Biomedical subjects

David W Proops

Publications and source records attributed to David W Proops.

13 recordsLinked to original sources

PubMed2005

Consensus statements on the BAHA system: where do we stand at present?

After more than 25 years of clinical experience, the BAHA (bone-anchored hearing aid) system is a well-established treatment for hearing-impaired patients with conductive or mixed hearing loss. Owing to its success, the use of the BAHA system has spread and the indications for application have gradually become broader. New indications, as well as clinical applications, were discussed during scientific roundtable meetings in 2004 by experts in the field, and the outcomes of these discussions are presented in the form of statements. The issues that were discussed concerned BAHA surgery, the fitting range of the BAHA system, the BAHA system compared to conventional devices, bilateral application, the BAHA system in children, the BAHA system in patients with single-sided deafness, and, finally, the BAHA system in patients with unilateral conductive hearing loss.

Adult↗

PubMed2005

Medical and surgical complications of the second 100 adult cochlear implant patients in Birmingham.

One hundred consecutive adult cochlear implant patients, numbered 101 to 200 in an ongoing series, were prospectively monitored and data collected using the same protocol as for the first 100 patients. The study period was 1999 to 2001. The total number of procedures was 122. Changes in practice following the first 100 implants included a standard surgical technique with a smaller incision and lesser flap mobilization, and routine facial nerve monitoring. As far as was practicable, the same commercial type of implant was used. There were 111 (91 per cent) implantation episodes, five (4 per cent) explantation episodes, four (3.3 per cent) reimplantation episodes and two (1.6 per cent) revision procedures. Eighty-nine patients underwent unilateral implantation and 11 underwent bilateral implantation. Major complications included flap breakdown (1.6 per cent), extrusion of electrode array (0.8 per cent) and device failure (0.8 per cent). The overall major complication rate was 3.2 per cent (4/122). The overall minor complication rate was 18 per cent. In addition, 7.3 per cent experienced transient vertigo and 5.7 per cent experienced local discomfort lasting three days on average with complete resolution. The overall complication rate in the second 100 implant patients was lower than in the first 100. Smaller incision and lesser flap mobilization reduced the minor complication rate.

Adolescent↗

PubMed2004

Cochlear implantation in 53 patients with otosclerosis: demographics, computed tomographic scanning, surgery, and complications.

OBJECTIVES: To collect data from a large number of cochlear implant recipients with otosclerosis and to make an assessment of these patients' clinical characteristics, computed tomographic scans, surgical findings, and complications, and to quantify the occurrence of postoperative facial nerve stimulation. STUDY DESIGN: Retrospective multicenter study. PATIENTS: Fifty-three patients with otosclerosis from four cochlear implant centers in the United Kingdom and The Netherlands were reviewed. Sixty surgical procedures were performed in these patients: 57 devices were placed in 56 ears. RESULTS: The computed tomographic imaging demonstrated retrofenestral (cochlear) otosclerotic lesions in the majority of patients. Although not statistically significant, the extent of otosclerotic lesions on the computed tomographic scan as categorized in three types tends to be greater in patients with rapidly progressive hearing loss, in patients in whom there is surgically problematic insertion of the electrode array, and in patients with facial nerve stimulation. In four patients, revision surgery had to be performed. Twenty of 53 (38%) patients experienced facial nerve stimulation at various periods postoperatively. CONCLUSION: Cochlear implant surgery in patients with otosclerosis can be challenging, with a relatively high number of partial insertions and misplacements of the electrode array demanding revision surgery. A very high proportion of patients experienced facial nerve stimulation mainly caused by the distal electrodes. This must be discussed with patients preoperatively.

Adult↗

PubMed2003

Occult bronchogenic carcinoma presenting as metastasis to the site of a bone anchored hearing aid.

The first report of a patient with metastatic bronchogenic carcinoma of the skin surrounding the abutment of a bone anchored hearing aid (BAHA) is presented. Complications of bone anchored hearing implantation have been well documented to date. We present a 68-year-old lady who presented with an unusual skin lesion surrounding the abutment of her BAHA. This was the first presentation of her bronchogenic tumour. We also review the literature regarding cutaneous metastasis and complications of BAHA.

Aged↗

PubMed2002

Bilateral submandibular duct relocation for drooling: an evaluation of results for the Birmingham Children's Hospital.

