Faculty Bibliography

Complete nasal aplasia is an extremely rare clinical entity and most infants are stillborn when this is associated with holoprosencephaly. A viable 3-year-old infant born with frontonasal arrest without holoprosencephaly is presented. The child's main complaint was lack of a nasal airway, which made eating extremely difficult. A method for craniofacial reconstruction of the nasopharynx is presented

The development of new processing strategies has allowed for the improvement of auditory skills in cochlear implant recipients. This study examines the effects of a change in processing strategy on the individual recipients of the Nucleus cochlear prosthesis. Twenty-five subjects who had used the F0F1F2 processing strategy (WSP III) for 2 years were switched to the MPeak strategy (MSP) and retested immediately and after 3 months. Results revealed an improvement in speech recognition ability with the MPeak strategy in those subjects who were able to perceive speech with the F0F1F2 processing strategy

One objective of the Department of Veterans Affairs study: A Prospective Randomized Study of Advanced Cochlear Implants was to attempt to identify preoperative patient characteristics that might predict postoperative performance. We studied the relationship between all preoperative factors and the 2-year postoperative performance on 24 audiological tests for 82 patients who were implanted with the Ineraid, Nucleus, or 3M/Vienna device. Results of the univariate analysis indicated that computed tomographic findings of the cochlea and round window, IQ, age at implantation, length of deafness, profound deafness, and lipreading ability weakly correlated to postoperative performance. The multivariate analysis showed age at time of implantation, IQ, and lipreading ability to be predictive of postoperative performance

Cochlear implant surgery by a group of experienced surgeons proceeded without major complications. Computed tomography scans tended to underestimate cochlear obstruction, but a drill-out was infrequently required if the scan was apparently nounal

This study examines the relationship of time to cochlear implant patient performance and the effect of device design on patient performance over time. Data were collected for patients who were implanted with Nucleus 22, Smith & Nephew Richards Ineraid, or 3M/Vienna cochlear implants as part of the Veterans Administration study on cochlear implants. Patients were administered a comprehensive audiological test battery prior to implantation, at stimulation, and 3 months, 1 year, and 2 years poststimulation. Results show that patient performance improved over the course of the study, with performance levels with each multichannel implant being similar at the study end point. The Nucleus device produced maximum performance sooner than the Ineraid device did, and performance of the single-channel 3M was consistently below that of the multichannel devices

Distortion product otoacoustic emissions (DPOAEs) for low stimulus levels (< 60 dB SPL) have been reported in adult humans under ideal conditions. In neonates, DPOAEs have been reported only for high-level stimuli. The purpose of this paper was to determine characteristics of the 2f1-f2 DPOAE for low-level stimuli in neonates and to assess the feasibility of obtaining such measures in a noisy environment. Subjects were 19 premature neonates presumed to have normal hearing based on systematic pneumatic otoscopy measures and evoked auditory brainstem responses. For stimuli centered at 2000 and 6000 Hz and presented over a range of 30 to 75 dB SPL, DPOAEs were measured employing linear time averaging for up to 128 time frames at each level. In quiescent subjects, the level of the noise floor was as low as that reported in cooperative adults under ideal conditions (approximately -30 dB SPL), and the functions were identical. That is, valid measures were obtained for very low stimulus levels (30 dB SPL), the rate of growth approached 1 dB/dB, and identical nonmonotonicities (saturation, plateaus, and notches) were observed as those reported for adults. When the noise floor was elevated due to subject activity, no valid data could be obtained for low-level stimuli even though the DPOAEs were at expected levels for high-level stimuli. These results have important implications for the use of such measures in this population because the DPOAEs associated with the metabolically active nonlinear cochlear processes at low stimulus levels may be contaminated with DPOAEs associated with other processes at high stimulus levels.

A 61-year-old woman was examined because of unilateral nonpulsatile tinnitus involving the right ear. CT scanning showed a soft-tissue mass in the hypotypanum. Angiographically, the mass was identified as a fenestrated or duplicated internal carotid artery associated with persistence of the stapedial artery. Embryologic considerations are discussed.