E Wolter
- Department of Otolaryngology - Head and Neck Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer K Wolter
- Department of Otolaryngology - Head and Neck Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Adrian L James
- Department of Otolaryngology - Head and Neck Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Olivia Ostrow
- Division of Pediatric Emergency Medicine, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Nicole K McKinnon
- Department of Critical Care Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Tobias Everett
- Department of Anesthesiology and Pain Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Blake C Papsin
- Department of Otolaryngology - Head and Neck Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Evan J Propst
- Department of Otolaryngology - Head and Neck Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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12
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Anderson CA, Cushing SL, Papsin BC, Gordon KA. Cortical imbalance following delayed restoration of bilateral hearing in deaf adolescents. Hum Brain Mapp 2022; 43:3662-3679. [PMID: 35429083 PMCID: PMC9294307 DOI: 10.1002/hbm.25875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 03/24/2022] [Accepted: 04/03/2022] [Indexed: 11/10/2022] Open
Abstract
Unilateral auditory deprivation in early childhood can lead to cortical strengthening of inputs from the stimulated side, yet the impact of this on bilateral processing when inputs are later restored beyond an early sensitive period is unknown. To address this, we conducted a longitudinal study with 13 bilaterally profoundly deaf adolescents who received unilateral access to sound via a cochlear implant (CI) in their right ear in early childhood before receiving bilateral access to sound a decade later via a second CI in their left ear. Auditory‐evoked cortical responses to unilateral and bilateral stimulation were measured repeatedly using electroencephalogram from 1 week to 14 months after activation of their second CI. Early cortical responses from the newly implanted ear and bilateral stimulation were atypically lateralized to the left ipsilateral auditory cortex. Duration of unilateral deafness predicted an unexpectedly stronger representation of inputs from the newly implanted, compared to the first implanted ear, in left auditory cortex. Significant initial reductions in responses were observed, yet a left‐hemisphere bias and unequal weighting of inputs favoring the long‐term deaf ear did not converge to a balanced state observed in the binaurally developed system. Bilateral response enhancement was significantly reduced in left auditory cortex suggesting deficits in ipsilateral response inhibition of new, dominant, inputs during bilateral processing. These findings paradoxically demonstrate the adaptive capacity of the adolescent auditory system beyond an early sensitive period for bilateral input, as well as restrictions on its potential to fully reverse cortical imbalances driven by long‐term unilateral deafness.
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Affiliation(s)
- Carly A. Anderson
- Archie's Cochlear Implant Laboratory The Hospital for Sick Children Toronto Ontario Canada
- Neurosciences and Mental Health, SickKids Research Institute Toronto Ontario Canada
| | - Sharon L. Cushing
- Department of Otolaryngology—Head and Neck Surgery The Hospital for Sick Children Toronto Ontario Canada
- Department of Otolaryngology—Head and Neck Surgery University of Toronto Toronto Ontario Canada
| | - Blake C. Papsin
- Department of Otolaryngology—Head and Neck Surgery The Hospital for Sick Children Toronto Ontario Canada
- Department of Otolaryngology—Head and Neck Surgery University of Toronto Toronto Ontario Canada
| | - Karen A. Gordon
- Archie's Cochlear Implant Laboratory The Hospital for Sick Children Toronto Ontario Canada
- Neurosciences and Mental Health, SickKids Research Institute Toronto Ontario Canada
- Department of Otolaryngology—Head and Neck Surgery The Hospital for Sick Children Toronto Ontario Canada
- Department of Otolaryngology—Head and Neck Surgery University of Toronto Toronto Ontario Canada
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13
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Cushing SL, Purcell PL, Papaiaonnou V, Neghandi J, Daien M, Blaser SI, Ertl-Wagner B, Wagner M, Sheng M, James AL, Bitnun A, Papsin BC, Gordon KA. Hearing Instability in Children with Congenital Cytomegalovirus: Evidence and Neural Consequences. Laryngoscope 2022; 132 Suppl 11:S1-S24. [PMID: 35302239 DOI: 10.1002/lary.30108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 02/05/2022] [Accepted: 03/03/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE/HYPOTHESIS Sensorineural hearing loss (SNHL) is a common sequela of congenital cytomegalovirus (cCMV), potentially exacerbating neurocognitive delay. The objectives of this study were to assess: (1) age at which SNHL in children with cCMV; (2) stimulability of the auditory system in children with cCMV following cochlear implantation (CI); and (3) whether features of magnetic resonance imaging (MRI) potentially are predictive of hearing outcomes. METHODS In this retrospective study of a prospectively acquired cohort, 123 children with cCMV who were referred for hearing loss at a single tertiary referral hospital over 20 years were compared with an unmatched comparative group of 90 children with GJB2-related deafness. Outcome measures were results of newborn hearing screening (NHS), behavioral audiograms, and, in a subgroup of cochlear implant (CI) users, responses from the auditory nerve and brainstem evoked by CI at initial activation, as well as lesional volume of FLAIR-hyperintense signal alterations on MRI. RESULTS All but 3 of 123 children with cCMV had confirmed and persistent SNHL. At birth, 113 children with cCMV underwent NHS, 31 (27%) passed in both ears and 23 (20%) passed in one ear (no NHS data in 10 children). At the first audiologic assessment, 32 of 123 (26%) had normal hearing bilaterally; 35 of 123 (28%) had unilateral SNHL; and 57 of 123 (46%) had bilateral SNHL. More than half (67 of 123, 54%) experienced hearing deterioration in at least one ear. Survival analyses suggested that 60% of children who developed SNHL did so by 2.5 years and 80% by 5 years. In the children who passed NHS in one or both ears, 50% developed hearing loss by 3.5 years in the ear, which passed unilaterally (n = 23 ears), and 50% by 5 years in bilateral passes (n = 62 ears). Hearing loss was significant enough in all but one child with isolated high-frequency loss for rehabilitation to be indicated. Hearing thresholds in individual ears were in the CI range in 83% (102 of 123), although duration of deafness was sufficient to preclude implantation at our center in 13 children with unilateral SNHL. Hearing aids were indicated in 16% (20 of 123). Responses from the auditory nerve and brainstem to initial CI stimulation were similar in children with cCMV-related SNHL compared with GJB2-related SNHL. Characteristic white matter changes on MRI were seen in all children with cCMV-related SNHL (n = 91), but the lesion volume in each cortical hemisphere did not predict degree of SNHL. CONCLUSIONS cCMV-related SNHL is often not detected by NHS but occurs with high prevalence in early childhood. Electrophysiological measures suggest equivalent stimulability of the auditory nerve and brainstem with CI in children with cCMV and GJB2-related SNHL. Hyperintense white matter lesions on FLAIR MRI are consistently present in children with cCMV-related SNHL but cannot be used to predict its time course or degree. Combined, the data show early and rapid deterioration of hearing in children with cCMV-related SNHL with potential for good CI outcomes if SNHL is identified and managed without delay. Findings support universal newborn screening for cCMV followed by careful audiological monitoring. LEVEL OF EVIDENCE 3 Laryngoscope, 2022.
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Affiliation(s)
- Sharon L Cushing
- Department of Otolaryngology: Head & Neck Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Otolaryngology: Head & Neck Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Patricia L Purcell
- C.S. Mott Children's Hospital, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Vicky Papaiaonnou
- Department of Otolaryngology: Head & Neck Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Otolaryngology: Head & Neck Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Communication Disorders, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jaina Neghandi
- Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Maya Daien
- Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Susan I Blaser
- Department of Otolaryngology: Head & Neck Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Diagnostic Imaging, Division of Paediatric Neuroradiology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Birgit Ertl-Wagner
- Department of Diagnostic Imaging, Division of Paediatric Neuroradiology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Matthias Wagner
- Department of Diagnostic Imaging, Division of Paediatric Neuroradiology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Min Sheng
- Department of Diagnostic Imaging, Division of Paediatric Neuroradiology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Adrian L James
- Department of Otolaryngology: Head & Neck Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Otolaryngology: Head & Neck Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ari Bitnun
- Department of Pediatrics (Infectious Diseases), University of Toronto, Toronto, Ontario, Canada
| | - Blake C Papsin
- Department of Otolaryngology: Head & Neck Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Otolaryngology: Head & Neck Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Karen A Gordon
- Department of Otolaryngology: Head & Neck Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Otolaryngology: Head & Neck Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Communication Disorders, Hospital for Sick Children, Toronto, Ontario, Canada
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14
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Gordon KA, Papsin BC, Feness M, Negandhi J, Cushing SL. First Generation Osseointegrated Steady State Implant Benefits in Children With Hearing Loss. Otol Neurotol 2022; 43:337-344. [PMID: 34935762 PMCID: PMC8843378 DOI: 10.1097/mao.0000000000003447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess outcomes of a new Osseointegrated Steady State Implant (OSSI) for bone conduction in adolescents. METHOD In an initial trial, 14 adolescents (14.5 years of age, SD = 2.22) were provided with an OSSI; unilateral OSSI (n = 13), bilateral OSSI in sequential surgeries (n = 1). Outcomes measured were surgical duration, complications, hearing thresholds, speech perception and self-reported hearing benefits using the Speech and Spatial Quality of Hearing Questionnaire. RESULTS The surgical times were mean 93.6 minutes (SD = 33.3). Surgery was slightly longer in three adolescents who required skin flap reduction (n = 1) or significant bone polishing (n = 2) (121.33 minutes, SD = 8.14). Adverse events occurred in two adolescents post-implant poor external device retention in one child requiring revision flap reduction and inflammation at the incision site due to magnet overuse in another. The "Digital Link Calibration" measure was a good proxy predictor of the strength of magnet required for external device adherence (p = 0.002). The OSSI increased audibility in the implanted ear by mean 31.48 dB HL (SE = 1.58). Aided thresholds were best at 1 kHz (mean 25.33 dB HL, SD = 22.60) and only slightly poorer at 3000 and 4000 Hz (estimate decrease = 8.33 dB HL, SE = 3.54), reflecting good auditory sensitivity even at high frequencies. Speech perception when using the new device alone was good (89.67%, SD = 7.84%) and self-reported hearing by participants and parents improved in all domains assessed by the Speech and Spatial Quality of Hearing Questionnaire (estimate = 1.90 points, SE = 0.25, p < 0.0001). CONCLUSION The OSSI provides hearing benefits with surgical safety in a carefully selected cohort of adolescents.
