The Value of Electrically Evoked Stapedius Reflex in Determining the Maximum Comfort Level of a Cochlear Implant

2018 ◽  
Vol 29 (04) ◽  
pp. 292-299 ◽  
Author(s):  
Kelly Cristina Lira de Andrade ◽  
Lilian Ferreira Muniz ◽  
Pedro de Lemos Menezes ◽  
Silvio da Silva Caldas Neto ◽  
Aline Tenório Lins Carnaúba ◽  
...  
Keyword(s):  
Cochlear Implant ◽  
Dynamic Range ◽  
Case Series ◽  
Comfort Level ◽  
Small Children ◽  
Case Series Study ◽  
Significant Difference ◽  
Stapedius Reflex ◽  
Reflex Threshold ◽  
Maximum Comfort

AbstractOne of the most important steps for good user performance with a cochlear implant (CI) is activation and programming, aimed at determining the dynamic range. In adults, current levels are determined by psychophysical measures. In babies, small children, or individuals with multiple disorders, this procedure requires techniques that may provide inconsistent responses because of auditory inexperience or the age of the child, making it a very difficult process that demands the collaboration of both the patient and the family.To study the relationship between the electrically evoked stapedius reflex threshold (ESRT) and maximum comfort level for stimulating electrodes (C-level) in postoperative CI users.Cross-sectional analytical observational case series study.We assessed 24 patients of both sexes, aged between 18 and 68 yr, submitted to CI surgery.Otoscopy and immittance. Next, an implant speech processor connected to an Itautec® computer containing the manufacturer’s software (custom sound Ep 3–2) was used, as well as an AT 235h probe inserted into the ear contralateral to the CI to capture the stapedius reflex, obtaining electrically evoked stapedius reflex thresholds.Data from the last programming, defining C-levels for each electrode studied, were extracted from the databank of each patient. The manual decay function of the AT 235h middle ear analyzer was used to observe ESRT response in a same window for a longer response capture time. Electrodes 22, 16, 11, 6, and 1 were tested when active, with the aim of using electrodes over the entire length of the CI, and ESRT was considered present when compliance was ≥0.05 ml. Stimuli, in current units, were always initiated at 20 cu above the C-level. The analysis of variance parametric test, Tukey’s honest significant difference test, the t-test, Wilcoxon nonparametric test, and the Kolmogorov–Smirnov test examined whether significant relationships existed between these other factors.The results demonstrate that all the electrodes selected for the study exhibited higher mean reflex threshold values than their mean C-level counterparts. However, there was no significant difference between them, for electrodes 1, 6, 11, and 16. The data provided allow the use of ESRT to define C-level values and make it possible to stipulate a correction factor ranging between 6 and 25.6 electrical units.The use of electrically evoked stapedius reflex thresholds can help the team in charge of programming CIs, making the process faster and safer, mainly for infants, small children, or individuals with multiple disorders.

scholarly journals Correlation between behaviorally measured comfort (c) levels and electrically evoked stapedius reflex thresholds (ESRT) in children with unilateral cochlear implant

2019 ◽  
Vol 11 (4) ◽  
pp. 201-206
Author(s):  
Roshani Mishra ◽  
Aparna Nandurkar
Keyword(s):  
Cochlear Implant ◽  
Cochlear Implantation ◽  
Pediatric Population ◽  
Adult Population ◽  
Age Groups ◽  
Acoustic Stimulation ◽  
Comfort Level ◽  
Clear Cut ◽  
Significant Difference ◽  
Stapedius Reflex

Introduction: Decrease in the lower age limit for paediatric cochlear implantation and increasing records of cochlear implantation in children with associated impairments demand quick and easily available objective measurements to provide MAP in these children as their speech and language ability may not be adequate to provide clear cut explanation about comfort level. Providing adequate amount of acoustic stimulation in this golden period of life (i.e. 0-2 years) is important in ensuring the proper utilization of acoustic cues. Findings of adult population cannot be directly applied to younger children and till date there is no Indian study reporting relationship between Electrically Evoked Stapedial Reflex Thresholds (ESRT) and behavioural Comfort levels, especially in pediatric population. Aim: The present study aimed to assess the correlation between behaviorally measured comfort (C) levels and Electrically Evoked Stapedius Reflex Thresholds (ESRT) in children with unilateral cochlear implant. Method: Children (n=40) with age range of 4-12 years, who received the same type of CI and electrode configuration, were selected for the study. Participants were divided into two groups – younger and older - based on their chronological age. Behavioural C-level measurement and ESRT measurement were done after tympanometry for both the groups. Correlation between the two measures was obtained and comparison between the two groups was done. Results and discussion: Recorded ESRT was consistently higher than the behaviorally obtained C-level for both the groups. The correlation between ESRT and C-level varies from moderate to very strong and strong to very strong for the younger and older groups respectively. No statistically significant difference was found between the correlations for the two age groups. Conclusions: High correlations were found between the ESRT and behaviorally obtained C-levels. Thus ESRT can be utilized as a tool for programming in younger implant recipients.

