Twenty-five children deafened by meningitis were compared with 10 congenitally deaf children on cochlear implant performance. All subjects had met the audiologic criterion of profound deafness as required for implant surgery. Twenty subjects in the meningitis group had some degree of ossification at the round window, and drilling was required for electrode insertion into the scala tympani. In six of these subjects, bone completely filled the scala. There was a significant relationship between extensive ossification and the etiologic pathogen Diplococcus pneumoniae, as determined by radiologic and surgical reports. Postoperative results revealed that all subjects could be electrically stimulated, except for one with extensive bone formation. On implant performance, the meningitis group demonstrated sound-field thresholds comparable to those of the group with congenital deafness but required significantly higher voltage settings. These findings suggest that even with extensive labyrinthine ossification caused by meningitic deafness, neural elements are present and can be stimulated if enough power can be safely provided.
Disruption of the nasofrontal ostia or ducts is an important factor in the development of immediate and delayed complications following frontal sinus fractures. Thorough evaluation of 50 consecutive patients with frontal sinus injuries caused by blunt trauma revealed several fracture patterns that frequently include injury to the drainage system. Anterior table fractures, even when displaced, do not produce such injuries unless associated with a fracture of the supraorbital rim or nasoethmoidal complex. Combined fractures of the anterior and posterior tables are almost always accompanied by injuries to the orifices. Severity of these injuries is variable but can be predicted from the sinus wall fracture patterns. Although CT scanning is incapable of directly imaging involvement of the ostia or ducts, it will give sufficient information to allow for accurate prediction of disruption of the drainage system.
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