The advantages to using acoustic hearing and electricity assistance together are better localization of sounds, better hearing of music, and greater understanding of words in noise, he said.
Explore This IssueMarch 2017
When testing patients for cochlear implantation, it’s critical to test in noise, Dr. Gantz said. “If you don’t do that, you’re going to have a lot of unhappy patients,” he said. “They’re crying because they cannot go out to dinner. They can’t socialize in their church, and they’re withdrawing.”
Dr. Gantz said that shorter electrodes, to preserve residual hearing at lower frequencies, tend to be used at his center. Patients with better than 80-decibel hearing at 1500 Hz are typically suitable for a shorter electrode, he said.
“We think that those who have more residual hearing do better in the long term,” he said. “They’ve got a better percentage of keeping that low frequency over time. And we know we can keep it up to 16 years now…. We need to consider implanting people younger when they do have this neural substrate, rather than older.”
Balloon Dilation for Eustachian Tube Dysfunction
Dennis Poe, MD, PhD, associate in otolaryngology and associate professor of otology and laryngology at Harvard Medical School and Boston Children’s Hospital, talked about the benefits of balloon dilation for treatment of Eustachian tube dilatory dysfunction, a procedure that just won FDA approval in September 2016 for individuals who are at least 22 years old.
Indications are persistent otitis media with effusion or non-adherent atelectasis; negative pressure on tympanogram; and inflammatory disease seen on pathology in the Eustachian tube. An exception is a patient with dysfunction that is only caused by pressure changes in a plane or while scuba diving, which must be accompanied by Eustachian tube pathology, Dr. Poe said.
The balloon is inflated, stopping before the isthmus of the Eustachian tube, and is left in for two minutes, then deflated. Researchers found that the procedure reduced inflammation in the tube. Biopsies taken immediately before the balloon dilation showed inflamed mucosa, a “disorderly” array of the pseudo-stratified columnar epithelium, loss of cilia, and submucosal inflammatory infiltrates with lymphoid follicles, Dr. Poe said.
But right afterward, the balloon has stripped off the epithelium, leaving a basal layer and “crushing” the lymphocytic infiltrate, he said. “It’s a much more impressive excoriation than you would expect from what you see clinically,” Dr. Poe said. A few weeks later, biopsies showed no lymphoid follicles, reduction in the lymphocytic infiltrate, and restoration of the pseudo-stratified columnar epithelium, with return of the ciliated border.