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Affiliation(s)
- Karen A. Gordon
- Department of Otolaryngology, Head and Neck Surgery, University of Toronto
- Department of Communication Disorders, Hospital for Sick Children
- Archie's Cochlear Implant Laboratory, Hospital for Sick Children
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Blake C. Papsin
- Department of Otolaryngology, Head and Neck Surgery, University of Toronto
- Department of Communication Disorders, Hospital for Sick Children
- Archie's Cochlear Implant Laboratory, Hospital for Sick Children
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - MaryLynn Feness
- Archie's Cochlear Implant Laboratory, Hospital for Sick Children
| | - Jaina Negandhi
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Sharon L. Cushing
- Department of Otolaryngology, Head and Neck Surgery, University of Toronto
- Department of Communication Disorders, Hospital for Sick Children
- Archie's Cochlear Implant Laboratory, Hospital for Sick Children
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
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15
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Zawawi F, Papsin BC, Dell S, Cushing SL. Vestibular and Balance Impairment Is Common in Children With Primary Ciliary Dyskinesia. Otol Neurotol 2022; 43:e355-e360. [PMID: 35061636 DOI: 10.1097/mao.0000000000003455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Primary ciliary dyskinesia (PCD) is a rare genetic disorder that presents with a wide range of respiratory complaints. The most common otologic associated disorder is middle ear effusion. We ask if children with PCD suffer from vestibular impairment. STUDY DESIGN Cross-sectional cohort study. SETTING Tertiary pediatric referral hospital. PATIENTS/PARTICIPANTS Children with confirmed PCD. INTERVENTION/METHODS All included participants were clinically assessed to be at baseline then basic demographics and medical histories were collected, including the specific genetic mutation these patients have. After which, all patients underwent two vestibular tests. The first was to assess their ability to stand on one foot with their eyes open and then with their eyes closed and the second was video head impulse test (vHIT). MAIN OUTCOME MEASURES Ability standing on one foot with the eyes closed and vHIT. RESULTS During this period, 25 children with PCD were recruited for the study. The mean age at recruitment was 11.26 years (4-18 yr). There were 11 women and 14 men. All patients were able to participate in both tests. Nineteen participants (76%) had vestibular impairment. Fifteen of them failed to stand on one foot with their eyes closed and six of 25 had abnormal vHIT. The most common involved gene was DNAH5 8/25 (32%) and it was associated with vestibular impairment in seven of eight participants (87.5%). CONCLUSION The majority of children with PCD that we tested suffered from vestibular impairment that was previously undiagnosed. This potentially indicates that imbalance and vestibular pathology is under-diagnosed in children with PCD.
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Affiliation(s)
- Faisal Zawawi
- Department of Otolaryngology-Head and Neck Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Otolaryngology-Head and Neck Surgery
| | - Blake C Papsin
- Department of Otolaryngology-Head and Neck Surgery
- Archie's Cochlear Implant Laboratory
| | - Sharon Dell
- Division of Respiratory Medicine, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto
- Division of Respiratory Medicine, Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Sharon L Cushing
- Department of Otolaryngology-Head and Neck Surgery
- Archie's Cochlear Implant Laboratory
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16
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Vegas N, Demir Z, Gordon CT, Breton S, Romanelli Tavares V, Moisset H, Zechi-Ceide R, Kokitsu-Nakata NM, Kido Y, Marlin S, Gherbi Halem S, Meerschaut I, Callewaert B, Chung B, Revencu N, Lehalle D, Petit F, Propst EJ, Papsin BC, Phillips JH, Jakobsen L, Le Tanno P, Thévenon J, McGaughran J, Gerkes EH, Leoni C, Kroisel P, Yang Tan T, Henderson A, Terhal P, Basel-Salmon L, Alkindy A, White SM, Passos Bueno MR, Pingault V, De Pontual L, Amiel J. Further delineation of Auriculocondylar syndrome based on 14 novel cases and reassessment of 25 published cases. Hum Mutat 2022; 43:582-594. [PMID: 35170830 DOI: 10.1002/humu.24349] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 02/08/2022] [Accepted: 02/11/2022] [Indexed: 11/08/2022]
Abstract
Auriculocondylar syndrome (ACS) is a rare craniofacial disorder characterized by mandibular hypoplasia and an auricular defect at the junction between the lobe and helix, known as a "Question Mark Ear" (QME). Several additional features, originating from the first and second branchial arches and other tissues, have also been reported. ACS is genetically heterogeneous with autosomal dominant and recessive modes of inheritance. The mutations identified to date are presumed to dysregulate the endothelin 1 signalling pathway. Here we describe 14 novel cases and reassess 25 published cases of ACS through a questionnaire for systematic data collection. All patients harbour mutation(s) in PLCB4, GNAI3 or EDN1. This series of patients contributes to the characterization of additional features occasionally associated with ACS such as respiratory, costal, neurodevelopmental and genital anomalies, and provides management and monitoring recommendations. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Nancy Vegas
- Laboratory of Embryology and Genetics of Malformations, Institut National de la Santé et de la Recherche Médicale (INSERM) UMR 1163, Université de Paris, Institut Imagine, Paris, France
| | - Zeynep Demir
- Laboratory of Embryology and Genetics of Malformations, Institut National de la Santé et de la Recherche Médicale (INSERM) UMR 1163, Université de Paris, Institut Imagine, Paris, France.,Unité d'hépatologie pédiatrie et transplantation, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
| | - Christopher T Gordon
- Laboratory of Embryology and Genetics of Malformations, Institut National de la Santé et de la Recherche Médicale (INSERM) UMR 1163, Université de Paris, Institut Imagine, Paris, France
| | - Sylvain Breton
- Service d'imagerie pédiatrie, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
| | - Vanessa Romanelli Tavares
- Centro de Pesquisas do Genoma Humano e Celulas Tronco, Departamento de Genetica e Biología Evolutiva, Instituto de Biociencias, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Hugo Moisset
- Laboratory of Embryology and Genetics of Malformations, Institut National de la Santé et de la Recherche Médicale (INSERM) UMR 1163, Université de Paris, Institut Imagine, Paris, France
| | - Roseli Zechi-Ceide
- Department of Clinical Genetics, Hospital for Rehabilitation of Craniofacial Anomalies, University of Sao Paulo, Bauru, Brazil
| | - Nancy M Kokitsu-Nakata
- Department of Clinical Genetics, Hospital for Rehabilitation of Craniofacial Anomalies, University of Sao Paulo, Bauru, Brazil
| | - Yasuhiro Kido
- Department of Pediatrics, Dokkyo Medical University Koshigaya Hospital, Saitama, Japan
| | - Sandrine Marlin
- Laboratory of Embryology and Genetics of Malformations, Institut National de la Santé et de la Recherche Médicale (INSERM) UMR 1163, Université de Paris, Institut Imagine, Paris, France.,Reference center for genetic hearing loss, Fédération de Génétique et de Médecine Génomique, Hôpital Necker, APHP.CUP, Paris, France
| | - Souad Gherbi Halem
- Reference center for genetic hearing loss, Fédération de Génétique et de Médecine Génomique, Hôpital Necker, APHP.CUP, Paris, France
| | - Ilse Meerschaut
- Center for Medical Genetics, Ghent University Hospital, and Department of Biomolecular Medicine, Ghent University, Belgium
| | - Bert Callewaert
- Center for Medical Genetics, Ghent University Hospital, and Department of Biomolecular Medicine, Ghent University, Belgium
| | - Brian Chung
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong
| | - Nicole Revencu
- Center for Human Genetics, Cliniques universitaires Saint Luc, Université catholique de Louvain, Brussels, Belgium
| | - Daphné Lehalle
- Centre de génétique- centre de référence des maladies rares, anomalies du développement et syndrome malformatifs, Centre Hospitalo-Universitaire de Dijon, Bourgogne, France.,UF de Génétique Médicale, Département de Génétique, Groupe Hospitalier Pitié-Salpêtrière, APHP Sorbonne Université, Paris, France
| | - Florence Petit
- CHU Lille, clinique de Génétique Guy Fontaine, F-59000, Lille, France
| | - Evan J Propst
- Department of Otolaryngology-Head and Neck Surgery, The Hospital for Sick Children, University of Toronto, Canada
| | - Blake C Papsin
- Department of Otolaryngology-Head and Neck Surgery, The Hospital for Sick Children, University of Toronto, Canada
| | - John H Phillips
- Department of Otolaryngology-Head and Neck Surgery, The Hospital for Sick Children, University of Toronto, Canada
| | - Linda Jakobsen
- Department of Plastic Surgery, Copenhagen University Hospital, Herlev, Denmark
| | - Pauline Le Tanno
- Service de Génétique et Université Grenoble-Alpes, Grenoble, France
| | - Julien Thévenon
- Service de Génétique et Université Grenoble-Alpes, Grenoble, France
| | - Julie McGaughran
- Genetic Health Queensland, Royal Brisbane and Women's Hospital, Herston and the University of Queensland, St Lucia, Brisbane, Australia
| | - Erica H Gerkes
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Chiara Leoni
- Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico A. Gemelli, IRCCS, Italy
| | - Peter Kroisel
- Institute of Human Genetics, Medical University of Graz, Graz, Austria
| | - Tiong Yang Tan
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Royal Children's Hospital, and Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Alex Henderson
- Northern Genetics Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Paulien Terhal
- Department of Medical Genetics, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Lina Basel-Salmon
- Pediatric Genetics, Schneider Children's Medical Center of Israel and Raphael Recanati Genetics Institute, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Felsenstein Medical Research Center, Rabin Medical Center, Petah Tikva, Israel
| | - Adila Alkindy
- Department of Genetics, Sultan Qaboos University Hospital, Muscat, Oman
| | - Susan M White
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Royal Children's Hospital, and Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Maria Rita Passos Bueno
- Centro de Pesquisas do Genoma Humano e Celulas Tronco, Departamento de Genetica e Biología Evolutiva, Instituto de Biociencias, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Véronique Pingault
- Laboratory of Embryology and Genetics of Malformations, Institut National de la Santé et de la Recherche Médicale (INSERM) UMR 1163, Université de Paris, Institut Imagine, Paris, France.,Fédération de Génétique et de Médecine Génomique, Hôpital Necker, APHP.CUP, Paris, France
| | - Loïc De Pontual
- Laboratory of Embryology and Genetics of Malformations, Institut National de la Santé et de la Recherche Médicale (INSERM) UMR 1163, Université de Paris, Institut Imagine, Paris, France.,Service de pédiatrie, Hôpital Jean Verdier, Bondy, France
| | - Jeanne Amiel
- Laboratory of Embryology and Genetics of Malformations, Institut National de la Santé et de la Recherche Médicale (INSERM) UMR 1163, Université de Paris, Institut Imagine, Paris, France.,Fédération de Génétique et de Médecine Génomique, Hôpital Necker, APHP.CUP, Paris, France
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17
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Gordon KA, Papsin BC, Papaioannou V, Cushing SL. The Importance of Access to Bilateral Hearing through Cochlear Implants in Children. Semin Hear 2021; 42:381-388. [PMID: 34912166 PMCID: PMC8660169 DOI: 10.1055/s-0041-1739371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Children with hearing loss require early access to sound in both ears to support their development. In this article, we describe barriers to providing bilateral hearing and developmental consequences of delays during early sensitive periods. Barriers include late identification of hearing loss in one or both ears and delayed access to intervention with hearing devices such as cochlear implants. Effects of delayed bilateral input on the auditory pathways and brain are discussed as well as behavioral effects on speech perception and other developmental outcomes including language and academics. Evidence for these effects has supported an evolution in cochlear implant candidacy in children that was started with unilateral implantation in children with profound deafness bilaterally to bilateral implantation to implantation of children with asymmetric hearing loss including children with single-side deafness. Opportunities to enhance the developmental benefits of bilateral hearing in children with hearing loss are also discussed including efforts to improve binaural/spatial hearing and consideration of concurrent vestibular deficits which are common in children with hearing loss.
