9 research outputs found
CPX/D Underestimates VO2 in athletes compared with an automated Douglas bag system
OBJECTIVES/HYPOTHESIS: To evaluate the influence of the introduction of newborn hearing screening programs on the age at cochlear implantation in children. STUDY DESIGN: Retrospective, multicenter cohort study. METHODS: All 1,299 pediatric cochlear implant users who received their implants before the age of 5 years between 1995 and 2011 in the Medical University Hannover, Germany and University Medical Center Utrecht, the Netherlands were enrolled in this study. Age at implantation and the number of children implanted within the first year of life was assessed for each center. RESULTS: Age at cochlear implantation gradually declined over the years in both centers. The introduction of the screening resulted in significant decline in the age at implantation in the Netherlands; simultaneously, the number of children implanted within their first year of life increased significantly. Comparing 4-year epochs immediately before and after introduction of the screening, the mean age decreased from 2.4 to 1.2 years, and the percentage of early implanted children increased from 9% to 37%. In the German population, a similar effect of the introduction of the hearing screening program was absent. CONCLUSIONS: The introduction of the national newborn hearing screening program has reduced the age at cochlear implantation in young children in the Netherlands but not in Germany. Correspondingly, it resulted in an increase in the number of children implanted early in life. The difference between the Dutch and German population might be due to differences in the follow-up and referral after the hearing screening. LEVEL OF EVIDENCE: 2b Laryngoscope, 125:985-990, 2015
Cost-Utility of Bilateral Versus Unilateral Cochlear Implantation in Adults: A Randomized Controlled Trial
OBJECTIVE: To study the cost-utility of simultaneous bilateral cochlear implantation (CI) versus unilateral CI. STUDY DESIGN: Randomized controlled trial (RCT). SETTING: Five tertiary referral centers. PATIENTS: Thirty-eight postlingually deafened adults eligible for cochlear implantation. INTERVENTIONS: A cost-utility analysis was performed from a health insurance perspective. MAIN OUTCOME MEASURES: Utility was assessed using the HUI3, TTO, VAS on hearing, VAS on general health and EQ-5D. We modeled the incremental cost per quality-adjusted life year (QALY) of unilateral versus bilateral CI over periods of 2, 5, 10, 25 years, and actual life-expectancy. RESULTS: Direct costs for unilateral and bilateral CI were euro43,883 +/- euro11,513(SD) and euro87,765 +/- euro23,027(SD) respectively. Annual costs from the second year onward were euro3,435 +/- euro1,085(SD) and euro6,871 +/- euro2,169(SD), respectively. A cost-utility analysis revealed that a second implant became cost-effective after a 5- to 10-year period, based on the HUI3, TTO, and VAS on hearing. CONCLUSION: This is the first study that describes a cost-utility analysis to compare unilateral with simultaneous bilateral CI in postlingually deafened adults, using a multicenter RCT. Compared with accepted societal willingness-to-pay thresholds, simultaneous bilateral CI is a cost-effective treatment for patients with a life expectancy of 5-10 years or longer
Effect of unilateral and simultaneous bilateral cochlear implantation on tinnitus: A Prospective Study
OBJECTIVES/HYPOTHESIS: To determine the effect of cochlear implantation on tinnitus perception in patients with severe bilateral postlingual sensorineural hearing loss and to demonstrate possible differences between unilateral and bilateral cochlear implantation. STUDY DESIGN: Prospective study. METHODS: Thirty-eight adult patients were included in this prospective study, as part of a multicenter randomized controlled trial investigating the benefits of bilateral cochlear implantation versus unilateral cochlear implantation. Pre- and postoperative tinnitus perception scores were evaluated, before and 1 year after implantation on three tinnitus questionnaires; the Tinnitus Handicap Inventory (THI), the Tinnitus Questionnaire (TQ), and a visual analogue scale for tinnitus burden. RESULTS: Before implantation, the tinnitus prevalence was 42.1% (16 of 38) in the whole study group. One year after implantation, the tinnitus questionnaire scores had decreased in 71.4% according to the TQ and 80.0% according to the THI. Tinnitus was induced after cochlear implantation in six patients, five in the bilateral and one in the unilateral group. CONCLUSIONS: Our study shows that cochlear implantation is effective in the reduction of tinnitus in patients with bilateral sensorineural hearing loss who suffered from preoperative tinnitus. Conversely, tinnitus may also increase or even be induced by the cochlear implantation itself. Cochlear implant candidates should be well informed about these possible consequences before undergoing surgery. LEVEL OF EVIDENCE: 2b Laryngoscope, 126:956-961, 2016
