Biomedical subjects

T P Nikolopoulos

Publications and source records attributed to T P Nikolopoulos.

At least 19 recordsLinked to original sources

PubMed2006

Laryngeal pemphigus without skin manifestations and review of the literature.

Pemphigus is an uncommon chronic disease with dermatologic and mucosal manifestations. Primary laryngeal involvement without skin lesions is extremely rare. The present paper describes a 72-year old man who presented with a 2-month history of hoarseness, haemoptisis and dysphagia. Clinical examination revealed an erythematous oral mucosa without ulcerations. Indirect laryngoscopy revealed supraglottic ulcerations mainly in the laryngeal surface of the epiglottis and in the right arytenoid. The lesions had characteristic gray color membranes. The patient underwent microlaryngoscopy under general anesthesia and biopsies were taken for histology that revealed inflammatory and granular lesions with necrosis. The diagnosis of pemphigus was based on immunohistopathology and the clinical examination. The patient underwent intravenous treatment with high doses of corticosteroids (prezolon 75 mg/24 h) for 10 days and gradually the dose was reduced to 10 mg/24 h. The patient had a very good response to the treatment and after a week approximately 80% of the lesions disappeared. However, the dose of 10 mg prednisolone per day was sustained for 3 months because any attempt of prednisolone discontinuation was related with reappearance of the clinical symptoms. After 3 months, finally the treatment was discontinued without problems. Now, 15 months later, the patient is well and without symptoms. He is under long-term follow-up. ENT surgeons should be aware of pemphigus as primary laryngeal manifestation in order to investigate and manage patients accordingly.

Aged↗

PubMed2006

Should we use ossicular remnants in ossicular reconstruction following cholesteatoma removal?

The remnants of the acoustic ossicles have been used in ossicular reconstruction during mastoid surgery for many decades. The present study assessed the status of the acoustic ossicles in 114 patients (57 with cholesteatoma and 57 without) during surgery for chronic otitis media using the operating microscope. In 52 cases, the ossicles (malleus and/or incus) were assessed using both the surgical and scanning electron microscope in order to reveal any erosions and compare the findings. From the 57 operated ears with cholesteatoma, 45 (79%) had ossicular erosion whereas 12 (21%) did not. In the group of 57 operated ears with chronic otitis media without cholesteatoma, 33 (58%) had ossicular erosion whereas 24 (42%) did not. This difference was statistically significant (p = 0.02). With regard to the 52 operated cases who were studied with both microscopes, in the cholesteatoma patients the surgical microscope was not able to reveal any ossicular erosions in 39% of the cases, whereas the scanning electron microscope revealed moderate or severe erosions in the same ears. This suggests that the operating microscope is not reliable enough to determine if ossicular remnants can be used in ossicular reconstruction following cholesteatoma surgery. There is a considerable risk that epithelia or other cholesteatoma particles remain in the areas of erosions that cannot be seen with the operating microscope. The use of such ossicular remnants may lead to cholesteatoma recurrence and failures in mastoid surgery. Therefore, autoclaving or alternative prosthesis may be considered in such cases.

Adult↗

PubMed2006

Evidence-based overview of ophthalmic disorders in deaf children: a literature update.

