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IMPORTANCE The cost of bilateral cochlear implantation (BCI) is usually not reimbursed by insurance companies because of a lack of well-designed studies reporting the benefits of a second cochlear implant. OBJECTIVE To determine the benefits of simultaneous BCI compared with unilateral cochlear implantation (UCI) in adults with postlingual deafness. DESIGN, SETTING, AND PARTICIPANTS A multicenter randomized clinical trial was performed. The study took place in 5 Dutch tertiary referral centers: the University Medical Centers of Utrecht, Maastricht, Groningen, Leiden, and Nijmegen. Forty patients eligible for cochlear implantation met the study criteria and were included from January 12, 2010, through November 2, 2012. The main inclusion criteria were postlingual onset of hearing loss, age of 18 to 70 years, duration of hearing loss of less than 20 years, and a marginal hearing aid benefit. Two participants withdrew from the study before implantation. Nineteen participants were randomized to undergo UCI and 19 to undergo BCI. INTERVENTIONS The BCI group received 2 cochlear implants during 1 surgery. The UCI group received 1 cochlear implant. MAIN OUTCOMES AND MEASURES The primary outcome was the Utrecht Sentence Test with Adaptive Randomized Roving levels (speech in noise, both presented from straight ahead). Secondary outcomes were consonant-vowel-consonant words in silence, speech-intelligibility test with spatially separated sources (speech in noise from different directions), sound localization, and quality of hearing questionnaires. Before any data were collected, the hypothesis was that the BCI group would perform better on the objective and subjective tests that concerned speech intelligibility in noise and spatial hearing. RESULTS Thirty-eight patients were included in the study. Fifteen patients in the BCI group used hearing aids before implantation compared with 19 in the UCI group. Otherwise, there were no significant differences between the groups' baseline characteristics. At 1-year follow-up, there were no significant differences between groups on the Utrecht Sentence Test with Adaptive Randomized Roving levels (9.1 dB, UCI group; 8.2 dB, BCI group; P = .39) or the consonant-vowel-consonant test (median percentage correct score 85.0% in the UCI group and 86.8% in the BCI group; P = .21). The BCI group performed significantly better than the UCI group when noise came from different directions (median speech reception threshold in noise, 14.4 dB, BCI group; 5.6 dB, BCI group; P <.001). The BCI group was better able to localize sounds (median correct score of 50.0% at 60 degrees, UCI group; 96.7%, BCI group; P CONCLUSIONS AND RELEVANCE This randomized clinical trial demonstrates a significant benefit of simultaneous BCI above UCI in daily listening situations for adults with postlingual deafness

Long-term results of bone-anchored hearing aid recipients who had previously used air-conduction hearing aids.

Contains fulltext : 48695.pdf (publisher's version ) (Closed access)OBJECTIVE: To study the long-term results (use, care, satisfaction, ear infections, and audiometry) of the application of a bone-anchored hearing aid (BAHA) to patients with conventional indications who had previously used air-conduction hearing aids. DESIGN: Follow-up study (mean duration, 9 years). SETTING: Tertiary referral center. PATIENTS: The study population comprised 27 patients with conductive or mixed hearing loss and who had participated in a previous study (N = 34). Seven could not be included anymore as a result of death, Alzheimer disease, or problems related to the implant. Everyone filled out the questionnaire, and 23 patients underwent audiometric evaluation. MAIN OUTCOME MEASURES: The patients filled out the adapted Nijmegen questionnaire. Aided free-field thresholds were measured as well as scores for speech in noise and in quiet. Results were compared with those obtained in the initial study. RESULTS: All 27 patients were still using their BAHA and appreciated it with regard to speech recognition in quiet, sound comfort, and improvements in ear infections. The audiometric results showed that most patients tested had stable bone-conduction thresholds over the years (after correction for age). Despite the treatment with BAHA, a significant deterioration in the cochlear hearing was observed in the other patients in the ear under study (their best hearing ear). CONCLUSIONS: Positive patient outcome measures emphasized the importance of BAHA application to patients with conventional indications. The audiometric data showed fairly stable cochlear function but not for all patients. This underlines that conservative treatment should be chosen (fitting of bone-conduction devices)

Cochlear implantation and quality of life in postlingually deaf adults:Long-term follow-up

