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Biomedical subjects

B Papsin

Publications and source records attributed to B Papsin.

12 recordsLinked to original sources
PubMed2005

Mitek QuickAnchor fixation of cochlear implants using a minimal access technique.

RATIONALE: In children with thick cortical bone, surgical exposure for cochlear implant fixation is difficult when using a minimal access technique. We report our experience in these children using the Mitek QuickAnchor system. METHODS: A retrospective review of all children undergoing cochlear implantation over a 12-month period was performed to identify those children in which a Mitek QuickAnchor was used. Measurements of cortical bone thickness at the receiver-stimulator well site were obtained from pre-operative CT scans of temporal bones of all children. The application of the Mitek QuickAnchor system was also reviewed. RESULTS: Cochlear implant fixation using the Mitek QuickAnchor system was performed in 14 children (mean age 12 years) during the study period. The mean cortical bone thickness was 5.6mm in patients receiving the Mitek QuickAnchor system and 3.2mm in patients undergoing conventional fixation. The difference in cortical thickness was highly statistically significant. Successful secure fixation was obtained in all cases. CONCLUSIONS: The Mitek QuickAnchor system provides an effective method of cochlear implant fixation when using a minimal access technique in children with thick cortical bone.

Child↗
PubMed2005

Acoustic analysis of the voice in pediatric cochlear implant recipients: a longitudinal study.

OBJECTIVE: To characterize inherent acoustic abnormalities of the deaf pediatric voice and the effect of artificially restoring auditory feedback with cochlear implantation. DESIGN: Inception cohort. SETTING: Academic referral center. PATIENTS: Twenty-one children with severe to profound hearing loss (15 prelingually deaf, 6 postlingually deaf) accepted into the cochlear implant program were followed for up to 6 months. Patients unable to perform the vocal exercises were excluded. INTERVENTIONS: Objective voice analysis was performed using the Computerized Speech Laboratory (Kay Elemetrics) prior to cochlear implantation, at the time of implant activation and at 2 and 6 months postactivation. Assessments were based on sustained phonations and dynamic ranges. MAIN OUTCOME MEASURE: Fundamental frequency, long-term control of fundamental frequency (vF0) and long-term control of amplitude (vAM) were derived from sustained phonations. The dynamic frequency range was derived from scale exercises. Formant frequencies (F1, F2, F3) were determined using linear predictive coding. RESULTS: Fundamental frequency was not altered by implant activation or experience (P = 0.342). With profoundly deaf subject, the most prevalent acoustic abnormality was a poor long-term control of frequency (vF0, 2.81%) and long-term control of amplitude (vAm, 23.58%). Implant activation and experience had no effect on the long-term control of frequency (P = 0.106) but normalized the long-term control of amplitude (P = 0.007). The mean frequency range increased from 311.9 Hz preimplantation to 483.5 Hz postimplantation (P = 0.08). The F1/F2 ratio remained stable (P = 0.476). CONCLUSION: In children, severe to profound deafness results in poor long-term control of frequency and amplitude. Cochlear implantation restores control of amplitude only and implies the need for additional rehabilitative strategies for restoration of control of frequency.

Acoustics↗
PubMed2004

Cochlear implant positioning in children: a survey of patient satisfaction.

INTRODUCTION: The past decade has been witness to significant diminution in incision size and placement for pediatric cochlear implantation at our institution. Furthermore, the orientation of the long axis of the implant relative to the skull base plane has generally evolved from a retro-verted to ante-verted direction to accommodate the ear level receiver stimulator and the new minimal access technique. OBJECTIVE: To characterize the cosmetic, functional and clinical implications of this evolution in cochlear implant positioning by means of a patient satisfaction survey. METHODS: A survey of patient satisfaction was administered to 100 cochlear implant recipients or their parents. The survey elicits the patient's level of satisfaction with respect to implant position and functional limitations. In addition, the angle formed by the long axis of the implant and the skull base plane (implant angle) was determined from lateral skull radiographs to detect the temporal evolution in implant positioning. RESULTS: Analysis of the radiographs revealed an implant angle of 65.4-125 degrees in patients implanted prior to 1997, an implant angle of 56.3-87.5 degrees in patients implanted from 1997 to 2001, and an implant angle of 35.1-78.1 degrees after 2002. In spite of this evolution in positioning, the patient satisfaction survey did not reveal any change in incidence of cosmetic, functional or clinical problems. DISCUSSION: The significant changes in incision and implant positioning represent a technical evolution in pediatric cochlear implant surgery. The fact that patients have been consistently satisfied over time suggests that the cosmetic, functional and clinical implications are minimal.

Adolescent↗
PubMed2001

Vocabulary acquisition rate after pediatric cochlear implantation and the impact of age at implantation.

