Showing papers by "Richard T. Ramsden published in 2006"
TL;DR: To objectively evaluate the clinical and functional outcomes of cochlear implantation in an elderly population, a large number of elderly people with hearing loss are surveyed for the first time.
Abstract: OBJECTIVES: To objectively evaluate the clinical and functional outcomes of cochlear implantation in an elderly population. DESIGN: Retrospective comparative study. SETTING: Neurotology unit at Manchester Royal Infirmary, a supraregional tertiary referral centre in collaboration with Adult Cochlear Implant Programme at The University of Manchester. PARTICIPANTS: All cochlear implant procedures (38) undertaken on post-lingually deafened elderly patients (age range at the time of implantation 65-80 years, n = 34) in the period from 1989 to 2002. MAIN OUTCOME MEASURES: Medical and surgical outcomes. Audiological performance outcomes for isolated words, words in sentences in quiet and noise. Functional outcome measures used are self-reported measures of the social, psychological and emotional aspects of quality of life, and the differences between expectations for functional outcomes and the realization of functional outcomes. They included expectation profiles, Glasgow Benefit inventory (GBI) and Glasgow Health Status Inventory Questionnaire (GHSI). RESULTS: There was statistically significant improvement post-implantation of both open and closed set test scores (P < 0.01). Eighty-two percentage of patients were completely satisfied with their cochlear implants. Patients judged that implantation restored half the loss of quality of life that they had experienced as a result of severe-profound deafness with a highly significant (P < 0.001) improvement in overall quality of life after implantation. The commonest post-operative observation was transient mild pyrexia. CONCLUSIONS: The age of a cochlear implant candidate should not be a factor in the candidacy decision-making process. The quality of life of our elderly recipients was significantly improved after cochlear implant.
111 citations
TL;DR: The high cerebrospinal fluid leak rate associated with the unusual presentations and ensuing management difficulties in controlling these leaks lead us to recommend that BioGlue not be used in translabyrinthine vestibular schwannoma surgery.
Abstract: Objective: To determine the effectiveness of BioGlue surgical adhesive in dural and middle ear closure after translabyrinthine vestibular schwannoma surgery.Study Design: A prospective study.Setting: Tertiary neurotological referral center.Patients: There were 24 patients in the BioGlue series. BioGlue was used in the same manner in all cases. All patients received similar postoperative care.Interventions: We studied the use of BioGlue and its possible effect on further reducing our department's cerebrospinal fluid leak rate for translabyrinthine vestibular schwannoma surgery.Main Outcome Measures: Postoperative events were documented that enabled us to determine the overall cerebrospinal fluid leak rate (including incidence of various leak routes and morbidity).Results: The overall cerebrospinal fluid leak rate was 62.5% (15 of 24). Rhinorrhoea was the commonest route (80%), followed by postaural wound leak (33.3%) and external auditory canal otorrhoea (33.3%). Forty percent of cases had more than one cerebrospinal fluid leak route; 73.3% of leak cases required lumbar drain insertion, 40% needed pressure bandaging, and 66.7% had to undergo formal surgical repair. Forty percent had recurrent leaks after the initial episode had completely ceased. The mean extra stay in hospital as a result of the cerebrospinal fluid leak was 13.3 days.Conclusion: Our preliminary prospective study of the use of BioGlue for dural and middle ear closure in translabyrinthine vestibular schwannoma surgery demonstrated poor results. The high cerebrospinal fluid leak rate associated with the unusual presentations and ensuing management difficulties in controlling these leaks lead us to recommend that BioGlue not be used in translabyrinthine vestibular schwannoma surgery. The manufacturers have noted our results and have considered adding our recommendation to the product data sheet.
26 citations
Journal Article•
TL;DR: In this article, the effectiveness of BioGlue surgical adhesive in dural and middle ear closure after translabyrinthine vestibular schwannoma surgery was evaluated in a prospective study.
Abstract: Objective: To determine the effectiveness of BioGlue surgical adhesive in dural and middle ear closure after translabyrinthine vestibular schwannoma surgery. Study Design: A prospective study. Setting: Tertiary neurotological referral center. Patients: There were 24 patients in the BioGlue series. BioGlue was used in the same manner in all cases. All patients received similar postoperative care. Interventions: We studied the use of BioGlue and its possible effect on further reducing our department's cerebrospinal fluid leak rate for translabyrinthine vestibular schwannoma surgery. Main Outcome Measures: Postoperative events were documented that enabled us to determine the overall cerebrospinal fluid leak rate (including incidence of various leak routes and morbidity). Results: The overall cerebrospinal fluid leak rate was 62.5% (15 of 24). Rhinorrhoea was the commonest route (80%), followed by postaural wound leak (33.3%) and external auditory canal otorrhoea (33.3%). Forty percent of cases had more than one cerebrospinal fluid leak route; 73.3% of leak cases required lumbar drain insertion, 40% needed pressure bandaging, and 66.7% had to undergo formal surgical repair. Forty percent had recurrent leaks after the initial episode had completely ceased. The mean extra stay in hospital as a result of the cerebrospinal fluid leak was 13.3 days. Conclusion: Our preliminary prospective study of the use of BioGlue for dural and middle ear closure in translabyrinthine vestibular schwannoma surgery demonstrated poor results. The high cerebrospinal fluid leak rate associated with the unusual presentations and ensuing management difficulties in controlling these leaks lead us to recommend that BioGlue not be used in translabyrinthine vestibular schwannoma surgery. The manufacturers have noted our results and have considered adding our recommendation to the product data sheet.
