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Biomedical subjects

E A Mylanus

Publications and source records attributed to E A Mylanus.

At least 19 recordsLinked to original sources
PubMed2001

The bone-anchored hearing aid: a solution for previously unresolved otologic problems.

A major challenge for otologists treating middle ear infection is to obtain a dry ear and optimal hearing. If the patient needs amplification and uses an air conduction hearing aid, the ear mold, occluding the ear canal, may provoke or aggravate the infection in the middle ear and thus cause otorrhoea. Continuous otorrhoea may cause cochlear damage in the long run. Bone conduction hearing aids offer an alternative for such patients.

Bone Conduction↗
PubMed2001

Multicenter audiometric results with the Vibrant Soundbridge, a semi-implantable hearing device for sensorineural hearing impairment.

The Vibrant Soundbridge, a semi-implantable hearing device for subjects with moderate to severe sensorineural hearing impairment was introduced commercially. First audiologic results are presented on 63 patients from 10 European implant centers. Hearing loss was at 0.5, 1, 2, and 4 kHz varying between 43 and 81 dB HL. The patients used the analogue audio processor, type 302. Measured sound-field gain was compared with NAL-R target values. For most patients an acceptable agreement was found. There was a subgroup of patients, however, with relatively low gain. The results suggest that this was related to the suboptimal positioning and fixation of the transducer to the incus.

Audiometry, Speech↗
PubMed2000

[Choice of ear drops in chronic otorrhea].

In chronic otitis, the use of ear drops has certain advantages over the use of systemic antibiotics. The choice of ear drop depends on the condition of the eardrum, microbial pathogens present and the efficacy of the components of the ear drop. Ototoxicity, contact allergy and the development of bacterial resistance have to be taken into account. Ototoxicity is a rare complication of the application of ear drops, most often described when aminoglycosides were applied. Contact allergy is also most often seen in aminoglycoside-containing eardrops. Evaluation of ear swabs demonstrated a 5% resistance of Pseudomonas aeruginosa to ciprofloxacin. The appearance of resistant strains may impede systemic use of fluoroquinolones. Therefore, this class of antibiotics should be considered as reserve medication only. The first choice in local application of antiseptics in case of an open eardrum is aluminium acetotartrate 1.2% and, of a combination preparation, bacitracin-colistin-hydrocortisone. In case of a closed eardrum (external otitis) aluminium acetotartrate 12%--combination preparations with corticosteroids are advised against in these cases.

Administration, Topical↗
PubMed2000

A solitary manifestation of mastocytosis in the head and neck.

Solitary mastocytosis in adulthood is a rare finding. Only two such lesions have been reported in the head and neck. We describe a 27-year-old woman who had a 10-year history of a forehead swelling that had fluctuated in size. Light trauma or pressure on the lesion resulted in an increase in its size. A mass was found to be situated just below the galea and was successfully removed surgically using a high forehead lift. Histologically, the specimen contained predominantly mast cells. A systemic mastocytosis was excluded by a multidisciplinary diagnostic approach and measurement of the 24-h urinary excretion of histamine metabolites. After 36 months of follow-up there has been no recurrence.

Adult↗
PubMed1999

The use of eardrops in an ENT department.

A survey of the pattern of usage of ototopical preparations in out-patients of the ENT department of a Dutch University Hospital has been performed. Data on clinical presentation and previous treatment of the patient, otoscopic results, prescribed current treatment and, if available, results of microbiological examination were collected. One-hundred and twenty-one evaluable patients were prospectively included. For 20% of the patients it concerned a first manifestation of the symptoms, 35% had a recurrence after a period free of symptoms and in 37% it concerned patients with persisting symptoms despite treatment. Forty-five percent of the patients' ears concerned had an intact tympanic membrane, in 25% a perforation was present and in 12% middle ear ventilation tubes were in situ. Thirty-five percent had already received previous treatment with ear drops. The species most often isolated was Staphylococcus aureus, followed by Pseudomonas aeruginosa. A wide range of products were prescribed. While previous treatment occurred with combination preparations, for current prescriptions, ofloxacin was most often used. Most patients received 2 to 3 drops 3 times a day for 7 to 10 days, which is in accordance with recommendations in the literature. Potentially ototoxic substances are regularly used in daily practice. Ofloxacin is widely used even thought it is not registered for this indication in the Netherlands and the development of resistance has to be taken into account. A new policy based on this survey is proposed, which will reduce the number of different preparations used and will eliminate ofloxacin from first the treatment.