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Affiliation(s)
- Karen A Gordon
- Archie's Cochlear Implant Laboratory, The Hospital for Sick Children, Toronto, Canada.,Department of Communication Disorders, The Hospital for Sick Children, Toronto, Canada.,Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Canada
| | - Blake C Papsin
- Archie's Cochlear Implant Laboratory, The Hospital for Sick Children, Toronto, Canada.,Department of Otolaryngology, The Hospital for Sick Children, Toronto, Canada.,Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Canada
| | - Vicky Papaioannou
- Department of Communication Disorders, The Hospital for Sick Children, Toronto, Canada.,Department of Otolaryngology, The Hospital for Sick Children, Toronto, Canada.,Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Canada
| | - Sharon L Cushing
- Archie's Cochlear Implant Laboratory, The Hospital for Sick Children, Toronto, Canada.,Department of Otolaryngology, The Hospital for Sick Children, Toronto, Canada.,Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Canada
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18
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Cushing SL, Gordon KA, Purcell PL, Feness M, Negandhi J, Papsin BC. Surgical Considerations for an Osseointegrated Steady State Implant (OSIA2®) in Children. Laryngoscope 2021; 132:1088-1092. [PMID: 34687460 DOI: 10.1002/lary.29892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 09/11/2021] [Accepted: 09/18/2021] [Indexed: 11/05/2022]
Affiliation(s)
- Sharon L Cushing
- Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, Toronto, Canada.,Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Canada.,Department of Communication Disorders, Hospital for Sick Children, Toronto, Canada.,Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Karen A Gordon
- Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, Toronto, Canada.,Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Canada.,Department of Communication Disorders, Hospital for Sick Children, Toronto, Canada.,Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Patricia L Purcell
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, USA
| | - MaryLynn Feness
- Department of Communication Disorders, Hospital for Sick Children, Toronto, Canada
| | - Jaina Negandhi
- Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Blake C Papsin
- Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, Toronto, Canada.,Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Canada.,Department of Communication Disorders, Hospital for Sick Children, Toronto, Canada.,Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Canada
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19
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McSweeny C, Cushing SL, Campos JL, Papsin BC, Gordon KA. Functional Consequences of Poor Binaural Hearing in Development: Evidence From Children With Unilateral Hearing Loss and Children Receiving Bilateral Cochlear Implants. Trends Hear 2021; 25:23312165211051215. [PMID: 34661482 PMCID: PMC8527588 DOI: 10.1177/23312165211051215] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Poor binaural hearing in children was hypothesized to contribute to related cognitive and
academic deficits. Children with unilateral hearing have normal hearing in one ear but no
access to binaural cues. Their cognitive and academic deficits could be unique from
children receiving bilateral cochlear implants (CIs) at young ages who have poor access to
spectral cues and impaired binaural sensitivity. Both groups are at risk for
vestibular/balance deficits which could further contribute to memory and learning
challenges. Eighty-eight children (43 male:45 female, aged 9.89 ± 3.40 years), grouped
by unilateral hearing loss (n = 20), bilateral CI
(n = 32), and typically developing (n = 36), completed a
battery of sensory, cognitive, and academic tests. Analyses revealed that children in both
hearing loss groups had significantly poorer skills (accounting for age) on most tests
than their normal hearing peers. Children with unilateral hearing loss had more asymmetric
speech perception than children with bilateral CIs (p < .0001) but
balance and language deficits (p = .0004, p < .0001,
respectively) were similar in the two hearing loss groups (p > .05).
Visuospatial memory deficits occurred in both hearing loss groups
(p = .02) but more consistently across tests in children with unilateral
hearing loss. Verbal memory was not significantly different than normal
(p > .05). Principal component analyses revealed deficits in a main
cluster of visuospatial memory, oral language, mathematics, and reading measures
(explaining 46.8% data variability). The remaining components revealed clusters of
self-reported hearing, balance and vestibular function, and speech perception deficits.
The findings indicate significant developmental impacts of poor binaural hearing in
children.
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Affiliation(s)
- Claire McSweeny
- Archie's Cochlear Implant Lab, 7979Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sharon L Cushing
- Archie's Cochlear Implant Lab, 7979Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Otolaryngology, Head & Neck Surgery, Faculty of Medicine, University of Toronto, Ontario, Canada.,Department of Otolaryngology, Head & Neck Surgery, 7979Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jennifer L Campos
- KITE-Toronto Rehabilitation Institute, Toronto, Ontario, Canada.,Department of Psychology, University of Toronto, Toronto, Ontario, Canada
| | - Blake C Papsin
- Archie's Cochlear Implant Lab, 7979Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Otolaryngology, Head & Neck Surgery, Faculty of Medicine, University of Toronto, Ontario, Canada.,Department of Otolaryngology, Head & Neck Surgery, 7979Hospital for Sick Children, Toronto, Ontario, Canada
| | - Karen A Gordon
- Archie's Cochlear Implant Lab, 7979Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Otolaryngology, Head & Neck Surgery, Faculty of Medicine, University of Toronto, Ontario, Canada
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20
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Stabenau KA, Zimmermann MT, Mathison A, Zeighami A, Samuels TL, Chun RH, Papsin BC, McCormick ME, Johnston N, Kerschner JE. RNA Sequencing and Pathways Analyses of Middle Ear Epithelia From Patients With Otitis Media. Laryngoscope 2021; 131:2590-2597. [PMID: 33844317 DOI: 10.1002/lary.29551] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/04/2021] [Accepted: 03/23/2021] [Indexed: 01/24/2023]
Abstract
OBJECTIVES Otitis media (OM) is the most common pediatric diagnosis in the United States. However, our understanding of the molecular pathogenesis of OM remains relatively poor. Investigation of molecular pathways involved in OM may improve the understanding of this disease process and elucidate novel therapeutic targets. In this study, RNA sequencing (RNA-Seq) was used to discern cellular changes associated with OME compared to healthy middle ear epithelium (MEE). STUDY DESIGN Ex vivo case-control translational. METHODS Middle ear epithelia was collected from five pediatric patients diagnosed with OME undergoing tympanostomy tube placement and five otherwise healthy pediatric patients undergoing cochlear implantation. Specimens underwent RNA-Seq and pathways analyses. RESULTS A total of 1,292 genes exhibited differential expression in MEE from OME patients compared to controls including genes involved in inflammation, immune response to bacterial OM pathogens, mucociliary clearance, regulation of proliferation and transformation, and auditory cell differentiation. Top networks identified in OME were organismal injury and abnormalities, cell morphology, and auditory disease. Top Ingenuity canonical pathways identified were axonal guidance signaling, which contains genes associated with auditory development and disease and nicotine degradation II and III pathways. Associated upstream regulators included β-estradiol, dexamethasone, and G-protein-coupled estrogen receptor-1 (GPER1), which are associated with otoprotection or inflammation during insult. CONCLUSIONS RNA-Seq demonstrates differential gene expression in MEE from patients with OME compared to healthy controls with important implications for infection susceptibility, hearing loss, and a role for tobacco exposure in the development and/or severity of OME in pediatric patients. LEVEL OF EVIDENCE 4 Laryngoscope, 2021.
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Affiliation(s)
- Kaleigh A Stabenau
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Michael T Zimmermann
- Bioinformatics Research and Development Laboratory, Genomic Sciences and Precision Medicine Center, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A.,Clinical and Translational Science Institute, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Angela Mathison
- Bioinformatics Research and Development Laboratory, Genomic Sciences and Precision Medicine Center, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Atefeh Zeighami
- Bioinformatics Research and Development Laboratory, Genomic Sciences and Precision Medicine Center, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Tina L Samuels
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Robert H Chun
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Blake C Papsin
- Archie's Cochlear Implant Laboratory, Department of Otolaryngology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Michael E McCormick
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Nikki Johnston
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A.,Department of Microbiology and Immunology, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Joseph E Kerschner
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
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21
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Zawawi F, Cushing SL, James AL, Gordon KA, Papsin BC. How I do it: Proximal cochlear implant electrode fixation using Ned's Knot. Int J Pediatr Otorhinolaryngol 2021; 142:110593. [PMID: 33378719 DOI: 10.1016/j.ijporl.2020.110593] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 12/21/2020] [Accepted: 12/21/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Electrode extrusion is an under-recognized complication of cochlear implants, especially in those with straight electrodes. METHODS This paper describes in details the steps to perform proximal fixation of an electrode around the incus buttress using Ned's knot technique. Written and video illustration is included. CONCLUSIONS Ned's Knot is an easy technique that can help diminish the extrusion rate of straight cochlear implants electrodes.
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Affiliation(s)
- Faisal Zawawi
- Department of Otolaryngology - Head and Neck Surgery, The Hospital for Sick Children, University of Toronto, Canada; Department of Otolaryngology - Head and Neck Surgery, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Sharon L Cushing
- Department of Otolaryngology - Head and Neck Surgery, The Hospital for Sick Children, University of Toronto, Canada; Archie's Cochlear Implant Laboratory, Hospital for Sick Children, University of Toronto, Canada; Institute of Medical Sciences, University of Toronto, Canada
| | - Adrian L James
- Department of Otolaryngology - Head and Neck Surgery, The Hospital for Sick Children, University of Toronto, Canada; Institute of Medical Sciences, University of Toronto, Canada
| | - Karen A Gordon
- Department of Otolaryngology - Head and Neck Surgery, The Hospital for Sick Children, University of Toronto, Canada; Archie's Cochlear Implant Laboratory, Hospital for Sick Children, University of Toronto, Canada; Department of Communication Disorders, Hospital for Sick Children, University of Toronto, Canada; Institute of Medical Sciences, University of Toronto, Canada
| | - Blake C Papsin
- Department of Otolaryngology - Head and Neck Surgery, The Hospital for Sick Children, University of Toronto, Canada; Archie's Cochlear Implant Laboratory, Hospital for Sick Children, University of Toronto, Canada; Institute of Medical Sciences, University of Toronto, Canada
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22
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Deep NL, Purcell PL, Gordon KA, Papsin BC, Roland Jr. JT, Waltzman SB. Cochlear Implantation in Infants: Evidence of Safety. Trends Hear 2021; 25:23312165211014695. [PMID: 34028328 PMCID: PMC8150451 DOI: 10.1177/23312165211014695] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 04/08/2021] [Accepted: 04/14/2021] [Indexed: 11/15/2022] Open
Abstract
The aim of this study was to investigate surgical, anesthetic, and device-related complications associated with cochlear implantation (CI) in children younger than 1 year of age. This was a multicenter, retrospective chart review of all children with severe-to-profound sensorineural hearing loss who underwent cochlear implantation with a Cochlear Nucleus Implant System before 1 year of age. Endpoints included perioperative course, major and minor surgical, anesthetic and device-related complications, and 30-day readmission rates. One hundred thirty-six infants (242 ears) met criteria. The mean age at implantation was 9.4 months (standard deviation 1.8). Six-month follow-up was reported in all patients. There were no major anesthetic or device-related complications. Adverse events were reported in 34 of implanted ears (14%; 7 major, 27 minor). Sixteen adverse events occurred ≤30 days of surgery, and 18 occurred >30 days of surgery. The 30-day readmission rate was 1.5%. The rate of adverse events did not correlate with preexisting medical comorbidities or duration under anesthesia. There was no significant difference detected in complication rate for patients younger than 9 months of age versus those 9 to 11 months of age. This study demonstrates the safety of CI surgery in infants and supports reducing the indication for cochlear implantation to younger than 1 year of age for children with bilateral, profound sensorineural hearing loss obtaining a Cochlear Nucleus Implant System.
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Affiliation(s)
- Nicholas L. Deep
- Department of Otolaryngology, Head & Neck Surgery, New York University Grossman School of Medicine, New York City, United States
| | - Patricia L. Purcell
- Department of Otolaryngology, Head & Neck Surgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Karen A. Gordon
- Department of Otolaryngology, Head & Neck Surgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Blake C. Papsin
- Department of Otolaryngology, Head & Neck Surgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - J. Thomas Roland Jr.
