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    <recommendedItem id="20100101_19_191"
                     title="Dissolving Implant Aids Nasal Surgery (CME/CE)"
                     score="-0.005"
                     href="http://www.medpagetoday.com/Surgery/PlasticSurgery/tb/18027?impressionId=1265798930662"
                     
      &lt;p&gt;A polymer-based, resorbable plate implanted in the nose as part of extracorporeal surgery to repair deviated septums appeared to improve outcomes, researchers said.&lt;/p&gt;
&lt;p&gt;Rhinomanometry confirmed that almost 82% of 396 patients receiving the polydioxanone implants at two centers achieved &quot;remarkably improved nasal flow&quot; according to Miriam Boenisch, MD, PhD, now of Medicent Linz in Linz, Austria, and Gilbert J. Nolst Trenit&amp;#233;, MD, PhD, of the University of Amsterdam in the Netherlands.&lt;/p&gt;
&lt;p&gt;No cases of perioperative complications such as bleeding, septal hematomas, inflammatory reactions, or necrosis were reported. &quot;Postoperative crusts disappeared after two weeks in almost all patients,&quot; Boenisch and Nolst Trenit&amp;#233; wrote in the January issue of the &lt;em&gt;Archives of Facial and Plastic Surgery&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Slight septal thickening, lasting some three weeks and disappearing over two months, occurred in 19 patients, they added.&lt;/p&gt;
&lt;p&gt;&quot;To date, we have encountered no short- or long-term complications as a consequence of the use of polydioxanone plate,&quot; the researchers wrote, adding that cosmetic results have been good as well, with up to 10 years of follow-up.&lt;/p&gt;
&lt;p&gt;&quot;The fundamental surgical goal, straightening of the nasal septum, was achieved in about 87% of patients. From the patients&apos; viewpoint, the success rate for improvement of nasal breathing was even higher and was supported by rhinomanometry results,&quot; according to the report.&lt;/p&gt;
&lt;p&gt;However, the study had no control group and reflected the experience of two centers in Austria, in Linz and Steyr.&lt;/p&gt;
&lt;p&gt;Boenisch and Nolst Trenit&amp;#233; reported that the first patients were treated treated with the polydioxanone plates in 1996.&lt;/p&gt;
&lt;p&gt;The material is water soluble and is completely resorbed by the body over a period of weeks. Polydioxanone plates have a long history in restoration of bone discontinuities, the researchers noted.&lt;/p&gt;
&lt;p&gt;Physicians at the centers believed such plates could help make extracorporeal septum repair  --  in which the septum is removed from the nose, reshaped, and perhaps augmented for reimplantation  --  more feasible for patients with extensive defects not reparable with conventional methods.&lt;/p&gt;
&lt;p&gt;Boenisch and Nolst Trenit&amp;#233; described a general procedure in which septal cartilage was removed and sutured to a custom-cut piece of polydioxanone for reimplantation.&lt;/p&gt;
&lt;p&gt;In patients with insufficient septal cartilage to create a full new septum, additional cartilage was harvested from their ears. In addition to the polydioxanone plate, foil made of the same material was used to stabilize the construction.&lt;/p&gt;
&lt;p&gt;A total of 47 patients required such compound grafts, including five in which the new septum was made entirely of ear cartilage.&lt;/p&gt;
&lt;p&gt;All but about 5% of the procedures, including those with compound grafts, could be completed in a single outpatient session, the researchers reported.&lt;/p&gt;
&lt;p&gt;The journal report included serial photographs of three patients before and after the procedures.&lt;/p&gt;
&lt;p&gt;One set showed a patient, six days after surgery, whose appearance was essentially normal, except for a scab at the base of the septum. Six months later, he appeared to be completely healed.&lt;/p&gt;
&lt;p&gt;Boenisch and Nolst Trenit&amp;#233; reported that one patient in the series needed revision surgery due to a nasal trauma suffered a month after the reconstruction. The patient originally had a so-called saddle deformity because of trauma, and the new injury caused it to recur after the polydioxanone resorbed.&lt;/p&gt;
&lt;p&gt;The researchers said the revision, performed seven months after the first attempt, involved a compound graft including ear cartilage, and healed well.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;No external funding for the study was reported. The polydioxanone plates and foil were supplied by Johnson &amp;amp; Johnson.&lt;/p&gt;&lt;p&gt;The researchers reported no potential conflicts of interest.&lt;/p&gt;&lt;p&gt;Boenisch analyzed the data as part of a PhD dissertation at the University of Pecs, Hungary. Medicent Linz, where she currently works, is part of a chain of private clinics in Austria.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_182"
                     title="Kids with Bionic Ears Have Trouble Controlling Their Voices (CME/CE)"
                     score="-0.005"
