G O Te | PubMed Health

PubMed1998

Pediatric tympanoplasty of iatrogenic perforations from ventilation tube therapy.

OBJECTIVES: This study aimed to determine surgical outcome of tympanoplasty in children with iatrogenic perforations, to determine whether age is a factor in successful tympanoplasty, and to determine whether surgical outcome is affected by preoperative factors (e.g., perforation size and location, otorrhea, cholesteatoma, and tympanosclerosis) or surgical technique (e.g., underlay or overlay). STUDY DESIGN: The study design was a retrospective series review. SETTING: The study was conducted at a multiphysician private otologic practice. PATIENTS: Ninety-three pediatric patients with iatrogenic perforations caused by the insertion of ventilation tubes for otitis media with effusion (OME) participated. Surgical selection criteria included a year's observation of the perforation with a 6-month OME-free interval in the involved and contralateral ear. The 46 males and 47 females had a mean age at surgery of 10.8 years (standard deviation = 2.9) ranging from 3-16 years. INTERVENTIONS: All patients underwent underlay or overlay tympanoplasty using temporalis fascia grafts. MAIN OUTCOME MEASURES: Outcome was evaluated in terms of drum healing (healed or perforated), hearing (air-bone gap), and complications. RESULTS: There was a graft take-rate of 94.6% with reperforations occurring in 5.4% with an average follow-up of 16.8 months. Duration of follow-up ranged from 10.8-77.5 months. The air-bone gap was completely closed in 53.8% and was closed to within 10 dB in 80.7% and 20 dB in 94.7%. The incidence of major and minor complications was 16.1%. Surgical outcome was not influenced by age, technique, or any of the preoperative factors. CONCLUSIONS: Tympanoplasty of persistent perforations after ventilation tube therapy for recurrent OME can be performed successfully regardless of age, surgical technique, or other preoperative factors.

Adolescent↗

PubMed1996

Early speech changes in children with multichannel cochlear implants.

A number of studies have demonstrated that cochlear implants provide an improved auditory signal and enhance the development of speech-perception and production skills for profoundly deaf children. However, exactly when these early speech skills begin to develop remains unclear. To explore this issue, we observed, for a 1-year period, four prelingually deaf children who underwent implantation consecutively within 1 month of each other, and we paid particular attention to the first few months of rehabilitation. We found immediate speech scores as early as the first day of implant tune-up. Speech production continued to improve rapidly throughout the first 4 months but exhibited a generally slower rate of progress in some of the speech-production skills at 1 year. We also found vowel-production skills to be the easiest to achieve, with word-pattern recognition and consonant voicing of intermediate difficulty. Consonant placing and manner of consonant production were the hardest skills to achieve. Results of speech-perception tests 1 year after implantation were markedly improved over preimplantation levels in three of the four children. These early speech changes stress the need for maximization of the capability of the cochlear implant by institution of immediate and intensive speech rehabilitation efforts for prelingually deaf children.

Child↗