Psychophysical and speech perception studies: a case report on a binaural cochlear implant subject

Further improvements in speech perception for cochlear implant patients in quiet and in noise should be possible with speech processing strategies using binaural implants. For this reason, presented here is a series of initial psychophysical and speech perception studies on the authors' first binaural cochlear implant patient. For an approximate matching of the places of stimulation on the two sides, the patient usually reported a single percept when the two sides were simultaneously stimulated. Lateralization was strongly influenced by amplitude differences between the electrical stimuli on the two sides, but only weakly by interaural time delays. Speech testing, comparing monaural with binaural electrical stimulation, showed a binaural advantage particularly in noise.     

Failure of a carbon fiber implant. A case report

STUDY DESIGN: Case report. OBJECTIVES: Failure of a carbon fiber implant. SUMMARY OF BACKGROUND DATA: To simplify the procedure of posterior lumbar interbody fusion, a carbon-fiber-reinforced polymer implant has been developed. The implant has ridges to resist retropulsion, struts to support weight, and a hollow area to allow packing of autologous bone graft. So far, no complications have been reported from the use of carbon implant as a fusion aid in spine surgery. METHODS: A patient with postoperative infection has been followed with computed tomography images and histologic examination from a reoperation. RESULTS: An entire nonunion across the width of the disc space and a clearly broken cage was visualized with computed tomography. The spinal canal was explored during a reoperation and the tissue surrounding the dura and nerves were all black. Microscopic examination showed a large quantity of carbon particulate debris. The authors have operated on approximately 100 patients so far and no other carbon cage has broken, to their knowledge. CONCLUSIONS: Carbon cages can break if a nonunion occurs and as a result free carbon particles move out to the spinal canal.     

First field trials with a portable CIS processor for the Ineraid multichannel cochlear implant

The continuous interleaved sampling (CIS) strategy is a promising sound processing strategy for multichannel cochlear implants which provides immediate improvements in speech recognition when tested on Ineraid users: patients with only a few hours of experience (in laboratory testing) with the CIS strategy score better than with the Ineraid prosthesis they used since they, were implanted. The goal of this study was to evaluate the benefits that can be gained by the use of the new strategy in every day life. Two patients, implanted with the Ineraid multichannel cochlear implant, were equipped with a portable numerical processor programmed to implement a high rate CIS strategy. Their speech recognition was evaluated periodically with consonant and vowel identification tests for more than 6 months of use. Tests were also made with the Ineraid processor during the same experimental sessions and patients were regularly interviewed about their experience. Performance with the portable CIS processor was superior or equal to that obtained previously in the laboratory with the same strategy. Both patients achieved the best scores in 6 years of cochlear implant use. Qualitative reports from the patients suggest that the CIS strategy can improve "hearing" performance of cochlear implant users in many important situations of every day life. Altogether, these results hold great promises for all users of the Ineraid multichannel cochlear implant.     

Tuberculosis of the middle ear. A case report

A case of tuberculous otitis media in an immunocompetent 11-year-old boy is reported. The difficult diagnosis is highlighted. The bibliography was reviewed.     

Loudness balance between acoustic and electric stimulation by a patient with a multichannel cochlear implant

Estimates of loudness balance were obtained for acoustically and electrically presented 250 Hz sine signals from a patient who uses the Ineraid multichannel cochlear implant. Acoustic and electric loudness matching was possible because the patient evidenced a 25 dB HL threshold at 250 Hz in his nonimplanted ear. The level of the electrical stimulus in microamperes required for a balance of loudness grew linearly with equal increments in decibels for the acoustic stimulus. These data, in concert with the very limited data from previous studies, provide a rationale for using a logarithmic transformation of acoustic to electric intensity in signal processors for cochlear implants.     

Iatrogenic tinnitus and kophosis treated by cochlear implant. Apropos of a case

A severe iatrogenic tinnitus has been successfully improved by cochlear implant, despite the hearing and intelligibility of the opposite ear were not profoundly impaired. This case report allows to discuss the eventual enlargement of the classic cochlear implant indications.     

