Objectives: To understand the growth rate of mastoid thickness and skull width associated with the age for both normal and malformed inner-ear anatomy groups. Also, to determine if there is any mathematical relation between cochlear size as measured by the “A” value against the age, mastoid thickness, and skull width. Methods: Ninety-two computed tomography image datasets of human temporal bone were made available that contained normal (n = 44) and malformed inner-ear (n = 48) anatomies. The age of the subjects ranged from 6 months to 79 years. CE marked OTOPLAN preplanning otology software was used to load the patient's preoperative images for making all the measurements including mastoid thickness, skull width, and the cochlear size as measured by the “A” value. Mastoid thickness was measured both in axial and coronal planes starting from the cochlear entrance to the skull surface, with the line in plane with the basal turn of the cochlea. Skull width was measured from side to side in both axial and coronal planes from the image slice that gave the highest width. The cochlear size in terms of basal turn diameter “A” was measured from “Cochlear View” in the oblique coronal plane. Results: Mastoid thickness and skull width increased with age in a logarithmic manner. The mastoid thickness increased from a minimum of 17 mm to around 34 mm and the skull width increased from 105 mm to around 146 mm as the age increased from 6 months to 20 years. At the age of around 20, both the mastoid thickness and skull width reached the plateau and thereafter with a very little growth. The skull width was linearly correlated with the mastoid thickness conveying the fact that bigger the head size is, thicker will be the mastoid. The size of the cochlea as measured by the “A” value did not have any meaningful correlation with the age, mastoid thickness, and skull width. This conveys the message that the cochlear size is independent of the overall size of head and the age of patient. Conclusions: Mastoid thickness and skull width increased with age, while the cochlear size was independent of age, mastoid thickness, and the size of the skull.

In early 2021, vaccination against COVID-19 became one of the most important measures needed to control the pandemic. This study aimed to investigate the levels of acceptance and factors affecting the decisions among Saudi parents and caregivers of children under 12 for getting them vaccinated. A cross-sectional survey of 1000 caregivers and parents was carried out from May 2021 to June 2021. The participants were from the eastern, central, southern, western, and northern provinces of Saudi Arabia. The data were collected and managed using Microsoft Excel (Microsoft^® Corp., Redmond, WA) and analyzed using SPSS version 23 (IBM Corp., Armonk, NY). Of the 1000 respondents, 281 (28.1%) reported they would vaccinate their children, 346 (34.6%) rejected vaccination, and 373 (37.3%) were not sure. Most caregivers (24.1%; n = 241) reported protecting children as the principal reason for accepting vaccination. Regarding those rejecting the vaccine, the most common concern was that children might experience side effects (42.9%; n = 429). The acceptance of the COVID-19 vaccine is dynamic and changes with legislations and public awareness policies. COVID-19 vaccine acceptance for children was low at the time of this study compared to the United Kingdom and United States. To achieve vaccination coverage that is adequate for herd immunity in Saudi Arabia, intense educational and awareness strategies are needed.

Background: Auditory neuropathy spectrum disorder (ANSD) is a distinct type of SNHL that is characterized by the presence of otoacoustic emissions and/or cochlear microphonics. Cochlear implantation was initially not recommended for ANSD children, later studies showed variable outcomes among those subjects. Objective: To assess the auditory and speech performance of cochlear implanted children with auditory neuropathy spectrum disorder (ANSD) and to compare these results to those obtained from cochlear implanted children with sensorineural hearing loss (SNHL) Material and methods: 18 cochlear implanted children with ANSD and 40 cochlear implanted children with SNHL were included in this study. Auditory and speech performance results were compared across both subject groups using the Category of Auditory Performance (CAP) and Speech Intelligibility Rate (SIR) tests, with measurements recorded one year post implantation. Results: Cochlear implanted children with ANSD showed clinically significant improvements that were comparable to those observed from cochlear implanted subjects without ANSD. Conclusions: Children with ANSD benefit from early cochlear implantation and can reach similar auditory and speech performance results as that achieved by children without ANSD.

