Common Cavity Research Articles

Direct Comparison of Impedance, Manometry, and pH Probe in Detecting Reflux Before and After a Meal

Combining GERD tests allows strengths and weaknesses of each method to be identified in detecting and characterizing reflux (RE). Aim of this study was to compare two methods that measure bolus volume of a refluxant (impedance monitoring (Imp) and manometry (common cavity)) to pH monitoring which measures changes in acid concentration of a refluxant. Nineteen symptomatic GERD patients and 10 normal volunteers were studied before and after a meal. All had 2-hr simultaneous manometry, pH, and Imp (six sites: 3, 5, 7, 9, 15, 17 cm above LES). Reflux by pH was a fall in pH from above to below 4. There were 973 RE's in all subjects, but only 19% were detected simultaneously by all three methods. Imp detected more RE's (96%) than manometry (76%) or pH probe (28%). Imp was the only method to detect 15% (144/973) of RE's, while detection only by pH probe (2%) or manometry (2%) was rare. Most RE's detected by Imp were detected simultaneously by manometry (75%,720/937). Those not detected by manometry were usually in blind spots either in the vulnerable period 2-3 sec after a swallow, during a posture change, or during a Valsalva. Most RE's detected by Imp were not detected by the pH probe. Though most liquid RE's fasting were detected by pH, most liquid postprandial RE's were not, due primarily to weakly acidic rather than superimposed acid RE's. Bolus clearing time by Imp and manometry was nearly identical, while acid clearing was threefold longer than bolus clearing by Imp or manometry. In conclusion, impedance monitoring is better than manometry and pH monitoring in RE detection before and after a meal, and manometry in determining RE composition as liquid or gas. The pH probe measures RE acidity and acid clearing. Simultaneous impedance and pH combines the two methods strengths, and is a powerful tool for reflux detection and characterization.

Cochlear Implantation in the Common Cavity Deformity

Cochlear Implantation in the Common Cavity Deformity

Cochlear Implantation in Children with Internal Ear Malformations

To evaluate surgical aspects and results of cochlear implantation in inner ear malformations. Retrospective cohort study. Ear, nose, and throat department of a tertiary referral hospital. Out of 260 implanted children, 18 (6.9%) had inner ear malformations: complex cochleovestibular malformation (n = 11), common cavity (n = 1), and enlarged vestibular aqueduct (EVA) (n = 6). Deafness was progressive in 12 cases (G1) and congenital in 6 cases (G2). Genetics lead to diagnosis in 12 of 13 cases: PSD mutation (n = 11), Waardenburg syndrome (n = 1), negative (1). Mean age at implant was 7.8 years. Mean follow-up period was 48 months. Medical and surgical outcomes were reported. Closed (CSW) and open (OSW) set word perception and level of speech production were evaluated each year. The results were compared pre- and postoperatively and between the two groups. Gusher at surgery was observed in 50% of cases, with a persistent leak in one case. No facial injury or infectious complications were observed. At 12 months, 83% of the population had achieved more than 75% recognition in CSW, versus 16% before implant (p = 0.001). After 2 years, 64% of patients had more than 50% recognition in OSW. Good oral language was seen in 76% at 2 years and 100% at 3 years, versus 55% before implant (respectively, p > 0.05 and p = 0.03). At 1 year after implant, 83% of the G1 and 20% of the G2 achieved more than 50% recognition in OSW (p = 0.02). After 24 months, 83% of G1 and 40% of G2 had more than 50% in OSW (p > 0.05). Before implant, 75% in G1 and 0% in G2 had good oral language (p = 0.01). At 1 year, 83% in G1 and 16% in G2 had good oral language (p = 0.02). At 2 years, 100% in G1 and 20% in G2 had good oral language (p = 0.02). One child in G1 had no improvement after implantation. No major complication was seen. Perceptive and linguistic results were variable and depended on the type of the deafness. In progressive deafness, the perceptive and linguistic result are expected to be good. In congenital deafness, the results are more variable.