BACKGROUND: Deaf children are heavily reliant on the sense of vision in order to develop efficient communication skills and explore the world around them. Any ophthalmic disorder may thus negatively impact on this process, especially if it is unrecognised in the early years of life. These disorders may be correctable (such as myopia) or treatable (such as cataract), and their early identification is of the utmost importance to optimise language development (spoken or sign, or both) and develop social cognition. Those children with non-correctable and non-treatable visual disorders, like retinitis pigmentosa in Usher syndrome, require multiple environmental adaptations and appropriate support services and information. AIM: : To review the accumulated scientific knowledge on ophthalmic disorders in deaf children and assess the quality of evidence published in the literature in order to contribute to better diagnosis and management of these conditions. MATERIAL AND METHODS: The project reviewed more than 1000 published papers and other sources. 191 papers complied with the aims of the study and were used in the project. From these studies, 95% were based on type III or IV evidence (mainly descriptive studies or case reports). Only 3% were based on type II evidence and 2% on type I evidence. RESULTS-CONCLUSIONS: The main conclusions of this project are: a) the overall quality of evidence in the literature concerning deaf children and their ophthalmic problems is very low, b) the prevalence of ophthalmic problems in deaf children is very high (approximately 40% to 60%) and these problems may remain undetected for years although they may have a serious impact on children's acquisition of communication skills, c) screening for ophthalmic problems in deaf children should be encouraged and specialist ophthalmic examination should be carried out as soon as the diagnosis of deafness is confirmed irrespective of age, and may need to be repeated at intervals following diagnosis, d) families should be informed about the nature of the screening process in discussion with the relevant professionals and appropriate information should be available in a range of formats and in different community languages, e) professionals administering the tests should be familiar with the needs of deaf children with ophthalmic problems and should be sensitive to the communication needs of the child, especially undertaking behavioural testing where their collaboration is needed, f) while orthoptists can perform the majority of psychophysical tests (visual and stereo acuity tests, ocular motility tests, etc.) a comprehensive opthalmologic assessment by slit lamp biomicroscopy, streak retinoscopy, direct and indirect ophthalmoscopy, intraocular pressure measurement etc is required. Electrophysiologic testing to help identification of Usher syndrome may also be required, and finally g) serial hearing assessments of children with dual sensory deficits are needed to monitor hearing thresholds, to optimise hearing aid use and to ensure timely referral for cochlear implantation for those who need it.

Child↗

PubMed2006

Topical antibiotic ear drops: are they safe?

A discharging ear is a very common condition for the general practitioner and the ENT surgeon. Oral and intravenous antibiotics have potential complications, are costly, and exhibit increasing resistance. This study explores the advantages and disadvantages of all common otic preparations and compares effectiveness, safety, cost and complication rates. In chronic otitis media (chronic discharging ears), topical antibiotics seem to be the treatment of choice by comparison with oral or intravenous antibiotics. Cultures and antibiograms do not correspond directly to clinical efficacy, as laboratory determination of resistance does not take into account the high concentration of antibiotics in local preparations. It is safer to use quinolone drops as a first-line treatment, but it is still possible to use short courses of other drops if quinolones are either unavailable or contraindicated (e.g. allergy), or when bacteria are resistant to them. However, in such a situation, a round window membrane involved in an established inflammatory process and therefore less permeable to the passage of topical preparations is the preferred setting, as ototoxicity is a potential complication, especially in the case of gentamicin, in which case patients should be warned accordingly.

Administration, Topical↗

PubMed2005

Cochlear implants: 100 pediatric case conversions from the body worn to the nucleus esprit 22 ear level speech processor.

OBJECTIVE: To assess performance of Nucleus 22 mini system pediatric users converted from the Spectra 22 body-worn to the ESPrit 22 ear-level speech processor using aided thresholds and speech discrimination measures before and after the conversion. STUDY DESIGN: Spectra 22 body-worn speech processor users were chosen using preselection criteria (stable map, ability to report on the quality of the signal, no device problems). The subjects underwent tuning, map conversion, fitting of the ESPrit 22, and aided soundfield threshold and speech discrimination testing. SUBJECTS: The first 100 consecutive conversions are analyzed in this study. Fifty children (50%) were female, and 50 (50%) were male. The average age at implantation was 4.6 years (median 4.3 years, range 1.7 to 11 years). The average age of fitting the ear level speech processor was 11.1 years (median 11 years, range 6.2 to 18.2 years). SETTING: Tertiary referral pediatric cochlear implant center in the United Kingdom. RESULTS: Of the 100 fittings attempted, all Spectra 22 maps could to be converted for use in the ESPrit 22. Of these 100 fittings, 44 were straightforward with no adjustment to map parameters being required, and 56 needed rate reductions and other map adjustments to achieve the conversion. The difference of the mean thresholds before and after the conversion did not exceed 2 dB across the frequencies studied (0.5-4 kHz). In 95% of the cases, the differences were less than 9 dB(A). With regard to speech discrimination testing, the mean threshold before the conversion was 53.4 dB and after the conversion 52.7 dB. Of the 100 conversions, only five children stopped using the ESPrit 22 despite fitting being achieved. CONCLUSION: Conversion from the Spectra 22 body worn to the ESPrit 22 ear level speech processor was found to be feasible in all the 100 cases studied. Only a minority (5%) of children chose not to use the ear level speech processor suggesting that children and parents were satisfied from the conversion.