- Department of Otolaryngology, Head & Neck Surgery, New York University Grossman School of Medicine, New York City, United States
| | - Susan B. Waltzman
- Department of Otolaryngology, Head & Neck Surgery, New York University Grossman School of Medicine, New York City, United States
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23
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Akiyama A, Tsai JD, W Y Tam E, Kamino D, Hahn C, Go CY, Chau V, Whyte H, Wilson D, McNair C, Papaioannou V, Hugh SC, Papsin BC, Nishijima S, Yamazaki T, Miller SP, Ochi A. The Effect of Music and White Noise on Electroencephalographic (EEG) Functional Connectivity in Neonates in the Neonatal Intensive Care Unit. J Child Neurol 2021; 36:38-47. [PMID: 32838628 DOI: 10.1177/0883073820947894] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The purpose of this study is to investigate whether listening to music and white noise affects functional connectivity on scalp electroencephalography (EEG) in neonates in the neonatal intensive care unit.Nine neonates of ≥34 weeks' gestational age, who were already undergoing clinical continuous EEG monitoring in the neonatal intensive care unit, listened to lullaby-like music and white noise for 1 hour each separated by a 2-hour interval of no intervention. EEG segments during periods of music, white noise, and no intervention were band-pass filtered as delta (0.5-4 Hz), theta (4-8 Hz), lower alpha (8-10 Hz), upper alpha (10-13 Hz), beta (13-30 Hz), and gamma (30-45 Hz). Synchronization likelihood was used as a measure of connectivity between any 2 electrodes.In theta, lower alpha, and upper alpha frequency bands, the synchronization likelihood values yielded statistical significance with sound (music, white noise and no intervention) and with edge (between any 2 electrodes) factors. In theta, lower alpha, and upper alpha frequency bands, statistical significance was obtained between music and white noise (t = 3.12, 3.32, and 3.68, respectively; P < .017), and between white noise and no intervention (t = 4.51, 3.09, and 2.95, respectively, P < .017). However, there was no difference between music and no intervention.Although limited by a small sample size and the 1-time only auditory intervention, these preliminary results demonstrate the feasibility of EEG connectivity analyses even at bedside in neonates on continuous EEG monitoring in the neonatal intensive care unit. They also point to the possibility of detecting significant changes in functional connectivity related to the theta and alpha bands using auditory interventions.
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Affiliation(s)
- Akiyoshi Akiyama
- Department of Paediatrics (Neurology), The 7979Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.,Department of Bioscience and Bioinformatics, 12924Kyushu Institute of Technology, Fukuoka, Japan
| | - Jeng-Dau Tsai
- Department of Paediatrics (Neurology), The 7979Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.,Department of Pediatrics, Chung Shan Medical University Hospital and Chung Shan Medical University, Taichung, Taiwan
| | - Emily W Y Tam
- Department of Paediatrics (Neurology), The 7979Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Daphne Kamino
- Department of Paediatrics (Neurology), The 7979Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Cecil Hahn
- Department of Paediatrics (Neurology), The 7979Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Cristina Y Go
- Department of Paediatrics (Neurology), The 7979Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Vann Chau
- Department of Paediatrics (Neurology), The 7979Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Hilary Whyte
- Department of Paediatrics (Neonatology), 7979The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Diane Wilson
- Department of Paediatrics (Neonatology), 7979The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Carol McNair
- Department of Paediatrics (Neonatology), 7979The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Vicky Papaioannou
- Department of Otolaryngology, The 7979Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Communication Disorders, The 7979Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sarah C Hugh
- Department of Surgery (Otolaryngology), Joseph Brant Hospital and McMaster University, Burlington, Ontario, Canada
| | - Blake C Papsin
- Department of Otolaryngology, The 7979Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sakura Nishijima
- Department of Paediatrics (Neurology), The 7979Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.,Department of Bioscience and Bioinformatics, 12924Kyushu Institute of Technology, Fukuoka, Japan
| | - Toshimasa Yamazaki
- Department of Bioscience and Bioinformatics, 12924Kyushu Institute of Technology, Fukuoka, Japan
| | - Steven P Miller
- Department of Paediatrics (Neurology), The 7979Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Ayako Ochi
- Department of Paediatrics (Neurology), The 7979Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
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24
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Purcell PL, Deep NL, Waltzman SB, Roland JT, Cushing SL, Papsin BC, Gordon KA. Cochlear Implantation in Infants: Why and How. Trends Hear 2021; 25:23312165211031751. [PMID: 34281434 PMCID: PMC8295935 DOI: 10.1177/23312165211031751] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 04/22/2021] [Accepted: 06/23/2021] [Indexed: 11/25/2022] Open
Abstract
In children with congenital deafness, cochlear implantation (CI) prior to 12 months of age offers the opportunity to foster more typical auditory development during late infancy and early childhood. Recent studies have found a positive association between early implantation and expressive and receptive language outcomes, with some children able to achieve normal language skills by the time of school entry. Universal newborn hearing screening improved early detection and diagnosis of congenital hearing loss, allowing for earlier intervention, including decision-making regarding cochlear implant (CI) candidacy. It can be more challenging to confirm CI candidacy in infants; therefore, a multidisciplinary approach, including objective audiometric testing, is recommended to not only confirm the diagnosis but also to counsel families regarding expectations and long-term management. Surgeons performing CI surgery in young children should consider both the anesthetic risks of surgery in infancy and the ways in which mastoid anatomy may differ between infants and older children or adults. Multiple studies have found CI surgery in infants can be performed safely and effectively. This article reviews current evidence regarding indications for implantation in children younger than 12 months of age and discusses perioperative considerations and surgical technique.
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Affiliation(s)
- Patricia L. Purcell
- Department of Otolaryngology, Head & Neck Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Nicholas L. Deep
- Department of Otolaryngology, Head & Neck Surgery, New York University Grossman School of Medicine, New York, New York, United States
| | - Susan B. Waltzman
- Department of Otolaryngology, Head & Neck Surgery, New York University Grossman School of Medicine, New York, New York, United States
| | - J. Thomas Roland
- Department of Otolaryngology, Head & Neck Surgery, New York University Grossman School of Medicine, New York, New York, United States
| | - Sharon L. Cushing
- Department of Otolaryngology, Head & Neck Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Blake C. Papsin
- Department of Otolaryngology, Head & Neck Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Karen A. Gordon
- Department of Otolaryngology, Head & Neck Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
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25
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Wolter NE, Gordon KA, Campos J, Vilchez Madrigal LD, Papsin BC, Cushing SL. Impact of the sensory environment on balance in children with bilateral cochleovestibular loss. Hear Res 2020; 400:108134. [PMID: 33310565 DOI: 10.1016/j.heares.2020.108134] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 11/01/2020] [Accepted: 11/24/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND The aim of the present study was to determine the role of auditory and visual sensory input on balance in children with bilateral cochlevestibular loss. The prevalence of vestibular impairment, and specifically bilateral vestibular loss (BVL) in children with sensorineural hearing loss (SNHL) is high and children with profound cochleovestibular loss (SNHL-BVL) have impaired balance (Suarez et al., 2007; Suarez et al., 2019). Given that both hearing and vestibular impairments are often congenital or acquired in early life, it remains difficult to tease out the individual developmental impact of either one on balance and spatial awareness in children who experience both of these sensory deficits. While cochlear implants (CI) can provide or restore access to sound in children with SNHL-BVL, there is currently no vestibular prosthetic available for clinical use in this population. These children may also use their intact sensory inputs (i.e. vision) to a greater extent to support balance. Alternately, restoring or providing access to sound may, on its own, help these children to balance better. We hypothesized that balance in children with SNHL-BVL who use bilateral CIs is: 1) improved in the presence of directional sound and 2) impaired when visual cues are dynamic (moving) rather than static. METHODS Balance was assessed in 18 children with SNHL-BVL and 34 typically developing children with intact vestibular function and normal hearing by performing the Bruininks-Oseretsky Test of Motor Proficiency-2 (BOT-2) balance subtest in a virtual-reality simulator under 4 sensory conditions of graded complexity. Randomized conditions combined 2 auditory (moving directional street sounds vs. directionless static white noise) and 2 visual (dynamic street scene vs. stationary street scene) stimuli designed to recreate a "real-world" busy downtown street. Balance ability in children with SNHL-BVL was also compared with CI on and off. RESULTS As expected and similar to previous work, balance was significantly worse in the children with SNHL-BVL compared to typically developing children in all sensory conditions (p<0.0001). As a group, the mean balance skills of the children with SNHL-BVL were equivalent to that of a 4.4-year-old child despite being much older (mean age =13.8 years). Balance ability improved slightly but significantly when children with SNHL-BVL had access to any sound through their CI (p=0.047) and was positively correlated with duration of implant use (p=0.02). Balance ability did not change further in the presence of moving directional sounds compared to static white noise (p=0.42), or when coupled to a moving visual environment (p=0.32) in children with SNHL-BVL, however opposite to what was hypothesized, in the typically developing group, there was a decrement in performance that occurred in the presence of moving directional sound compared to directionless, static white noise (p=0.02). CONCLUSIONS Balance ability in children with SNHL-BVL who use bilateral CI was, as expected, poorer than their typically developing peers in all sensory conditions but improved slightly when they had access to any sound through their implants, with this benefit increasing as duration of implant use increased. This suggests that providing sound inputs through bilateral CIs positively affects balance in children with SNHL-BVL where vestibular and/or auditory inputs are compromised. This benefit was achieved even with auditory inputs that were devoid of moving directional cues (i.e. directionless static white noise) and is consistent with poor spatial hearing in children using bilateral CI.
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Affiliation(s)
- Nikolaus E Wolter
- Toronto Rehabilitation Institute (Institution where work was conducted) iDAPT Challenging Environmental Assessment Laboratory, 550 University Avenue, Toronto, Ontario M5G 2A2, Canada; Archie's Cochlear Implant Laboratory, Hospital for Sick Children, 555 University Avenue, Rm 6184, Toronto, Ontario M5G 1×8, Canada; Department Otolaryngology- Head and Neck Surgery, University of Toronto, 190 Elizabeth St., Rm 3S-438 , Toronto, Ontario M5G 2N2, Canada.
| | - Karen A Gordon
- Toronto Rehabilitation Institute (Institution where work was conducted) iDAPT Challenging Environmental Assessment Laboratory, 550 University Avenue, Toronto, Ontario M5G 2A2, Canada; Archie's Cochlear Implant Laboratory, Hospital for Sick Children, 555 University Avenue, Rm 6184, Toronto, Ontario M5G 1×8, Canada; Department Otolaryngology- Head and Neck Surgery, University of Toronto, 190 Elizabeth St., Rm 3S-438 , Toronto, Ontario M5G 2N2, Canada.
| | - Jennifer Campos
- Toronto Rehabilitation Institute (Institution where work was conducted) iDAPT Challenging Environmental Assessment Laboratory, 550 University Avenue, Toronto, Ontario M5G 2A2, Canada; Department of Psychology, University of Toronto, 100 St. George Street, 4th Floor, Sidney Smith Hall, Toronto, Ontario M5S 3G3, Canada.
| | - Luis D Vilchez Madrigal
- Archie's Cochlear Implant Laboratory, Hospital for Sick Children, 555 University Avenue, Rm 6184, Toronto, Ontario M5G 1×8, Canada; Department Otolaryngology- Head and Neck Surgery, University of Toronto, 190 Elizabeth St., Rm 3S-438 , Toronto, Ontario M5G 2N2, Canada; Otolaryngology Department, National Children's Hospital, San José, Costa Rica.
| | - Blake C Papsin
- Archie's Cochlear Implant Laboratory, Hospital for Sick Children, 555 University Avenue, Rm 6184, Toronto, Ontario M5G 1×8, Canada; Department Otolaryngology- Head and Neck Surgery, University of Toronto, 190 Elizabeth St., Rm 3S-438 , Toronto, Ontario M5G 2N2, Canada.
| | - Sharon L Cushing
- Toronto Rehabilitation Institute (Institution where work was conducted) iDAPT Challenging Environmental Assessment Laboratory, 550 University Avenue, Toronto, Ontario M5G 2A2, Canada; Archie's Cochlear Implant Laboratory, Hospital for Sick Children, 555 University Avenue, Rm 6184, Toronto, Ontario M5G 1×8, Canada; Department Otolaryngology- Head and Neck Surgery, University of Toronto, 190 Elizabeth St., Rm 3S-438 , Toronto, Ontario M5G 2N2, Canada.