Cochlear implantation for cochlear dysplasia

Profound sensorineural hearing loss secondary to cochlear dysplasia presents a number of surgical challenges during cochlear implantation. The standard transmastoid-facial recess approach can be performed in the majority of cases. In cases of common cavity deformity, the transmastoid labyrinthotomy approach has a number of advantages. A high incidence of CSF gushers occurs in this population but can be managed by creating a small cochleostomy and tightly sealing the cochleostomy with connective tissue. Acceptable postoperative speech perception results can be expected.

Double Posterior Labyrinthotomy Technique: Results In Three Med-El Patients With Common Cavity

This study reports on the use of the double posterior labyrinthotomy surgical technique and a custom-designed electrode to ensure better positioning of stimulating electrodes within the common cavity and thus demonstrate suitable outcomes in patients. Cochlear implantation has proven beneficial for numerous children with congenital malformations of the inner ear. Several studies show good auditory perception outcomes in children with common cavity. However, there have been risks involved with surgical techniques used in the actual implantation. These include possible aberrant facial nerve and the strong potential for a cerebrospinal fluid gusher. Improved surgical techniques and electrode design could allow for better electrode contact and avoid electrode placement in the internal auditory meatus. The double posterior labyrinthotomy technique was carried out in three cases using a custom made MED-EL COMBI 40+ electrode. Surgery was carried out with no complications and is no more technically demanding than other standard surgical approaches. The speech processor program remains stable over time, and auditory perception results are similar to those obtained from children with no cochlear abnormalities. These results demonstrate the success of the double posterior labyrinthotomy approach with modified cochlear implant, and this could be recommended as the procedure of choice in children presenting to an implant team with a common cavity.

Sleeve sensor versus high-resolution manometry for the detection of transient lower esophageal sphincter relaxations

Transient lower esophageal sphincter relaxations (TLESRs) are the most important mechanism by which gastroesophageal reflux occurs, and sleeve sensor manometry is the gold standard for detection of TLESRs. The aim of this study was to evaluate manometry with closely spaced sideholes (high-resolution manometry) for the detection of TLESRs as an alternative. In 12 patients with gastroesophageal reflux disease, a 90-min postprandial manometry was performed by using a catheter incorporating both a sleeve sensor and closely spaced sideholes in the esophagogastric junction. TLESRs recorded with both techniques were scored. Reflux during TLESRs was detected by using manometry (common cavity), intraluminal impedance, and pH monitoring. A total of 145 TLESRs were detected by using both techniques, 117 with high-resolution manometry and 108 with sleeve sensor manometry [not significant (NS)]. Manometric signs of reflux during TLESRs detected with high-resolution and sleeve sensor manometry were found in 62.4 and 56.5%, NS, respectively, versus 38.5 and 35.2%, NS on pH-metry and 70.1 and 60.2%, NS on impedance monitoring. TLESRs recognized only with high-resolution manometry were more often accompanied by reflux, as detected with manometry (59.5%) and impedance monitoring (67.6%), than TLESRs recognized only with sleeve sensor manometry (32.1 and 28.6%). High-resolution manometry is at least as accurate as sleeve sensor manometry for the detection of TLESRs.

A rare complication of embolization in juvenile nasopharyngeal angiofibroma

Juvenile nasopharyngeal angiofibroma (JNA) is one of the most common benign nasal cavity tumors of adolescence. It exhibits a strong tendency to bleed and despite being microscopically benign, its behavior is locally aggressive. Preoperative embolization is helpful to minimize intraoperative bleeding. However, embolization procedure may have some important thromboembolic complications such as central retinal artery occlusion. In this article, a young male with juvenile nasopharyngeal angiofibroma, who lost his vision in the left eye following embolization was presented and the possible therapeutic options in such a complication were discussed.