Child↗

PubMed2005

Newborn hearing screening: effectiveness, importance of high-risk factors, and characteristics of infants in the neonatal intensive care unit and well-baby nursery.

BACKGROUND: In contrast to the recommendations of the Joint Committee on Infant Hearing, neonatal hearing screening programs are still not universally available, and many countries implement elective screening in high-risk newborns. OBJECTIVE: To assess the failure rates of neonates in hearing screening and the relative importance of risk factors for hearing impairment, both in neonatal intensive care units and in well-baby nursery neonates. The impact on cost-effectiveness is also evaluated. SUBJECTS: In the current study, 25,288 newborns were assessed; 23,574 were full-term newborns in the well-baby nursery and 1,714 neonates were in neonatal intensive care units. METHODS: All neonates had a general examination (including assessment for congenital anomalies and related history) and were assessed using transient evoked otoacoustic emissions. All newborns were older than 36 weeks at examination and thus had reliable transient evoked otoacoustic emissions. RESULTS: From the 23,574 full-term neonates in the well-baby nursery, 23,123 (98.1%) passed the test and 451 failed (1.9%). Fifty-three of the 23,574 neonates (0.2%) had a risk factor for hearing impairment; 44 (83%) passed the test and 9 failed (17%). Family history of congenital hearing loss and congenital anomalies were the most frequent risk factors for hearing loss. From the 1,714 neonates in neonatal intensive care units, 1,590 (93%) passed the test and 124 failed (7%). Two hundred thirty-two of the 1,714 neonates (14%) had a risk factor for hearing impairment; 205 (88%) passed the test and 27 failed (12%). In neonatal intensive care unit neonates, toxic levels of ototoxic drugs, mechanical ventilation for more than 24 hours, prematurity, and low birth weight were the most frequent risk factors for hearing loss. Congenital anomalies/syndromes were the most important risk factors for failing screening in both the neonatal intensive care unit and the well-baby nursery, as they showed the highest risk of failing hearing screening. The second most important factor in neonatal intensive care unit newborns was low birth weight, and the third was prematurity in relation to the possibility of failing hearing screening. CONCLUSION: The present study found 575 neonates failing hearing screening of 25,288 tested newborns (2.3%). The fact that 78% of newborns who failed hearing screening were in the well-baby nurseries further supports the necessity of universal hearing screening instead of selective screening in neonatal intensive care units, even with the obvious impact on cost-effectiveness. Even if limited funding lead to selective screening in neonatal intensive care units, this should not be applied to high-risk newborns but to all neonatal intensive care unit neonates. Continuous assessment of risk factors and the related possibility of failing hearing screening are of paramount importance in designing hearing screening programs and refining the respective criteria.

Cost-Benefit Analysis↗

PubMed2002

Variations in gains in auditory performance from pediatric cochlear implantation.

OBJECTIVE: To investigate variations in gains in auditory performance in children with cochlear implants. STUDY DESIGN: The auditory performance of 98 children was measured with the Category of Auditory Performance survey instrument. All data were collected prospectively. Variables used to explain gain in Category of Auditory Performance were age at implantation, sex, the duration of "untreated" deafness, the year in which implantation occurred, health care inputs, and cause of hearing impairment. The data were analyzed by ordered probabilistic regression analysis. RESULTS: Gain in Category of Auditory Performance was observed to be negatively related to age at implantation, the year in which implantation took place, and the number of medical consultations the child received. None of the other variables were significant determinants of gain in Category of Auditory Performance. CONCLUSION: This study demonstrates the value of examining incremental gain from implantation rather than simply examining outcome levels. It was found that pediatric implantation is subject to diminishing returns. This suggests that further relaxation of entry criteria to implant programs should be undertaken only after careful consideration. The study also confirmed that age at implantation is an important determinant of outcomes. Greater gain in Category of Auditory Performance was experienced by those who underwent implantation at a younger age. This finding has implications for screening, as well as for purchasers and providers of implant services, highlighting the importance of responding in a timely fashion to identified need.