Background and Objectives: Electrode migration after cochlear implantation (CI) is a rare complication that accounts for 1to 15% of all revision surgery. This study is a systematic review of the literature for investigating the knowledge and approaches to the incidence of electrode migration after CI. Methods: A systematic electronic search of the literature was carried out using PubMed, Cochrane, Virtual Health Library, Scopus and Web of Science (ISI). All original articles that reported electrode migration after CI surgery were included. The Newcastle-Ottawa Scale and CARE checklist were utilized for the assessment of the risk of bias. Descriptive data analysis was performed using SPSS software. Results: A total of 26 studies including 4,316 patients were included. Out of them, 289 patients had electrode migration following CI. To diagnose electrode migration, traditional computed tomography scan was used in 13 studies, while cone-beam computed tomography was applied in three studies. In addition, electrode migration was detected during intraoperative exploration in eight studies. The most common presenting symptom was change in sound/poor performance (n = 43) followed by pain sensation (n = 15) and facial nerve stimulation (n = 10). Cholesteatoma was the most common associated pathology (n = 10) followed by infection (n = 9) and ossification of the basal turn of the cochlea (n = 8). Conclusion: Electrode migration is a major complication of CI and could be more common than previously thought. As it may occur with or without clinical complaints, long-term follow-up through routine radiological scanning is recommended. Further studies are warranted to identify the underlying mechanism of electrode extrusion and the appropriate fixation method.

OBJECTIVES: To evaluate the feasibility of performing cochlear implantation under conscious sedation (CS) as day surgery with same-day fitting. MATERIALS and METHODS: All patients underwent cochlear implantation under CS between November 2017 and April 2018. The data collected included demographic information, preoperative clinical characteristics, surgical details, postoperative fitting information, and side effects, if any. RESULTS: Nine patients had 11 cochlear implants (CIs) placed under CS (2 patients received bilateral CIs). One patient’s data were excluded from the audiological results because conversion to general anesthesia (GA) was necessary. One patient (11%) vomited just before the end of the procedure. Seven patients had uneventful procedures. Eight (88%) patients were discharged home the same day. There was a statistically significant difference in recovery time between the CS group and the GA group (t=-2.26, df=12, p<0.05). In the CS group, there was no statistically significant change in the maximum comfortable loudness level for all electrodes from the day of the surgery to the following day. However, there was a statistically significant difference in the threshold levels of all electrodes from the day of the surgery to the following day (Z=-2.04, N=120, p<0.05). Further analysis revealed a statistically significant difference in the four most apical electrodes (Z=-3.496, N=40, p<0.0001), but not in the middle or basal electrodes. CONCLUSION: Cochlear implantation can be performed under CS with careful patient selection. This approach facilitates same-day fitting and day surgery by minimizing comorbidity. Cite this article as: Aldhafeeri AM, Saleh S, Almuhawas F, Hagr A. Feasibility of Day Surgery for Cochlear Implantation under Conscious Sedation with Same-Day Fitting. J Int Adv Otol 2020; 16(3): 303-8.

Objectives: The growing adoption of cochlear implants (CIs) necessitates understanding the factors influencing long-term performance and improved outcomes. This work investigated the long-term effect of early activation of CIs on electrode impedance in a large sample of CI users at different time points. Methods: A retrospective study on 915 ears from CI patients who were implanted between 2015 and 2020. According to their CI audio processor activation time, the patients were categorized into early activation (activated 1 day after surgery, n = 481) and classical activation (activated 4 weeks after surgery, n = 434) groups. Then, the impact of the activation times on the electrode impedance values, along the electrode array contacts, at different time points up to two years was studied and analyzed. Results: The early activation group demonstrated lower impedance values across all the electrode array sections compared to the classical activation at 1 month, 1 year, and 2 years post-implantation. At 1 month, early activation was associated with a reduction of 0.34 kΩ, 0.46 kΩ, and 0.37 kΩ in the apical, middle, and basal sections, respectively. These differences persisted at subsequent intervals. Conclusions: Early activation leads to sustained reductions in the electrode impedance compared to classical activation (CA), suggesting that earlier activation might positively affect long-term CI outcomes.