Drooling is a problem of the neurologically impaired that often leads to stigmatisation and social isolation. Bilateral submandibular duct relocation (BSMDR) is a surgical procedure that may be used to control troublesome drooling. The aim of this study was to assess the results following surgery and attempt to identify those factors that would mitigate against a successful outcome. A retrospective case note review was performed, and data were collected on 23 neurologically impaired patients who underwent the procedure between 1993 and 2000 at the Birmingham Children's Hospital, UK. An overall improvement in drooling was demonstrated in 20 (87%) cases, with complete cessation of drooling in 13 (57%) cases. The complications included one ranula, three transient submandibular gland swellings and two persistent swellings requiring gland excision. It is difficult to predict which patients will have an unsuccessful outcome following surgery. In our series, three (13%) patients had poor results. We could not determine any special features that could account for this, except that these patients in particular demonstrated the greatest degree of oral-motor dysfunction. BSMDR is a technically straightforward procedure associated with minimal morbidity and a high success rate. It is the procedure of choice at our institution.

Adolescent↗

PubMed2002

Osseointegrated implants in the management of childhood ear abnormalities: with particular emphasis on complications.

Little has been published about the difficulties encountered during the insertion of osseointegrated implants for the attachment of bone anchored hearing aids (BAHA) and auricular prostheses in children. This study examines this issue in the first 51 children implanted at our centre. During surgery, the most common problem encountered was the presence of thin bone resulting in incomplete insertion of fixtures. Five fixtures had failed to integrate and six fixtures were lost in the long-term, however, only five children required revision surgery. The reason why few patients require revision was due to the judicious insertion of 'sleeper' fixtures. At follow-up, seven children required counselling for psychological problems. It is apparent from this study that osseointegrated implants in children are associated with difficulties, re-emphasizing that a paediatric osseointegration programme requires significant investment, and should only be undertaken by institutions that are committed to its success.

Adolescent↗

PubMed2002

Prescription of binaural hearing aids in the United Kingdom: a knowledge, attitude and practice (KAP) study.

The purpose of this questionnaire study was to evaluate the existing knowledge of binaural hearing and the attitudes and practices of prescribing bilateral hearing aids amongst otolaryngologists in the United Kingdom. Of the 950 questionnaires sent to the current members of the British Association of Otolaryngologists and Head and Neck Surgeons (BAO-HNS), there were 591 respondents (62 per cent). The true response rate with completed questionnaires was 59 per cent. Eighty-one per cent of the respondents were aware of the importance of binaural hearing and had a positive attitude towards binaural fitting. The practice of bilateral hearing aid prescriptions was found to be poor amongst all grades on the NHS (less than 10 per cent of all hearing aid prescriptions). This practice in the private sector was variable, dependent largely on patient preference and affordability. The practice of binaural prescription was higher for patients in the paediatric age group than amongst adults. Two common indications for hearing aid prescriptions for unilateral deafness were otitis media with effusion in children (23 per cent of respondents) and for tinnitus masking in adults (12 per cent of respondents). Many otolaryngologists believed that there was not enough evidence to support bilateral bone-anchored hearing aid implantation and bilateral cochlear implantation. Ninety-four per cent of the respondents believed that binaural hearing was as important as binocular vision.

Attitude of Health Personnel↗

PubMed2002

The Glasgow benefit inventory in the evaluation of patient satisfaction with the bone-anchored hearing aid: quality of life issues.

The Birmingham osseointegration programme began in 1988 and during the following 10 years there were a total of 351 bone-anchored hearing aid (BAHA) implantees. In the summer of 2000, a postal questionnaire study was undertaken to establish the impact of the bone-anchored hearing aid on all aspects of patients' lives. We used the Glasgow benefit inventory (GBI), which is a subjective patient orientated post-interventional questionnaire especially developed to evaluate any otorhinolaryngological surgery and therapy. It is maximally sensitive to any change in health status brought about by a specific event: in this case the provision of a BAHA. A total of 312 bone-anchored hearing aid patients, who had used their aids for a minimum period of six months, were sent GBI questionnaires. Two hundred and twenty-seven questionnaires were returned and utilized in the study. The results revealed that the use of a bone-anchored hearing aid significantly enhanced general well being (patient benefit), improved the patient's state of health (quality of life) and finally was considered a success by patients and their families.

Adolescent↗

PubMed2002

An intra-individual comparison of the previous conventional hearing aid with the bone-anchored hearing aid: The Nijmegen group questionnaire.

