Faculty Bibliography

The use of traditional electrocautery is prohibited in revision or replacement cochlear implant surgery because of the concern for end organ tissue damage. Additionally, electrical current spread to the malfunctioning device could interfere with an accurate cause-of-failure analysis. Clinical reports have confirmed the utility of the Shaw scalpel for dermatologic, ophthalmic, and head and neck surgery. The Shaw scalpel is a thermally activated cutting blade that provides a bloodless field through immediate capillary and small vessel hemostasis. Avoidance of wound and flap complications is of primary concern in cochlear implant surgery. The long-term wound healing compared favorably to that of other surgical cutting instruments in several experimental reports. We have routinely used the Shaw scalpel in revision cochlear implant surgery and in primary surgery whenever electrocautery was contraindicated. We have retrospectively evaluated 22 cases in which the Shaw scalpel was used for cochlear implant revision and primary surgery. The chart review included patient demographics, the indication for surgery, the contraindication for electrocautery, intraoperative surgical notes, the wound healing evaluation, the evaluation for alopecia, and postoperative speech understanding. No significant complications occurred intraoperatively, and the long-term wound healing results were no different from those obtained with conventional surgical techniques. The explanted devices were undamaged, and valuable diagnostic information could be obtained. All patients performed at or better than their preoperative levels on speech recognition testing. Our results indicate that the Shaw scalpel is a relatively safe, easy-to-use, and effective instrument

The known etiologies of acquired sensorineural hearing loss include acoustic trauma, physical trauma, ototoxicity, genetic predisposition, infections, Meniere's disease, aging, and autoimmune disease. Treatments are directed at eliminating or managing the underlying disease process and aiding hearing with amplification. Rarely is it possible to improve unaided hearing after sensorineural loss except when the severe to profound level of loss is reached and cochlear implantation becomes an option. Autoimmune inner ear disease, however, is a treatable cause of sensorineural hearing loss and it is important for physicians and hearing health professionals to recognize that proper early diagnosis and management strategies may result in stabilization and possibly improvement in hearing

[structure: see text] Studies on the synthesis of the spirocyclic cyclohexadienone ring system 2 of the schiarisanrin family of natural products 1 are described and were based on the Lewis acid-promoted C-alkylation of the corresponding phenolic precursor

OBJECTIVE: This study was conducted to evaluate the insertion properties and intracochlear trajectories of three perimodiolar electrode array designs and to compare these designs with the standard Cochlear/Melbourne array. BACKGROUND: Advantages to be expected of a perimodiolar electrode array include both a reduction in stimulus thresholds and an increase in dynamic range, resulting in a more localized stimulation pattern of the spiral ganglion cells, reduced power consumption, and, therefore, longer speech processor battery life. METHODS: The test arrays were implanted into human temporal bones. Image analysis was performed on a radiograph taken after the insertion. The cochleas were then histologically processed with the electrode array in situ, and the resulting sections were subsequently assessed for position of the electrode array as well as insertion-related intracochlear damage. RESULTS: All perimodiolar electrode arrays were inserted deeper and showed trajectories that were generally closer to the modiolus compared with the standard electrode array. However, although the precurved array designs did not show significant insertion trauma, the method of insertion needed improvement. After insertion of the straight electrode array with positioner, signs of severe insertion trauma in the majority of implanted cochleas were found. CONCLUSIONS: Although it was possible to position the electrode arrays close to the modiolus, none of the three perimodiolar designs investigated fulfilled satisfactorily all three criteria of being easy, safe, and atraumatic to implant

OBJECTIVE: To report early postimplantation speech recognition results in children who received Nucleus CI24M cochlear implants. STUDY DESIGN: The study group consisted of 19 consecutively implanted children. PATIENTS AND SETTING: Congenitally deaf children (20 months to 15 years old) were implanted with the Nucleus CI24M and followed-up at New York University Medical Center for a period of 3 to 12 months. MAIN OUTCOME MEASURES: Speech perception was evaluated preoperatively and postoperatively using the Early Speech Perception (ESP) test, the Glendonald Auditory Screening Procedure (GASP) word and sentence tests, Phonetically Balanced Kindergarten (PBK) monosyllabic word lists, Common Phrases test, the Multisyllabic and Lexical Neighborhood (MLNT, LNT) tests, and the Banford-Kowal-Bench (BKB) sentence test. RESULTS: One-way analyses of variance revealed significant improvement in open-set speech recognition in children able to perform measurement tasks. CONCLUSIONS: The Nucleus CI24M cochlear implant provides significant benefit to children after short-term use