Multichannel cochlear implantation with inner ear malformation: case report of performance and management

A small percentage of children who have received the Nucleus multichannel cochlear implant have cochlear malformations of the inner ear and consequent partial electrode insertions. This case describes one child with a cochlear "common cavity" who received an implant at a young age. The case has been further complicated by a gradual malfunction of the electrode array, although the device has not failed completely. Despite the increase in the number of nonfunctional electrodes over time, the subject has continued to improve in auditory, speech production, and language development over a 30-month period. Methods are discussed for clinical monitoring of both performance and the stability of electrodes over time. The circumstances of this case reinforce the importance of postimplant collaboration with families and school staff and highlight the need for objective measures to evaluate both longitudinal changes in performance and device integrity.     

Indications for middle ear obliteration within the scope of cochlear implant management

BACKGROUND: Cochlear implants have gained worldwide acceptance as a reliable method of rehabilitation of profoundly hearing-impaired patients. Due to thorough patient selection major postoperative complications rarely occur and are flap related in most cases. Deafness can develop during chronic suppurative otitis media, either coincidentally or secondary to the medical treatment; normally this condition is regarded as a contraindication for cochlear implantation. In cases with a mastoid cavity after surgical treatment for cholesteatoma, the electrode covered only by the epithelial lining will likely become exposed or extruded. Therefore we suggest the obliteration of the middle ear cleft with abdominal fat and the blindsac closure of the external ear canal before cochlear implantation in these conditions. PATIENTS: The average age of our 12 patients was 48 years, whereas the youngest was 2 1/2 years of age. Due to chronic inflammatory ear disease. 11 patients had a mastoid cavity on both ears. Eight patients had a cholesteatoma, the chronic bone destroying process in the temporal bone of two female patients was considered as a fibroinflammatory pseudotumor. The child had a congenital deafness in both ears with a Mondini dysplasia in CT scan. She had already developed two episodes of pneumococcal meningitis which was caused by a defect in the stapes footplate through which a liquor-filled cystic sac herniated in the middle ear. Because of a massive liquorrhoea after opening of the sac, we decided to obliterate the middle ear cleft after successful insertion of the electrode array. RESULTS: All active electrodes of 10 Nucleus implants (Cochlear) and two Clarion devices (Advanced Bionics Corp.) were successfully inserted in the cochlea of the 12 patients. After an average follow-up of 15 months, a temporary facial palsy in one patient and an insufficient closure of a retroauricular fistula over the mastoid cavity in two cases were observed as postoperative complications. One patient with a fibroinflammatory pseudotumor developed a massive inflammatory reaction in the implanted ear two months after cochlear implantation, which could not be controlled by conservative treatment. The implant had to be removed and local conditions settled after administration of immunosuppressive treatment with cyclophosphamide. The patient received a new implant seven months ago. CONCLUSIONS: Implantation of a foreign body in a potentially infected space which communicates intracranially means a surgical challenge which can be managed by obliteration of the middle ear after subtotal petrosectomy with abdominal wall fat combined with a reliable closure of the external ear canal. In case of massive inflammation we would prefer a two-stage procedure.     

Ectopic cerebral tissue in the middle ear. A case report

Most idiopathic generalized epilepsies have an onset in childhood or adolescence, with a moderate second incidence peak in the presenium predominantly in women. This study addressed the question of a later onset. The available literature and the records of four personal data sets (two prospective incidence surveys of epileptic seizures, one prevalence study of epilepsy, and one clinical series of individuals with epilepsy) were screened for patients who had experienced a first generalized convulsive seizure with bilateral spike-wave complexes on EEG after 60 years of age. Reports of first idiopathic generalized tonic-clonic seizures occurring after age 60 were extremely rare and none was found in our four cohorts regardless of the methodology involved. Only five case reports were found, all involving a woman. Two had a family history of seizure disorders and two had had at least one seizure earlier in life. Idiopathic generalized epilepsy of late onset, if this condition actually exists, is likely to be the consequence of a genetic predisposition triggered by acquired epileptogenic factors.     