OBJECTIVE: To investigate long-term quality of life (QoL) in postlingually deaf adults after entering the cochlear implantation (CI) program. STUDY DESIGN AND SETTING: Follow-up study from 1998 onwards in tertiary university medical center. Long-term CI users, patients who have not received a CI, and relatively short-term CI users were re-evaluated six years after initial data collection in 1998 by using three questionnaires (NCIQ, HUI3, and SF36) and speech perception tests. RESULTS AND CONCLUSIONS: In general, the beneficial effect of CI remained stable during long-term follow-up, though scores on the questionnaires decreased slightly. Outcomes before and after cochlear implantation were significantly different. The group without a CI demonstrated slightly decreasing trends in outcomes. Long-term speech perception performance improved in time. SIGNIFICANCE: This is the first study to investigate long-term follow-up of CI patients, in all aspects of QoL combined with speech perception performance, in comparison with postlingually deaf adults without CI

Impact of cochlear implantation on the function of the three semicircular canals

Contains fulltext : 229881.pdf (Publisher’s version ) (Open Access)OBJECTIVE: To assess the effect of cochlear implantation on the function of the semicircular canals (SCC) and on experienced vestibular symptoms. Second, to determine the relation between vestibular test results. DESIGN: Retrospective cohort study assessing absolute and categorised results of caloric irrigation test, video Head Impulse Test (vHIT) and Dizziness Handicap Inventory (DHI) before and after cochlear implantation.Study sample: 192 patients, aged ≥7 years old, without preoperative areflexia. RESULTS: Mean maximum slow phase velocity decreased with 3.1°/s and 4.7°/s for warm and cold caloric irrigation respectively. About 37.4% of the patients deteriorated one or more categories on caloric testing. Complete caloric postoperative areflexia was found in 6.2%. Mean vHIT gain decreased with 0.06, 0.04 and 0.05 for anterior, lateral and posterior SCC, respectively. Seven patients (7.7%) acquired an abnormal gain value for the anterior SCC. Only mean score on DHI's physical subdomain rose significantly (1.4 points). Overall, 9.0% of the patients deteriorated one or two categories on DHI. Only few weak correlations were found between caloric test, vHIT and DHI shifts. CONCLUSIONS: Although mean objective and subjective-physical vestibular deteriorations were significant, its clinical impact seems limited. However, 9% of patients experience vestibular deterioration, thus, advocate assessment. Vestibular test results show no or merely weak mutual correlations

Auf Tribenzotriquinacen und Fulleren basierende supramolekulare Aggregate: Baukastenprinzip funktioneller Nano-Module

Im Rahmen der vorliegenden Arbeit wurden zwei neuartige Rezeptoren synthetisiert, die eine optimierte Passform für C60 besitzen. Die anschließenden spektroskopischen Untersuchungen mit C60 haben Aufschluss über die Zusammensetzung und die jeweilige Stärke der Wirt-Gast-Komplexe in Lösung gegeben. Diese grundlegende Selbstorganisations-Strategie aufgreifend, konnte der variable Einsatz von Rezeptor-Bausteinen und funktionalisierten Fullerenen, ebenfalls mittels Komplexierungsstudien, gezeigt werden. Diese Ergebnisse geben das positive Signal, dass weitere Untersuchungen zu molekularen Ratschen und Motoren auf dieser Basis möglich und sinnvoll sind. Um elementare Erkenntnisse zur Fixierung von Tribenzotriquinacenen auf Oberflächen realisieren zu können, wurde abschließend ein am "Rückgrat" funktionalisiertes Tribenzotriquinacen synthetisiert. Dieses konnte in einer gemischten Monolage zusammen mit Hexan- bzw. Decanthiol auf Gold-(111) immobilisiert und mit einem Rastertunnelmikroskop detektiert und untersucht werden.In the present doctoral thesis two novel receptors have been synthesized that provide a structurally optimized fit for fullerene C60. The subsequent spectroscopic studies with C60 gave information about the composition and the respective strengths of the host-guest complexes in solution. By picking up this basic self-organization strategy, the variable use of receptorblock and functionalized fullerenes was demonstrated by using spectroscopic studies as well, whereby the possible feasibility of molecular ratchets and motors was confirmed. Finally, a backbone-functionalized tribenzotriquinacene was synthesized, immobilized as a mixed monolayer with hexane- or decanethiol on gold-(111) and detected and investigated with a scanning tunneling microscope to carry out basic studies on surfaces