Decision making in bone conduction and active middle ear implants - hearing outcomes and experiences over a 10-year period

OBJECTIVES

To review the decision-making paradigm in the recommendations of BCI and aMEI overlapping candidacy for patients with conductive or mixed HL, and to determine if there are differences in hearing and quality of life outcomes between these implantable hearing devices.

METHODS

Retrospective data from patients receiving BCI or aMEI in the past decade were analysed. Patients were grouped into: 1. BCI candidates, 2. BCI or aMEI candidates, and 3. aMEI candidates. We compared outcomes and examined the impact of BC threshold, age at implantation, and duration of hearing loss on candidacy.

RESULTS

89 participants were included: 30 BCI, 37 aMEI, and 22 BCI or aMEI candidates. All groups performed similarly in aided sound field threshold testing. BCI group had lower speech scores in quiet compared to 'BCI or aMEI.' No significant differences were found in APHAB global scores. BC threshold, duration of hearing loss, and age at implantation had no significant effects.

DISCUSSION

Outcomes were generally similar across groups, except for higher effective gain in the aMEI group.

CONCLUSION

Our proposed patient pathway and decision-making approach facilitate candidate selection for aMEI and BCI, aiming to optimise outcomes.

Misplaced incus: an unusual complication of a temporal bone fracture

A 24-year-old man sustained significant injuries as a result of a motor bicycle accident. CT scans demonstrated multiple intracranial injuries including bilateral temporal bone fractures. On emergence from sedation, the patient reported right-sided hearing loss which was attributed to ossicular chain disruption after the incus was found to be in the external auditory canal. Unexpectedly, the initial conductive hearing loss resolved with conservative management and an ossicular chain reconstruction was not required. This is an unusual case of impressive long-term good hearing outcomes following complete dislocation of the incus and extrusion from the middle ear.

An investigation of the applicability of the inventory, satisfaction with amplification in daily life, at 2 weeks post hearing aid fitting

OBJECTIVE

To investigate the applicability of the self-report inventory, Satisfaction with Amplification in Daily Life (SADL), at 2 wk postfitting.

DESIGN

The SADL was completed by two groups of hearing aid users, one fitted 2 wk before completion, the other at least 1 yr before. All SADLs were completed as a paper and pencil exercise, without involvement of an audiologist or other clinic staff. All the aid users were Government funded, all were fitted with the same model hearing aid, all were over the age of 60 yr, and all were fitted and counselled by the same two audiologists. Comparisons were made of the two groups' scores on each subscale and Global score, as well as on scores for each individual question.

RESULTS

All scores for subscales, Global score, and individual questions were higher at 2 wk postfitting than at 1 yr. Significant differences were found for subscales Positive Effect (p < 0.05), Service and Cost (p < 0.025), Negative Features (p < 0.001), as well as for the Global score (p < 0.001). The only subscale not resulting in a significant difference was Personal Image (p > 0.10). It was noted that Negative Features, such as background interference, acoustic feedback, and problems with telephone use, apparently take longer to be observed than Positive Effects such as improved communication and good sound quality. By contrast with some other reported studies, these results all display a reduction in self-reported outcome, rather than stability, or even improvement, over time. Among other possibilities, this finding may suggest the SADL measures something different to that measured by other inventories.

CONCLUSIONS

The results of this investigation suggest that, if the aim is to predict long-term satisfaction with aid fitting, 2 wk postfitting is too early for meaningful application of the SADL as an outcome measure. It is possible that an earlier stability in SADL scores might be obtained by inclusion of additional questions aimed at earlier detection of negative features. Such inclusions may detract from one of the SADL's advantages, namely its brevity. It also is suggested that the long-term value of self-report methods will depend on development of rigorous and scientifically acceptable administration procedures, including appropriate times for application.

The pharmacology of acute pain

Multimodal analgesia is the cornerstone of acute pain management. Paracetamol and NSAIDs provide background analgesia to which opioids and or adjuvant analgesics can be added, once the cause of pain is identified. Although simple analgesics have fixed-dose regimens, individual patient titration of opioids is essential. Dispelling opioid myths is fundamental to achieving this. Different routes of administration should not affect the level of analgesia achieved. Prompt recognition and treatment of side-effects helps to optimise pain management.

Molecular biology of APO E alleles in Alzheimer's and non-Alzheimer's dementias

Current research into the aetiology of the dementias is focused upon genetic factors which give rise to the disease process. Recently the Apolipoprotein E gene (APO E) and in particular the epsilon 4 allele has been shown to be a risk factor for late onset Alzheimer's disease (AD) where there is an increased frequency of the epsilon 4 allele. The epsilon 4 allele has also been shown to reduce the age at onset of dementia in AD in a dose dependent manner, with the epsilon 2 allele having an opposing effect. We have genotyped a large series of clinically and neuropathologically confirmed cases of AD and found the expected increase in the Apolipoprotein epsilon 4 allele frequency when compared to a control population. Similarly, in Lewy Body Dementia (LBD) an increased epsilon 4 frequency is also found though a normal epsilon 2 frequency exists, unlike in AD where the epsilon 2 frequency is reduced. No changes in APO E allele frequencies were found in presenile AD, Parkinson's disease with or without dementia, or in Down's syndrome. No association was found between any of the APO E alleles and the histopathological indices of AD, cortical senile plaques and neurofibrillary tangles, in any disease category. Neurochemical indicators of AD, loss of choline acetyltransferase activity was also unaffected by APO E genotype. Whilst their appears to be a strong association between the APO E allele and AD and also in LBD, other related neurodegenerative disorders associated with dementia do not show such a linkage. Changes in the epsilon 2 allele frequency may indicate a genetic difference between AD and LBD. The epsilon 4 allele does not appear to influence the burden of AD type pathology and this is particularly relevant given the relative lack of NFT in LBD indicating that factors other than SP or NFT may govern the onset of dementia.