23 citations
TL;DR: In this article, an approach using a semi-structured interview/questionnaire was administered to 20 individuals with neurofibromatosis 2 (NF2) of varying severity and the most important problem highlighted by this study and not by the open-ended approach is the loss of employment, due to communication difficulties resulting from their hearing impairment.
Abstract: As part of an investigation of the psychosocial aspects of neurofibromatosis 2 (NF2) an approach using a semi-structured interview/questionnaire was administered to 20 individuals with NF2 of varying severity. Previously the same individuals and their partners had completed open-ended questionnaires on such effects. The most important problem highlighted by this study and not by the open-ended approach is the loss of employment, due to communication difficulties resulting from their hearing impairment. Most patients reported excellent support from their spouses/ partners although occasionally the relationships ended in divorce. Three young people reported the ending of their close relationships because of their NF2. It was of note that support from family members was very strong, and appreciated by the patients.
12 citations
TL;DR: An extremely rare case of a patient with CED who presented with deafness due to gross abnormalities affecting both middle ear and cochlea is reported.
Abstract: Camurati-Engelmann's disease (CED) is a rare hereditary disorder affecting mainly the diaphysis of long bones but multiple cranial nerve deficits may also develop secondary to bony sclerosis of their foramina, including visual loss, facial palsy, deafness, vestibular disturbances and sensory deficits along the distribution of the trigeminal nerve. Deafness has been reported in about 18 per cent of these cases due to narrowing of the internal auditory canals caused by bony encroachment on nerves and vessels. We report an extremely rare case of a patient with CED who presented with deafness due to gross abnormalities affecting both middle ear and cochlea. The issues relating to the management of these patients with temporal bone involvement are discussed.
10 citations
TL;DR: A prospective national audit of VS management and outcomes with neurosurgical colleagues is recommended and this would also be of value in manpower planning particularly if a minimum caseload could be identified below which results were seen to be less good.
Abstract: INTRODUCTIONIt is generally agreed that the successful management of a vestibular schwannoma (VS) usually involves close collaboration between a neuro-otologist and neurosurgeon. In addition, it is accepted that the experience of the team managing such tumours is one of the key determinants of outcome after surgical intervention. The aim of this study was to identify current practice in the management of such tumours amongst otolaryngologists in the UK and to observe whether such collaborative working practices exist. MATERIALS AND METHODSA cross sectional postal questionnaire survey of consultant members of the British Association of Otorhinolaryngologists – Head and Neck Surgeons (n = 542). RESULTSA total of 336 replies were received (62%). Of respondents, 299 consultants referred their patients to another surgeon for further management; 242 referred to another ENT surgeon (80.9%), 29 to a neurosurgeon (9.7%) and 28 to a combined team (9.4%). Twenty-eight of the responding otolaryngologists (8.6%) manag...
9 citations
TL;DR: This paper represents the second part of the study shown in an accompanying paper, on the results of a semi-structured approach to the psychosocial impact of NF2.
Abstract: This paper represents the second part of the study shown in an accompanying paper, on the results of a semi-structured approach to the psychosocial impact of NF2.The most important areas highlighted by this study and not by an earlier open-ended approach are of communication, balance problems and depression. Generally speaking, patients do not consider tinnitus and facial palsy to be major difficulties.
7 citations
TL;DR: It will be argued that the disciplines becoming clinically and professionally isolated from one another, as is being observed in the USA, would be to the benefit of no-one, and the future lies in renewed collaboration between the disciplines, delivering sophisticated and high quality care to hearing and balance impaired patients in multi-disciplinary teams characterized by respect and integration of purpose.
Abstract: The relationship between the disciplines of audiology and otology is in an interesting and potentially troubled state. Recent developments such as the Universal Neonatal Hearing Screening Programme and the Modernising Hearing Aid Services programme are revolutionising the services available and delivered to patients with hearing and balance disorders in the UK. These have had minimal input however, from the otological community, which is suboptimal given that patients within these programmes may well require otological management. Additionally, there are significant changes in the political landscape. Specifically, it is interesting to note the formation of the British Academy of Audiology (http://www.baaudiology. org) with a vision of drawing all UK audiologists into one group with strategic vision and purpose, and of the British Otology, Hearing and Balance Group (http:// www.entuk.org.uk), which aims at providing a forum for interdisciplinary exchange of views. This Editorial reviews the present situation, and delineates opportunities and threats facing otology and audiology. It will be argued that the disciplines becoming clinically and professionally isolated from one another, as is being observed in the USA, would be to the benefit of no-one. Rather, the future lies in renewed collaboration between the disciplines, delivering sophisticated and high quality care to hearing and balance impaired patients in multi-disciplinary teams characterized by respect and integration of purpose.
2 citations