scholarly journals Prediction accuracy of standard and total keratometry by swept-source optical biometer for multifocal intraocular lens power calculation

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Hun Lee ◽  
Jae Lim Chung ◽  
Young Jun Kim ◽  
Jae Yong Kim ◽  
Hungwon Tchah
Keyword(s):  
Cataract Surgery ◽  
Case Series ◽  
Intraocular Lenses ◽  
Power Calculation ◽  
Neutral Position ◽  
Swept Source ◽  
Refractive Outcomes ◽  
Case Series Study ◽  
Significant Difference ◽  
Optical Biometer

AbstractWe aimed to compare the refractive outcomes of cataract surgery with diffractive multifocal intraocular lenses (IOLs) using standard keratometry (K) and total keratometry (TK). In this retrospective observational case series study, a total of 302 patients who underwent cataract surgery with multifocal IOL implantation were included. Predicted refractive outcomes were calculated based on the current standard formulas and a new formula developed for TK using K and TK, which were obtained from a swept-source optical biometer. At 2-month postoperatively, median absolute prediction errors (MedAEs) and proportion of eyes within ± 0.50 diopters (D) of predicted postoperative spherical equivalent (SE) refraction were analyzed. There was no significant difference between MedAEs or proportion of eyes within ± 0.50D of predicted refraction from K and TK in each formula. In TFNT00 and 839MP IOL cases, there was no difference between MedAEs from K and TK using any formula. In 829MP IOL cases, MedAE from TK was significantly larger than that from K in Barrett Universal II/Barrett TK Universal II (P = 0.033). In 677MY IOL cases, MedAE from TK was significantly larger than that from K in Haigis (P = 0.020) and Holladay 2 (P = 0.006) formulas. In the subgroup analysis for IOL, there was no difference between the proportion of eyes within ± 0.50 D of predicted refraction from K and TK using any formula. TFNT00 and 839MP IOLs were favorable with TK, with 677MY IOL with K and 829MP IOL being in a neutral position, which necessitates the study that investigates the accuracy of the new TK technology.

scholarly journals Anatomical and Visual Effects of Implantable Phakic Contact Lens on Correction of Myopia

2022 ◽  
Author(s):  
Mahmoud Ekram ◽  
Ahmed Mohamed Kamal Elshafei ◽  
Asmaa Anwar Mohamed ◽  
Mohamed Farouk Sayed Othman Abdelkader
Keyword(s):  
Visual Acuity ◽  
Anterior Chamber ◽  
Contact Lens ◽  
Anterior Segment ◽  
Anterior Chamber Depth ◽  
Case Series ◽  
Care Group ◽  
Case Series Study ◽  
Significant Difference ◽  
The Mean

Abstract Purpose: To evaluate the anatomical effects of implantable phakic contact lens (IPCL) (Care Group, India) on anterior segment and its visual outcomes .Patients and methods: In a prospective interventional case series study, 60 highly myopic eyes of 32 patients were subjected to IPCL implantation in the Ophthalmology Department of Minia University Hospital, Egypt from January 2019 to June 2021. All patients had complete ophthalmic examination and were followed up for 1 year. Pentacam was used for preoperative and postoperative estimation of anterior chamber depth (ACD), anterior chamber angle (ACA), anterior chamber volume (ACV) and IPCL vault in the 1st, 3rd, and 12th months. Assessment of corneal endothelium was done using specular microscope preoperatively and after 12 months. Preoperative and postoperative refraction and visual acuity were measured. Results: There was a statistically significant decrease in ACD, ACA, and ACV. There was no significant difference between preoperative and postoperative mean intraocular pressure (IOP) by the 12th month (P=0.163). The mean preoperative endothelial cell count (ECD) was significantly reduced from 2929.3±248 cells/mm2 to 2737.9±303 cells/mm2 at the 12th month (P<0.001). with a statistically highly significant improvement of mean Log Mar uncorrected visual acuity (UCVA) from 1.48±0.19 preoperatively to 0.46±0.11 by the end of follow up (P<0.001) with insignificant difference between preoperative best corrected visual acuity (BCVA) and postoperative UCVA (P=0.209). In the 12th month, the mean vault was 240±540 μm. No sight threatening complications occurred.Conclusion: Although IPCL induced anatomical changes, it was safe and effective for correction of high myopia.