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Propst EJ, Papsin BC, Wolter NE. Suspension Microesophagoscopy for Foreign Body Removal in Children. Laryngoscope 2020; 131:E2066-E2068. [PMID: 33155683 DOI: 10.1002/lary.29240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 10/10/2020] [Accepted: 10/21/2020] [Indexed: 11/06/2022]
Affiliation(s)
- Evan J Propst
- Department of Otolaryngology - Head & Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Blake C Papsin
- Department of Otolaryngology - Head & Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Nikolaus E Wolter
- Department of Otolaryngology - Head & Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Canada
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Ganek H, Forde-Dixon D, Cushing SL, Papsin BC, Gordon KA. Cochlear implant datalogging accurately characterizes children's 'auditory scenes'. Cochlear Implants Int 2020; 22:85-95. [PMID: 33008284 DOI: 10.1080/14670100.2020.1826137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Objectives: This study sought to determine if children's auditory environments are accurately captured by the automatic scene classification embedded in cochlear implant (CI) processors and to quantify the amount of electronic device use in these environments. Methods: Seven children with CIs, 36.71 (SD = 11.94) months old, participated in this study. Three of the children were male and four were female. Eleven datalogs, containing outcomes from Cochlear's™ Nucleus® 6 (Cochlear Corporation, Australia) CI scene classification algorithm, and seven day-long audio recordings collected with a Language ENvironment Analysis (LENA; LENA Research Foundation, USA) recorder were obtained for analysis. Results: Results from the scene classification algorithm were strongly correlated with categories determined through human coding (ICC = .86, CI = [-0.2, 1], F(5,5.1) = 5.9, P = 0.04) but some differences emerged. Scene classification identified more 'Quiet' (t(8.2) = 4.1, P = 0.003) than human coders, while humans identified more 'Speech' (t(10.6) = -2.4, P = 0.04). On average, 8% (SD = 5.8) of the children's day was spent in electronic sound, which was primarily produced by mobile devices (39.7%). Discussion: While CI scene classification software reflects children's natural auditory environments, it is important to consider how different scenes are defined when interpreting results. An electronic sounds category should be considered given how often children are exposed to such sounds.
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Affiliation(s)
- Hillary Ganek
- Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Deja Forde-Dixon
- Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sharon L Cushing
- Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology Head and Neck Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Otolaryngology Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Blake C Papsin
- Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology Head and Neck Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Otolaryngology Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Karen A Gordon
- Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology Head and Neck Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Otolaryngology Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Communication Disorders, Hospital for Sick Children, Toronto, Ontario, Canada
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Trimble K, Rosella LC, Propst E, Gordon KA, Papaioannou V, Papsin BC. Speech Perception Outcome in Multiply Disabled Children Following Cochlear Implantation: Investigating a Predictive Score. J Am Acad Audiol 2020; 19:602-11; quiz 651. [DOI: 10.3766/jaaa.19.8.4] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Children with multiple disabilities account for a small percentage of implantees in a cochlear implant program, but they remain the most challenging group for which to predict benefit from the implant and for cooperation with habilitation postoperatively.
Purpose: To assess the relationship of pre-implant functional disabilities with postoperative speech perception scores and determine the feasibility of predicting outcome with a cochlear implant in a multiply disabled pediatric population.
Research Design: Retrospective cohort study.
Study Sample: Sixty-six children with a cochlear implant and at least one additional disability.
Data Collection And Analysis: We retrospectively examined the relationship between pre-implant Graded Profile Analysis (GPA) scores and postimplant speech perception scores. A pre-implant functional disability score (based on the Battelle developmental screen) was applied to the same cohort of patients and its association with postimplant speech perception scores was examined.
Results: The functional disability score significantly predicted high (k > 24) and low (k < 7) speech perception scores (p < 0.001 and p < .0001) and had excellent discrimination ability (c statistic = 0.88 and 0.93 respectively). The GPA score was not significantly associated with speech perception scores (p = 0.519 and p = 0.146) and demonstrated no ability to discriminate postimplant speech perception scores in this implant population (c statistic = 0.49 and c = 0.57).
Conclusions: Prediction of outcomes following cochlear implantation in multiply disabled children can be facilitated using this newly developed functional disability score as an adjunct to traditional candidacy assessments.
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Polonenko MJ, Carinci L, Gordon KA, Papsin BC, Cushing SL. Hearing Benefit and Rated Satisfaction in Children with Unilateral Conductive Hearing Loss Using a Transcutaneous Magnetic-Coupled Bone-Conduction Hearing Aid. J Am Acad Audiol 2020; 27:790-804. [DOI: 10.3766/jaaa.15092] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Bilateral hearing is important for learning, development, and function in complex everyday environments. Children with conductive and mixed hearing loss (HL) have been treated for years with percutaneous coupling through an abutment, which achieves powerful output, but the implant site is susceptible to skin reactions and trauma. To overcome these complications, transcutaneous magnetic coupling systems were recently introduced.
Purpose: The purpose of the study was to evaluate whether the new transcutaneous magnetic coupling is an effective coupling paradigm for bone-conduction hearing aids (BCHAs). We hypothesized that magnetic coupling will (1) have limited adverse events, (2) provide adequate functional gain, (3) improve spatial hearing and aid listening in everyday situations, and (4) provide satisfactory outcomes to children and their families given one normal hearing ear.
Research Design: Retrospective analysis of audiological outcomes in a tertiary academic pediatric hospital.
Study Sample: Nine children aged 5–17 yr with permanent unilateral conductive HL (UCHL) or mixed HL were implanted with a transcutaneous magnet–retained BCHA. Average hearing thresholds of the better and implanted ears were 12.3 ± 11.5 dB HL and 69.1 ± 11.6 dB HL, respectively, with a 59.4 ± 4.8 dB (mean ± standard deviation) conductive component.
Data Collection and Analysis: Data were extracted from audiology charts of the children with permanent UCHL or mixed HL who qualified for a surgically retained BCHA and agreed to the magnetic coupling. Outcomes were collected from the 3- to 9-mo follow-up appointments, and included surgical complications, aided audiometric thresholds with varying magnet strength, speech performance in quiet and noise, and patient-rated benefit and satisfaction using questionnaires. Repeated measures analysis of variance was used to analyze audiometric outcomes, and nonparametric tests were used to evaluate rated benefit and satisfaction.
Results: All nine children tolerated the device and only one child had discomfort at the wound site. Similar access to sound was achieved regardless of magnet strength. Speech performance did not significantly improve in quiet or noise conditions with +10 and +5 dB signal-to-noise ratio. Children benefited from spatially separating the noise from the speech signal, regardless of whether the noise was directed to the implanted or better ear. When wearing the BCHA, the children reported satisfaction and significant implant benefit, particularly in background noise, but at the expense of increased aversiveness to sound.
Conclusions: Our findings, therefore, indicate that providing a transcutaneous magnetic-coupled BCHA to children who have UCHL or mixed HL provides benefit on some objective measures of bilateral hearing, as well as some subjective benefit in noise and everyday situations.
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Khurana P, Cushing SL, Chakraborty PK, Dunn JK, Papaioannou VA, Moodie RG, Papsin BC, Wong PD. Early hearing detection and intervention in Canada. Paediatr Child Health 2020; 26:141-144. [PMID: 33936331 DOI: 10.1093/pch/pxaa064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 04/19/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Puneeta Khurana
- Division of Paediatric Medicine, Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario
| | - Sharon L Cushing
- Department of Otolaryngology, Head and Neck Surgery, Hospital for Sick Children Faculty of Medicine, University of Toronto, Toronto, Ontario
| | - Pranesh K Chakraborty
- Division of Metabolics, Department of Paediatrics, University of Ottawa, Ottawa, Ontario
| | - Jessica K Dunn
- Division of Infectious Diseases, Department of Paediatrics, University of Ottawa, Ottawa, Ontario
| | - Vicky A Papaioannou
- Department of Otolaryngology, Head and Neck Surgery, Hospital for Sick Children Faculty of Medicine, University of Toronto, Toronto, Ontario
| | - Rosemary G Moodie
- Division of Neonatology, Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario
| | - Blake C Papsin
- Department of Otolaryngology, Head and Neck Surgery, Hospital for Sick Children Faculty of Medicine, University of Toronto, Toronto, Ontario
| | - Peter D Wong
- Division of Paediatric Medicine, Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario.,Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario
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Francom CR, Javia LR, Wolter NE, Lee GS, Wine T, Morrissey T, Papsin BC, Peyton JM, Matava CT, Volk MS, Prager JD, Propst EJ. Pediatric laryngoscopy and bronchoscopy during the COVID-19 pandemic: A four-center collaborative protocol to improve safety with perioperative management strategies and creation of a surgical tent with disposable drapes. Int J Pediatr Otorhinolaryngol 2020; 134:110059. [PMID: 32339971 PMCID: PMC7172675 DOI: 10.1016/j.ijporl.2020.110059] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 04/19/2020] [Indexed: 01/25/2023]
Abstract
Aerosolization procedures during the COVID-19 pandemic place all operating room personnel at risk for exposure. We offer detailed perioperative management strategies and present a specific protocol designed to improve safety during pediatric laryngoscopy and bronchoscopy. Several methods of using disposable drapes for various procedures are described, with the goal of constructing a tent around the patient to decrease widespread contamination of dispersed droplets and generated aerosol. The concepts presented herein are translatable to future situations where aerosol generating procedures increase risk for any pathogenic exposure. This protocol is a collaborative effort based on knowledge gleaned from clinical and simulation experience from Children's Hospital Colorado, Children's Hospital of Philadelphia, The Hospital for Sick Children in Toronto, and Boston Children's Hospital.
