Comorbid conditions are medical illnesses that accompany cancer. The impact of these conditions on the outcome of patients with head and neck cancer is well established. However, all of the comorbidity studies in patients with head and neck cancer reported in the literature have been performed using the Kaplan-Feinstein index (KFI), which may be too complicated for routine use. This study was performed to introduce and validate the use of the Charlson comorbidity index (CI) in patients with head and neck cancer and to compare it with the Kaplan-Feinstein comorbidity index for accuracy and ease of use. Study design was a retrospective cohort study. The study population was drawn for three academic tertiary care centers and included 88 patients 45 years of age and under who underwent curative treatment for head and neck cancer. All patients were staged by the KFI and the CI for comorbidity and divided into two groups based on the comorbidity severity staging. Group 1 included patients with advanced comorbidity (stages 2 or 3), and group 2 included those with low-level comorbidity (stages 0 or 1). Outcomes were compared based on these divisions. The KFI was successfully applied to 80% of this study population, and the CI was successfully applied in all cases (P < 0.0001). In addition, the KFI was found to be more difficult to use than the CI (P < 0.0001). However, both indices independently predicted the tumor-specific survival (P = 0.007), even after adjusting for the confounding effects of TNM stage by multivariate analysis. Overall, the CI was found to be a valid prognostic indicator in patients with head and neck cancer. In addition, because comorbidity staging by the CI independently predicted survival, was easier to use, and more readily applied, it may be better suited for use for retrospective comorbidity studies.

ABSTRACT. Objectives. As a result of universal newborn hearing screening and improved evaluation tools, many children with severe to profound hearing loss are being diagnosed as infants. This affords the opportunity to provide these children access to cochlear implantation, although medical and audiologic challenges must be addressed. The purpose of this study was to investigate the safety and efficacy of cochlear implantation in children who are younger than 1 year.Methods. A prospective study was conducted of 18 children who had confirmed severe to profound sensorineural hearing loss and received cochlear implants at our medical center before 12 months of age. The length of device usage ranged from 6 months to 4 years, 5 months. The main outcomes measured were perioperative and postoperative surgical/medical aspects, the InfantToddler Meaningful Auditory Integration Scale and ageappropriate phoneme, and word and sentence recognition tests, when appropriate.Results. All children had full insertions of the electrode array without surgical complications and are developing age-appropriate auditory perception and oral language skills.Conclusions. Early implantation is feasible and beneficial in some children who are younger than 12 months and should be considered with attention to variables involved in the decision-making process, including possible increased surgical risk, skull size and scalp thickness, and mastoid development. U niversal newborn hearing screening has allowed for the identification of severe to profound hearing loss at birth or within a few months thereafter. Because universal hearing screening programs have been and continue to be established throughout the United States, between 85% and 99% of newborns are being screened for hearing loss within 1 day of being born, with the remainder being tested within the first few months of life. This new population of hearing-impaired infants, who by virtue of the extent of their hearing losses are possible candidates for cochlear implantation, provides new opportunities and challenges.Research over time has demonstrated that the early identification of significant hearing loss followed by intervention procedures, including hearing aid usage commencing during the first 6 months of life, significantly increases the level of language development, speech intelligibility, and emotional stability as compared with children with later identification and intervention. 1-3 On average and over all degrees of hearing loss, children achieve higher levels in linguistic, academic, and social skills when management of hearing loss commences at an early age. Because much achievement in the world is based on linguistic competence, the ability of children to communicate often defines many aspects of their educational and social development. Consequently, the window of opportunity for language learning is critical to overall childhood development. For the most part, those critical years have been determined to be from birth to ϳ7 years of age, by which time the majority of th...

The model used for this study provides valuable information to cochlear implant surgeons and design engineers. The Contour Advance electrode, inserted with the Advance Off Stylet technique, represents an improvement over the Contour electrode inserted with the standard insertion technique.

Objectives Commercially available cochlear implant systems attempt to deliver frequency information going down to a few hundred Hz, but the electrode arrays are not designed to reach the most apical regions of the cochlea which correspond to these low frequencies. This may cause a mismatch between the frequencies presented by a cochlear implant electrode array and the frequencies represented at the corresponding location in a normal hearing cochlea. In the following study, the mismatch between the frequency presented at a given cochlear angle and the frequency expected by an acoustic hearing ear at the corresponding angle is examined for the cochlear implant systems that are most commonly used in the United States. Design The angular insertion of each of the electrodes on four different electrode arrays (MED-EL Standard, MED-EL Flex28, Advanced Bionics HiFocus 1J, and Cochlear Contour Advance) was estimated from x-rays. For the angular location of each electrode on each electrode array, the predicted spiral ganglion frequency was estimated. The predicted spiral ganglion frequency was compared with the center frequency provided by the corresponding electrode using the manufacturer’s default frequency-to-electrode allocation. Results Differences across devices were observed for the place of stimulation for frequencies below 650 Hz. Longer electrode arrays (i.e. the MED-EL Standard and Flex28) demonstrated smaller deviations from the spiral ganglion map than the other electrode arrays. For insertion angles up to approximately 270°, the frequencies presented at a given location were typically approximately an octave below what would be expected by a spiral ganglion frequency map, while the deviations were larger for angles deeper than 270°. For frequencies above 650 Hz, the frequency to angle relationship was consistent across all four electrode models. Conclusions A mismatch was observed between the predicted frequency and default frequency provided by every electrode on all electrode arrays. The mismatch can be reduced by changing the default frequency allocations, inserting electrodes deeper into the cochlea, or allowing cochlear implant users to adapt to the mismatch. Further studies are required to fully assess the clinical significance of the frequency mismatch.

Hypothesis An objective cochlear framework, for evaluation of the cochlear anatomy and description of the position of an implanted cochlear implant electrode, would allow the direct comparison of measures performed within the various sub-disciplines involved in cochlear implant research. Background Research on the human cochlear anatomy in relation to tonotopy and cochlear implantation is conducted by specialists from numerous disciplines such as histologists, surgeons, physicists, engineers, audiologists and radiologists. To allow accurate comparisons between and combinations of previous and forthcoming scientific and clinical studies, cochlear structures and electrode positions must be specified in a consistent manner. Methods Researchers with backgrounds in the various fields of inner ear research as well as representatives of the different manufacturers of cochlear implants (Advanced Bionics Corp, Med-El, Cochlear Corp) were involved in consensus meetings held in Dallas, March 2005 and Asilomar, August 2005. Existing coordinate systems were evaluated and requisites for an objective cochlear framework were discussed. Results The consensus panel agreed upon a 3-dimensional, cylindrical coordinate system of the cochlea using the “Cochlear View” as a basis and choosing a z-axis through the modiolus. The zero reference angle was chosen at the centre of the round window, which has a close relationship to the basal end of the Organ of Corti. Conclusions Consensus was reached on an objective cochlear framework, allowing the outcomes of studies from different fields of research to be compared directly.

Evolution in surgical techniques, with particular attention to exposed air cell tracts, abdominal fat graft, and Palva periosteal flap for closure, has had a significant effect in decreasing the author's CSF leak rate after vestibular schwannoma surgery. Conservative management was successful in approximately 50% of cases. Repeat exploration, when needed, was directed at blocking the air cell tract (usually perimeatal or perilabyrinthine) responsible for the CSF leak.

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Cochlear implantation in children <12 months of age is safe and efficacious over an extended period of time. Rates and nature of both major and minor complications are comparable to studies in adults and older children and support continued monitoring of these patients over the long-term.