Many of the people who seek hearing healthcare services have compromised immune systems that make them unusually susceptible to common microorganisms that, under certain conditions, can cause localized infection or systemic disease. Dispensing environments draw patients from all age and socioeconomic groups and who come in with a wide range of underlying diseases and history of pharmacologic interventions. These are all factors with potential implications for a person's immune system. In a clinical environment where patients may be especially vulnerable to opportunistic infections, infection control procedures play a critical role in reducing cross-contamination and the risk of disease. Hand washing and other aspects of good hygiene are basic and necessary infection control procedures. However, they are not enough. In their handling of hearing aids and of reusable instruments that come in contact with hearing aids, dispensing professionals must also be vigilant about taking measures to minimize the potential for cross-contamination. Hearing aids have been identified as a potential source of microbial transmission. In an earlier investigation, Bankaitis found light to heavy amounts of microbial growth on hearing aid surfaces, which included both expected and unexpected strains of bacteria and/or fungi.1 While some of the recovered microorganisms were consistent with what would be expected to be found in the external auditory canal (e.g., Staphylococcus, diphtheroids, fungal spores), most were not. Furthermore, several of the microorganisms found were extremely virulent (e.g., Staphylococcus aureus, Pseudomonas aeruginosa), and others were considered exceptionally unhygienic. For example, several hearing aids were contaminated with light to heavy amounts of bacteria (Enterococci) specifically found in fecal matter. While that study provided initial evidence on contamination of hearing aid surfaces, it evaluated only one hearing aid from each subject. Thus, it did not determine if the microbial composition on a pair of hearing instruments worn by the same subject would vary between ears. The primary purpose of this study was to determine what microbial growth would be detected on the surfaces of hearing aids from a different pool of subjects. A second purpose was to compare the microbial composition between hearing aids worn by the same subject. METHODOLOGY Subjects Twelve hearing aid patients from the Section of Communication Disorders and Sciences of the Department of Otolaryngology at Rush University Medical Center in Chicago participated in this study. The eight males and four females were people who had arrived at an audiology or otolaryngology clinic while wearing hearing aid(s). They were informed of the proposed study near the start of their scheduled appointment and asked to volunteer. This resulted in the sequential selection of subjects. The subjects ranged in age from 7 to 97 years with a mean of 51.2 (SD = 26.7 years). All but two were over age 18. All the patients had been previously fitted with custom hearing instruments and had worn them for at least 2 weeks. Of the 12 subjects, half were bilateral hearing aid wearers and half wore only one, so there were 18 hearing aids in all. After obtaining informed consent, the primary researcher removed the hearing aids from the subjects' ears and swabbed. Specimen collection The researcher used the Copan Transport Stuart System (made by Copan Diagnostics, Inc.). This culturette system consists of two dry, sterile, rayon-tipped swabs individually anchored to a plastic cap. The swabs are encased in a container comprising a plastic tube topped off with a plastic cap. Before a hearing aid was removed from a subject's ear, the culturette system was removed from its sealed packaging. The researcher then removed the hearing aid from the subject's ear using gloved hands. After taking the cap off the culturette system, the investigator obtained hearing aid cultures by aligning both tips of the swabs on hearing aid surfaces and simultaneously swabbed the entire outer surface of the hearing aid. Once the specimen was collected, the swabs were re-inserted into the original tube until both tips were in direct contact with the system's soft polyurethane foam sponge. The sponge was soaked with 1.0 ml of liquid transport medium to activate the culture. The specimen was then labeled using a coding system to ensure anonymity. After a specimen was collected, the researcher performed an otoscopic examination to ensure there was no active outer or middle ear disease or perforation of the tympanic membrane. The collected specimens were sent directly to Rush Medical Laboratories in the Division of Clinical Microbiology for analysis. The lab technician randomly chose one swab for routine bacterial identification and the other for routine fungal identification. RESULTS Table 1 lists the bacterial and/or fungal microorganisms recovered from the surfaces of the 17 hearing aids for which analysis could be completed. (Due to funding issues, analysis of hearing aid 18 [from subject 12] could not be completed.)Table 1: Results of microbial growth recovered from hearing aid surfaces.Six different bacteria and three fungi were isolated from the group of hearing aids swabbed. The majority of hearing aids (14 of 17 or 82%) were contaminated with at least one bacterium, with Coag Neg staphylococcus recovered from 71% (12/17) of the hearing aids. Nearly one-third (5/17 or 29%) contained two or more independent bacteria, including Coag Neg staphylococcus, Staphylococcus aureus, Pseudomonas aeruginosa, Diphtheroids, klebsiella pneumoniae, and unidentified gram-positive rods. In addition to bacterial growth, 24% (4/17) of the hearing aids were contaminated with unspecified fungal growth. Of the 11 subjects for whom data were available, 6 were bilateral hearing aid wearers. As shown in Table 2, in five of the six hearing aid pairs, the bacterial