Auditory Threshold↗

PubMed2001

Communication development in young deaf children: review of the video analysis method.

It is widely recognised that preverbal communication skills underpin development of spoken language. This historical review outlines the establishment of a quantitative methodology for assessing preverbal communication skills in children with hearing aids and cochlear implants. The method is shown to be reliable and free from observer bias. The review also summarises findings from a series of cross-sectional and longitudinal observational studies utilising the methodology. Profoundly deaf young children, either with cochlear implants or successful users of hearing aids, show similar patterns of preverbal communication development that contrast with those of unsuccessful hearing-aid users. Preverbal measures obtained 12 months after implantation are predictive of late performance on speech perception tasks. Moreover, there is a significant association between the preverbal measure of 'autonomy' obtained before implantation and later speech perception performance. This latter finding has important theoretical implications for understanding of language development and suggests that intervention that promotes autonomy in adult-child interaction may lead to improved outcomes. Such intervention could be commenced as soon as deafness is discovered.

Child, Preschool↗

PubMed2001

Cochlear implantation in children with large vestibular aqueduct syndrome and a review of the syndrome.

OBJECTIVE: Children with Large Vestibular Aqueduct Syndrome (LVAS) frequently develop speech and language skills prior to deterioration of their hearing. Operations designed to halt the progression of hearing loss have largely failed so the question of Cochlear Implantation in these children has arisen. It had been suggested that there would be technical difficulties in implanting these patients and, therefore, there had been an initial reluctance to proceed to implantation. The aim of the present paper is to assess surgical and functional outcomes in implanted children with LVAS and review the related literature. MATERIAL AND METHODS: From the 170 children assessed by MRI in the Nottingham Paediatric Cochlear Implant Programme, seven (4%) were identified as having LVAS. Four of these children were implanted and had at least 12 months follow up. Two of the children are on the waiting list for implantation and one child was not implanted because of absence of the cochlear nerve. Operative findings, complications and outcome measures were recorded. The auditory skills of the children were assessed before implantation and 1 year following implantation. A literature search was done to identify other series with experience in implanting children with LVAS. RESULTS: Full insertion of the electrode array was achieved in all our cases. After cochleostomy two patients experienced a mild CSF leak that was easily controlled by the muscle graft. On the first day post-operation two patients were nauseous and one had an episode of vomiting, however, all were discharged within 24 h of surgery. Initial outcome measures at 12 months post-implantation were encouraging showing significant progress in children's auditory skills. CONCLUSIONS: The results of the present study and the review of the literature suggest that LVAS is not a contraindication to implantation as initial concerns about severe perilymph leaks and surgical complications have proved to be unfounded. The post-operative progress of these children in listening skills also suggest that these children are suitable for cochlear implantation

Auditory Threshold↗

PubMed2001

Indirect costs, cost-utility variations and the funding of paediatric cochlear implantation.

OBJECTIVE: To demonstrate the existence of variations in cost-utility associated with indirect costs in paediatric cochlear implantation; to illustrate the implications of this for purchasing decisions and; to posit a potential solution to anomalies in purchasing that may otherwise result when services are publicly funded. METHODS: Data was taken from published sources on the cost of implantation, outcomes measured in terms of quality adjusted life years (QALY) and in savings in education costs associated with paediatric cochlear implantation. Cost-utility ratios across education authorities were calculated using a single centre's implantation costs. RESULTS: Variations in savings across education authorities show that the cost per QALY gain associated with paediatric cochlear implantation can vary between approximately $12,000 and $18,000 assuming an exchange rate of $1.45 = 1 pound sterling for the same implant centre. These variations have the potential to produce situations in which less efficient implant centres are preferred by purchasers over more efficient ones or in which candidates with poorer outcomes are selected for funding over candidates with superior outcomes. It is important that savings associated with education be taken into consideration in evaluations intended to inform purchasing decisions regarding implantation. Equally it is important that potentially anomalous decisions be avoided if evaluations are to remain credible. It is argued that this may be achievable if public funding for implantation is determined at a national level and ring-fenced i.e. devoted exclusively to use in cochlear implantation.

