Acta oto-laryngologica
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Acta oto-laryngologica · Sep 2005
Superficial temporal artery graft for bypass of the maxillary to proximal middle cerebral artery using a transantral approach: an anatomical and technical study.
Using a transantral approach, we examined a new bypass of the maxillary artery (MA) to proximal middle cerebral artery (MCA). The caliber of the MA was suitable to provide sufficient blood flow. The length of the graft was shorter and it had a straighter course in the new technique than in previously described techniques. ⋯ The mean caliber of the MA was 2.4+/-0.3 mm before the origin of the descending palatine artery branch. The mean caliber of the largest trunk of the M2 segment of the MCA was 2.3+/-0.3 mm. The average length of the graft was 24+/-3 mm.
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Antibiotic treatment does not absolutely prevent the development of otogenic intracranial complications (ICC); however, their incidence is relatively low (0.36%). Various pathogens can be isolated in cultures of patients with these complications, but combinations of third- or fourth-generation cephalosporins with chloramphenicol, vancomycin, metronidazole or aminoglycosides can provide good results. Underlying cholesteatoma is common and is usually associated with intracranial abscess or sinus thrombosis. High morbidity rates warrant long-term follow-up. ⋯ Meningitis was the commonest complication (46.4%), followed by brain abscess, epidural abscess, sigmoid sinus thrombosis, subdural empyema, perisinus abscess and transverse and cavernous sinus thrombosis. Twelve patients (42.9%) had received antibiotic treatment prior to admission. Chronic otitis media, cholesteatoma and brain abscess were diagnosed mainly in adults, while acute otitis media and epidural abscess were more frequent in children. Twenty-one patients underwent mastoidectomy to eradicate the source of infection. The commonest finding at surgery was granulations (81%). Cholesteatoma was seen in 38.1% of cases. Cholesteatoma and brain abscess were usually associated with Gram-negative bacterial infection. Meningitis, however, was caused by Streptococcus pneumoniae in 40% of cases. CT showed a sensitivity of 92.75% for diagnosing otogenic ICC. There was no mortality. The morbidity rate was high (71.4%) and included hearing impairment, hemiparesis, hydrocephalus, mental retardation, polyneuropathy and epilepsy.
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Acta oto-laryngologica · Jul 2005
Comparisons between neural response imaging thresholds, electrically evoked auditory reflex thresholds and most comfortable loudness levels in CII bionic ear users with HiResolution sound processing strategies.
The data collected in this study indicated that first Neural Response Imaging (NRI) thresholds had a better correlation with HiResolution most comfortable loudness (M) levels than tNRI thresholds. Electrically evoked auditory reflex thresholds (EARTs) had a higher correlation with HiResolution M levels than tNRI thresholds and a lower correlation than first NRI thresholds. NRI is a very useful method for programming the cochlear implants of young children who cannot demonstrate a reliable judgment of loudness. ⋯ For 8 patients (53 stimulating electrodes) the correlation between tNRI threshold and M level was r=0.675 (p=0.000) and that between first NRI thresholds and M level was r=0.741 (p=0.000). On average the M-level value was 20 CU (Current Unit) lower than the first NRI threshold value and 12 CU higher than the tNRI threshold value. The M-level patterns across the electrode array overall were similar to the tNRI or first NRI threshold patterns. For 7 patients (112 stimulating electrodes) the correlation between EART and M levels was r=0.710 (p=0.000). On average the EART value was 14 CU higher than the M-level value.
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Acta oto-laryngologica · Mar 2005
Surgical considerations in cochlear implantation in children and adults: a review of 342 cases in Vienna.
Our data represent the experience of the largest cochlear implant program in Austria. In conclusion, cochlear implantation is a safe procedure, associated with a low rate of intra- and postoperative complications. Nevertheless, patients should be informed about possible problems and especially about the risk of a reoperation due to device failure. ⋯ The etiology of deafness was predominantly congenital or progressive (66.89%). The routine mastoidectomy approach was chosen in 300 patients (87.72%) and the suprameatal approach in 42 (12.28%). Intraoperatively, 4 children (2.53%) had a cerebrospinal fluid fistula and 35 patients (10.23%) showed cochlear ossification. Three adults (1.63%) and two children (1.27%) had facial nerves with an aberrant course. The overall complication rate was 12.2%, the rate of major complications was 4.97% and the rate of minor complications was 4.09%. There were no cases of either postoperative meningitis or facial nerve palsy. Both flap necrosis and electrode dislocation occurred in one adult patient (0.54%), but in none of the children. Formation of cholesteatoma was found in one adult (0.54%) and one child (0.63%). The rate of device failure was 7.07% for adults and 13.92% for children.
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Acta oto-laryngologica · Nov 2004
Patient contact with healthcare professionals after elective tonsillectomy.
To assess the amount and causes of patient contact with healthcare professionals after elective tonsillectomy. ⋯ Although the patients repeatedly received both written and oral information, nearly half of them still contacted healthcare professionals during the recovery period. Frequent post-tonsillectomy contact should be taken into account when the financial and personnel resources of day surgery units are evaluated. In order to reduce the amount of post-tonsillectomy contact with healthcare professionals, careful attention must be paid to the quality of patient counseling prior to discharge.