Prediction of Dynamic Range from Stapedius Reflex in Cochlear Implant Patients

1988 ◽  
Vol 9 (1) ◽  
pp. 4-8 ◽  
Author(s):  
James Jerger ◽  
Terrey A. Oliver ◽  
Rose A. Chmiel
Keyword(s):  
Cochlear Implant ◽  
Dynamic Range ◽  
Stapedius Reflex

scholarly journals Depressive disorders in patients with pharmaco-resistant mesial temporal lobe epilepsy

2017 ◽  
Vol 46 (2) ◽  
pp. 752-760 ◽  
Author(s):  
Eleonora Borges Gonçalves ◽  
Tania Aparecida Marchiori de Oliveira Cardoso ◽  
Clarissa Lin Yasuda ◽  
Fernando Cendes
Keyword(s):  
Depressive Disorder ◽  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Depressive Disorders ◽  
Case Series ◽  
Mesial Temporal Lobe Epilepsy ◽  
Psychiatric Interview ◽  
Case Series Study ◽  
Significant Difference ◽  
Mesial Temporal Lobe

Objectives To assess depressive disorders in patients with mesial temporal lobe epilepsy (MTLE) refractory to medical treatment. Methods Adult patients with refractory MTLE completed two questionnaires (Mini International Neuropsychiatric Interview (MINI) and the Beck Depression Inventory (BDI) had a semi-structured psychiatric interview and a high resolution MRI scan. For complete neuropsychiatric diagnosis, as per International Classification of Diseases (ICD-10), the results were combined with clinical history and additional information from the patients’ family. Results Of the 40 patients identified for this case series study which took place from 2008–2012, 31 (77.5%) had a depressive disorder: 14 had dysthymia, 11 had recurrent depressive disorder and 6 had bipolar disorder. Of the nine patients without a firm diagnosis of mood disorder, seven had isolated symptoms of depression or anxiety and two presented with mixed depression/anxiety symptoms. Only 8/31 (25.8%) patients were receiving antidepressant treatment. There was no association between BDI scores and seizure frequency. No significant difference was found between patients with and without depression and the presence or laterality of HA. Conclusions Depressive disorders are common, underdiagnosed and undertreated in patients with refractory MTLE.

Stability of corneal topography and aberrometry after hyperopic laser in situ keratomileusis with a 500-Hz excimer laser platform: A 3-year follow-up study

2019 ◽  
Vol 30 (6) ◽  
pp. 1238-1245
Author(s):  
Ana B Plaza-Puche ◽  
Verónica Vargas ◽  
Pilar Yébana ◽  
Samuel Arba ◽  
Jorge L Alio
Keyword(s):  
Excimer Laser ◽  
Spherical Aberration ◽  
Case Series ◽  
Corneal Topography ◽  
Laser In Situ Keratomileusis ◽  
Case Series Study ◽  
Significant Difference ◽  
Optical Zone

Purpose: The aim of this study is to analyze the long-term stability of the corneal topography, the functional optical zone, and the refractive stability throughout 3 years following laser in situ keratomileusis surgery for hyperopia using a 500-Hz excimer laser system. Methods: This retrospective consecutive observational case series study comprised 66 eyes that underwent laser in situ keratomileusis to correct hyperopia with a postoperative follow-up of 3 years. Laser in situ keratomileusis procedures were performed using the SCHWIND Amaris 500-Hz excimer laser. Main outcomes measured were stability of the functional optical zone at corneal topography and corneal aberrometry. Results: Statistically significant differences were found in simulated keratometry (K2 (steep meridian) and Km (mean keratometry)) between 3 and 36 months postoperatively ( p ⩽ 0.01); these differences disappeared at 12 and 36 months ( p ⩾ 0.18). No statistically significant changes were observed in the horizontal and vertical diameter of the functional optical zone throughout the whole follow-up ( p ⩾ 0.07). A statistically significant difference was found in the spherical aberration between 3 and 36 months ( p = 0.02); this difference disappeared when compared between 12 and 36 months ( p = 0.72). Statistically significant correlations were detected between the vertical functional optical zone and coma root mean square ( r = –0.510, p < 0.01) and between the vertical functional optical zone and spherical aberration ( r = 0.441, p = 0.02) 36 months after surgery. Conclusion: Following 3 years of hyperopic laser in situ keratomileusis with a 500-Hz Amaris excimer laser, keratometry, functional optical zone, and corneal aberrations remain stable from 1 year after surgery. Topographical regression is not observed in hyperopic laser in situ keratomileusis with this excimer laser technology from 1 year after surgery.