                     href="http://www.medpagetoday.com/Surgery/Otolaryngology/tb/18018?impressionId=1265798930662"
                     
      Although children who are deaf may be able to hear when fitted with cochlear implants in both ears, they have a more difficult time controlling their voices than kids with normal hearing, a single-center study showed.&lt;br&gt;
&lt;br&gt;Children with bilateral implants had deficits in controlling both the pitch and loudness of their voices when making a sustained &quot;ahh&quot; sound (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001 for both), according to Karen Gordon, PhD, of the Hospital for Sick Children in Toronto, and colleagues.&lt;br&gt;
&lt;br&gt;Pitch control, however, improved significantly the longer the implants were used (&lt;em&gt;P&lt;/em&gt;=0.03), the researchers reported in the January issue of &lt;em&gt;Archives of Otolaryngology  --  Head &amp;amp; Neck Surgery.&lt;/em&gt;&lt;br&gt;
&lt;br&gt;&quot;The more experience one has with hearing, the better able to produce voice they have,&quot; Gordon said in an interview.&lt;br&gt;
&lt;br&gt;The number of children who receive cochlear implants for deafness has been increasing steadily over the past two decades, and it is now common, she said.&lt;p&gt;&lt;/p&gt;
&lt;p&gt;The implants directly stimulate the auditory nerve to compensate for a nonfunctioning cochlea, regardless of the reason for the deafness.&lt;/p&gt;
&lt;p&gt;At the Hospital for Sick Children, a multidisciplinary team  --  including an audiologist, otolaryngologist, social worker, speech language pathologist, and auditory verbal therapist  --  assesses each child&apos;s suitability for the implants.&lt;/p&gt;
&lt;p&gt;&quot;We really look at the child, their candidacy from a hearing point of view, their expectations for what the implant can do for them, whether they&apos;re up for the surgery, and whether they&apos;re up for the therapy that&apos;s involved afterward,&quot; Gordon said.&lt;/p&gt;
&lt;p&gt;Although children with cochlear implants are able to hear, it&apos;s unclear exactly what their perception of sound is, she said. All must go through therapy lasting about two years to be able to interpret what they&apos;re hearing.&lt;/p&gt;
&lt;p&gt;However, the voicing of children with the implants compared with that of kids with normal hearing has not been extensively studied.&lt;/p&gt;
&lt;p&gt;So Gordon and her colleagues evaluated how 27 children with bilateral implants  --  ages 3 to 15  --  were able to control their voices, finding poorer control of long-term frequency perturbation (pitch) and long-term amplitude perturbation (loudness) compared with those with normal hearing.&lt;/p&gt;
&lt;p&gt;&quot;Despite the incredible opportunities that cochlear implants provide for auditory and linguistic development, abnormalities in acoustic voice outcomes persist,&quot; they wrote.&lt;/p&gt;
&lt;p&gt;However, through a four-month follow-up, pitch control  --  but not loudness control  --  improved significantly with increased implant use.&lt;/p&gt;
&lt;p&gt;&quot;This result underlines the importance of early recognition and treatment of children with hearing loss to provide auditory experience as soon as possible,&quot; the researchers wrote.&lt;/p&gt;
&lt;p&gt;However, the use of cochlear implants is not free of complications, according to another study in the same issue of the journal by Natalie Loundon, MD, of the H&amp;#244;pital d&apos;Enfants Armand-Trousseau in Paris, and colleagues.&lt;/p&gt;
&lt;p&gt;Among 434 children younger than 16 who received the devices, 9.9% had complications, nearly two-thirds of which occurred more than eight days after implantation (mean 2.2 years).&lt;/p&gt;
&lt;p&gt;Major complications included severe cutaneous infections or hematoma, magnet displacement, meningitis, cholesteatoma, cerebrospinal fluid leak, and electrode misplacement.&lt;/p&gt;
&lt;p&gt;Minor complications included vertigo, soft-tissue infection, persistent otitis media, and facial nerve palsy.&lt;/p&gt;
&lt;p&gt;A large minority of those with complications (30.2%) required reimplantation.&lt;/p&gt;
&lt;p&gt;Trauma to the mastoid area and inner ear malformations were risk factors for delayed major complications and early minor complications, respectively (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001 for both).&lt;/p&gt;
&lt;p&gt;Age at implantation was not associated with complication risk.&lt;/p&gt;
&lt;p&gt;&quot;The finding of complications several years after surgery highlights the need for long-term medical follow-up in this population and the importance of repeatedly providing information to the patients and their family,&quot; Loundon and colleagues wrote.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;None of the authors of either of the studies made any financial disclosures.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_1_592"
                     title="Listen Up: Cradle to Grave, Many Americans Can?��t Hear What is Being Said"
                     score="-0.006"
                     href="