Faculty Bibliography

OBJECTIVE: Since 1987, when the use of multichannel cochlear implants was initiated in children, candidacy has expanded; many thousands of children have received these devices, and results have revealed a wide range of performance. However, few long-term studies exist on a large population of these children. There have been concerns expressed that cochlear implant function might degrade over time, that devices and electrodes might migrate and extrude in the growing child, or that there might even be a deleterious effect of long-term stimulation of the cochlear nerve. The purpose of this study was to explore the long-term effects of implantation as a function of performance over time, reimplantation, and educational factors. STUDY DESIGN AND SETTING: We studied 81 children who received implants at a major academic medical center and were followed for 5 to 13 years. RESULTS: Results revealed significant gains in speech perception, use of oral language, and ability to function in a mainstream environment. There was no decrease in performance over time and no significant incidence of device or electrode migration or extrusion, and device failure did not cause a deterioration in long-term outcome. CONCLUSIONS: Multichannel cochlear implants in children provide perception, linguistic, and educational advantages, which are not adversely affected by long-term electrical stimulation

OBJECTIVE: To determine the efficacy of cochlear implants with current processing strategies in children and adults with long-term congenital deafness, and to determine whether the growth of auditory perceptual skills in these patients is similar to the data reported for patients who have undergone implantation with earlier devices and coding strategies. STUDY DESIGN: A prospective study of children and adults fulfilling the study inclusion criteria. SETTING: University medical center. PATIENTS: Thirty-five congenitally deaf children who received implants after the age of 8 years and 14 congenitally deaf adults who received implants as adults participated in this study. Length of device use ranged from 6 months to 3 years. MAIN OUTCOME MEASURES: Open set phoneme, word recognition tests, and sentence recognition tests were administered in quiet and noise auditory only conditions preoperatively and postoperatively. Changes in test scores were examined by paired t tests, and differences between groups were compared by Student's t tests. Spearman correlation coefficients were calculated to identify associations between scores and subject characteristics. A two-sided alpha of less than 0.05 was considered statistically significant. RESULTS: The results indicated significant improvement in open set speech perception skills in the children after implantation; the adults demonstrated improved mean scores on both word and sentence recognition. A shorter length of deafness correlated with better postoperative performance, but all subjects continued to improve over time. The improvement in test scores was similar between the devices, and no significant differences were detected between the different processing strategies. CONCLUSION: Children and adults with long-term congenital deafness can obtain considerable open set speech understanding after implantation. Length of deafness (age at implantation), length of device use, and mode of communication contribute to outcome

Bioresorbable implants (meshs and plates) are increasingly used in reconstructive craniofacial and skull base surgery. Usually these implants must be contoured to fit the complex craniofacial anatomy ex vivo; occasionally final contouring is performed in vivo and must be done without damaging surrounding structures (e.g., dura, brain). We report a precision method for in vivo contouring of bioresorbable implants using the Shaw hemostatic thermal scalpel

The goal of this study was to test 2 hypotheses about language development in pediatric cochlear implant (CI) users. The 'language instinct' hypothesis states that children with CIs will develop language in the same sequence as children with normal hearing, but in a delayed fashion. In other words, noun plurals will develop first, and the use of the uncontractible copula and regular past tense will follow. An alternative hypothesis (the 'perceptual prominence' hypothesis) is that the pattern of language development in CI users will be strongly affected by the perceptual prominence of the relevant morphological markers. This hypothesis predicts that the uncontractible copula will develop first, followed by noun plurals, and then by regular past tense. A sentence completion task was used to measure the performance of 9 pediatric CI users and compare it to that of several groups of children with normal hearing. The results from the CI users were consistent with the perceptual prominence hypothesis. In particular, the scores for the copula probe were higher than those for the noun plural probe for 8 of the 9 CI users. This result represents a rather striking inversion with respect to the usual development pattern in children with normal hearing and even in children with specific language impairment. If the perceptual prominence hypothesis receives further support in future studies, clinicians who work in language rehabilitation of CI users may choose to target those aspects of grammar that are less acoustically prominent to these children. In addition, and from a theoretical standpoint, these results suggest that although there may well be an innate language acquisition mechanism, patterns of language development can be strongly affected by the acoustic input. $$:

BACKGROUND: Squamous cell carcinoma of the tongue base can be treated with comparable control and survival rates when neck dissection (ND) is performed before radiation therapy (RT). METHODS: Fourteen patients were treated between 1990 and 2000. Tumor stage on presentation was: T2, 6; T3, 4; T4, 4. Average radiation dose was 7,268 cGy. Follow-up ranged from 2 to 11 years (median, 50 months). Ten patients (71.4%) who presented with cervical metastases underwent neck dissection. All neck dissections were performed prior to RT. RESULTS: The initial local control rate was 85.7%. The 10-year survival rate was 62.8%. Patients tolerated their procedure well and were ready for RT within 2 to 4 weeks. CONCLUSIONS: Our preliminary data indicate that our treatment protocol results in control and survival rates which are comparable with other regimens. It is our impression that in contrast to patients undergoing ND after radiation, our patients tolerated their initial ND well and were better prepared for the second part of the treatment. Future studies will use quality-of-life research methods to study this aspect of the treatment protocol

Computer-assisted medical imaging was used to locate the mandibular foramen and the portion of the inferior alveolar nerve canal at the level of the angle of the mandible in 19 hemimandibles of patients with craniofacial microsomia. The distance from each of these two points to the borders of the mandible was measured. The ratios of these distances to the height, anteroposterior, and buccolingual extents of the mandibular ramus were calculated. These ratios were compared among affected hemimandibles (Pruzansky classification I, n = 4; and Pruzansky classification II, n = 10), unaffected hemimandibles (n = 9), and the hemimandibles of patients with nonsyndromic, sutural synostosis (n = 7). Comparison of mean distance ratios showed that the mandibular foramen was located significantly more proximally in the affected cohort than in either the unaffected or synostosis control groups. The mandibular foramen was also located significantly closer to the buccal cortex of the mandible in the affected cohort when compared with unaffected patients. The distance from the mandibular foramen to the anterior or posterior tables of the mandible divided by the total anteroposterior distance did not vary among the three groups studied. The distance ratios between the inferior alveolar nerve canal at the level of the angle of the mandible and the mandibular borders also did not vary significantly among the groups studied. An inferior alveolar nerve canal could not be identified in any patient with Pruzansky grade III mandibular deficiency. This quantitative, three-dimensional description of points along the proximal path of the inferior alveolar nerve canal in patients with craniofacial microsomia provides useful information to assist the surgeon during osteotomy planning and may help in avoiding injury to the nerve at the time of surgery

OBJECTIVES/OBJECTIVE:To report recurrent uveitis as a manifestation of poststreptococcal syndrome and discuss a role of adenotonsillectomy as a treatment option. STUDY DESIGN/METHODS:Case study. METHODS:A case report of a 6-year-old, otherwise healthy girl with group A streptococcal uveitis managed successfully with adenotonsillectomy. RESULTS:In the year after surgery there were only two episodes of uveitis, contrasted with a preoperative 3-year history of 8 to 10 annual episodes despite corticosteroid therapy. Moreover, as a result of the postoperative improvement the child was able to avoid impending methotrexate therapy. CONCLUSIONS:Although the role of tonsillectomy in managing poststreptococcal uveitis is unknown, our results suggest a positive impact independent of the baseline tonsillitis frequency. Otolaryngologists should be aware of these uncommon sequelae of streptococcal infection and the potential role of tonsillectomy in treatment.