Administration, Topical↗
PubMed1999

Percutaneous implants in the temporal bone for securing a bone conductor: surgical methods and results.

Clinical results of an extended follow-up of percutaneous titanium implants for application of bone conductors are presented. A simplified 1-stage surgical procedure is introduced. This study entails a consecutive series of 163 implants in 155 patients 9 to 80 years old who received a bone conductor coupled to a percutaneous titanium implant since June 1988 at the University Hospital Nijmegen. The maximum follow-up is 7 years. The bone conductor can be connected to a percutaneous abutment fixed to a titanium fixture anchored in the temporal bone. Several clinical trials from different clinics have shown its efficacy in patients with a conductive or mixed hearing loss. In this study attention is paid to the following issues: the occurrence of skin reactions, the condition of the skin around the abutment, the stability of the fixture, and a simplified surgical technique.

Administration, Cutaneous↗
PubMed1999

Transalar sphenoidal encephalocele and respiratory distress in a neonate: a case report.

We present a full-term newborn infant who suffered from immediate postpartum severe respiratory distress. The infant had an inspiratory stridor as a result of a swelling of the soft palate, extending from the roof of the nasopharynx. Transoral endotracheal intubation resulted in normal saturation levels. Histologic examination after an open biopsy showed mature neuroglial tissue. Radiology demonstrated the presence of a right parapharyngeal process obstructing the nasopharynx and oropharynx and extending to the right middle and posterior fossa, via the foramen ovale. After transoral debulking, the infant was extubated successfully. After an uneventful period of 5 months, the patient was readmitted at our hospital for treatment of meningitis. Subsequently, the inspiratory stridor recurred, and staged surgery was performed. First, a transcranial approach was used to remove a large intradural part of the process and close the defect at Meckel's cave. Two weeks later the retro- and parapharyngeal part of the process were removed transorally. Given the site of the defect of the skull base and the intradural location of the process, the diagnosis is a transalar sphenoidal encephalocele. This is a rare type of basal encephalocele, and has never been reported in an infant nor known to present with respiratory distress. The pathogenesis, clinical presentation, pathology, and therapeutic implications of basal encephaloceles are discussed.

Encephalocele↗
PubMed1998

Intraindividual comparison of the bone-anchored hearing aid and air-conduction hearing aids.

BACKGROUND: Some patients have to stop using their air-conduction hearing aid(s) because it causes or exacerbates chronic otitis. Then, a solution is the use of a bone-conduction hearing aid such as the percutaneous bone-anchored hearing aid (BAHA). OBJECTIVE: To compare patients' performance with their previous air-conduction hearing aid(s) and their BAHA using audiometric tests and a questionnaire. DESIGN: Prospective clinical evaluation in a single subject design. PATIENTS: The results of 34 consecutive patients from the Nijmegen, the Netherlands, BAHA series were included. The patients had bilateral conductive or mixed hearing loss and chronic ear problems. Before the BAHA was fitted, the patients used air-conduction hearing aids. RESULTS: The results of the speech recognition in noise test showed a small but significant improvement with the BAHA. This improvement was related to the size of the air-bone gap. The greater the air-bone gap, the poorer the results with the air-conduction hearing aid(s). The questionnaire demonstrated that the majority of patients preferred the BAHA; diminished occurrence of ear infections played a significant role. The patients did not express an evident preference concerning speech recognition. CONCLUSIONS: In patients with chronic ear problems a BAHA is an acceptable alternative if an air-conduction hearing aid is contraindicated. Preoperative assessment of the size of the air-bone gap is of some help to predict whether speech recognition may improve or deteriorate with the BAHA compared with the air-conduction hearing aid.

Adult↗
PubMed1998

Binaural application of the bone-anchored hearing aid.