OBJECTIVE: To compare the short-term development of open-set speech perception between implementations of the spectral peak (SPEAK) strategy in adults using the Nucleus 22 (N22) Spectra processor and the Nucleus 24 (N24) system with the SPrint processor. STUDY DESIGN: Two sets of patients with a follow-up period of 3 months were compared. SETTING: This study was conducted at the New York University (NYU) Medical Center. PATIENTS: Thirty-six profoundly hearing-impaired adults were included in this study. INTERVENTION: Sixteen adults received the N22 cochlear implant with the Spectra speech processor and twenty adults received the N24 cochlear implant with the SPrint speech processor. MAIN OUTCOME MEASURES: Open-set speech perception for the patients with N22 implants was evaluated preoperatively and postoperatively using the following measures: NU-6 monosyllabic words, Iowa sentences, and CID sentences. CNC words, CUNY sentences, and HINT sentences were used to assess the patients with N24 implants. RESULTS: Results revealed that the N22 and N24 cochlear implant recipients had significant open-set speech recognition 3 and 6 months after implantation. The apparent favorable absolute scores for the patients with N24 implants were equalized when a multivariate analysis was performed to account for their younger age at time of implantation and shorter length of deafness. CONCLUSIONS: The growth of open-set word and sentence recognition in similar between the N22 and N24 cochlear implants. Longitudinal studies are needed to determine if higher ceiling scores are present in the N24. Further exploration of monopolar versus bipolar stimulation is warranted

Previously, we have shown that melanosomes of Xenopus laevis melanophores are transported along both microtubules and actin filaments in a coordinated manner, and that myosin V is bound to purified melanosomes (Rogers, S., and V.I. Gelfand. 1998. Curr. Biol. 8:161-164). In the present study, we have demonstrated that myosin V is the actin-based motor responsible for melanosome transport. To examine whether myosin V was regulated in a cell cycle-dependent manner, purified melanosomes were treated with interphase- or metaphase-arrested Xenopus egg extracts and assayed for in vitro motility along Nitella actin filaments. Motility of organelles treated with mitotic extract was found to decrease dramatically, as compared with untreated or interphase extract-treated melanosomes. This mitotic inhibition of motility correlated with the dissociation of myosin V from melanosomes, but the activity of soluble motor remained unaffected. Furthermore, we find that myosin V heavy chain is highly phosphorylated in metaphase extracts versus interphase extracts. We conclude that organelle transport by myosin V is controlled by a cell cycle-regulated association of this motor to organelles, and that this binding is likely regulated by phosphorylation of myosin V during mitosis

OBJECTIVE: To determine cochlear implant electrode stability in the young patient. Electrode migration due to future skull growth was a concern that led to prohibiting implantation in children less than 2 years of age. Recently, the high level of performance achieved by young implantees has led to a re-evaluation of this lower age limit, requiring an assessment of the effects of skull growth over time. STUDY DESIGN: Prospective radiographic analysis of electrode position of cochlear implants in young children. METHODS: Twenty-seven children implanted with the Nucleus (Cochlear Corp., Denver, CO) or Clarion (Advanced Bionics Inc., Sylmar, CA) multi-channel cochlear prostheses were subjects for this study. Follow-up radiographic studies were obtained for a period of 1 month to 5 years after implantation. The age at time of implantation ranged from 14 months to 5 years. An intraoperative modified Stenver's view plain radiograph was obtained as a baseline. After implantation, on a yearly basis transorbital Stenver's and base views were obtained for comparative purposes. Additional radiographs were obtained whenever a change in performance or electrode map caused suspicion for extrusion. Electrode position was determined using a computer graphics enhancement technique whereby image contrast filters enhanced the visibility of the electrode array and surrounding bony structures. RESULTS: An analysis of the data revealed no migration of the electrode array over time. CONCLUSIONS: The confirmation of the stability of the electrode array alleviates the concern of the effects of skull growth on cochlear implantation in young children