Child↗

PubMed2001

Pediatric cochlear implantation: the parents' perspective.

OBJECTIVE: To analyze parental views on cochlear implantation, before and in the years following implantation, to determine whether the results from the intervention met their expectations. DESIGN: Prospective longitudinal study to assess parental perspectives of an unselected group of children with cochlear implantation. SETTING: Tertiary referral pediatric cochlear implant center in the United Kingdom. SUBJECTS: Forty-three parents of children with cochlear implantation. INTERVENTION: A specifically designed questionnaire was administered to assess preimplant expectations and observed changes and concerns at 1, 2, and 3 years following implantation. Three key domains were evaluated: (1) communication with others, (2) listening to speech without lipreading, and (3) the development of speech and language. RESULTS: Preoperative expectations were met or surpassed at each of the follow-up intervals. In the area of communication, 35 (81%) parents expected a definite improvement preoperatively, and 3 years following implantation, 42 (98%) actually saw such an improvement. The respective numbers in the area of listening to speech were 15 (35%) and 38 (88%), and for speech development, 37 (86%) and 37 (86%). Speech development was the major area of concern at all intervals. CONCLUSION: This study demonstrates the ability of cochlear implantation to meet or surpass parental expectations in 3 important outcome domains: communication, listening to speech, and the development of speech and language.

Child↗

PubMed2001

Hearing evaluation with distortion-product otoacoustic emissions in young patients undergoing haemodialysis.

Sensorineural hearing loss is frequently reported in young patients with chronic renal failure having haemodialysis. The effect of a single session of haemodialysis on hearing acuity was assessed prospectively in nine children with end-stage renal disease using pure-tone audiometry (PTA) and distortion-product otoacoustic emissions (DPOAEs). Results were compared with those obtained from nine audiologically normal healthy children also tested with PTA and DPOAEs twice during a 4-h interval. Sensorineural hearing loss of unknown aetiology was found in 55.5% of renal patients, mainly in the higher frequencies. Patients on HD had mean PTA thresholds significantly poorer than those of the control group in the frequency range 1000-12 000Hz (P < 0.05). Their mean DPOAE amplitudes were significantly lower in all frequencies > 1184 Hz (P < 0.05). Furthermore, patients' ears with normal PTA thresholds between 250 and 4000 Hz also had decreased DPOAE amplitudes. No significant changes in PTA thresholds or DPOAE amplitudes were encountered in renal patients before and after a HD session (P > 0.05). Changes in PTA thresholds or DPOAE amplitudes were not significantly different than those in the control group (P > 0.05). In conclusion, sensorineural hearing loss of unknown origin, especially in high frequencies, is frequent in young renal patients under HD and single HD sessions do not seem to alter the hearing acuity of these patients. DPOAEs seem to be more sensitive to incipient cochlear damage than behaviour thresholds in monitoring renal patients.

Adolescent↗

PubMed2001

Use of the telephone in prelingually deaf children with a multichannel cochlear implant.

OBJECTIVE: To assess progress in the use of the telephone in a group of prelingually deaf children after cochlear implantation. SETTING: Tertiary referral pediatric cochlear implant center in the U. K. STUDY DESIGN: A prospective study was undertaken on a consecutive group of 150 congenital and prelingually deaf children up to 5 years after implantation. The study group was confined to prelingually deaf children aged less than 7 years at the time of implantation. No child was lost to follow-up, and there were no exclusions from the study. At the time of the study, 129 children had reached the 1-year stage, and 91, 68, 40, and 23 had reached the 2-, 3-, 4-, and 5-year intervals, respectively. METHODS: A specifically designed profile was used to assess the telephone use of the implanted children. Regression analysis was used to assess the correlation between the results of the telephone profile with the outcomes of the Iowa sentence test and connected discourse tracking. RESULTS: After implantation, prelingually deaf children showed significant progress in telephone use over time, not reaching a plateau at the 5-year interval (median score 27 with maximum score available 34). The results of the telephone profile showed significant correlations with the other tests of speech perception (correlation coefficients from 0.47 to 0.79, all statistically significant p < 0.0001). CONCLUSION: The telephone profile provided a useful method of monitoring children's telephone use. The profile was easily administered, and it was sensitive in assessing the progress of prelingually deaf children with cochlear implants. Outcomes from the profile were highly correlated with results from other widely used closed- and open-set tests.