Implante coclear en malformaciones congénitas

ObjectiveThe main objective is to evaluate the complications and problems encountered in a population with inner ear congenital malformation undergoing cochlear implantation. Materials and methodsThe present study includes 33 patients with congenital inner ear malformation, from a total population of 346 cochlear implant patients, implanted from February 1993 to March 2004. Radiological evaluation and neurological exams were performed to all these patients in order to evaluate all the preoperative conditions. ResultsThe most common cochlear anomalies we found were: cochlear hypoplasia, Incomplete partition and Common cavity (n=15). In 4 cases an enlarge aqueduct was also associated to the cochlear anomaly. We also found 6 cases with labyrinthine anomalies. The surgical procedure was performed in 23 cases, and in 18 of them we obtained an electrical stimulation of the neural elements. ConclusionsThere are no differences between patients with Incomplete Partition of the cochlea and mild Cochlea hypoplasia, if compared with those with normal cochlea. Severe malformations as Common Cavity or severe hypoplasia may have a higher rate of surgical complications and the outcome cannot be predicted.

Cochlear Implantation in Children With Anomalous Cochleovestibular Anatomy

To evaluate outcomes after cochlear implantation in children with anomalous cochleovestibular anatomy, a review of radiological classification, surgical implantation, and outcome of 103 children with such anomalies was performed. The hypothesis was that children with anomalous cochleovestibular anatomy would have poorer outcomes and therefore be poorer candidates as a result of their diminished ability to interpolate and use auditory information delivered through a cochlear implant. A series of studies was carried out to review the cochleovestibular anomalies among 298 children implanted over the decade ending in January 2002. Children were grouped based on cochleovestibular anatomy as follows: normal (n = 195), common cavity deformity (n = 8), hypoplastic cochlea (n = 16), incomplete partition (n = 42), and vestibular aqueduct enlargement (n = 37). Concomitant anomalies of the posterior labyrinth (n = 26) and internal auditory canal/cochlear canal (n = 11) were also identified. Findings at surgery, postoperative speech perception outcomes, and speech processor programmability were examined as a function of cochleovestibular anatomy. A database containing demographics (age at implant, duration of implant use), audiological characteristics, pure-tone average, surgical findings (cerebrospinal fluid leak/perilymph leak, abnormal facial nerve anatomy), speech perception data (from two closed-set and three open-set tests), and data relating to speech processor programmability were used for analysis. Electrically evoked auditory brainstem response was measured in 94 of the children (2 cases of common cavity deformity, 7 of hypoplastic cochlea; 10 of incomplete partition; and 12 of vestibular aqueduct enlargement). Response morphological findings were assessed by visual inspection of the waveforms. Data were analyzed using analyses of variance with post hoc testing using the Bonferroni multiple-comparisons test. To further assess differences in outcomes between different categories of cochleovestibular anomalies, linear regression analyses were performed. The significance level was set at P < .05. The use of high-resolution imaging techniques resulted in the detection of a cochleovestibular anomaly in 35% of implanted ears. Implantation was more challenging in 24% of the children as a result of abnormal middle ear anatomy (17.5%) or cerebrospinal fluid leak/perilymph leak (6.7%). There was no significant difference in speech perception scores in children with anomalous cochleae compared with children with normal cochleovestibular anatomy. Children with narrowing of the internal auditory canal/cochlear canal performed more poorly than all other groups. Children with common cavity deformity and hypoplastic cochlea had reduced dynamic range and increased incidence of facial simulation and were judged to be more difficult to program despite the fact that no fewer electrodes were inserted. Children with common cavity deformity and hypoplastic cochlea tended to require wider pulse widths more often than children in other groups, and these requirements were associated with abnormal morphological findings on evoked auditory brainstem response testing. The authors have been continuing to assess the candidacy of each child applying for cochlear implantation individually, and the results of present study have suggested that the presence of anomalous cochleovestibular anatomy, with the exception of narrowing of the internal auditory canal/cochlear canal, should not play a significant role in candidacy assessment. Children with narrow internal auditory canal/cochlear canal should be carefully and individually considered. In children with anomalous cochleovestibular anatomy, the potentially increased difficulty in the establishment of optimal stimulation levels and the higher potential for surgical difficulty must be weighed in candidacy decisions but do not universally preclude successful implantation and a good outcome.