and/or fungal growth differed between the two ears.Table 2: Comparison of microbial growth recovered from hearing aid pairs worn by binaural hearing aid subjects.DISCUSSION The predominant organism recovered was Coag Neg Staphylococcus, found on 12 of 17 hearing aids. Five other bacteria and three unidentifiable fungi were recovered from most of the hearing instrument surfaces. A small number of hearing aids (3/17 or 17%) came back negative from the lab, indicating no microbial growth. Of the 14 contaminated with microbial growth, 6 (42%) exhibited unique bacterial and/or fungal combinations not observed on any other hearing instrument. The remaining eight hearing aids exhibited microbial compositions that were the same as at least one other hearing aid in that group. Microbial growth creates risk Finding light to heavy amounts of microbial growth on hearing aid surfaces is not surprising, particularly since some of the recovered bacteria and fungi reside in abundance throughout the environment. For example, Coag Neg Staphylococcus, found on 12 of the 17 hearing instruments, thrives on skin surfaces and is typically cultured, along with other micro- organisms, from the external auditory canal.2,3 Given the ubiquitous nature of this bacterium, its presence on hearing aid surfaces is not unexpected. However, microbial growth on hearing aid surfaces creates significant concerns from an infection control perspective. Staphylococcus is a bacterium represented by various species and subspecies, and is traditionally classified into one of two groups according to whether or not the specific species produces the blood-clotting enzyme coagulase.4S. aureus is the only species of staphylococcus found in humans that produces coagulase; therefore, all species of staphylococcus not identified as S. aureus, including S. albus and S. epidermis, may be generically referred to as Coag Neg staphylococcus.4 In other words, 12 of the 17 hearing aids contaminated with Coag Neg Staphylococcus were most likely contaminated with more than one species of Staphylococcus. Secondly, Coag Neg Staphylococcus accounts for the highest rates of nosocomial (hospital-acquired) infection. Even though this bacterium is found in abundance throughout the environment, when it comes in contact with an individual whose immune system is weakened, Coag Neg Staphylococcus can cause serious, even life-threatening, infection and disease.4 In the context of the dispensing environment, the potential for disease transmission must be taken seriously. The external auditory canal is an orifice that can serve as a portal for microorganisms to enter the body. If inadequate infection control causes a hearing aid to become contaminated with microbial organisms not part of the individual's normal ear canal flora, when that instrument is inserted into the ear canal, it gives microorganisms uncontested access to a dark, warm, and moist environment. When obstructed by a hearing instrument or earmold, the ear canal becomes an even warmer, darker, and moister environment, one that changes the pH balance of cerumen and results in an environment conductive to microbial proliferation. In the event the patient exhibits any degree of immunocompromise due to either underlying disease (e.g., diabetes), age (pediatric or geriatric patients), or medical history (chemotherapy, pharmacological intervention), given the right conditions, even seemingly innocuous microorganisms can become very aggressive, causing localized or systemic infection and disease.5 Infection can be spread between a patient's ears In her initial study, Bankaitis warned of the need to assess infection control practices in the dispensing clinic, and she emphasized the potential for cross-contamination when a clinician handles hearing aids from multiple patients. The results of the present study not only warrant reiterating these warnings, but also raise an additional concern about the potential risk of handling two hearing aids from the same bilaterally fitted patient without adhering to appropriate infection control principles. In this study, unlike the earlier one, six hearing aid pairs were obtained from six bilateral wearers. Five of the six hearing aid pairs were found to have differing microbial compositions from ear to ear. For example, hearing aid B, worn by subject 1, was contaminated with Coag Neg Staphylococcus, while hearing aid A from the same patient was contaminated with three different bacteria. Thus, cross-contamination becomes an issue even when the clinician is working with only one person. If a clinician handles a patient's right hearing aid with unwashed, bare hands and then, still without washing his or her hands, handles that patient's left hearing aid, the result may be to contaminate the left hearing aid with what was on the right hearing aid. When the instruments are put back on the patient, both ear canals may be exposed to microbial organisms not found among the natural flora of that particular ear canal. If the patient has a compromised immune system, even common microbes could become opportunistic and expose the patient to potentially pathogenic bacteria and/or fungi. This study provides further evidence to support Bankaitis's earlier findings regarding the presence of bacterial and fungal growth on hearing aid surfaces. While additional research is needed to help ascertain if disease transmission does take place in the hearing aid dispensing environment, the Occupational Safety and Health Administration (OSHA) has developed and outlined specific regulations that provide clear direction as to what is expected in terms of infection control in settings where patients receive care. To ensure that clinicians effectively apply OSHA standards in the dispensing environ- ment, hearing aid-specific infection control protocols must be implemented that will minimize the potential for contamination and disease transmission in the clinic.
