Provision of hearing aids in patients with audiometrically demonstrable hearing loss can play a very important part in tinnitus control. The additional improvement in tinnitus control observed following introduction of programmable digital aids had a summative effect in the management of these patients.
One hundred consecutive adult cochlear implant patients, numbered 101 to 200 in an ongoing series, were prospectively monitored and data collected using the same protocol as for the first 100 patients. The study period was 1999 to 2001. The total number of procedures was 122. Changes in practice following the first 100 implants included a standard surgical technique with a smaller incision and lesser flap mobilization, and routine facial nerve monitoring. As far as was practicable, the same commercial type of implant was used. There were 111 (91 per cent) implantation episodes, five (4 per cent) explantation episodes, four (3.3 per cent) reimplantation episodes and two (1.6 per cent) revision procedures. Eighty-nine patients underwent unilateral implantation and 11 underwent bilateral implantation. Major complications included flap breakdown (1.6 per cent), extrusion of electrode array (0.8 per cent) and device failure (0.8 per cent). The overall major complication rate was 3.2 per cent (4/122). The overall minor complication rate was 18 per cent. In addition, 7.3 per cent experienced transient vertigo and 5.7 per cent experienced local discomfort lasting three days on average with complete resolution. The overall complication rate in the second 100 implant patients was lower than in the first 100. Smaller incision and lesser flap mobilization reduced the minor complication rate.
Of the first 100 patients implanted on the Midland Cochlear Implant Programme the commonest aetiologies of deafness were idiopathic 31 per cent, meningitis 28 per cent and cochlear otosclerosis 16 per cent.The major complication rate was three per cent. The most severe was one individual who post-operatively developed a cerebral infarct and subsequently died. The minor complication rate was 39 per cent, all of which successfully resolved, and included 11 cases of wound infection, nine cases of vertigo, three transient facial palsies and two post-operative bleeds.Older patients and men were most likely to have a post-operative medical complication. Women were more likely to have an abnormal electrode insertion. Meningitis and otosclerosis were the most complicated aetiologies in terms of cochlear ossification and electrode insertion. A non-patient cochlea was associated with fewer active electrodes. In six cases which had been reported pre-operatively as showing patent cochleas, some form of obstructional ossification was encountered. Patients functioning with greater than 15 active electrodes performed better on auditory tests than patients with fewer than 15 active electrodes.
Nasolacrimal intubation has been advocated to obviate the need for dacryocystorhinostomy (DCR) for childhood epiphora which fails to resolve despite apparently successful probings. Twenty-eight intubations were attempted on children falling into this category. Of these, 25 were anatomically successful intubations (3 having had to be abandoned because of difficulties in retrieving the silicone tubes from the nose). Twenty patients (80%) had complete resolution of symptoms, 2 (8%) had improvement of symptoms such that no further intervention was necessary and 3 (12%) proceeded to DCR. A greater likelihood of a good outcome was seen if the tubes were left in situ for 6 months or more. We suggest that primary nasolacrimal intubation (that is nasolacrimal intubation without DCR) should be the next step in the management of childhood epiphora which fails to resolve after two probings. This approach may avoid a DCR in over 80% of children.
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