Inner Ear Anomalies Causing Congenital Sensorineural Hearing Loss: CT and MR Imaging Findings

Many congenital dysplasias of the osseous labyrinth have been identified, and the differential diagnosis of these dysplasias is essential for delivering proper patient management. We retrospectively reviewed the computed tomography (CT) and magnetic resonance (MR) imaging findings of 20 children who had congenital sensorineural hearing loss. The children included cases of enlarged vestibular aqueduct and endolymphatic sac (n=8), aplasia of the semicircular canal (n=4), lateral semicircular canal-vestibule dysplasia (n=3), common cavity malformations with a large vestibule (n=1), cochlear hypoplasia (n=1), Mondini's dysplasia with large vestibular aqueduct (n=1), Mondini's dysplasia with a large vestibule (n=1), and small internal auditory canal (n=1). Six cases were unilateral. Nine cases had combined deformities, and nine cases had cochlear implants. CT was performed with a 1.0-mm thickness in the direct coronal and axial sections with using bone algorithms. MR was performed with a temporal 3D T2 FSE 10-mm scan and with routine brain images. We describe here the imaging features for the anomalies of the inner ear in patients suffering from congenital sensorineural hearing loss.

Gastric flow and mixing studied using computer simulation

The fed human stomach displays regular peristaltic contraction waves that originate in the proximal antrum and propagate to the pylorus. High-resolution concurrent manometry and magnetic resonance imaging (MRI) studies of the stomach suggest a primary function of antral contraction wave (ACW) activity unrelated to gastric emptying. Detailed evaluation is difficult, however, in vivo. Here we analyse the role of ACW activity on intragastric fluid motions, pressure, and mixing with computer simulation. A two-dimensional computer model of the stomach was developed with the 'lattice-Boltzmann' numerical method from the laws of physics, and stomach geometry modelled from MRI. Time changes in gastric volume were specified to match global physiological rates of nutrient liquid emptying. The simulations predicted two basic fluid motions: retrograde 'jets' through ACWs, and circulatory flow between ACWs, both of which contribute to mixing. A well-defined 'zone of mixing', confined to the antrum, was created by the ACWs, with mixing motions enhanced by multiple and narrower ACWs. The simulations also predicted contraction-induced peristaltic pressure waves in the distal antrum consistent with manometric measurements, but with a much lower pressure amplitude than manometric data, indicating that manometric pressure amplitudes reflect direct contact of the catheter with the gastric wall. We conclude that the ACWs are central to gastric mixing, and may also play an indirect role in gastric emptying through local alterations in common cavity pressure.

Analysis of the radial and longitudinal effects of a planar sample in a single TE 102 rectangular electron paramagnetic resonance (EPR) cavity

The response of the cavity to the rotation of a concentrically positioned planar sample of variable width, w ∈ 〈1 mm, 10 mm〉, around the common cavity-sample x-axis in a Bruker single TE 102 rectangular cavity (radial effect) has been analysed. The observed dependence of the EPR signal intensity, Ipp, on the rotation angle has a general ovaloid shape with an eccentricity, ɛ, which varies linearly with the width, w , of the sample, ɛ = 0.0246 + 0.0311 × w , correlation, R = 0.996, for samples with a width greater than 2 mm but shows a positive deviation from linearity for the 1 and 2 mm samples. The dependence of the Ipp value on the planar sample width, w , is non-linear for all polar-angle values investigated. These experimental observations are in a very good agreement with theoretical calculations in which the response is modelled using the Cassinian curves modified for planar sample geometry. Similar trends of the angular Ipp dependence were observed for any position of the planar sample as the centre was moved along the vertical x-axis of the cavity. In the longitudinal Ipp dependence for a planar sample whose length, L = 30 mm, is greater than that of the cavity, then (i) for the case where the whole cavity length is occupied by the sample a constant value for the Ipp (a plateau) is observed and (ii) for sample movement in and out of this plateau region the dependence varies according to the left and right halves of a modified “sine-squared” function. The variation in the signal amplitude along the cavity x-axis (longitudinal effect) can be calculated theoretically using a “sine-squared” curve, modified for an “over full-length cavity” planar sample. In general, the response of the cavity to a planar sample situated at any position on the common sample cavity x-axis can be represented as a product of a modified Cassinian curve and a modified “sine-squared” curve. The non-linear radial effect may give rise to serious sources of systematic error in quantitative EPR spectroscopy with planar sample geometry and shows that accurate and precise positioning of the sample in the microwave cavity is essential.

