Biomedical subjects
Publications and source records attributed to R Laszig.
Cochlear implantation is nowadays a well-accepted method of auditory rehabilitation in selected adults and children. We present rehabilitation data on 21 adult patients provided with the Nucleus CI22M.
Since 1992 11 subjects with bilateral neural deafness due to cerebellopontine angle tumors have been provided with a multichannel auditory brainstem implant. The long term follow-up varies between 12 and 48 months. 10 subjects experienced auditory sensations with various pitch during stimulation of several surface electrodes, 7 of them are still full time users. 1 patient died 18 months after implantation after having been using his device continuously and 1 died due to pneumonic emboly without having been stimulated. 2 subjects revealed uncomfortable side-effects such as motoric or somatosensoric stimulations several months after initial stimulation. 1 of them is not using the device any more. The presented long term results suggest, that deaf neurofibromatosis-patients can regain acoustic contact to the environment, enlarge their communication skills and improve their quality of life by using a multichannel auditory brainstem prosthesis.
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OBJECTIVE: To conduct a pilot study in adults with the Nucleus CI24M/SP5 cochlear implant system. PATIENTS AND METHODS: Eight postlingually deafened adults who had received little or no benefit from conventional hearing aids, equipped with the Nucleus CI24M/SP5 cochlear implant system. RESULTS AND CONCLUSIONS: The results indicate that most of the subjects were able to perform well in speech recognition tests. The test performances appeared to be strongly affected by the duration of deafness. The speech processor's four user-selectable program memories have been extremely useful for the subjects to evaluate variations to the speech coding strategies in ordinary surroundings outside of the laboratory. The telemetry functions of the new implant provide a set of useful clinical and research tools for gathering greater insights into the in-situ operation of the implant.
The large vestibular aqueduct syndrome (LVAS) is commonly found when presurgical computed tomography is performed in advance of cochlear implantation. We present data on two patients with LVAS, in whom computed tomography (CT) and magnetic resonance imaging (MRI) was performed. Cochlear implantation when these malformations are present may be complicated by an intraoperative gusher, but it appears to be safe and produces a favorable outcome.
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A case of bilateral endolymphatic sac tumours is reported. In a patient with von Hippel-Lindau syndrome, tumour growth in the right cerebellopontine angle caused deafness. The tumour was removed and classified as a metastasis from a thyroid carcinoma. However, on thyroidectomy no primary neoplasm could be found. Eight years later a similar tumour was operated on in the left petrosal bone. Histological appearance, immunocytochemical findings, and the clinical context gave evidence that the tumours had to be reclassified as endolymphatic sac tumours--extremely rare entities. The report supports the hypothesis, suggested by the few earlier case reports, that endolymphatic sac tumours could be one of the inherent tumour manifestations in von Hippel-Lindau syndrome.
Our Cochlear Implant Program started in Hannover in 1984 and continued from 1993 on in Freiburg. Up to date, more than 550 patients have received a multichannel cochlear implant and 12 patients an auditory brainstem implant. During these 10 years of experience, many things changed, not only regarding surgery but also regarding indications, speech processing strategies and rehabilitation. The aim of this paper is to present the current state of cochlear implantation and to review important steps of development which have always been linked with efforts to eliminate possible pitfalls. As technology is developing rapidly, this review can only be provisional.
Portable videonsystagmography is equipment to detect nystagmus or other eye movements independent from time, place and medical specialists. It has been demonstrated that patients suffering from Ménière's disease have been diagnosed earlier using portable videonystagmography.
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Central electrical stimulation of the auditory pathway can allow hearing in patients suffering from deafness localized in the auditory nerve. Developments in a multi-channel auditory brainstem implant based on the Nucleus Mini 22 Cochlear implant with transcutaneous signal transmission is discussed. The devices have been implanted in nine European patients suffering from Neurofibromatosis Type 2. Preliminary speech perception results and patient satisfaction are encouraging, and the data presented include some limited open speech recognition.
In this investigation the following anatomical measurements of the petrous bone preceding cochlear implant were evaluated using computed tomography (CT): the width of the basal coil of the cochlea, the thickness of the promontory, the distance between the sigmoid sinus and the posterior wall of the external auditory canal and the thickness of the squamous part of the temporal bone in the area of operation. Initially it was necessary to ascertain how accurately CT represents the anatomical structures of the petrous bone. The procedure of CT investigation in adult patients was simulated using the base of a skull. The CT plane in which the above mentioned measurements preceding cochlear implant can be made was represented and measurements were taken. Subsequently the same plane in CT was represented macroscopically with a specially developed method. The results show that anatomical structures measured in CT are magnified by 5% in contrast to the original. This magnification is presumably attributable to the computing of connective tissue which is adjacent to bone and the incapacity of CT to image structures of different density in the same voxel. In the second part of this investigation we evaluated 66 preoperative CT's of patients who were given a cochlear implant. The results must be adjusted by 5% to allow for this error in magnification. In conclusion a preoperative radiologic evaluation of the anatomical structures relevant to cochlear implant is without doubt tenable. Also the negligible difference between CT and the anatomical original requires no operative consequences. Because cochleostomy is carried out with a diamond burr of 1 mm diameter, a tenth of a millimeter is negligible according to our experience.
The extended incision in cochlear implantation has to be performed for several reasons; therefore the wound closure needs single or continuous suture for the skin. The suture removal seems to be traumatic for children. That is why we have using an intracutaneous absorbable suture to avoid material removal for more than 6 months now without any complications in the 35 patients in question.
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Central electrical stimulation of the auditory pathway can allow hearing in patients suffering from deafness localized in the auditory nerve. Developments in a multichannel auditory brain stem implant based on the Nucleus Mini 22 cochlear implant with transcutaneous signal transmission is discussed. The device has been implanted in seven European patients who suffered from neurofibromatosis type 2. Preliminary speech perception results and patient satisfaction are encouraging, and the data presented include some limited open-set speech recognition.