OBJECTIVE: studies of early vocabulary development after pediatric cochlear implantation show growth rates that approach normality. Do these growth rates continue to rise over time and, therefore, allow a 'catch up' with ideal scores for age, or do they decline after an initial peak. Could age at implantation be a decisive factor in that process? DESIGN: retrospective study (mean follow-up 4 years). PATIENTS: pre-lingually deaf children implanted between 1988 and1999, who serially performed Peabody Picture Vocabulary Test-Revised (PPVT), (37 patients) and Expressive One-word Picture Vocabulary Test-Revised (EOWPVT), (35 patients). OUTCOME MEASURES: the mean rates of age equivalent scores were determined for the whole follow-up period and analyzed further for two post-implant periods (the two halves of follow-up duration of individual patients). After sub-grouping by age at implantation (younger or older than 5 years old), the same analysis was executed for each subgroup. RESULTS: the mean EOWPVT rate of the earlier period was higher than that of the later period (1.33 vs. 0.67, P<0.01) and the mean PPVT rate of the earlier period was higher than that of the later period (0.72 vs. 0.5). The latter difference was not statistically significant (P>0.05). Within subgroups by age at implantation, the PPVT mean rates were stable for younger implanted patients (0.56 for both periods) and dropped for the older implanted sub-group (0.87-0.43, P>0.05). The EOWPVT mean rates declined significantly for the older patients group (1.72-0.55, P<0.01) but insignificantly for the younger patients (0.99-0.77, P>0.05). CONCLUSIONS: vocabulary acquisition rates decline in the post-implantation period. This is more pronounced with older implanted children and the EOWPVT rates. This information on the time course development of vocabulary after implantation would be valuable in counseling and planning habilitation in addition to candidate selection.

Age Factors↗
PubMed2001

Disordered breathing during sleep in patients with mucopolysaccharidoses.

OBJECTIVE: Obstructive sleep apnoea (OSA) has been reported as a feature of children with mucopolysaccharidoses (MPS). However, the incidence and severity of OSA with respect to disease type is poorly defined. The aim of the present study was to measure objectively the degree of OSA in a group of children with a range of MPS syndromes. METHODS: In a cross-sectional study, cardiopulmonary sleep studies were performed during unsedated sleep in 26 children with MPS over a period of 2 years. Scores of OSA severity based upon clinical history and upon objective sleep study data were made in each case and compared. RESULTS: OSA was present in 24/26 patients, and ranged in severity from mild to severe. OSA was most marked in MPS type IH (Hurler syndrome) followed by types IHS (Hurler--Scheie syndrome) and II (Hunter syndrome). Frequent arousals and poor sleep quality, not suspected clinically, were noted in several patients. There was agreement between the clinical and objective scoring systems in only 17/26 patients (65%) with clinical history scores tending to underestimate the most severe cases (5/26 cases) and overestimate the severity in the mild cases (4/26 cases). CONCLUSIONS: Obstructive respiratory problems are frequent in MPS patients and there are differences in severity of OSA between the different MPS types. Assessments of the severity of OSA based upon clinical history alone are inadequate. Our results suggest that objective sleep studies are necessary to evaluate these cases, to monitor clinical outcome and to assess the effects of therapeutic intervention. Prospective studies in larger numbers of patients are needed to validate these observations.

Adolescent↗
PubMed2001

Utilization of bone-anchored hearing aids in children.

OBJECTIVE: Bone-anchored hearing aids (BAHAs) are indicated for use in children with bilateral microtia or chronic suppurative otitis media, which precludes the use of conventional hearing aids. METHODS: Nineteen consecutive children using BAHAs were reviewed retrospectively. Outcome measures included the long-term stability of BAHAs, frequency of adverse dermatological reactions at the implant site, and audiologic thresholds. RESULTS: Osseointegration was achieved in 95% of patients. One patient lost the implant fixture secondary to direct head trauma. Site revisions were required for only two patients secondary to soft-tissue overgrowth at the abutment site. There were no differences between pre-implantation and post-implantation bone or air conduction thresholds, but there was a statistical improvement in the post-implantation aided thresholds. CONCLUSIONS: Utilization of paediatric BAHAs, in a distinct population, is a reliable and successful method for audiologic rehabilitation.

Adolescent↗
PubMed2001

The effects of age of cochlear implantation on speech perception outcomes in prelingually deaf children.

We have made a retrospective analysis on 70 prelingually deaf children (78% congenital; age range 2-15 years) followed for up to 5 years post-implant during which both closed set speech perception tests (TAC, WIPI) and open set tasks (PBK, GASP) were administered. We used a binary partitioning algorithm to optimally divide our dataset on the basis of age at implantation This technique achieves an optimal split when the heterogeneity of the data is most reduced (maximal drop in deviance). For the closed set speech perception tests (TAC and WIPI) partitioning best divided-out data at age 4.4 years. For the open set tests optimal division was at a higher age of implantation (GASP word, 5.6 years; PBK word, 8.4 years). Using these partitioning values, we have found statistically significant differences between rate of improvement of scores in the younger implanted children compared with those implanted later.

Adolescent↗
PubMed2000

Clinical course of pediatric congenital inner ear malformations.