Sexual reproduction of the photosymbiotic ascidian Diplosoma virens in the Ryukyu Archipelago, Japan: vertical transmission, seasonal change, and possible impact of parasitic copepods

Diplosoma virens is a colonial ascidian hosting prokaryotic algae Prochloron sp. in the common cloacal cavity of the colonies and is sometimes parasitized by notodelphyid copepods. In ascidian–Prochloron symbiosis, it is generally known that the host larvae acquire the algal symbionts from their mother colonies to maintain the symbiosis. A histological study of the sexually mature colonies of D. virens showed that the algal symbionts attach to pre-hatching larvae on the rastrum (plant rake) projected from the postero-dorsal part of the larval trunk, and then the rastrum is packed in the posterior half of the larval trunk that will become a cloacal cavity after metamorphosis. This process is the same as that of D. simile. Monthly sampling of D. virens colonies showed that they have embryos in summer in Ryukyus, situated near the northern-most limit of the coral reefs in the West Pacific. While the frequencies of copepod parasitism were variable among the populations, the colonies from a highly parasitized population had a significantly smaller number of eggs/embryos per zooid than the colonies from the less parasitized populations. The parasites probably have an inhibitory impact on the sexual reproduction of the host colonies.

Cochlear implant surgery in challenging cases

Expanding selection criteria and increasing numbers of cochlear implantations have revealed several challenging cases with regard to surgery and medical point of view. Cochlear implantation of congenitally deaf children with inner-ear malformations may involve difficulties in preoperative evaluation, surgical approach and postoperative follow-up. Cochlear nerve aplasia (as evidence of only one existing nerve in three dimensional magnetic esonance imaging) and hypoplastic cochleas are among the most difficult cases and sometimes children are considered unsuitable for cochlear implantation. However, there is always the possibility that hypoplastic cochleas may include ganglion cells and the only nerve in the internal auditory canal (facial nerve) may contain auditory fibres as well. A positive history of auditory experience and evidence of electrical auditory brainstem response or response to the promontory or round window electrical stimulation may imply that a functioning auditory system is in place. Malformations like common cavity deformity, isolated bilateral vestibular aqueduct enlargement and Mondini dysplasia are usually less challenging, although cerebrospinal fluid leak and postoperative meningitis may be a possibility. In cases of post-meningitic deaf patients, ossification (or obliteration) may be a serious problem even if computed tomography and MRI scan show a patent cochlea or minimal changes. Acoustic neuromas and neurofibromatosis type 2 are other challenging cases, as there is always the possibility that the sensorineural hearing loss is secondary to cochlear damage by interference of the tumour to cochlear blood supply. In conclusion, challenging cases are becoming more common as we are expanding selection criteria, and we should be prepared for alternative cochlear implant devices (straight electrode arrays, dual arrays, compressed arrays, etc.), increased rate of possible complications at, and following, surgery, and functional outcome that may vary considerably among implantees.