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Affiliation(s)
- Christian R. Francom
- Department of Otolaryngology, Head and Neck Surgery, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, CO, USA,Corresponding author. Children's Hospital Colorado, University of Colorado School of Medicine, 13123 East 16th Avenue, Box 455, Aurora, CO, 80045, USA.
| | - Luv R. Javia
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Pennsylvania Perelman School of Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Nikolaus E. Wolter
- Department of Otolaryngology, Head and Neck Surgery, University of Toronto, The Hospital for Sick Children, Toronto, Canada
| | - Gi Soo Lee
- Department of Otolaryngology, Head and Neck Surgery, Harvard Medical School, Boston Children's Hospital, Boston, MA, USA
| | - Todd Wine
- Department of Otolaryngology, Head and Neck Surgery, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, CO, USA
| | - Tyler Morrissey
- Department of Anesthesiology, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, CO, USA
| | - Blake C. Papsin
- Department of Otolaryngology, Head and Neck Surgery, University of Toronto, The Hospital for Sick Children, Toronto, Canada
| | - James M. Peyton
- Department of Anesthesiology, Harvard Medical School, Boston Children's Hospital, Boston, MA, USA
| | - Clyde T. Matava
- Department of Anesthesia and Pain Medicine, University of Toronto, The Hospital for Sick Children, Toronto, Canada
| | - Mark S. Volk
- Department of Otolaryngology, Head and Neck Surgery, Harvard Medical School, Boston Children's Hospital, Boston, MA, USA
| | - Jeremy D. Prager
- Department of Otolaryngology, Head and Neck Surgery, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, CO, USA
| | - Evan J. Propst
- Department of Otolaryngology, Head and Neck Surgery, University of Toronto, The Hospital for Sick Children, Toronto, Canada
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Purcell PL, Cushing SL, Papsin BC, Gordon KA. Unilateral Hearing Loss and Single-Sided Deafness in Children: an Update on Diagnosis and Management. Curr Otorhinolaryngol Rep 2020. [DOI: 10.1007/s40136-020-00293-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Sharma SD, Cushing SL, Papsin BC, Gordon KA. Hearing and speech benefits of cochlear implantation in children: A review of the literature. Int J Pediatr Otorhinolaryngol 2020; 133:109984. [PMID: 32203759 DOI: 10.1016/j.ijporl.2020.109984] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 03/05/2020] [Accepted: 03/06/2020] [Indexed: 11/30/2022]
Abstract
Cochlear implantation is a safe and reliable treatment for children with severe to profound hearing loss. The primary benefit of these medical devices in children is the acquisition of hearing, which promotes development of spoken language. The present paper reviews published literature demonstrating predictive effects of a number of factors on acquisition of hearing development and speech recognition. Of the many variables that contribute to an individual child's development after implantation, age at implantation, the presence of medical comorbidities, social determinants of health, and the provision of bilateral versus unilateral hearing are those that can vary widely and have consistently shown clear impacts. Specifically, age of implantation is crucial to reduce effects of deafness on the developing auditory system and capture the remarkable plasticity of early development. Language development after cochlear implantation requires therapy emphasizing hearing and oral communication, education, and other support which can be influenced by known social determinants of health; specifically, outcomes in children decline with reductions in socioeconomic status and levels of parental education. Medical co-morbidities also slow rates of progress after cochlear implantation. On the other hand, benefits of implantation increase in children who are provided with access to hearing from both ears. In sum, cochlear implants promote development of hearing in children and the best outcomes are achieved by providing early access to sound in both ears. These benefits can be limited by known social determinants of health which restrict access to needed support and medical comorbidities which add further complexity in care and outcome.
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Affiliation(s)
- Sunil D Sharma
- Department of Otolaryngology: Head & Neck Surgery, Hospital for Sick Children, Toronto, ON, Canada; Department of Otolaryngology: Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Sharon L Cushing
- Department of Otolaryngology: Head & Neck Surgery, Hospital for Sick Children, Toronto, ON, Canada; Department of Otolaryngology: Head & Neck Surgery, University of Toronto, Toronto, ON, Canada; Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
| | - Blake C Papsin
- Department of Otolaryngology: Head & Neck Surgery, Hospital for Sick Children, Toronto, ON, Canada; Department of Otolaryngology: Head & Neck Surgery, University of Toronto, Toronto, ON, Canada; Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Karen A Gordon
- Department of Otolaryngology: Head & Neck Surgery, Hospital for Sick Children, Toronto, ON, Canada; Department of Otolaryngology: Head & Neck Surgery, University of Toronto, Toronto, ON, Canada; Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Department of Communication Disorders, Hospital for Sick Children, Toronto, ON, Canada
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Wolter NE, Matava CT, Papsin BC, Oloya A, Mercier ME, Salonga E, Propst EJ. Enhanced Draping for Airway Procedures During the COVID-19 Pandemic. J Am Coll Surg 2020; 231:304-305. [PMID: 32467049 PMCID: PMC7248632 DOI: 10.1016/j.jamcollsurg.2020.04.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 04/29/2020] [Indexed: 12/15/2022]
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Affiliation(s)
- K A Gordon
- Archie's Cochlear Implant Laboratory, The Hospital for Sick Children, Toronto, ON, Canada; Department of Otolaryngology-Head & Neck Surgery, University of Toronto, ON, Canada.
| | - B C Papsin
- Archie's Cochlear Implant Laboratory, The Hospital for Sick Children, Toronto, ON, Canada; Department of Otolaryngology-Head & Neck Surgery, University of Toronto, ON, Canada
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Ganek HV, Feness ML, Goulding G, Liberman GM, Steel MM, Ruderman LA, Papsin BC, Cushing SL, Gordon KA. A survey of pediatric cochlear implant recipients as young adults. Int J Pediatr Otorhinolaryngol 2020; 132:109902. [PMID: 32006862 DOI: 10.1016/j.ijporl.2020.109902] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 01/20/2020] [Accepted: 01/20/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To identify the influence of pediatric cochlear implantation on long term communication modality, education, and income. METHODS A telephone survey was conducted with 56 young adults who had received cochlear implants (CI) as children. The participants were, on average, 10.6 (SD = 64) when they received their CI and 21 (SD = 2.29) when they participated in this study. All of the participants used a unilateral CI at the time of the survey. Where applicable, survey results were compared to the general population of similar aged individuals in Ontario using chi-squared tests of proportionality. RESULTS Participants (49/56, 88%) indicated that they used their CI all waking hours and 75% (42/56) reported using spoken language as their primary mode of communication. They attended post-secondary school at higher rates than the general population (χ2(1) = 14.35, p < .001); a wide range of study areas were identified with a greater proportion involved in fine arts than the general population (χ2(1) = 25.50, p < .001). The rates of employment in this group were below general rates (χ2(1) = 21.87, p < .001). However, those who were employed reported salaries similar to their hearing peers. CONCLUSION The findings from this study suggest that young adults who received a unilateral CI in childhood typically continue to use their CIs to support spoken language. Their increased rates of post-secondary education are encouraging and they may be choosing unique areas of study. Longer term studies are required to further investigate lower rates of employment in this cohort.
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Affiliation(s)
- Hillary V Ganek
- Cochlear Implant Program, The Hospital for Sick Children, Canada.
| | - Mary-Lynn Feness
- Cochlear Implant Program, The Hospital for Sick Children, Canada
| | - Gina Goulding
- Cochlear Implant Program, The Hospital for Sick Children, Canada
| | | | - Morrison M Steel
- Department of Psychiatry, University of California San Diego, USA
| | - Leanne A Ruderman
- Thanatology Program, King's University College at Western University, Canada
| | - Blake C Papsin
- Cochlear Implant Program, The Hospital for Sick Children, Canada; Department of Otolaryngology-HNS, University of Toronto, Canada
| | - Sharon L Cushing
- Cochlear Implant Program, The Hospital for Sick Children, Canada; Department of Otolaryngology-HNS, University of Toronto, Canada
| | - Karen A Gordon
- Cochlear Implant Program, The Hospital for Sick Children, Canada; Department of Otolaryngology-HNS, University of Toronto, Canada
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Smieja DA, Dunkley BT, Papsin BC, Easwar V, Yamazaki H, Deighton M, Gordon KA. Interhemispheric auditory connectivity requires normal access to sound in both ears during development. Neuroimage 2020; 208:116455. [DOI: 10.1016/j.neuroimage.2019.116455] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 11/21/2019] [Accepted: 12/09/2019] [Indexed: 10/25/2022] Open
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Sharma SD, Park E, Purcell PL, Gordon KA, Papsin BC, Cushing SL. Age-related variability in pediatric scalp thickness: Implications for auditory prostheses. Int J Pediatr Otorhinolaryngol 2020; 130:109853. [PMID: 31887567 DOI: 10.1016/j.ijporl.2019.109853] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 12/22/2019] [Accepted: 12/22/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Minimizing soft tissue reduction during the placement of percutaneous implants has been encouraged to improve cosmesis and perhaps decrease soft tissue complications. However, the fidelity of sound transmission and retention of transcutaneous magnet devices relates to the intervening soft tissue thickness. The objective of this study was to examine age-related variability in scalp thickness in patients receiving either percutaneously implanted or transcutaneous magnet-retained auditory prostheses. METHODS Children undergoing percutaneous implant retained prostheses or cochlear implantation underwent two scalp thickness measurements: 1) a superior measurement at the conventional marked site for cochlear implant receiver stimulator and 2) an inferior measurement 1.5 cm below the superior measurement representing the conventional marked site for cochlear implant fantail. Linear regression was used for statistical analysis. RESULTS Eighty-five children (median age 6 years; range 9 months-17 years) were examined. Scalp thickness at the two sites ranged from 1 to 10 mm (superior mean = 4.1 mm; inferior mean = 4.3 mm). A strong correlation was observed between age and scalp thickness at the superior (R = 0.62, p < 0.01) measurement, while a moderate correlation was observed at the inferior (R = 0.45, p < 0.01) sites. Children younger than 7 years displayed little variability in scalp thickness, and no correlation between age and scalp thickness (R = 0.002, p = 0.74). CONCLUSION In older children, scalp thickness varies significantly with age. However, children younger than 7 years consistently have scalp thicknesses of 3-4 mm. Lack of variability in scalp thickness in children younger than 7 years argues against the use of an age-adjusted approach to soft tissue management in this age group.
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Affiliation(s)
- Sunil D Sharma
- Department of Otolaryngology, Head & Neck Surgery, Hospital for Sick Children, Toronto, ON, Canada; Department of Otolaryngology, Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Edward Park
- Department of Otolaryngology, Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Patricia L Purcell
- Department of Otolaryngology, Head & Neck Surgery, Hospital for Sick Children, Toronto, ON, Canada; Department of Otolaryngology, Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Karen A Gordon
- Department of Otolaryngology, Head & Neck Surgery, Hospital for Sick Children, Toronto, ON, Canada; Department of Otolaryngology, Head & Neck Surgery, University of Toronto, Toronto, ON, Canada; Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Department of Communication Disorders, Hospital for Sick Children, Toronto, ON, Canada
| | - Blake C Papsin
- Department of Otolaryngology, Head & Neck Surgery, Hospital for Sick Children, Toronto, ON, Canada; Department of Otolaryngology, Head & Neck Surgery, University of Toronto, Toronto, ON, Canada; Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Sharon L Cushing
- Department of Otolaryngology, Head & Neck Surgery, Hospital for Sick Children, Toronto, ON, Canada; Department of Otolaryngology, Head & Neck Surgery, University of Toronto, Toronto, ON, Canada; Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
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Denoyelle F, Simon F, Chang KW, Chan KH, Cheng AG, Cheng AT, Choo DI, Daniel SJ, Farinetti A, Garabedian EN, Greinwald JH, Hoff SR, Hone S, Licameli GR, Papsin BC, Poe DS, Pransky S, Smith RJH, Triglia JM, Walton J, Zalzal G, Leboulanger N. International Pediatric Otolaryngology Group (IPOG) Consensus Recommendations: Congenital Cholesteatoma. Otol Neurotol 2020; 41:345-351. [DOI: 10.1097/mao.0000000000002521] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Steel MM, Polonenko MJ, Giannantonio S, Hopyan T, Papsin BC, Gordon KA. Music Perception Testing Reveals Advantages and Continued Challenges for Children Using Bilateral Cochlear Implants. Front Psychol 2020; 10:3015. [PMID: 32038391 PMCID: PMC6985588 DOI: 10.3389/fpsyg.2019.03015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 12/19/2019] [Indexed: 11/25/2022] Open
Abstract
A modified version of the child’s Montreal Battery of Evaluation of Amusia (cMBEA) was used to assess music perception in children using bilateral cochlear implants. Our overall aim was to promote better performance by children with CIs on the cMBEA by modifying the complement of instruments used in the test and adding pieces transposed in frequency. The 10 test trials played by piano were removed and two high and two low frequency trials added to each of five subtests (20 additional). The modified cMBEA was completed by 14 children using bilateral cochlear implants and 23 peers with normal hearing. Results were compared with performance on the original version of the cMBEA previously reported in groups of similar aged children: 2 groups with normal hearing (n = 23: Hopyan et al., 2012; n = 16: Polonenko et al., 2017), 1 group using bilateral cochlear implants (CIs) (n = 26: Polonenko et al., 2017), 1 group using bimodal (hearing aid and CI) devices (n = 8: Polonenko et al., 2017), and 1 group using unilateral CI (n = 23: Hopyan et al., 2012). Children with normal hearing had high scores on the modified version of the cMBEA and there were no significant score differences from children with normal hearing who completed the original cMBEA. Children with CIs showed no significant improvement in scores on the modified cMBEA compared to peers with CIs who completed the original version of the test. The group with bilateral CIs who completed the modified cMBEA showed a trend toward better abilities to remember music compared to children listening through a unilateral CI but effects were smaller than in previous cohorts of children with bilateral CIs and bimodal devices who completed the original cMBEA. Results confirmed that musical perception changes with the type of instrument and is better for music transposed to higher rather than lower frequencies for children with normal hearing but not for children using bilateral CIs. Overall, the modified version of the cMBEA revealed that modifications to music do not overcome the limitations of the CI to improve music perception for children.
