Faculty Bibliography

OBJECTIVE: This study aimed to evaluate the change in performance when the Speak processing strategy replaced the Mpeak strategy. SUBJECTS: Twenty-one veterans who participated in the original Department of Veterans Affairs Multicenter Cochlear Implant Study, received the Nucleus F0F1F2 processor (Cochlear Corp., Englewood, CO, U.S.A.) (WSP) and were subsequently upgraded to the Mpeak (MSP) processing strategy. METHODS: Closed- and open-set speech recognition in quiet and in noise in auditory only conditions at the phoneme, word, and sentence levels were evaluated. RESULTS: Changes in audiologic parameters were evaluated using a paired t-test for related samples. Statistically significant improvements in mean scores were found for all tests and were greatest for the speech-in-noise conditions. An examination of individual data revealed that 61% of the subjects improved for tests administered in quiet, whereas up to 69% of the subjects had improved performance in noise. Subjects with no open set speech discrimination using the Mpeak strategy showed no improvement with the Speak strategy. CONCLUSIONS: Cochlear implants can provide improved performance using modifications to external speech processor hardware and software without changing the internal implant

OBJECTIVE: To assess and document the development of open-set speech recognition in congenitally deaf children implanted with the Nucleus multichannel cochlear prosthesis at < 5 years of age. STUDY DESIGN: The study group consisted of 38 consecutively chosen children in whom the decision to proceed with implantation had already been made. PATIENTS AND SETTING: Congenitally profoundly deaf children were implanted with the Nucleus multichannel cochlear implant at < 5 years of age and followed at NYU Medical Center for a period of 1-5 years. MAIN OUTCOME MEASURES: Open-set speech perception was evaluated preoperatively and postoperatively using the following: the Glendonald Auditory Screening Procedure (GASP) word subset, the GASP sentence subtest, Phonetically Balanced Kindergarten monosyllabic word lists, Common Phrases test, Multisyllabic Lexical Neighborhood test, and Lexical Neighborhood test. RESULTS: Correlation coefficients were calculated between scores at each interval and age at implantation; one-way analyses of variance were performed independently. Results showed that all subjects had significant open-set speech recognition at the time of the last postoperative evaluation. Thirty-seven of the children use oral language as their sole means of communication. CONCLUSIONS: Multichannel cochlear implants provide significant and usable open-set speech perception in congenitally deaf children given implants at < 5 years of age

Two sisters presented to our medical center with nontraumatic cerebrospinal fluid (CSF) fistulas from left sphenoid sinocranial junction defects. One sister had recurrent meningitis over a 20-year period that prompted a skull base evaluation. Four years later, her younger sister presented with profuse CSF rhinorrhea. Transethmoid sphenoidotomy with sinus obliteration and lumbar-subarachnoid temporary CSF diversion successfully treated one sister, while the other required reoperation and permanent lumbar-peritoneal shunting. In both cases the skull base defect was identically located in the posterolateral left sphenoid sinus. Embryological considerations, evaluation and management are presented

A retrospective analysis was performed on 174 patients operated on from 1992 to 1995 to evaluate the safety and efficacy of continuous lumbar cerebrospinal fluid drainage (CLCFD) in the management of cerebrospinal fluid (CSF) leaks following acoustic neuroma surgery. There was a 17% incidence of CSF leak. CLCFD stopped the leak in 87% of cases. There were no cases of meningitis associated with CLCFD. One deep vein thrombosis was treated without sequelae. It is concluded that CLCFD is safe and efficacious. The authors recommend that CLCFD be implemented immediately when indicated, foregoing a trial of conservative therapy. Indications and precautions are discussed

BACKGROUND: Inverting papillomas usually originate from the lateral wall of the nose and sporadically from the ethmoid, maxillary, sphenoid, or frontal sinuses. Intracranial extension and dural penetration is rare and often associated with recurrent disease that has degenerated into squamous cell carcinoma. A case of inverting papilloma with dural penetration in the absence of malignant degeneration has prompted an investigation into the incidence and treatment of dural invasion by benign inverting papilloma. METHODS: A literature search revealed 1468 cases of inverting papilloma. A detailed analysis was performed to obtain data on the incidence of intracranial invasion. RESULTS: Of the 1468 cases, 5 were noted to be associated with intracranial extension without histologic evidence of malignancy (0.34%). Treatment consisted of surgery alone in 3, radiotherapy in 1, and combined therapy in the last patient. Dural invasion was documented histopathologically in one case. CONCLUSION: Intracranial extension and dural penetration of benign inverting papilloma is extremely rare, and a uniform treatment plan has not been established. Further investigation is necessary in the pathophysiology and management of intracranial inverting papilloma