(1) To report on the results and complications arising from using a minimal tissue removal procedure for the placement of an osseointegrated hearing implant. (2) To comment on the advantages and disadvantages for this technique compared to current standard techniques.Case series with chart review; 2008-2010.Tertiary care facility.All consecutive patients undergoing osseointegrated hearing implant surgery with a minimal tissue removal technique were reviewed.A small incision (1.5 cm) with little to no soft tissue (fat only) removal with good skin to periosteum fixation after placement of implant and abutment.Thirty-one adults were assessed (aged 18-86, range of follow-up 3-45 months). No patients experienced hair loss, significant numbness, cosmetic defects, or intraoperative or audiologic complications. Eight patients required some combination of antibiotic ointment, steroid ointment, and/or oral antibiotic for mild erythema around the abutment, and 3 patients required soft tissue revision. Five children under the age of 18 were also assessed. One of these patients required soft tissue revision in the operating room and 1 required removal of the implant.We have demonstrated comparable outcomes to other surgical techniques with less cosmetic and other associated complaints. This study indicates that a less invasive approach for the surgical implantation of the osseointegrated auditory implant may have merit.
Objectives: (1) Describe a classification for the sinus tympani (ST) different types based on their otoendoscopic and surgical anatomy in relation to their development theories. (2) Evaluate possible approaches to each of its types. (3) Eliminate the discrepancy between the various methods used to describe it in literature. Methods: Fifty‐five temporal bones were dissected, and the anatomic details were studied using an operating microscope and otoendoscopes of different angles. In addition, the ST anatomy and relations were studied in 200 temporal bones’ computed tomography scans. Results: Four distinct types of ST could be observed. Type 1, the most common type, was pneumatized and consisted of an orifice and cavity. In Type 2, the well‐pneumatized type, the cavity was deep enough posteriorly to exceed the level of the mastoid segment of the facial nerve in any direction. In Type 3, the common posterior tympanic sinus, ST communicated with the upper posterior tympanic sinus proper or with a retro‐ponticulus up‐ward extension. Type 4, the nonpneumatized type, was shallow with no true orifice and cavity. Types 1 and 4 were mainly approached via the transcanal route. Types 2 and 3 required a combined transcanal and transmastoid approach. Endoscopic transcanal approach alone was satisfactory for types 1 and 4 but to a lesser extent in type 3. Conclusions: ST shape and extension both depend mainly on the extent of its pneumatization, which in turn influences its relation to the surrounding structures in the retrotympanic area. Extensively or unusually pneumatized types need special or combined approaches.
Pneumomediastinum may be produced by a simple facial fracture. It may also be a sign of other aerodigestive tract injuries, and this possibility should be ruled out. A minimal patient workup should include panendoscopy and soft tissue neck x-ray films in all cases. If no other injuries are found, resolution of the pneumomediastinum may be expected without further treatment.
Arachnoid cysts of the posterior fossa are rare. When arachnoid cysts are encountered, the presenting symptoms are frequently otologic, with hearing loss and imbalance occurring commonly. Three cases are presented with a previously unreported otologic symptom, that of bilateral hearing loss, which in one case was fluctuant. None of the patients had the common symptoms of unilateral hearing loss and headache. With the advent of computed tomography and magnetic resonance imaging, these cysts may be readily identified, usually with diagnostic imaging alone. Unfortunately there is often a delay in diagnosis because of the vague and fleeting nature of the symptoms. Because no single diagnostic symptom pattern is able to characterize all cases, it is believed computed tomography or magnetic resonance imaging or both are indicated in patients with long‐standing otologic complaints—even in the absence of unilateral symptoms. Treatment of posterior fossa arachnoid cysts primarily consists of surgical procedures designed to decompress the cyst. In this series, treatment with diuretics alone resulted in improvement of symptoms duirng several years of followup, with no evidence of enlargement of the cysts.