Child↗

PubMed2001

Reliability of a rating scale for measuring speech intelligibility after pediatric cochlear implantation.

OBJECTIVE: To evaluate the reliability of the Speech Intelligibility Rating scale to monitor the speech intelligibility of deaf children who have received cochlear implants. STUDY DESIGN: A prospective study assessing the speech intelligibility of deaf children with cochlear implants by local and cochlear implant program speech and language therapists. SETTING: Pediatric tertiary referral center for cochlear implantation. PATIENTS AND METHODS: Fifty-four children were each rated by two speech and language therapists, one working with the child locally and the other working with the child at the cochlear implant program. All children were between 1.2 and 10.9 years of age at the time of implantation (median, 4.0 years). The follow-up intervals ranged from before implantation to 9 years after implantation. MAIN OUTCOME MEASURE: Correlation coefficient, intraclass correlation coefficient, and kappa statistics were used to assess the interobserver reliability of the Speech Intelligibility Rating scale. RESULTS: Spearman rank correlation coefficient and intraclass correlation coefficient were 0.82 with high statistical significance (p < 0.00001). Kappa statistical analysis revealed a moderate to substantial agreement between the ratings. This agreement also reached a high statistical significance (overall kappa = 0.53, p < 0.000001). The Speech Intelligibility Rating scale was found to be able to discriminate speech intelligibility among subjects, and the ratings covaried with high consistency. CONCLUSION: The study found a high rate of agreement between observers when they used the Speech Intelligibility Rating scale to assess the speech intelligibility of deaf children after cochlear implantation. Because the scale presents information in a format that is understood by parents, local professionals, and health care purchasers, it will be useful to provide them with accessible information on speech intelligibility outcomes of deaf children who have received cochlear implants.

Child↗

PubMed2000

Determinants of speech perception in children after cochlear implantation.

BACKGROUND: Cochlear implants provide access to the speech signal in those profoundly deaf children who derive no material benefit from acoustic hearing aids. Speech perception after implantation can vary widely--we have analysed the contribution of several factors. METHODS: We examined 40 children with mean age at implantation of 52 months who were either born deaf or became deaf before 3 years. All patients received the same multichannel implant system and were followed up for 5 years. We used connected discourse tracking (CDT) as the measure of speech perception. The effect of five potential predictors (age at implantation, number of inserted electrodes, origin of deafness, mode of communication, and socioeconomic group) on speech perception was analysed. FINDINGS: The mean number of words per minute perceived increased from 0 before implantation to 44.8 (SD 24.3) 5 years after implantation. Repeated-measures ANOVA showed that children significantly progressed over time (p=0.001). Age at implantation was a significant covariate (p=0.01) and mode of communication was a significant between-individuals factor (p=0.04). INTERPRETATION: Young age at intervention and oral communication mode are the most important known determinants of later speech perception in young children after cochlear implantation. Early identification of candidate children necessitates implementation of universal neonatal screening programmes for hearing impairment.

Child, Preschool↗

PubMed2000

Impairments, disabilities, and handicaps after acoustic neuroma surgery.