Intraoperative evoked potentials monitoring for cochlear implantation in common cavities

Objectives: To determine the efficacy of intraoperative evoked compound action potential (ECAP) monitoring for optimal electrode placement and postoperative programming in cochlear implantation for patients with common cavity malformations. Methods: Retrospective case review of 1 child with a common cavity malformation undergoing revision cochlear implantation with a Clarion HiRes 90K™ implant. Outcome measures included neural response amplitude curves from intraoperative ECAP for each of 16 independent output circuits. Postoperative ECAP aided in mapping configuration to adjust threshold (T) and most comfortable loudness (M) levels across hearing frequencies. Results: Intraoperative ECAP confirmed proximity of the electrode to the neural response elements in this child with a common cavity defect by demonstrating expected neural response amplitudes across 10 of the 16 independent output circuits. No intraoperative repositioning of the electrode was required. Postoperative computed tomography imaging confirmed the location of electrodes with present ECAP responses to be along the medial most wall of the cavity. Postoperative ECAP aided the adjustment of mapping configuration to optimize threshold levels across frequencies for this child. Conclusion: Intraoperative ECAP can aid placement of a cochlear electrode in patients with common cavity malformations, particularly when the location of the neural response elements within the malformed otic capsule are unknown. ECAP can also assist in optimizing the postoperative mapping configurations in these patients.

Cochlear implantation in children with mondini deformity.

Objectives: This study reviews the results of cochlear implantation in 11 children between the ages of 2 to 18 years with Mondini deformity of the cochlea, who underwent surgery between 1988 and 2003. Of these, 7 children had a true Mondini with incomplete partition and 4 had a “cocks” common cavity. Methods: A Hortmann ball electrode device was used in 3 cases, a medel ball electrode device in 1 case, and a Medel compressed Combi40 in 1 case. Six cases received Clarion devices, 4 precurved enhanced bipolar, 1 HiFocus I, and 1 HiRes 90K. In all cases, there was complete insertion of electrodes and intraoperative sealing of the gusher. The precurved electrode was the safest and easiest to surgically introduce. Three cases with a common cavity developed a postoperative leak and had to have a lumboperitoneal shunt Results: The speech perception and speech production average scores attained were higher in patients with a true Mondini deformity and with multielectrode devices. The highest scores were attained with children using paired pulsatile stimuli strategies. On long-term follow-up, the 3 Hortmann single electrode devices failed between 3 and 4 years and the Medel single electrode device after 5 years, although functioning could not maintain sufficient hearing thresholds. Conclusions: From this study, we can conclude that children with true Mondini deformity (incomplete partition) and multielectrode devices, using a paired pulsatile strategy, although slower, perform as well as their matched counterparts with a normal cochlea.

Congenital malformation of the inner ear and pediatric cochlear implantation.

To study the surgical aspects and performance outcome of cochlear implantation in children with malformed inner ears. Clinical and audiometric evaluation in 13 patients. Patient data concerning surgery, postoperative follow-up, and pre- and postimplantation audiometry were obtained from the cochlear implant center's database and evaluated. A review of the literature has been included. Tertiary referral center. The patients had a variety of inner ear malformations and profound hearing loss. One patient with recurrent meningitis had a severe cochlear malformation (common cavity). Major complications did not occur. In one patient with an abnormal position of the cochlea and concurring middle ear disease, it was difficult to find the scala tympani during surgery. A cerebrospinal fluid gusher was encountered in two patients and an aberrant facial nerve in another, which did not lead to any complications. The patients with mild cochlear malformation such as an incomplete partition demonstrated a good performance in speech perception tests. Even the child with the common cavity deformity had some open-set speech perception 1 year after implantation. Viewing the patients from this study and patients from a review of the literature concerning cochlear implantation in children with malformed inner ears including severe cochlear malformations, the occurrence of an aberrant facial nerve was 17%, which increases to 27% if one reviews the surgical findings in children with severe malformed cochleae such as a common cavity or a severe cochlear hypoplasia. In the latter patients, results in speech perception vary. Although the result of cochlear implantation may be promising, as in our patient with a common cavity, during preoperative counseling the child's parents must be informed that the result is uncertain.