Mobius syndrome is characterized by congenital facial diplegia, frequent impairment of gaze, variable involvement of other cranial muscles, and various musculoskeletal anomalies. The site of dysfunction remains debatable. We performed detailed electrophysiologic studies in 5 children and 2 adults with Mobius syndrome to better delineate the pathophysiology of this disorder. Sensory and motor conduction studies were normal in the extremities. Facial compound muscle action potential amplitudes were reduced in all patients. The blink reflex R1 responses were unobtainable unilaterally in 2 patients and unobtainable bilaterally in 3 patients. Otherwise, R1 and R2 latencies were variably prolonged. The jaw jerk and masseter silent periods, tested in 2 patients, were normal. Detailed electromyographic studies of facial muscles revealed multifocal, chronic neurogenic changes. The findings indicate a brain stem process predominantly affecting the facial nuclei and their internuclear connections rather than a supranuclear or muscular site of involvement.
Objectives:1- Describe the anatomical bases related to the concept of the functionalendoscopic tympanic surgery (FETS) based on the fact that restoring adequatetympanic cavity ventilation is one of the main key factors toachievethis concept and restore normal middle ear functions.2- Review and explain the possible theory and concept of the FETS in relationto these bases.Methods: Fifty-five temporal bones were dissected, and the ventilationpathways were studied utilizing otoendoscopes of different angles and anoperating microscope. In addition, the anatomy and relations of these pathwayswere studied in 200 temporal bones computed tomography scans(CT).Results:Theventilation pathways of the tympanic cavity (with all of its subdivisions)and the mastoid air cells were variable and unique for each temporalbone. Basically, the ventilation patterns could be classified either directlyfrom the eustachian tube or indirectly through communicating withotherspaces via mucosal, ligamental and/or bony apertures or isthmi. Mesotympanum,protympanum, hypotympanum and anterior epitympanum typeCwere the only spaces directly ventilated, while retrotympanum with all ofitsrecesses, anterior epitympanum types A and B, Prussak’s space, vonTroeltschpouches, compartments of posterior epitympanum (medial andlateralsuperior and medial incudal spaces), antrum and mastoid air cellswereindirectly ventilated. It was possible to approach most of the pathwaysendoscopicallyvia transcanal or combined transcanal and transmastoid approaches.Conclusions: Theoretically, ventilation pathways could be endoscopicallyapproached and therefore restored in certain cases. CT scans are a possibletool to study them.
ADVERTISEMENT RETURN TO ISSUEPREVArticleNEXTPhotocleavage of diarylnitrosamines in neutral mediaDavid S. Crumrine, Charles M. Brodbeck, Paul H. Dombrowski, Thomas J. Haberkamp, Rita J. Kekstas, Pat Nabor, Glenn S. Nomura, Henry A. Padleckas, David J. Suther, and James P. YonanCite this: J. Org. Chem. 1982, 47, 22, 4246–4249Publication Date (Print):October 1, 1982Publication History Published online1 May 2002Published inissue 1 October 1982https://pubs.acs.org/doi/10.1021/jo00143a013https://doi.org/10.1021/jo00143a013research-articleACS PublicationsRequest reuse permissionsArticle Views691Altmetric-Citations7LEARN ABOUT THESE METRICSArticle Views are the COUNTER-compliant sum of full text article downloads since November 2008 (both PDF and HTML) across all institutions and individuals. These metrics are regularly updated to reflect usage leading up to the last few days.Citations are the number of other articles citing this article, calculated by Crossref and updated daily. Find more information about Crossref citation counts.The Altmetric Attention Score is a quantitative measure of the attention that a research article has received online. Clicking on the donut icon will load a page at altmetric.com with additional details about the score and the social media presence for the given article. Find more information on the Altmetric Attention Score and how the score is calculated. Share Add toView InAdd Full Text with ReferenceAdd Description ExportRISCitationCitation and abstractCitation and referencesMore Options Share onFacebookTwitterWechatLinked InRedditEmail Other access optionsGet e-Alertsclose Get e-Alerts
