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Data and Picture Interpretation Stations: Cases 1–45
Published in Peter Kullar, Joseph Manjaly, Livy Kenyon, Joseph Manjaly, Peter Kullar, Joseph Manjaly, Peter Kullar, ENT OSCEs, 2023
Peter Kullar, Joseph Manjaly, Livy Kenyon, Joseph Manjaly, Peter Kullar, Joseph Manjaly, Peter Kullar
A bone anchored hearing aid is a type of bone conduction device. These should be considered for any patient who is failing/unable to benefit from conventional hearing aids and yet has adequate cochlear reserve to benefit from amplification of sound.
ENT trauma in children
Published in S. Musheer Hussain, Paul White, Kim W Ah-See, Patrick Spielmann, Mary-Louise Montague, ENT Head & Neck Emergencies, 2018
Implants used within paediatric ENT surgery may also be vulnerable to trauma, particularly from falls and sporting activities. These implants may be osseointegrated (e.g. a bone-anchored hearing aid) or non-osseointegrated (e.g. cochlear implant). Several cases of trauma to bone-anchored hearing aids have been reported; significant complications are, fortunately, very rare.7 Good fixation of cochlear implant internal components is recommended in paediatric patients due to the increased risk of minor head trauma and thin overlying soft tissue. The internal magnetic component within the receiver-stimulator package of a cochlear implant may be liable to displacement either as a result of trauma or from strong magnetic traction.8,9 This may be replaced and secured surgically.
Hearing Aids
Published in John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed, Paediatrics, The Ear, Skull Base, 2018
Disadvantages of non-implanted bone-conduction hearing aids include their wearing comfort and the limited sensation level they can provide. A commonly used form of bone-conduction hearing aid is the bone-anchored hearing aid, in which the vibrations are transmitted to the skull via an embedded titanium screw, thereby increasing stimulation of the cochlea by about 15 dB compared to a bone conductor applied to the skin. Bone-anchored hearing aids have been used successfully for patients with unilateral or bilateral conductive or mixed loss. They are also routinely being fitted to people with unilateral sensorineural loss, referred to as single-sided sensorineural deafness. The output levels they can achieve make them suitable for people with cochlear loss up to about 45 dB HL for head-worn devices and up to about 60 dB HL for body-worn devices. Bone-anchored hearing aids can provide greater cochlear stimulation than air conduction hearing aids for patients with air-bone gaps greater than about 30 dB.
Visual and auditory verbal long-term memory in individuals who rely on augmentative and alternative communication
Published in Augmentative and Alternative Communication, 2020
Michal Icht, Yedida Levine-Sternberg, Yaniv Mama
Of the 12 participants, eight had an estimated cognitive function within the normal range (according to their medical and educational records, and general level of function in everyday life), and four were judged to have a learning disability. Five had vision within normal limits, and seven had a visual impairment and used glasses. A single participant had hearing impairment and used a bone-anchored hearing aid. Seven participants were non-speaking and five had minimal functional speech with very low intelligibility, per SLP report. Note, the non-speaking participants were included since the production conditions did not involve speech (verbal production) but producing the target word using the AAC device (selecting the word’s letters on the SGD grid). Literacy skills were assessed by the SLPs, based on spelling abilities (for regular and irregular words, high and low frequency words), and on reading comprehension, and by parental or self-report on reading habits (e.g., reading novels or newspapers, home computer use, including e-mails, Facebook, etc.). Literacy level was scored on a 4-point scale, by SLPs (1: basic literacy level, could write and read in about the 4th grade level; 2: 7/8th-grade level; 3: 11th/12-grade level; 4: high or adult literacy level; see: Bar-On, 2011). Two participants scored 2, five scored 3, and five scored 4. Participants’ characteristics are presented in Table 1.
Tjellström A et al. – Analysis of the mechanical impedance of bone-anchored hearing aids. Acta Oto-Laryngol 1980; 89: 85–92
Published in Acta Oto-Laryngologica, 2018
The present paper is the first in a series of presentations implying an inter-disciplinary development program for bone-anchored hearing aids. The study described and examined the mechanical system used to gain osseointegrated entry into the skull. The input impedance into the head in the frequency range of 250 to 8000 Hz, both with and without skin penetration, was measured in 8 patients. The observations were of the utmost significance for further development of bone-anchored hearing aids, which nowadays are such useful tools for the rehabilitation of many hearing disabled individuals.
Diagnosis and management of eosinophilic otitis media: a systematic review
Published in Acta Oto-Laryngologica, 2021
Tiffany Chen, Peter E. Ashman, Dennis I. Bojrab, Andrew P. Johnson, Robert S. Hong, Brian Benson, Peter F. Svider
The role of surgery in the treatment of this disease appears to be limited, although may be useful for refractory or progressive cases. No surgical treatment has demonstrated consistent improvement in EOM. However, since definitive diagnosis requires the presence of an eosinophilic middle ear effusion, then a myringotomy and tube insertion can be performed to provide this information and be therapeutic in draining the middle ear effusion. As such, myringotomy with tube insertion should be used both initially as a diagnostic modality with potential therapeutic benefits of draining an effusion, and for refractory cases to intratympanic steroids. Having a tube in place can also provide access for topical steroids to enter the middle ear space to help resolve the inflammatory process there. In addition, there may be some utility in granulation tissue resection in severe EOM as well as mastoidectomy when the spectrum of disease progresses to eosinophilic otomastoiditis. Of the studies included in this review, mastoidectomy was performed in six patients but only effective in one with refractory otomastoiditis. Nine patients from Neff et al. were reported to have received tympanoplasty or mastoidectomy, therefore a precise number of each could not be extracted. Surgical resection of granulation tissue can help control otorrhea, improve hearing loss and allow use of hearing aids, as there appears to be limited long term efficacy of steroid treatment in granulation type EOM. The limitation of surgery to specific cases indicates the importance of grading the severity of EOM in determining the most effective treatment. Different assessment scales have been used in several studies but standardization of this process across the field is needed to help develop more effective guidelines in treatment based on severity. Lastly, although surgery may not play a large role in resolving otologic symptoms, a number of case reports emphasize the value of cochlear implants and bone anchored hearing aids in improving quality of life for refractory patients who suffer from hearing loss [13,19,20].