Showing papers by "Marlan R. Hansen published in 2009"

Hybrid 10 clinical trial: preliminary results.

Abstract: Acoustic plus electric (electric-acoustic) speech processing has been successful in highlighting the important role of articulation information in consonant recognition in those adults that have profound high-frequency hearing loss at frequencies greater than 1500 Hz and less than 60% discrimination scores. Eighty-seven subjects were enrolled in an adult Hybrid multicenter Food and Drug Administration clinical trial. Immediate hearing preservation was accomplished in 85/87 subjects. Over time (3 months to 5 years), some hearing preservation was maintained in 91% of the group. Combined electric-acoustic processing enabled most of this group of volunteers to gain improved speech understanding, compared to their preoperative hearing, with bilateral hearing aids. Most have preservation of low-frequency acoustic hearing within 15 dB of their preoperative pure tone levels. Those with greater losses (>30 dB) also benefited from the combination of electric-acoustic speech processing. Postoperatively, in the electric-acoustic processing condition, loss of low-frequency hearing did not correlate with improvements in speech perception scores in quiet. Sixteen subjects were identified as poor performers in that they did not achieve a significant improvement through electric-acoustic processing. A multiple regression analysis determined that 91% of the variance in the poorly performing group can be explained by the preoperative speech recognition score and duration of deafness. Signal-to-noise ratios for speech understanding in noise improved more than 9 dB in some individuals in the electric-acoustic processing condition. The relation between speech understanding in noise thresholds and residual low-frequency acoustic hearing is significant (r = 0.62; p < 0.05). The data suggest that, in general, the advantages gained for speech recognition in noise by preserving residual hearing exist, unless the hearing loss approaches profound levels. Preservation of residual low-frequency hearing should be considered when expanding candidate selection criteria for standard cochlear implants. Duration of profound high-frequency hearing loss appears to be an important variable when determining selection criteria for the Hybrid implant.

Perioperative fever and outcome in surgical patients with aneurysmal subarachnoid hemorrhage

Abstract: OBJECTIVE: We examined the incidence of perioperative fever and its relationship to outcome among patients enrolled in the Intraoperative Hypothermia for Aneurysm Surgery Trial. METHODS: One thousand patients with initial World Federation of Neurological Surgeons grades of I to III undergoing clipping of intracranial aneurysms after subarachnoid hemorrhage were randomized to intraoperative normothermia (36 degrees C-37 degrees C) or hypothermia (32.5 degrees C-33.5 degrees C). Fever (> or =38.5 degrees C) and other complications (including infections) occurring between admission and discharge (or death) were recorded. Functional and neuropsychologic outcomes were assessed 3 months postoperatively. The primary outcome variable for the trial was dichotomized Glasgow Outcome Scale (good outcome versus all others). RESULTS: Fever was reported in 41% of patients. In 97% of these, fever occurred in the postoperative period. The median time from surgery to first fever was 3 days. All measures of outcome were worse in patients who developed fever, even in those without infections or who were World Federation of Neurological Surgeons grade I. Logistic regression analyses were performed to adjust for differences in preoperative factors (e.g., age, Fisher grade, initial neurological status). This demonstrated that fever continued to be significantly associated with most outcome measures, even when infection was added to the model. An alternative stepwise model selection process including all fever-related measures from the preoperative and intraoperative period (e.g., hydrocephalus, duration of surgery, intraoperative blood loss) resulted in the loss of significance for dichotomized Glasgow Outcome Scale, but significant associations between fever and several other outcome measures remained. After adding postoperative delayed ischemic neurological deficits to the model, only worsened National Institutes of Health Stroke Scale score, Barthel Activities of Daily Living index, and discharge destination (home versus other) remained independently associated with fever. CONCLUSION: These findings suggest that fever is associated with worsened outcome in surgical subarachnoid hemorrhage patients, although, because the association between fever and the primary outcome measure for the trial is dependent on the covariates used in the analysis (particularly operative events and delayed ischemic neurological deficits), we cannot rule out the possibility that fever is a marker for other events. Only a formal trial of fever treatment or prevention can address this issue.

Middle ear cancer: a population-based study.