OBJECTIVE: To determine any factors that could improve the early detection and management of congenital inner ear malformations. STUDY DESIGN: A retrospective review was performed of all patients with a diagnosis of inner ear malformation at Loyola University Medical Center (LUMC) and the Hospital for Sick Children (HSC) between 1987 and 1995. Clinical records and audiometric data were accumulated. One neuroradiologist reviewed every temporal bone computed tomography (CT) scan. METHODS: Forty-six pediatric patients with congenital inner ear anomalies evaluated at two tertiary care hospitals. RESULTS: The average patient age at initial assessment was 25.7 months. A family history of hearing loss was noted in only five patients (12.8%). A major nonotological deformity was seen in 41% of patients. The average hearing threshold was 88 dB. All three patients with sudden hearing loss had vestibular aqueduct enlargement. Two of the three patients with common cavity anomalies had a history of recurrent meningitis. Twenty-seven patients had a vestibular aqueduct deformity, the most frequent radiographic abnormality in the series. CONCLUSIONS: Because inner ear malformation was diagnosed after 24 months of age in a significant percentage of patients, we recommend increased parental education and vigilance by primary care practitioners. Universal newborn screening may be the key to earlier detection of these infants. For children with idiopathic sensorineural hearing loss, we recommend a temporal bone CT scan. Patients with vestibular aqueduct enlargement must be counseled about the risk of progressive sensorineural hearing loss, meningitis, and the need to avoid contact sports. Patients with common cavity abnormalities should be considered for exploratory tympanotomy and also educated about the risk for meningitis.

Acoustic Impedance Tests↗
PubMed2000

Use of a commercially available metal detector for the localization of metallic foreign body ingestion in children.

UNLABELLED: Metallic foreign body (FB) ingestion is a common occurrence in the general paediatric population. We have shown that the use of a commercially available metal detector is sensitive in localizing and confirming metallic FB objects in the digestive tract. METHOD: In a double-blinded randomized control trial, we used a commercially available metal detector to localize metal coins in the digestive tract in an animal model. Localization of the coins was confirmed using fluoroscopy. In 10 consecutive patients with metallic FB ingestion, detection and localization of the FB using the metal detector was compared with standard confirmatory radiographic imaging. RESULTS: Using a commercially available, hand-held metal detector, we were able to localize a metallic FB in the gastrointestinal tract with 100% sensitivity in both the animal model and in 10 paediatric patients.

Child↗
PubMed1998

Utility of frameless stereotaxy in the resection of skull base and Basal cerebral lesions in children.

Since 1991, we have performed nearly 300 stereotactic procedures using the ISG viewing wand on a variety of cranial lesions in patients under 22 years of age. Of these, 38 procedures were performed on 34 patients for basal cerebral and skull base lesions. Our patients ranged in age from 3.5 months to 22 years with a mean age of 9.45 years. There were 18 females and 16 males. Twenty-one patients had basal cerebral lesions located in the thalamus (10), basal ganglia (2), third ventricle (2), and hypothalamus (7). Thirteen patients had skull base lesions located within the anterior optic apparatus (3), sella turcica (4), middle and posterior cranial fossae (4), and craniocervical region (2). Preoperative CT and/or MRI scan images were taken as a volume acquisition and transferred to the computer workstation utilizing the ISG Wand software. This workstation was transferred to the operating room where it was calibrated to a faro Surgicom arm which interfaces with the patient and the three-dimensional radiological image. The ISG Wand was utilized to plan the scalp and bone flaps and to select the optional trajectory to lesion. The surgical approaches which were specifically used in this series with the ISG Wand included transcallosal (15), pterional (5), frontal (3), subtemporal (4), transsphenoidal (3), temporal (3), tumor cyst shunt insertion (1), burr hole drainage (1), transoral (2), bifrontal (1), bifrontal mid facial (1), and transnasal (1). Although brain shift occurred following craniotomy and with brain retraction, the relative immobility of these lesions at the skull or cerebral base permitted an accurate targeting of all lesions with an error range of 1.0-2.5 mm throughout the entire procedure. This relatively precise intraoperative feedback led to more accurate recognition of tumor landmarks. It is the authors' impression that a more aggressive resection of these lesions was achieved than could be without the device. We conclude that a frameless stereotactic device such as the ISG Wand is particularly valuable in the approach to skull base and basal cerebral tumors in children.

Journal Article↗
PubMed1996

Value of nasal radiographs in nasal trauma management.

OBJECTIVE: To assess the value of routinely acquiring plain nasal radiographs in patients following nasal trauma both clinically and cost effectively. DESIGN: A questionnaire was devised to determine the factors that influence physicians to order nasal x-rays and whether or not the results of these radiographs influence management. SETTING: The questionnaire was distributed to the otolaryngology staff and residents, emergency physicians, and family physicians affiliated with the University of Toronto. METHODS: Descriptive statistics were employed. MAIN OUTCOME MEASURES: Percentages of reasons for ordering nasal x-rays and their part in treatment management. RESULTS: The commonest reasons for ordering nasal x-rays in these cases included perceived severity of injury and detection of unsuspected facial fractures, as well as presumed need for medicolegal documentation. CONCLUSIONS: Nasal x-rays are not of substantial medicolegal value and do not play a role in the treatment of the patient. Nasal radiographs are not a cost-effective investigation in the management of trauma to the nose, and their routine use should be abandoned.

Cost-Benefit Analysis↗