The edition · ENT & Head and Neck Surgery
After a median 17 years of unilateral deafness, most patients still gained from an implant
Sixty-eight adults implanted after more than a decade of single-sided deafness gained a mean 28.4 percentage points of word recognition, and duration of deafness did not predict the result. Plus a phenotype-led algorithm for suprastomal collapse, hearing and brain amyloid, and the surveillance nobody arranges after nasopharyngeal radiation.
The edition in brief
A five-centre retrospective cohort implanted 68 adults with more than ten years of unilateral severe to profound hearing loss (median 17 years, IQR 12-35). Word recognition improved by a mean 28.4 percentage points (SD 31.6, P < 0.001); 54.5% gained at least 20 points and 32.7% at least 50. Mean daily device use was 8.4 hours in the first year and 7.1 hours after. Duration of deafness did not predict post-implant word recognition on multivariable analysis. Twenty-five children undergoing 28 procedures for suprastomal collapse after tracheostomy were classified by dynamic bronchoscopy as anterior, posterior, lateral or combined, with the operation chosen by phenotype. All 18 with anterior or combined collapse were decannulated; posterior collapse achieved 75% and lateral 100%, with 92% overall. In 223 late middle-aged adults, worse word recognition was associated with higher amyloid standardised uptake on positron emission tomography across temporal, parietal, cingulate and right frontal regions and globally (β 0.064 per 10% worsening, P = 0.005). Pure-tone average reached significance only in the left temporal region. A randomised trial of patient-specific 3D-printed temporal bones in 40 cochlear implant operations found lower cognitive load for attending surgeons (3.8 vs 5.5) and higher load for residents (7.2 vs 4.8). A systematic review of 12 studies and 69 ears found cochlear implantation after nasopharyngeal carcinoma radiation gave audiometric improvement in 91.3%, with a mean 6.5 years of profound hearing loss before implantation.
Long-standing single-sided deafness is not an exclusion for implantation
Assess cochlear implant candidacy individually in long-standing single-sided deafness — duration did not predict word recognition outcome in this cohort.
Suprastomal collapse is four problems, and the operation should follow which one
Assess suprastomal collapse dynamically with the tracheostomy tube out and classify its direction before choosing the operation — the assessment, not the technique, is the transferable part.
Worse word recognition tracked with more amyloid, and pure-tone average barely did
Poor word recognition out of proportion to the pure-tone average is worth noting in its own right, but nothing here justifies imaging or a preventive claim.
A 3D-printed temporal bone helped the consultant and burdened the resident
Match planning adjuncts to experience level — 3D-printed temporal bones lowered cognitive load for consultants and raised it for residents.
Unilateral middle ear effusion in an adult means examining the nasopharynx
Look at the nasopharynx endoscopically before treating any unilateral middle ear effusion in an adult, and never place a grommet without having done so.
Arrange audiological follow-up after nasopharyngeal radiation, because the implant works late
Schedule audiological surveillance after nasopharyngeal radiation and refer for implant assessment — patients in this review had been profoundly deaf for a mean 6.5 years before implantation.
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