Rumination documented by using combined multichannel intraluminal impedance and manometry

According to the Rome criteria, rumination is considered to be an esophageal functional disorder. Because documentation of rumination is difficult, it has been suggested that rumination is a clinical diagnosis. Even though a clinical diagnosis of rumination can be based only on history, this conclusion often leaves both the patient and the physician dissatisfied. In this article we describe the case of a 26-year-old man referred for evaluation of persistent regurgitation. By using combined multichannel intraluminal impedance and manometry we were able to document the sequence of events leading to regurgitation. These include an increase in intra-abdominal pressure identified in the pressure transducer located in the stomach, which initiates the reflux event identified by both impedance changes as well as common cavity phenomenon, followed by peristaltic fore contractions, which clear the intraesophageal content, a pattern highly suggestive for rumination. The opportunity to review these documented changes visually helps to make the patient aware of the functional aspects of the condition, avoiding unwarranted therapies and providing the opportunity to reinforce behavioral modifications.

Coordinated gastric and sphincter motility evoked by intravenous CCK-8 as monitored by ultrasonomicrometry in rats.

Gastric and sphincter motility evoked by intravenous injection of CCK-8 were investigated in urethane-anesthetized rats. Digital ultrasonomicrometry was used to monitor pyloric (PYL), antral (ANT), corpus (COR), and lower esophageal sphincter (LES) movements while simultaneously measuring intragastric pressure (IGP) and, in some experiments, subdiaphragmatic intraesophageal pressure (sIEP). Intracrystal distances (ICD) were measured continuously between pairs of piezoelectric crystals affixed to the serosa of PYL, ANT, COR (circular and longitudinal), and LES. Consecutive intravenous injections of CCK-8 (0.3, 1, and 3 microg/kg) at 30-min intervals caused dose-dependent simultaneous tonic contractions of PYL and ANT, LES opening, and drops in IGP with peak changes at 3 microg/kg of -17.9 +/- 2.1, -7.7 +/- 2.5, 6.5 +/- 1.4, and -29.2 +/- 3.8%, respectively, whereas intravenous saline had no effect. Rhythmic contractile activity was inhibited by CCK-8. COR responses were not significantly different from vehicle controls for most metrics, and the direction of response for circular COR varied between preparations, although not for repeated trials in a single preparation. During the LES response to CCK-8, sIEP rose in parallel with drops in IGP, indicating formation of a common cavity. Recovery of LES ICD after intravenous CCK occurred more rapidly than recovery of PYL ICD, suggesting the importance of preventing simultaneous patency of gastroesophageal and gastroduodenal passages. The CCK(A) receptor antagonist devazepide (500 microg/kg intravenous) inhibited motion responses evoked by intravenous CCK-8. These data revealed CCK-8-induced gastric and sphincter activity consistent with retropulsion of gastric content.

Cochlear Implantation in Children with Congenital Inner Ear Malformations

To assess the audiologic and surgical outcomes for pediatric cochlear implant patients with inner ear malformations. Retrospective review of 315 pediatric cochlear implant cases from 1994 to 2002. Twenty-eight pediatric cochlear implant patients with known inner ear malformations determined on high-resolution computed tomography (HRCT) of the temporal bone were the subjects of review. Results of HRCT findings, intraoperative findings, postoperative complications, and objective measures of both closed- and open-set testing of speech perception were analyzed. Patients with the constellation of an incompletely partitioned (IP) cochlea, enlarged vestibular aqueduct (EVA), and a dilated vestibule (i.e., Mondini's malformation) as well as those with an isolated EVA or partial semicircular canal aplasia have relatively good levels of speech perception. Patients with total semicircular canal aplasia, isolated IP, cochlear hypoplasia, or common cavity demonstrated lower levels of performance. Poor performance may be related to associated developmental delays rather than labyrinthine anatomy alone. Complications of surgery were relatively limited. Cochlear implantation can be successfully performed in children with inner ear malformations. These children and their parents can expect significant auditory benefits from this intervention. The various types of inner ear malformations may have quite different prognoses for good auditory performance.