Silicone elastomer microshards in fluid from a painful metatarsophalangeal implant site. A case report

Histopathologic studies have demonstrated microshards from silicone elastomer metatarsophalangeal joint implants in adjacent tissues in a setting of chronic inflammation and in inguinal lymph nodes. Cytologic smears of synovial fluid from symptomatic implanted joints should show these refractile, nonpolarizing microshards in the reactive inflammatory context. Nonspecific enzymatic inflammatory activity contributes to further destabilization of the implants, eventuating in symptoms and signs requiring prosthesis removal. Cytopathologic examination of aspirated fluid from the vicinity of a symptomatic implanted joint demonstrates foreign body reaction to silicone elastomer, predicting a need for intervention before the local damage is severe and disabling.     

Primary adenomatous tumor of the middle ear: a case report

This study was aimed at evaluating the level of metabolic control and cardiovascular risk factors in a population of Type 2 diabetic patients with coronary artery disease. We used myocardial thallium-201 scintigraphy as a measure of coronary perfusion integrity. One hundred and forty six diabetic patients presenting with chest pain, ischaemic ECG changes or a positive exercise test underwent myocardial thallium-201 imaging perfusion in conjunction with exercise stress. Scintigrams were assessed by a computer assisted image analysis. The cardiovascular risk factors considered were sex, age, BMI and waist-hip ratio, smoking, systolic and diastolic blood pressure, serum lipids (total cholesterol and triglycerides), glycated haemoglobin A1, urinary albumin excretion, white blood cell count, and diabetes duration. The proportion of male diabetic subjects with a positive scintigraphy was 63% while that of diabetic women was 45% (p < 0.05). Mean age, anthropometric measures and diabetes indices were similar when diabetic patients with positive or negative scintigraphy were compared. The prevalence of patients with microalbuminuria and retinopathy (both non-proliferative and proliferative) was higher in positive (26% and 27%, respectively) than in negative (10% and 11%, respectively, p = 0.01) diabetic patients. Total cholesterol and white blood cell counts were also higher in positive diabetics (p < 0.05-0.01). These findings suggest that a cluster of risk factors (cholesterol, white blood cells, microalbuminuria) may be implicated in the development of coronary artery disease in Type 2 diabetes mellitus.     

A new technique of elbow arthrodesis. A case report

Changes in body composition, somatic growth, power and strength of high school wrestlers (W, n = 8, 15.9 +/- 0.3 yrs) and controls (C, n = 6, 16.1 +/- 0.2 yrs) were studied early, mid-, late-, and 3.5-months post-season. Elbow flexion peak power (FPP), peak torque (FPT), extension peak power (EPP), and peak torque (EPT) were measured on an isokinetic dynamometer. C demonstrated normal rates of somatic growth and gains in strength and power. However, for W, significant (p < 0.05) decreases were found in: weight (WT, 61.6 +/- 2.8 to 59.2 +/- 2.8 kg), relative fat (%BF) (7.8 +/- 0.7 to 6.1 +/- 0.7 %), FPT (33.3 +/- 2.3 to 29.9 +/- 2.7 Nm), FPP (125.8 +/- 0.3 to 107.8 +/- 8.4 W), EPT (37.5 +/- 2.5 to 36.2 +/- 3.8 Nm), and EPP (132.7 +/- 8.4 to 126.7 +/- 12.3 W), between early-season and late-season and significant increases in WT (5.4 +/- 0.4 kg), fat-free mass (FFM, 4.4 +/- 0.7 kg), FPT (9.4 +/- 1.7 Nm), FPP (38.8 +/- 8.8 W), EPT (6.5 +/- 1.0 Nm), and EPP (24.4 +/- 4.7 W), between late-season and post-season. Compared to C, W had significantly (p < 0.05) smaller increases in mid-arm girth and flexed mid-arm cross-sectional muscle area (X-SECT) during the wrestling season and larger increases in shoulder girth, abdominal girth, and mid-arm girth, X-SECT, and biacromial, biilium, and anterior-posterior chest breadths during the post-season. Power and strength measures were significantly correlated with FFM, lean upper limb volume (ULV), and X-SECT (r = 0.74 to 0.93, p <0.0001). When covaried for FFM, ULV or X-SECT seasonal declines in strength and power were no longer significant while post-seasonal increases remained. In conclusion, pre- to late- season W demonstrated a lack of lean tissue accretion and reductions in strength. At post-season these variables returned to, or were above, pre-season levels. Results of analysis of covariance indicated that lean tissue changes were associated with the changes in strength and power.     