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Affiliation(s)
- Morrison M Steel
- Archie's Cochlear Implant Laboratory, The Hospital for Sick Children, Toronto, ON, Canada
| | - Melissa J Polonenko
- Archie's Cochlear Implant Laboratory, The Hospital for Sick Children, Toronto, ON, Canada
| | - Sara Giannantonio
- Archie's Cochlear Implant Laboratory, The Hospital for Sick Children, Toronto, ON, Canada
| | - Talar Hopyan
- Archie's Cochlear Implant Laboratory, The Hospital for Sick Children, Toronto, ON, Canada
| | - Blake C Papsin
- Archie's Cochlear Implant Laboratory, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Karen A Gordon
- Archie's Cochlear Implant Laboratory, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
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Gorodensky JH, Alemu RZ, Gill SS, Sandor MT, Papsin BC, Cushing SL, Gordon KA. Binaural hearing is impaired in children with hearing loss who use bilateral hearing aids. J Acoust Soc Am 2019; 146:4352. [PMID: 31893744 DOI: 10.1121/1.5139212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 11/11/2019] [Indexed: 06/10/2023]
Abstract
This paper asked whether children fitted with bilateral hearing aids (BHA) develop normal perception of binaural cues which are the basis of spatial hearing. Data from children with BHA (n = 26, age = 12.6 ± 2.84 years) were compared to data from a control group (n = 12, age = 12.36 ± 2.83 years). Stimuli were 250 Hz click-trains of 36 ms and a 40 ms consonant-vowel /da/ at 1 Hz presented through ER3A insert-earphones unilaterally or bilaterally. Bilateral stimuli were presented at different interaural level difference (ILD) and interaural timing difference (ITD) conditions. Participants indicated whether the sound came from the left or right side (lateralization) or whether one sound or two could be heard (binaural fusion). BHA children lateralized ILDs similarly to the control group but had impaired lateralization of ITDs. Longer response times relative to controls suggest that lateralization of ITDs was challenging for children with BHA. Most, but not all, of the BHA group were able to fuse click and speech sounds similarly to controls. Those unable to fuse showed particularly poor ITD lateralization. Results suggest that ITD perception is abnormal in children using BHAs, suggesting persistent effects of hearing loss that are not remediated by present clinical rehabilitation protocols.
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Affiliation(s)
- Jonah H Gorodensky
- Archie's Cochlear Implant Laboratory, The Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada
| | - Robel Z Alemu
- Archie's Cochlear Implant Laboratory, The Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada
| | - Simrat S Gill
- Archie's Cochlear Implant Laboratory, The Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada
| | - Mark T Sandor
- Archie's Cochlear Implant Laboratory, The Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada
| | - Blake C Papsin
- Archie's Cochlear Implant Laboratory, The Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada
| | - Sharon L Cushing
- Archie's Cochlear Implant Laboratory, The Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada
| | - Karen A Gordon
- Archie's Cochlear Implant Laboratory, The Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada
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Wolter NE, Gordon KA, Campos JL, Vilchez Madrigal LD, Pothier DD, Hughes CO, Papsin BC, Cushing SL. BalanCI: Head-Referenced Cochlear Implant Stimulation Improves Balance in Children with Bilateral Cochleovestibular Loss. Audiol Neurootol 2019; 25:60-71. [PMID: 31678979 DOI: 10.1159/000503135] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 09/03/2019] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION To determine the impact of a head-referenced cochlear implant (CI) stimulation system, BalanCI, on balance and postural control in children with bilateral cochleovestibular loss (BCVL) who use bilateral CI. METHODS Prospective, blinded case-control study. Balance and postural control testing occurred in two settings: (1) quiet clinical setting and (2) immersive realistic virtual environment (Challenging Environment Assessment Laboratory [CEAL], Toronto Rehabilitation Institute). Postural control was assessed in 16 and balance in 10 children with BCVL who use bilateral CI, along with 10 typically developing children. Children with neuromotor, cognitive, or visual deficits that would prevent them from performing the tests were excluded. Children wore the BalanCI, which is a head-mounted device that couples with their CIs through the audio port and provides head-referenced spatial information delivered via the intracochlear electrode array. Postural control was measured by center of pressure (COP) and time to fall using the WiiTM (Nintendo, WA, USA) Balance Board for feet and the BalanCI for head, during the administration of the Modified Clinical Test of Sensory Interaction in Balance (CTSIB-M). The COP of the head and feet were assessed for change by deviation, measured as root mean square around the COP (COP-RMS), rate of deviation (COP-RMS/duration), and rate of path length change from center (COP-velocity). Balance was assessed by the Bruininks-Oseretsky Test of Motor Proficiency 2, balance subtest (BOT-2), specifically, BOT-2 score as well as time to fall/fault. RESULTS In the virtual environment, children demonstrated more stable balance when using BalanCI as measured by an improvement in BOT-2 scores. In a quiet clinical setting, the use of BalanCI led to improved postural control as demonstrated by significant reductions in COP-RMS and COP-velocity. With the use of BalanCI, the number of falls/faults was significantly reduced and time to fall increased. CONCLUSIONS BalanCI is a simple and effective means of improving postural control and balance in children with BCVL who use bilateral CI. BalanCI could potentially improve the safety of these children, reduce the effort they expend maintaining balance and allow them to take part in more complex balance tasks where sensory information may be limited and/or noisy.
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Affiliation(s)
- Nikolaus E Wolter
- Department of Otolaryngology, Head and Neck Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Otolaryngology, Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Karen A Gordon
- Department of Otolaryngology, Head and Neck Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Otolaryngology, Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, Ontario, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada.,Department of Communication Disorders, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jennifer L Campos
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada.,Department of Psychology, University of Toronto, Toronto, Ontario, Canada
| | | | - David D Pothier
- Department of Otolaryngology, Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Centre for Advanced Hearing and Balance Testing, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Cían O Hughes
- UCL Ear Institute, Royal National Throat, Nose and Ear Hospital, London, United Kingdom
| | - Blake C Papsin
- Department of Otolaryngology, Head and Neck Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Otolaryngology, Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, Ontario, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Sharon L Cushing
- Department of Otolaryngology, Head and Neck Surgery, Hospital for Sick Children, Toronto, Ontario, Canada, .,Department of Otolaryngology, Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada, .,Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, Ontario, Canada, .,Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada,
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Purcell PL, Marquez Garcia J, Zawawi F, Propst EJ, Papsin BC, Blaser SI, Wolter NE. Ectopic cervical thymus in children: Clinical and radiographic features. Laryngoscope 2019; 130:1577-1582. [PMID: 31461169 DOI: 10.1002/lary.28248] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 07/14/2019] [Accepted: 08/05/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Ectopic thymus is rare and can be a diagnostic challenge. This study evaluated the management of children radiographically diagnosed with ectopic cervical thymus. METHODS A retrospective review of 100 patients was performed. Data related to clinical presentation, radiological imaging, pathology, and management were collected. Changes in lesion volume were tracked over time. Clinical characteristics were compared based on lesion location in the neck using analysis of variance modelling. RESULTS There were 115 lesions with radiographic features of ectopic cervical thymus (15 children had bilateral lesions). Diagnosis was based on ultrasound in 98% of patients, magnetic resonance imaging in 18%, and computed tomography in 11%. Mean (SD) follow-up duration was 2 (2.2) years. Forty-four percent (51/115) of lesions involved the thyroid gland, 29% (33/115) were in the central neck but separate from the thyroid, 18% (21/115) had mediastinal extension, and 8% (9/115) involved the submandibular region. Location was unclear for two patients. Submandibular lesions were on average 12.4 cm3 larger (95% CI, 8.2, 16.6) than mediastinal lesions at diagnosis, P ≤ .001. Volume of thymic tissue decreased over time, from a mean (standard deviation [SD]) volume of 4.3 cm3 (9.2) at initial ultrasound to 2.7 cm3 (6.1) at final ultrasound (paired t-test, P = .008). Only two patients required surgery: one for compressive symptoms, and the other to rule out malignancy. CONCLUSION Ninety-eight percent of children with ectopic cervical thymus were managed conservatively without issues. We propose a classification system based on location to ease communication among clinicians and to help follow these lesions over time. LEVEL OF EVIDENCE 4, case series Laryngoscope, 130:1577-1582, 2020.
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Affiliation(s)
- Patricia L Purcell
- Department of Otolaryngology, Head & Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Juan Marquez Garcia
- Department of Otolaryngology, Head & Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Faisal Zawawi
- Department of Otolaryngology, Head & Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Evan J Propst
- Department of Otolaryngology, Head & Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Blake C Papsin
- Department of Otolaryngology, Head & Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Susan I Blaser
- Department of Diagnostic Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Nikolaus E Wolter
- Department of Otolaryngology, Head & Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Polonenko MJ, Papsin BC, Gordon KA. Cortical plasticity with bimodal hearing in children with asymmetric hearing loss. Hear Res 2019; 372:88-98. [DOI: 10.1016/j.heares.2018.02.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 01/12/2018] [Accepted: 02/09/2018] [Indexed: 11/17/2022]
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Abstract
Children frequently present with complaints of vertigo and/or disequilibrium. The etiology of such diagnoses include inner ear pathology, migraine and its variants, lesions of the central nervous system as well as mental health disorders, among others. The ability to reliably evaluate vestibular end-organ function is central to accurate diagnosis, however, examining children can be challenging. The current chapter will focus on the approach to assessing vestibular end-organ function in children, as well as the causes of vestibular impairment that are unique to this population.