scholarly journals Central Auditory Nervous System Stimulation through the Cochlear Implant Use and Its Behavioral Impacts: A Longitudinal Study of Case Series

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Marina Isabel Cavalcanti ◽  
Liliane Aparecida Fagundes Silva ◽  
Maria Valéria Schmidt Goffi Gomez ◽  
Tsuji Robinson Koji ◽  
Ricardo Ferreira Bento ◽  
...  
Keyword(s):  
Cochlear Implant ◽  
Oral Language ◽  
Auditory Evoked Potentials ◽  
Case Series ◽  
Behavioral Skills ◽  
Case Series Study ◽  
And Gender ◽  
Clinical Resource ◽  
Effective Use ◽  
Cortical Maturation

The purpose of this study was to investigate, over a period of five years, the cortical maturation of the central auditory pathways and its impacts on the auditory and oral language development of children with effective use and without effective use of a Cochlear Implant (CI). A case series study was conducted with seven children who were CI users and seven children with normal hearing, with age- and gender-matched to CI users. The assessment was performed by long-latency auditory evoked potentials and auditory and oral language behavioral protocols. The results pronounced P1 latency decrease in all CI users in the first nine months. Over five years, five children with effective CI use presented decrease or stabilization of P1 latency and a gradual development of auditory and oral language skills, although, for most of the children, the electrophysiological and behavior results remained poor than their hearing peers’ results. Two children who stopped the effective use of CI after the first year of activation had worsened auditory and oral language behavioral skills and presented increased P1 latency. A negative correlation was observed between behavioral measures and the P1 latency, the P1 component being considered an important clinical resource capable of measuring the cortical maturation and the behavioral evolution.

Treatment of adult lead poisoning with D-penicillamine

2019 ◽  
Vol 34 (2) ◽  
Author(s):  
Maryam Paeezi ◽  
Nasim Zamani ◽  
Hossein Hassanian-Moghaddam ◽  
Shahin Shadnia ◽  
Naghmeh Zamani ◽  
...  
Keyword(s):  
Lead Poisoning ◽  
Day Treatment ◽  
Lead Level ◽  
Case Series ◽  
Blood Lead ◽  
Signs And Symptoms ◽  
Outpatient Setting ◽  
Treatment Protocols ◽  
Case Series Study ◽  
Significant Difference

Abstract Background The aim of the current study was to evaluate the efficacy of D-penicillamine in the treatment of lead poisoning mainly in the outpatient setting. Methods In a case series study performed during the recent epidemic of lead poisoning in Iran, lead-poisoned patients referring to our outpatient clinic were treated with 250-mg D-penicillamine capsules administered every 6 h for 5 or 10 days based on availability of the medication. They were recommended to re-check blood lead level (BLL) 4 weeks after cessation of the treatment and refer to our clinic again. Results In 63 patients with lead poisoning but without signs and symptoms of lead encephalopathy, median BLL was 106 [84, 131] μg/dL on presentation, which declined to a mean of 52.6 ± 28.8 μg/dL after a median treatment period of 7 [5, 10] days (p < 0.001). There was no statistically significant difference between the 5- and 10-day treatment protocols regarding complications and recovery. Treatment had resulted in a median decrease of 54 μg/dL [33, 90] (range: −20 to 231 μg/dL) in the patients’ BLLs (33.9% declined in BLL measurements; range: −29.69% to 99.06%). Conclusions D-penicillamine may be an acceptable substitute treatment in adult lead poisoning. Although our sample size was limited, we could not detect any serious adverse effects in our cases showing that D-penicillamine resulted in acceptable recovery rates. This may be helpful especially in epidemics with limitations in antidote access.

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