The measurement of a patient's health-related quality of life following acoustic neuroma surgery is important because the surgery itself can impose significant symptoms postoperatively. This study describes the most common problems experienced by the patients, using an open-ended questionnaire mailed to a series of 70 patients who had undergone acoustic neuroma surgery. Patient responses were classified by impairment, disability and handicap, according to the World Health Organization (WHO) classification. Results showed that this group of patients had a wide variety of symptoms and concerns, and particularly highlighted the relative importance of visual (49% of the patients) and psychosocial problems (34% of the patients) associated with surgery in contrast to tinnitus that seemed to be of minor importance. Open-ended questionnaires are useful in assessing outcomes from a quality of life perspective.

Disability Evaluation↗

PubMed2000

The prognostic value of promontory electric auditory brain stem response in pediatric cochlear implantation.

OBJECTIVE: To test the hypothesis that children with clear promontory electrically evoked auditory brain stem responses (prom-EABRs) would outperform, after cochlear implantation, children who had no prom-EABR preoperatively. DESIGN: A prospective study was undertaken on 47 implanted children assigning them to two groups (group A: 35 children with a clear wave e-V in the preoperative prom-EABR and group B: 12 children with no prom-EABR). Speech perception and speech intelligibility were assessed annually up to 3 yr after implantation with the IOWA sentence test (level A and level B), Connected Discourse Tracking, Categories of Auditory Performance, and Speech Intelligibility Rating. t-test and Mann-Whitney U test were used to compare the above outcome measures in the two groups. RESULTS: There was no statistically significant difference between the two groups on any of the outcome measures at any interval. Moreover, the small differences observed showed no consistent trend toward either group of children. Further analysis revealed that the outcomes have not been affected by possible confounding factors (age at implantation, duration of deafness, preoperative unaided pure-tone thresholds, and number of inserted electrodes). CONCLUSIONS: The results suggest that children with no prom-EABR performed at levels comparable with children who had clear promontory responses preoperatively. The prognostic value of prom-EABR is limited and absence of a prom-EABR is not, by itself, a contraindication for cochlear implantation. However, in selected cases (congenital malformations, cochlear nerve dysplasia or suspected aplasia, narrow internal auditory canal, etc.) the presence of a prom-EABR is a positive finding in the assessment of candidates for cochlear implantation as it confirms the existence of intact auditory neurones.

Audiometry, Pure-Tone↗

PubMed2000

Impact of facial paralysis on patients with acoustic neuroma.

OBJECTIVE: To assess the psychological distress, the ways of coping with that stress, and the self-esteem of patients with facial paralysis after acoustic neuroma surgery. Possible predictors and associations between these measures were also explored. STUDY DESIGN: Four validated questionnaires were completed by patients with facial paralysis after acoustic neuroma surgery: 1) the Derriford Appearance Scale (DAS) to measure psychological distress, 2) the COPE questionnaire to measure how patients cope with facial paralysis, 3) the Personal Report questionnaire to measure the self-esteem of patients, and 4) the Facial Paralysis Questionnaire (FPQ) to measure the severity of facial paralysis. PATIENTS: One hundred three patients with facial paralysis after surgical removal of acoustic tumors. RESULTS: Distress spanned a wide range in these patients. There was no statistically significant association between the level of distress and the grade of facial paralysis or between time since operation and levels of distress. Women had higher levels of distress (P = .02) and a significant negative correlation was found between levels of distress and age (r = -0.28, P = .005). High levels of distress were associated with low levels of self-esteem, as shown by the significant negative correlation between level of distress and self-esteem (r = -0.59, P = .01). A significant correlation between distress and maladaptive coping (r = 0.31, P = .002) was also found. Stepwise multiple regression of the distress scores revealed that self-esteem was the most important contributing factor (standardized coefficient beta -0.60, P = .0001), followed by age (beta -0.24, P = .006) and sex (beta -0.21, P = .04). This model explained 44% of the distress variance. CONCLUSION: Clinicians must be aware of the distress felt by some patients experiencing facial palsy after acoustic neuroma surgery and that the level of distress may not be related to the clinical grade of the facial nerve paralysis. People with low self-esteem, young people, and women suffer from more distress due to the facial palsy. Clinicians should thoroughly counsel patients before and after surgery and should implement measures that increase patients' self-esteem and decrease their distress, especially in these high-risk groups.

Adaptation, Psychological↗