Recurrent bronchogenic cyst with rupture into the pericardium. A case report

A case of tamponnade due to intrapericardial rupture of a recurrent bronchogenic cyst, presenting as pericarditis, is described. This case is unique because it demonstrates the possibility of rupture of a bronchogenic cyst into the pericardium and by the unusual mode of presentation. It also shows that bronchogenic cysts may recur many years after incomplete ablation. Bronchogenic cysts are benign dysembrioplasic formations characterised by their respiratory epithelial lining. The usual presentation in the adult is by haemorrhage or infection, but our case shows that recurrent pericarditis without an obvious cause may be due to bronchogenic cyst, which should be systematically excluded. The diagnosis suspected after medical imaging (chest X-ray, scanner, magnetic resonance imaging) is confirmed by histology. Total surgical ablation is the treatment of choice and may be curative.     

Primary biliary cirrhosis and systemic lupus erythematosus. A new case report

Systemic lupus erythematosus and primary biliary cirrhosis are two autoimmune disorders that rarely occur in the same patient. Ten well-documented cases have been reported to date. We add the case of a woman who was diagnosed with systemic lupus erythematosus at 54 years of age then with primary biliary cirrhosis 18 years later. Interestingly, primary biliary cirrhosis antedated the systemic lupus erythematosus in all the other reported cases. The possibility that a patient may develop more than one autoimmune disorder should be borne in mind.     

Optimizing multiple individual anterior implant restorations with a new generation implant-abutment system; IMZTwinPlus: a case report and treatment rationale

A 53-year-old male with a history of initial oral facial trauma causing the loss of three maxillary incisors, multiple failures of tooth-borne fixed prosthetic reconstructions, and a resultant condition of structural failure of abutment cuspids and lateral incisor was to be retreated. The case contained numerous anatomic and dimensional constraints. The patient's desire to achieve a long-term, dependable prosthetic reconstruction prompted professional consideration of incorporating implants to lend structural support in the edentulous area. An extensive review of current implant-abutment options and their single-tooth implant replacement design and treatment rationales was conducted. The IMZ Generation III (IMZTwinPlus) implant system, a nonhex system, was chosen for treatment of the case of report to optimize mechanics, biomechanics, and esthetics for multiple individual-tooth implant replacement.     

Olmsted syndrome: report of a new case

We report the case of a 20-year-old man, who was born with an intense erythema of the genital area, unresponsive to any treatment employed. When he was 9 months old, he presented with well-defined hyperkeratotic erythematous plaques around the mouth, eyes, nose, and perianal area, with similar plaques on the lateral aspect of the neck and axillae. At the same time the erythema of the genital area became hyperkeratotic. When he was 2 years old, he presented with a disabling palmoplantar keratoderma, initially focal, and later diffuse, also unresponsive to local or systemic treatments employed. The lesions have varied during the course of the disease without ever clearing completely. The axillary and inguinal plaques have shown spontaneous resolution on occasion. Six skin biopsies have been performed with no conclusive histological diagnosis of any of the typical disorders of keratinization. All treatments, topical and systemic, including etretinate and acitretin, have failed to improve the condition. We believe that this patient has Olmsted syndrome, a rare form of palmoplantar keratoderma with periorificial keratotic plaques.