There is a significant bilateral advantage of adding a second ear for this group. We were unable to predict when the second ear would be the better performing ear, and by implanting both ears, we guarantee implanting the better ear. Sequential implantation with long delays between ears has resulted in poor second ear performance for some subjects and has limited the degree of bilateral benefit that can be obtained by these users. The dual microphone does not provide equivalent benefit to bilateral implants.
Obliteration of old mastoids and wet middle ears with autologous abdominal fat seems to be a reliable technique to render chronically discharging mastoid cavities or open middle ears dry and closed. This paper is the third in the series and looks at the intermediate results at five years. Of the 16 patients (one bilateral) 94.1 per cent of the ears are still dry and uninfected with closed external meati. Recurrent cholesteatoma was found in two patients at implantation and removed.
Various approaches and techniques are used in discontinuing tracheostomy in children. The variability in the use of resources is considerable. The objective of this study was to assess decannulation in children attended in a university-affiliated children's hospital. A retrospective analysis was made of the medical records of patients who had both tracheostomy (n = 177) and decannulation (n = 30) from 1985 to 1994. Tracheostomies, placed at a mean age of 38 months, were discontinued (on the average) 22 months later. Most children underwent airway endoscopy in the operating room in preparation for decannulation. Twenty-four children had downsizing, then capping of the tracheostomy as a functional trial. Six children underwent staged laryngotracheoplasty before decannulation. Two children had decannulation as part of a single-stage laryngotracheoplasty. Attention to at least one comorbid factor (e.g., pulmonary, neurologic, or cardiac disease) was important in the decannulation of each patient in this series. The individualization of tracheostomy decannulation is necessary for children.
We present a case of bilateral absence of the eighth cranial nerve in the internal auditory meatus (IAM). This caused total failure of responses after cochlear implantation in a six-year-old patient with congenital deafness. Pre-operative magnetic resonance (MR)imaging is important to show not only the anatomy of the middle and inner ears but also the structures in the IAM.
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