Most, but not all, hearing-impaired patients with air conduction hearing aids prefer binaural amplification instead of monaural amplification. The binaural application of the bone conduction hearing aid is more disputable, because the attenuation (in decibels) of sound waves across the skull is so small ( 10 dB) that even one bone conduction hearing aid will stimulate both cochleas approximately to the same extent. Binaural fitting of the bone-anchored hearing aid was studied in three experienced bone-anchored hearing aid users. The experiments showed that sound localization, and speech recognition in quiet and also under certain noisy conditions improved significantly with binaural listening compared to the monaural listening condition. On the average, the percentage of correct identifications (within 45 degrees ) in the sound localization experiment improved by 53% with binaural listening; the speech reception threshold in quiet improved by 4.4 dB. The binaural advantage in the speech-in-noise test was comparable to that of a control group of subjects with normal hearing listening monaurally versus binaurally. The improvements in the scores were ascribed to diotic summation (improved speech recognition in quiet) and the ability to separate sounds in the binaural listening condition (improved sound localization and improved speech recognition in noise whenever the speech and noise signals came from different directions). All three patients preferred the binaural bone-anchored hearing aids and used them all day.

Adult↗
PubMed1998

Removal of titanium implants from the temporal bone: histologic findings.

OBJECTIVE: This study aimed to evaluate the histologic examination of bone tissue surrounding three titanium implants, which were removed since the patients presented with long-standing pain in the implant area. The histologic examination was both qualitatively and quantitatively performed. Furthermore, could an explanation be obtained for the pain in the implant area, which, after removal of the percutaneous implant, disappeared immediately? STUDY DESIGN: Retrospective case review; clinical histomorphometric. SETTING: University Hospital Nijmegen, Göteborg University, Sweden. PATIENTS: Three patients of a consecutive series of 189; 1 man and 2 women who had received a bone-anchored, percutaneous, skin-penetrating, commercially pure titanium implant in the temporal bone, on which a transducer was mounted. The implants were removed because of pain in the implant area from the three patients after 31 months, 18 months, and 8 months, respectively. MAIN OUTCOME MEASURES: The percentage of direct bone-to-metal contact was 81%, 59%, and 42%, respectively. The percentage of bone volume between the threads of the screw was 90, 78, and 75, respectively. RESULTS: The qualitatively histologic findings showed no major differences among the three investigated samples. Quantitatively, the amount of osseointegration depended on the duration of implantation. CONCLUSIONS: Direct bone-to-metal contact and the bone volume between the threads increased as the implantation time increased. No explanation was found for the longstanding pain in the implant area and the relief of pain after removal of the percutaneous implant.

Adult↗
PubMed1995

Patients' opinions of bone-anchored vs conventional hearing aids.

OBJECTIVE: To evaluate patients' opinions of the bone-anchored hearing aid (BAHA) compared with a conventional hearing aid. DESIGN: Prospective study with two questionnaires. Questionnaire A consisted of questions that compared patients' previous hearing aid with the BAHA. Questionnaire B consisted of questions about the patients' experiences with the hearing aids. PATIENTS: Sixty-five consecutive patients who had used conventional hearing aids. SETTING: Tertiary referral center. INTERVENTION: A percutaneous titanium implant in the temporal bone for the BAHA. MAIN OUTCOME MEASURE: Qualitative descriptive results of questionnaire A and difference scores from questionnaire B comparing conventional hearing aids and the BAHA. RESULTS: Patients favored the BAHA to the conventional bone-conduction hearing aid. Patients with BAHA reported a significant improvement in speech recognition in quiet and in noise, in sound quality, and in comfort (P < .01). The results with the BAHA compared with the air-conduction hearing aid were ambiguous for speech recognition, but all the patients reported a decrease in ear infections. CONCLUSION: The BAHA is a good alternative for the conventional bone-conduction hearing aid if a patient can no longer use an air-conduction hearing aid.

Audiometry, Speech↗
PubMed1995

Bone-anchored hearing aids in patients with sensorineural hearing loss and persistent otitis externa.

Recently, a new bone-conduction hearing aid has become available which can be connected percutaneously to the skull: the bone-anchored hearing aid or BAHA. Several clinical trials have shown its efficacy in patients with a conductive or mixed hearing loss. A second group of potential candidates are patients who suffer from an almost instantaneous skin reaction to any kind of earmould. Three such patients with a predominant sensorineural hearing loss were fitted with a BAHA. The aided free-field thresholds proved to be poor compared with the desired values using prescriptive rules. Speech recognition measured objectively (with tests) and subjectively (with a questionnaire) was comparable or better than with conventional bone-conduction hearing aids. Two patients were using their BAHA all day, whereas the third patient was only using it for a few hours per day. Although it did not produce optimal results, the BAHA seems to be the best solution for these patients.

Adolescent↗
PubMed1995

The bone-anchored hearing aid compared with conventional hearing aids. Audiologic results and the patients' opinions.