Abstract: Objectives/Hypothesis: Primary carcinoma of the middle ear is a rare clinical entity, best suited for evaluation using a population-based database. The objective of this study was to utilize the Surveillance, Epidemiology, and End Results (SEER) database to determine the incidence, treatment, and survival of middle ear carcinoma. Study Design: Analysis of national cancer database. Method: Using SEER*Stat software, records for patients diagnosed with middle ear carcinoma between 1973 and 2004 were extracted from the SEER database. Five-year, observed survival was analyzed, with significant differences determined by the Wilcoxon statistic. Results: The 5-year observed survival rate for the 215 patients in this study was 36.4%. Histologic subtypes included squamous cell carcinoma (62.8%), adenocarcinoma (18.2%), other carcinomas (13.0%), and noncarcinomas (6.0%), with 5-year survival rates of 23.9%, 65.0%, 60.0%, and 38.6%, respectively (P = .003). Of the 123 patients with known stage, 23.6% had local, 69.1% had regional, and 7.3% had distant disease, with their 5-year survival rates being 64.9%, 34.2%, and 0%, respectively (P < .001). Treatment included surgery (31.2%), radiation (16.3%), surgery and radiation (38.6%), or no treatment (8.4%) with 5-year survival of 69.2%, 14.6%, 26.4%, and 0%, respectively (P < .001). Conclusions: Patients with primary middle ear carcinoma have a relatively poor prognosis. However, subsets of patients, such as those with adenocarcinomas and with localized tumors, demonstrated significantly better survival. Surgery alone had significantly better survival than the other treatment groups, presumably due to less advanced disease in this treatment group. These data are useful in counseling patients and understanding the natural history of middle ear carcinoma. Laryngoscope, 2009

Neurolymphomatosis mimicking chemotherapy-induced ototoxicity.

Abstract: Objective To present an unusual cause of bilateral sensorineural hearing loss mimicking chemotherapy-induced ototoxicity. Patient A 76-year-old woman with bilateral sudden sensorineural hearing loss after chemotherapy for non-Hodgkin lymphoma was referred for cochlear implantation. Interventions Prednisone and acyclovir were administered empirically during the course of the diagnostic evaluation. Main outcome measures Diagnostic tests were obtained, including audiometry, positron emission tomography/computed tomographic imaging, and magnetic resonance imaging scan of the brain with gadolinium. Results Audiometry revealed bilateral profound sensorineural hearing loss without improvement after steroid and acyclovir treatment. Postchemotherapy positron emission tomography/computed tomographic imaging obtained 1 week after onset of hearing loss suggested the lymphoma to be in remission. However, magnetic resonance imaging obtained a few weeks later, concurrent with progression of symptoms to include facial palsy and numbness, demonstrated enhancement and thickening of multiple cranial nerves, consistent with neurolymphomatosis (malignant lymphocytic infiltration of nerves). Conclusion Particular vigilance must be given to the potential for malignant invasion of the peripheral nervous system in the context of new-onset sensorineural hearing loss after chemotherapy. Such a neurologic deficit should not be assumed to be chemotherapy induced even if the hearing loss is bilaterally symmetric and the only neurologic abnormality.

Acute radiographic workup of blunt temporal bone trauma: maxillofacial versus temporal bone CT.

Abstract: Objectives/Hypothesis: To evaluate the radiographic workup of blunt temporal bone trauma and determine the utility of maxillofacial computed tomography (CT) versus temporal bone CT in identifying carotid canal fractures. Study Design: Retrospective review. Methods: The charts of 227 patients evaluated at a level I trauma center receiving a temporal bone CT for blunt head trauma within 48 hours of admission were reviewed. Acute evaluation findings and complications were noted. Sensitivity, specificity, positive predictive value, and negative predictive (NPV) value were calculated for maxillofacial CT's ability to identify carotid canal fractures compared to temporal bone CT. Results: One hundred forty fractures were found. Physical exam findings of blood in the external auditory canal as the sole finding, and blood in the external auditory canal with associated hemotympanum were significantly associated with absence and presence of fracture respectively. The sensitivity and specificity of maxillofacial CT for identifying carotid canal fractures, when compared to temporal bone CT, were 90.3% and 94.4% respectively (NPV > 95%). Only 6% of all patients either did have or should have had their management changed based on the temporal bone CT findings. All of these changes were regarding further workup for blunt carotid artery injury. Conclusions: A combination of helical computed tomography and physical exam findings can allow for judicious use of temporal bone CTs when no maxillofacial CT is indicated. Temporal bone CTs rarely change acute management. But when they do, it is in regard to the need for further workup of possible vascular injury. Lastly, maxillofacial CTs are adequate for identifying carotid canal fractures. Laryngoscope, 119:442–448, 2009