Ear Consultants of Georgia

Analyze indications, findings, and outcomes of revision procedures for a totally implantable active middle ear implant (AMEI) over the past 17 years. Retrospective review. Single institution, private practice setting. Adult patients using a totally implantable AMEI called the Esteem middle ear implant by Envoy Medical who needed revision to their original implant between 2005 and 2022. Thirty-nine patients had 60 revision procedures. History of a totally implantable AMEI revision procedure. Indications for revision were related to either surgical wound issues or reduced device function. Device diagnostics, audiometric outcomes, and documented subjective report. Surgical site wound issues were readily corrected in the majority of patients; most had risk factors for wound breakdown. For sterile wound dehiscence, it was not always necessary to remove the sound processor for an extended time to promote healing. Outcomes for revision procedures because of device issues ranged from 31 to 100% success rate, depending on the cause of issue. The most common indication for revision was reduced device function caused by scar band and/or fibrotic tissue accumulation in the middle ear. Revision of fully implantable AMEI can be successful for many indications. Appropriate preoperative device troubleshooting and medical evaluation is helpful in identifying the issue and determining surgical approach. Suboptimal device function and feedback can sometimes be improved by removing tissue around the implant, although permanency of this procedure varies among patients.

(Am J Obstet Gynecol. 2020;222:372.e1–372.e10) Enhanced recovery after surgery (ERAS) involves multiple changes in perioperative care to improve patient outcomes, reduce postoperative patient stay, and standardize postoperative patient care to optimize patient satisfaction levels. Currently, no randomized studies exist addressing possible postoperative impacts of ERAS for cesarean deliveries. This study aimed to investigate whether the implementation of an ERAS pathway versus standard care could improve patient satisfaction and reduce the postoperative length of stay for patients undergoing cesarean deliveries.

1) To provide long-term hearing outcome measures of a totally implantable hearing system (implant) and compare to the baseline unaided (BLU) and baseline aided (BLA) conditions, and 2) discuss relevant safety measures. Prospective, nonrandomized, multicenter, single-subject-as-own-control design. Fifty-one subjects with mild to severe sensorineural hearing loss were implanted between 2008 and 2009 and enrolled in this postmarket approval study in the setting of private and hospital-based practices. Forty-nine of these subjects completed the 5-year study, which included annual follow-ups. Primary effectiveness endpoints were speech reception threshold (SRT) and word recognition scores at 50 dB (WRS50s). Secondary effectiveness endpoints were WRSs and the Abbreviated Profile of Hearing Aid Benefit (APHAB) scores. Adverse Device Effects (ADEs) and Serious Adverse Device Effects (SADEs) reported during the study period and a comparison of bone conduction scores are submitted as safety measures. Compared to the BLA condition, 1) SRT scores were improved at every annual follow-up; 2) WRS50s were better in 49%, and the same in 41% at the 5-year follow-up; 3) WRSs were improved by 17% at the 5-year follow-up; and 4) APHAB scores were improved in most subscales at every annual follow-up. There were three SADEs in three subjects and 15 ADEs in 11 subjects. Bone conduction scores increased by 3.7 dB at the 5-year follow-up. Average battery life was 4.9 years. The implant compared favorably to the subjects' hearing aid throughout the 5-year period in all of the areas measured and was found to be safe. 2b. Laryngoscope, 128:210-216, 2018.