The bone-anchored hearing aid (BAHA) was evaluated in 65 patients by comparing speech recognition and questionnaire results with those obtained with the patients' own previous hearing aids. In the majority of patients who previously used a conventional bone conductor, significantly improved speech recognition scores were found with the BAHA. The majority preferred the BAHA to their previous bone conductors. For the patients who previously used air conduction hearing aids but had to stop because of chronic draining ears, the results were ambiguous. Nevertheless, the BAHA seems to be the best solution for this subgroup as well. It is concluded that the BAHA is a valuable addition to the audiologists' tools.

Adult↗
PubMed1995

Air-bone gap in patients with X-linked stapes gusher syndrome.

It is often possible to elicit the stapedius reflex in patients suffering from recessive X-linked progressive mixed deafness syndrome with stapes gusher. The presence of an air-bone gap in the audiogram and the ability to elicit the stapedius reflex are conflicting. Measurements were performed on two patients who were suffering from this syndrome, to establish whether the hearing loss was of the mixed or purely sensorineural type. It was argued that, owing to congenital malformations, the audiovestibular system might act as a more than normally efficient transducer, to convert skull vibrations into inner ear fluid motions, leading to bone conduction thresholds that are better than expected. The results of tone and speech audiometry, stapedius reflex measurements, and brainstem evoked response audiometry in this study showed a pattern similar to that generally seen in patients with purely sensorineural hearing loss. This supports the hypothesis that the air-bone gap in the audiogram does not have the usual significance of a conductive hearing loss component.

Adult↗
PubMed1994

Clinical results of percutaneous implants in the temporal bone.

The bone-anchored hearing aid is an alternative to the conventional bone-conduction hearing aid, without the disadvantages of pressure pain or skin irritation and with direct sound transmission to the skull. The bone-anchored hearing aid is coupled to a percutaneous titanium implant, which is placed in the mastoid process in two surgical stages. We analyzed the clinical results of 68 percutaneous implants in 65 patients. After a follow-up period of 8 to 45 months, 97% of the implants were anchored in the bone. In 86% of the implants, no potentially dangerous skin reactions occurred. The occurrence of skin reactions was not time dependent. Movement of the skin, thick skin, and poor skin condition around the implant were related to the onset of skin reactions. This study showed that the percutaneous titanium implant forms a stable link between the bone-anchored hearing aid and the skull.

Adolescent↗
PubMed1994

Aided free-field thresholds in children with conductive hearing loss fitted with air- or bone-conduction hearing aids.

Although conductive hearing loss is often found in children, few reports have appeared on the fitting of hearing aids in these children. In the present study, aided thresholds were determined in 40 children and 30 adults with pure conductive hearing loss (bone-conduction thresholds of 20 dB HL or less) who were successfully fitted with hearing aids. The patient group was split into subgroups according to the type of hearing aid used (bone-conduction hearing aid, binaural or monaural air-conduction hearing aids). Within each subgroup, the aided thresholds proved to be comparable between the adults and children and were nonconsistently related to the degree of (air-conduction) hearing loss. In the patients with a bone-conduction hearing aid, the aided free-field thresholds at the most important frequencies for speech perception (1, 2 and 4 kHz) were found to be between 20 and 30 dB HL, while in the patients with an air-conduction hearing aid, irrespective of whether it was applied monaurally or binaurally, these thresholds were between 15 and 20 dB HL. It is suggested that these values should be considered as target thresholds when fitting hearing aids in children with conductive hearing loss.

Adolescent↗
PubMed1994

A one-stage surgical procedure for placement of percutaneous implants for the bone-anchored hearing aid.

The bone-anchored hearing aid (BAHA) is an alternative to the conventional bone conduction hearing aid. The transducer is coupled to a percutaneous titanium implant which is traditionally inserted into the temporal bone in two stages. This study focusses on a one-stage surgical technique for the implantation of percutaneous implants. The preliminary clinical results of 33 one-stage implants in 33 patients are presented. Post-operative necrosis of the skin grafts did not occur. After a follow-up which varied from nine to 25 months, 31 out of the 33 fixtures (94 per cent) were anchored firmly in the skull. Twenty-six out of the 33 implants (79 per cent) remained free from potentially dangerous skin reactions. The results were statistically comparable to those obtained with two-stage implants at the same clinic. Although longer follow-up is needed before a general statement can be made about replacing the two-stage technique, the preliminary one-stage results are promising.

Adolescent↗