Browsing by Subject "Hearing Loss, Sensorineural"
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Item Masqueraders for Appendicitis(2015-01-26) Farzal, Zehra; Khan, N.; Cope-Yokoyama, S.; Fischer, A.C.INTRODUCTION: Patients with cystic fibrosis (CF) are often subject to pulmonary infections treated with antibiotics such as aminoglycosides which have the side effect of sensorineural hearing loss (SNHL). Since children with CF are often on prolonged courses and/or higher doses, they are particularly at risk. OBJECTIVE: To review the role of routine hearing screening for SNHL in children with CF who have been on aminoglycoside therapy. DATA SOURCES: PubMed, Cochrane, SCOPUS, and OVID databases REVIEW METHODS: A systematic review of the literature was performed in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A comprehensive PubMed MeSH search of the English language literature with human subjects only was performed to include all indexed years and the search strategy was adapted to the additional databases. Results: Twelve studies (1979-2014) were included in the review. Three of the 12 articles also studied adult CF patients. The study population included 762 children (age range, 5 months-20 years). Objective hearing screening measures included pure tone audiometry (PTA) at standard ± high frequency threshold (12/12), distortion product otoacoustic emissions (DPOAE) (4/12), transient-evoked otoacoustic emissions (1/12), and automated auditory brainstem response (AABR) (1/12). The overall prevalence of SNHL ranged from 0% to 29%. In a subset of children with high levels of exposure, up to 44% had SNHL. Eight studies recommended hearing screening in CF children on aminoglycosides of which 2 studies recommended screening regardless of aminoglycoside exposure. Four studies made no recommendations and in three of these, the children had a short course of aminoglycosides. HFPTA was the most commonly recommended screening measure followed by DPOAEs. CONCLUSION: Hearing screenings are quick and inexpensive measures leading to interventions that can prevent significant cognitive and linguistic developmental difficulties in children secondary to hearing loss. Routine hearing screening in children with CF exposed to aminoglycosides is supported by the current literature based on the high prevalence of SNHL in this population. Future studies should define the optimal timing for hearing screening during and after aminoglycoside therapy.Item Reflections on a Single Institution Cochlear Implant Experience(2020-05-01T05:00:00.000Z) Schauwecker, Natalie Marie-Rose; Hunter, Jacob B.; Kutz, J. Walter; Isaacson, BrandonOBJECTIVE: To utilize cochlear implant (CI) outcomes to further explore health disparities, hearing preservation (HP) surgery, and standardization of pre- and post-operative CI assessment, with the goal of predicting and improving CI outcomes, including quality of life. STUDY DESIGN: Retrospective chart review of adult patients who underwent CI evaluation and surgery at a single institution between 2009 and 2018. MAIN OUTCOME MEASURES: Improvement in open sentence testing postoperatively, according to patient marital status, race, and gender, as well as HP status. RESULTS: Post-operative performance: Of the 402 total patients who underwent CI during the study period, 372 were followed and programmed at the institution. A total of 87% of these patients achieved "good performance" with their CI, based upon an improvement in post-operative open sentence testing ≥10%. Patient demographics, including gender, age, marital status, and race did not significantly affect whether a patient achieved higher post-operative performance levels. Unmarried patients saw poorer outcomes, but this did not reach significance (37.5% vs 24.3%, p = 0.2123). HEARING PRESERVATION: HP surgery evolved during the study period, with modern "soft surgery" technique defined by perioperative steroids, round window cochleostomy, and atraumatic CI insertion. A slight majority of HP surgical patients maintained low frequency hearing postoperatively (54.2%). However, documentation of preserved hearing was limited, with only 53.7% of patients with recorded unaided audiograms. Analyzing speech perception outcomes, HP candidates, and patients who underwent "soft surgery," did not demonstrate significantly larger improvements with their post-operative open sentence testing when compared to patients who underwent standard CI, and were concurrently not HP candidates, during the study period (overall improvement: 41% vs 53% respectively, p = 0.10). Additionally, non-white hearing preservation candidates were less likely to retain low frequency hearing post-operatively, but this did not reach significance in the study population (22.2% vs 8.5%, p=0.0992). However, HP surgery, and overall CI surgery outcomes assessment was limited by lack of standardized documentation. CONCLUSIONS: Unmarried patients and non-white patients continue to warrant special attention post-operatively to ensure equability in CI. HP surgery has evolved over the past decade. All, patients, should also have their quality of life evaluated, with standard assessment through open sentence testing failing to demonstrate the added benefit of HP, and likely the overall benefit of any CI. There continues to be a need for standardization in CI evaluation, documentation, and follow-up to allow for larger outcomes based research. IRB: STU 032018-085 PROFESSIONAL PRACTICE GAP AND EDUCATIONAL NEED: The field of CI is in need of large outcome based studies to better predict which patient factors, including demographics and HP status, may predict CI success. DESIRED RESULT: Systematic review of a decade of cochlear implantation outcomes in order to identify areas in which improvement will result in increased ability to assess outcomes, and augmented cochlear implant success leading to improved CI patient quality of life.