By spring 2000, a total of 351 patients were implanted in the Birmingham bone-anchored hearing aid (BAHA) programme. This group consisted of 242 adults and 109 children. The aim of this retrospective questionnaire study was to directly assess patient satisfaction with their current bone-anchored hearing aid in comparison with their previous conventional air and/or bone-conduction hearing aids. The Nijmegen group questionnaire was sent by post to 312 patients who used their BAHA for six months or longer. The questionnaire used was first described by Mylanus et al. (Nijmegen group) in 1998. The total response rate was 72 per cent (227 of 312 patients). The bone-anchored hearing aid was found to be significantly superior to prior conventional hearing aids in all respects.

Adolescent↗

PubMed2002

Day to day use and service-related issues with the bone-anchored hearing aid: the Entific Medical Systems questionnaire.

Over a 12-year period, the Birmingham implantation otology unit has implanted more than 300 patients with bone-anchored hearing aids (BAHA). The Entific Medical Systems questionnaire was administered to these patients to evaluate the day to day use of the BAHA, professional needs, after-care, wear and tear concerns and service related issues. Data analysis revealed that most patients used their BAHA for more than eight hours a day (90 per cent of BAHA users) and every day of the week (93 per cent of BAHA users). A high degree of satisfaction was expressed as regards sound amplification, listening to radio or television news, listening to music, speech perception in quiet conditions, during conversation with one person in noisy surroundings and conversation with family at home. Some degree of difficulty was expressed with the use of the BAHA during conversation with two or more people in noisy surroundings. A slow process of perceptual acclimatization was noticed with the majority of the patients. The majority of patients were pleased with the service as regards care of the wound, BAHA nursing clinics, device repairs and other service-related issues.

Adolescent↗

PubMed2002

Disability, handicap and benefit analysis with the bone-anchored hearing aid: the Glasgow hearing aid benefit and difference profiles.

The Birmingham bone-anchored hearing aid programme began in 1988 and by autumn 2000 a total of 351 patients had been fitted with such an aid. The aim of this study was to assess the effectiveness of hearing rehabilitation with the bone-anchored hearing aid. This was a prospective interview-based questionnaire study carried out in the autumn 2000. A total of 84 adult patients were interviewed. Each patient had worn their BAHA for more than one year. The questionnaire used during these interviews was the Glasgow hearing aid benefit profile (GHABP) and the Glasgow hearing aid difference profile (GHADP). This was first derived and validated by Gatehouse in 1999. The use of bone-anchored hearing aids was found to reduce the level of disability and handicap and provided the most patient benefit and satisfaction.

Adult↗

PubMed2002

Patient satisfaction with bilateral bone-anchored hearing aids: the Birmingham experience.

The Birmingham bone-anchored hearing aid (BAHA) programme has fitted more than 300 patients with unilateral bone-anchored hearing aids since 1988. Some of the patients who benefited well with unilateral aids and who had used bilateral conventional aids previously applied for bilateral amplification. To date, 15 patients have been fitted with bilateral BAHAs. The benefits of bilateral amplification have been compared to unilateral amplification in 11 of these patients. Subjective analysis in the form of validated comprehensive questionnaires was undertaken. The Glasgow benefit inventory (GBI), which is a subjective patient orientated post-interventional questionnaire developed to evaluate any otorhinolaryngological surgery and therapy was administered. The results revealed that the use of bilateral bone-anchored hearing aids significantly enhanced general well being (patient benefit) and improved the patient's state of health (quality of life). The Chung and Stephens questionnaire which addresses specific issues related to binaural hearing was used. Our preliminary results are encouraging and are comparable to the experience of the Nijmegen BAHA group.

Adult↗

PubMed2002

Speech intelligibility with bilateral bone-anchored hearing aids: the Birmingham experience.

The Birmingham bone-anchored hearing aid (BAHA) programme, since its inception in 1988, has fitted more than 300 patients with unilateral bone-anchored hearing aids. Recently, some of the patients who benefited extremely well with unilateral aids applied for bilateral amplification. To date, 15 patients have been fitted with bilateral BAHAs. The benefits of bilateral amplification have been compared to unilateral amplification in 11 of these patients who have used their second BAHA for 12 months or longer. Following a subjective analysis in the form of comprehensive questionnaires, objective testing was undertaken to assess specific issues such as 'speech recognition in quiet', 'speech recognition in noise' and a modified 'speech-in-simulated-party-noise' (Plomp) test. 'Speech in quiet' testing revealed a 100 per cent score with both unilateral and bilateral BAHAs. With 'speech in noise' all 11 patients scored marginally better with bilateral aids compared to best unilateral responses. The modified Plomp test demonstrated that bilateral BAHAs provided maximum flexibility when the origin of noise cannot be controlled as in day-to-day situations. In this small case series the results are positive and are comparable to the experience of the Nijmegen BAHA group.

Adult↗