While both prophylactic antibiotics and tympanostomy tube insertion have a role in the treatment of recurrent acute otitis media (AOM) and otitis media with effusion (OME) in children previous work has shown that patients in our urban clinic are not compliant with prophylactic antibiotics. Concerned about the potential for decreased compliance in a non-compliant population, we performed a retrospective review to assess the incidence of complications from the insertion of tympanostomy tubes in the same pediatric clinic population. A total of 391 tubes were placed in 165 patients. Follow-up ranged from 0-49.4 months with a mean of 21.3 months. Three ears (1.14%) had persistent perforations. Tympanosclerosis was found in 30 ears (11.1%). No ear showed a chronic retraction or cholesteatoma. Six ears (1.70%) developed postoperative otorrhea. Thirty-five patients had at least one episode of otorrhea outside of the perioperative period, and a total of 60 episodes (19.6% of ears) occurred during the study period. The mean pure tone average prior to tube placement was 25.0 dB, with tubes in place was 2.44 dB and after the last set of tubes had extruded was 6.97 dB. Our study shows that the incidence of complications of tympanostomy tubes was minimal in our inner city clinic population

A cochlear lubricant may facilitate the surgeon's ability to place the electrode array deep within the cochlea. Patient performance with the multichannel cochlear implant may be enhanced with a deeper electrode insertion. Theoretically, deeper insertion and stimulation will recruit and activate more surviving spiral ganglion neurons. Several studies have shown that neuron survival is a factor for cochlear implant success, especially in the postmeningitis patient. We studied the histologic and electrophysiologic effects of the intracochlear injection of three potential lubricants in the guinea pig: glycerin, hyaluronic acid, and hydroxypropyl methylcellulose. All three have approved medical uses, reduce friction, and are readily available. Results show that when compared to surgical controls (cochleostomy without injection), there is no significant reduction in the spiral ganglion neuronal count at 2 and 8 weeks postinjection, and the dendrite and axon histology is well preserved. Injection of any of the substances within the cochlea causes severe hearing loss (detected by direct round window electrocochleographic responses to auditory stimuli) that only partially recovers with time. These findings suggest that any of the three tested substances could be considered as lubricants for intracochlear electrode insertion

PURPOSE: To present the postoperative radiographic appearance of the multichannel cochlear implant and to suggest criteria for the radiographic evaluation of postimplant patients. METHODS: One hundred forty-one patients, 73 female and 68 male, had multichannel cochlear implants inserted. One hundred thirty-five intraoperative radiographs, 31 postoperative radiographic examinations, and 10 postoperative CT examinations were retrospectively reviewed. RESULTS: In 135 patients, a Stenver's or anteroposterior projection confirmed the normal placement of the implant by demonstrating the electrodes to be regularly spaced and gently curved within the first turn of the cochlea. The insertion depth was determined by counting the number of electrodes that projected medial to the cochlear promontory. In 5 patients in whom intracochlear placement of the electrode array could not be confirmed on plain radiographs, CT demonstrated the location of the electrode array. In 3 patients with postoperative infections, CT either correctly identified or excluded the presence of a collection beneath the implant. CONCLUSION: Plain radiographs of the temporal bone are sufficient for the postoperative treatment of the majority of postimplant patients. CT should be performed when plain radiographs cannot adequately show the location of the electrode array or if postoperative infection is suspected

PURPOSE: To present the CT characteristics of histologically confirmed venous vascular malformations limited to the submandibular triangle in patients without clinical stigmata of venous vascular malformations. METHODS: The clinical records and CT scans of five women with venous vascular malformations limited to the submandibular triangle were reviewed. Patients ranged from 39 to 70 years of age. None of the patients had a history of malignant tumors. All patients presented with a solitary suprahyoid neck mass. None of the patients demonstrated cutaneous manifestations of venous vascular malformation. RESULTS: Contrast-enhanced CT scans in all five patients demonstrated a lobulated, heterogeneously enhancing, well-circumscribed solid mass, separable from the submandibular gland. Areas of contrast enhancement within each mass were isodense to the internal jugular vein in four of five cases. Only two of five lesions demonstrated focal calcifications. Excisional biopsy (two patients) demonstrated pathologic features compatible with venous vascular malformation. Fine needle aspirations (three patients) yielded venous blood or blood-tinged fluid. CONCLUSIONS: Venous vascular malformations may present as isolated neck masses in adults without typical clinical stigmata. Clues to the CT diagnosis include a lobulated appearance to the mass with intense but heterogeneous contrast enhancement. This appearance, in combination with results of fine needle aspiration, may be sufficiently diagnostic to preclude excisional biopsy

Postoperative cerebrospinal fluid (CSF) leak is a serious complication of acoustic neuroma surgery. The authors retrospectively reviewed the charts of 492 patients who underwent acoustic neuroma surgery to determine the efficacy of fibrin glue in preventing postoperative CSF leak. Thirteen of 92 patients (14%) undergoing retrosigmoid/transmeatal surgery experienced CSF leak when fibrin glue was used; 29 of 199 patients (15%) when it was not used. Nineteen of 85 patients (22%) experienced CSF leak when fibrin glue was used following translabyrinthine surgery; 23 of 116 patients (20%) when it was not used. No decrease was noted in the incidence of CSF leak following acoustic neuroma surgery with the use of autologous fibrin glue