Comparison of Bilateral and Unilateral Cochlear Implantation in Adults A Randomized Clinical Trial
Disorders of the head and nec
Stable benefits of bilateral over unilateral cochlear implantation after two years: A randomized controlled trial
Item does not contain fulltextOBJECTIVES/HYPOTHESIS: To investigate hearing capabilities and self-reported benefits of simultaneous bilateral cochlear implantation (BiCI) compared with unilateral cochlear implantation (UCI) after a 2-year follow-up and to evaluate the learning effect of cochlear implantees over time. STUDY DESIGN: Multicenter randomized controlled trial. METHODS: Thirty-eight postlingually deafened adults were included in this study and randomly allocated to either UCI or simultaneous BiCI. Our primary outcome was speech intelligibility in noise, with speech and noise coming from straight ahead (Utrecht-Sentence Test with Adaptive Randomized Roving levels). Secondary outcomes were speech intelligibility in noise with spatially separated sources, speech intelligibility in silence (Dutch phoneme test), localization capabilities and self-reported benefits assessed with different quality of hearing and quality of life (QoL) questionnaires. This article describes the results after 2 years of follow-up. RESULTS: We found comparable results for the UCI and simultaneous BiCI group, when speech and noise were both presented from straight ahead. Patients in the BiCI group performed significantly better than patients in the UCI group, when speech and noise came from different directions (P = .01). Furthermore, their localization capabilities were significantly better. These results were consistent with patients' self-reported hearing capabilities, but not with the questionnaires regarding QoL. We found no significant differences on any of the subjective and objective reported outcomes between the 1-year and 2-year follow-up. CONCLUSIONS: This study demonstrates important benefits of simultaneous BiCI compared with UCI that remain stable over time. Bilaterally implanted patients benefit significantly in difficult everyday listening situations such as when speech and noise come from different directions. Furthermore, bilaterally implanted patients are able to localize sounds, which is impossible for unilaterally implanted patients. LEVEL OF EVIDENCE: 1b Laryngoscope, 127:1161-1168, 2017
Brain stem Response Audiometry: I. Its Use in Distinguishing between Conductive and Cochlear Hearing Loss
Inaccuracies in the Measurement of Auditory Brainstem Response Data in Normal Hearing and Cochlear Hearing Loss
Brainstem Response Audiometry: II. Classification of Hearing Loss by Discriminant Analysis
Casi-mercados, segregaci贸n escolar y desigualdad educativa: una trilog铆a con final abierto
La expansi贸n de las l贸gicas de casi-mercado en la (re)configuraci贸n de los reg铆menes educativos ha hecho mella tanto en la articulaci贸n de la oferta como en la gesti贸n de la demanda escolar. En lo relativo a la demanda, la potenciaci贸n del casi-mercado se ha plasmado, principalmente, en la extensi贸n de pol铆ticas de distinta 铆ndole dirigidas a ampliar el margen formal de elecci贸n escolar por parte de las familias. En el terreno de la oferta, y m谩s all谩 de las v铆as abiertas a la privatizaci贸n de la ense帽anza, el mismo proceso ha comportado la devoluci贸n a las escuelas de mayores m谩rgenes de autonom铆a, en diversos campos (curricular, gesti贸n de personal y presupuestos, admisi贸n de alumnos...). En este art铆culo se repasan, desde una perspectiva europea y cr铆tica, algunos de los principales peligros atribuibles a estos procesos, fundamentalmente relacionados con la segregaci贸n escolar, y se se帽alan algunas claves explicativas para contribuir a comprender su naturaleza e implicaciones