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Siu JM, Blaser SI, Gordon KA, Papsin BC, Cushing SL. Efficacy of a selective imaging paradigm prior to pediatric cochlear implantation. Laryngoscope 2019; 129:2627-2633. [PMID: 30613974 DOI: 10.1002/lary.27666] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 09/27/2018] [Accepted: 10/12/2018] [Indexed: 01/11/2023]
Abstract
OBJECTIVES/HYPOTHESIS There is no consensus on the necessary preoperative imaging in children being evaluated for cochlear implantation (CI). Dual-imaging protocols that implement both magnetic resonance imaging (MRI) and high resolution computed tomography (HRCT) create diagnostic redundancy in the face of potentially unnecessary radiation and anaesthetic exposure. The objectives of the current study were to examine the efficacy of an MRI-predominant with selective HRCT imaging protocol. STUDY DESIGN Retrospective review. METHODS The protocol was implemented over a 4-year period, during which HRCT was obtained in addition to MRI only if specific risk factors on clinical assessment were identified or if imaging findings in need of further evaluation were detected on initial MRI evaluation. Retrospective review of operative reports and prospective review of imaging were performed; anesthetic exposure and costing information were also obtained. RESULTS Of the 240 patients who underwent assessment, seven (2.9%) had combined HRCT and MRI performed concurrently based on initial clinical assessment, 15 (6.3%) underwent HRCT based on imaging anomalies found on MRI, and MRI alone was ordered for the remaining 218 (90.1%). All patients were implanted without complication. Overall, radiation exposure, general anesthesia (GA), and healthcare costs were reduced. CONCLUSIONS MRI alone can be used in the vast majority of cases for preoperative evaluation of pediatric CI candidates resulting in a significant reduction in healthcare costs, radiation, and GA exposure in children. The additional need for HRCT occurs in a small proportion and can be predicted up front on clinical assessment or on initial MRI. LEVEL OF EVIDENCE 4 Laryngoscope, 129:2627-2633, 2019.
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Affiliation(s)
- Jennifer M Siu
- Department of Otolaryngology-Head and Neck Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Susan I Blaser
- Department of Diagnostic Imaging-Head and Neck Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Karen A Gordon
- Department of Otolaryngology-Head and Neck Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada.,Archie's Cochlear Implant Laboratory, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Communication Disorders, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Blake C Papsin
- Department of Otolaryngology-Head and Neck Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada.,Archie's Cochlear Implant Laboratory, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Communication Disorders, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Sharon L Cushing
- Department of Otolaryngology-Head and Neck Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada.,Archie's Cochlear Implant Laboratory, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Communication Disorders, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
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Faucett EA, Lam-Bellissimo S, Zawawi F, Cushing SL, Papsin BC. Cranial orthosis after cochlear implantation in an infant: Helmet modifications. Int J Pediatr Otorhinolaryngol 2018; 114:101-105. [PMID: 30262345 DOI: 10.1016/j.ijporl.2018.08.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 08/25/2018] [Accepted: 08/28/2018] [Indexed: 11/17/2022]
Abstract
We present an infant with bilateral sensorineural hearing loss caused by bacterial meningitis, and moderate/severe plagiocephaly requiring simultaneous treatment of cochlear implantation for hearing loss and cranial orthosis for plagiocephaly. A helmet modification was created, so that the infant was able to be treated for his plagiocephaly while bilateral cochlear implants were in place, bringing attention to serve needs of those patients requiring cochlear implant and cranial orthosis concurrently. While this case was the first time such a modification was required, which was due to the young age at implantation, the occurrence of the concurrent need may increase as we continue to push the boundaries of early implantation.
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Affiliation(s)
- Erynne A Faucett
- Department of Otolaryngology, Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | | | - Faisal Zawawi
- Department of Otolaryngology, Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Sharon L Cushing
- Department of Otolaryngology, Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.
| | - Blake C Papsin
- Department of Otolaryngology, Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
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Parkes WJ, Cushing SL, Blaser SI, Papsin BC. Transmastoid access in branchio-oto-renal syndrome: A reappraisal of computed tomography imaging. Int J Pediatr Otorhinolaryngol 2018; 114:92-96. [PMID: 30262375 DOI: 10.1016/j.ijporl.2018.08.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 08/21/2018] [Accepted: 08/22/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate for temporal bone abnormalities that might affect transmastoid surgery such as cochlear implantation in cases of branchio-oto-renal syndrome (BOR). STUDY DESIGN Retrospective review. METHODS Qualitative assessment of temporal bone computed tomography imaging was performed by a neuroradiologist for 30 individuals with BOR (60 ears) and 20 controls with normal hearing (20 ears). Transmastoid access was assessed categorically across 4 features: tip development, cortex pneumatization, tegmen height, and facial recess pneumatization. The appearance of 4 standard landmarks (Koerner's septum, antrum, prominence of the horizontal semicircular canal, incudal short process) was also dichotomized as normal or abnormal. Data were compared using Fisher's exact testing. RESULTS Mastoid height differed between the groups with tip underdevelopment noted in 72% of BOR ears vs. 40% of controls (p = 0.02), and a low tegmen was seen in 68% of BOR ears and 25% of controls (p < 0.01). Significant differences in pneumatization were also found for the mastoid cortex (28% non-pneumatized in BOR vs. 5% in controls; p = 0.03) and the facial recess (27% non-pneumatized in BOR vs. 0% in controls; p = 0.01). Standard landmarks were easily identified in all of the control mastoids. In the BOR group, Koerner's septum was abnormally located or absent in 45%, and the antrum was severely hypoplastic or absent in 50%. Similarly, the prominence of the horizontal semicircular canal and the short process of the incus were dysplastic in 73% (44/60) and 62% (37/60), respectively. CONCLUSIONS Mastoid abnormalities are common in BOR syndrome. Restricted transmastoid access and abnormal or absent mastoid landmarks should be anticipated in those patients with BOR who become cochlear implant candidates. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- William J Parkes
- Division of Otolaryngology, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA; Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Sharon L Cushing
- Department of Otolaryngology-Head and Neck Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Susan I Blaser
- Department of Otolaryngology-Head and Neck Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Diagnostic Imaging, Division of Neuroradiology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Blake C Papsin
- Department of Otolaryngology-Head and Neck Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Vilchez-Madrigal LD, Blaser SI, Wolter NE, James AL, Papsin BC, Gordon KA, Cushing SL, Propst EJ. Children with unilateral cochlear nerve canal stenosis have bilateral cochleovestibular anomalies. Laryngoscope 2018; 129:2403-2408. [PMID: 30353559 DOI: 10.1002/lary.27559] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 07/18/2018] [Accepted: 08/16/2018] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS To investigate the cochleovestibular apparatus bilaterally in children with isolated unilateral bony cochlear nerve canal (bCNC) stenosis. STUDY DESIGN Retrospective review. METHODS Imaging studies of children with unilateral bCNC stenosis (<1.0 mm) on computed tomography imaging (N = 36) were compared with controls imaged due to trauma without temporal bone injury (N = 32). Twenty-six measurements were obtained in each ear, assessing the bony internal auditory canal (IAC), cochlea, and vestibular end-organs, and were analyzed using one-way analysis of variance for intersubject comparisons and paired t tests for intrasubject comparisons with a Bonferroni adjustment for multiple comparisons (P = .0006). RESULTS Patients with bCNC stenosis had a smaller IAC (P < .000) and cochlea (P < .000) on the stenotic side as compared with controls. Although the vestibular end-organ was also smaller in bCNC ears, this difference was not significant. The contralateral ear also had a smaller bCNC (P < .000) and cochlea (P < .000) as compared with controls, although to a lesser degree than the stenotic side. CONCLUSIONS Children with unilateral bCNC stenosis have abnormal biometry of both the cochlea and the vestibular end-organ in the affected and the normal contralateral ear as compared with controls. LEVEL OF EVIDENCE 3b Laryngoscope, 129:2403-2408, 2019.
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Affiliation(s)
- Luis D Vilchez-Madrigal
- Department of Otolaryngology-Head and Neck Surgery, National Children's Hospital, San Jose, Costa Rica
| | - Susan I Blaser
- Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.,Department of Diagnostic Imaging, Division of Neuroradiology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Nikolaus E Wolter
- Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Adrian L James
- Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Blake C Papsin
- Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.,Archie's Cochlear Implant Laboratory, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Karen A Gordon
- Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.,Archie's Cochlear Implant Laboratory, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.,Department of Communication Disorders, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Sharon L Cushing
- Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.,Archie's Cochlear Implant Laboratory, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Evan J Propst
- Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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50
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Alkhunaizi E, Shaheen R, Bharti SK, Joseph-George AM, Chong K, Abdel-Salam GMH, Alowain M, Blaser SI, Papsin BC, Butt M, Hashem M, Martin N, Godoy R, Brosh RM, Alkuraya FS, Chitayat D. Warsaw breakage syndrome: Further clinical and genetic delineation. Am J Med Genet A 2018; 176:2404-2418. [PMID: 30216658 DOI: 10.1002/ajmg.a.40482] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 06/26/2018] [Accepted: 06/29/2018] [Indexed: 01/01/2023]
Abstract
Warsaw breakage syndrome (WBS) is a recently recognized DDX11-related rare cohesinopathy, characterized by severe prenatal and postnatal growth restriction, microcephaly, developmental delay, cochlear anomalies, and sensorineural hearing loss. Only seven cases have been reported in the English literature, and thus the information on the phenotype and genotype of this interesting condition is limited. We provide clinical and molecular information on five additional unrelated patients carrying novel bi-allelic variants in the DDX11 gene, identified via whole exome sequencing. One of the variants was found to be a novel Saudi founder variant. All identified variants were classified as pathogenic or likely pathogenic except for one that was initially classified as a variant of unknown significance (VOUS) (p.Arg378Pro). Functional characterization of this VOUS using heterologous expression of wild type and mutant DDX11 revealed a marked effect on protein stability, thus confirming pathogenicity of this variant. The phenotypic data of the seven WBS reported patients were compared to our patients for further phenotypic delineation. Although all the reported patients had cochlear hypoplasia, one patient also had posterior labyrinthine anomaly. We conclude that while the cardinal clinical features in WBS (microcephaly, growth retardation, and cochlear anomalies) are almost universally present, the breakage phenotype is highly variable and can be absent in some cases. This report further expands the knowledge of the phenotypic and molecular features of WBS.
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Affiliation(s)
- Ebba Alkhunaizi
- The Prenatal Diagnosis and Medical Genetics Program, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.,Division of Clinical and Metabolic Genetics, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Ranad Shaheen
- Department of Genetics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Sanjay Kumar Bharti
- Laboratory of Molecular Gerontology, National Institute on Aging, National Institutes of Health, NIH Biomedical Research Center, Baltimore, Maryland
| | - Ann M Joseph-George
- Cytogenomics Laboratory, Division of Genome Diagnostics, Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Karen Chong
- The Prenatal Diagnosis and Medical Genetics Program, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Ghada M H Abdel-Salam
- Department of Clinical Genetics, Human Genetics and Genome Research Division, National Research Centre, Cairo, Egypt
| | - Mohammed Alowain
- Department of Medical Genetics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Susan I Blaser
- Division of Neuroradiology, Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Blake C Papsin
- Department of Otolaryngology - Head & Neck Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Mohammed Butt
- Department of Radiology, King Abdulaziz University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Mais Hashem
- Department of Genetics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Nicole Martin
- The Prenatal Diagnosis and Medical Genetics Program, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Ruth Godoy
- The Prenatal Diagnosis and Medical Genetics Program, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Robert M Brosh
- Laboratory of Molecular Gerontology, National Institute on Aging, National Institutes of Health, NIH Biomedical Research Center, Baltimore, Maryland
| | - Fowzan S Alkuraya
- Department of Genetics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.,Department of Anatomy and Cell Biology, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.,Saudi Human Genome Program, King Abdulaziz City for Science and Technology, Riyadh, Saudi Arabia
| | - David Chitayat
- The Prenatal Diagnosis and Medical Genetics Program, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.,Division of Clinical and Metabolic Genetics, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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