Psychometric validity of the Cochlear Implant Function Index (CIFI): A quality of life assessment tool for adult cochlear implant users

Coelho, Daniel H; Hammerschlag, Paul E; Bat-Chava, Yael; Kohan, Darius
2009;10(2):70-83, Cochlear Implants International
Objective: The Cochlear Implant Function Index (CIFI) is created to assess adult cochlear implant (CI) auditory effectiveness in real world situations. Our objective is to evaluate the CIFI as a reliable psychometric tool to assess 1) reliance on visual assistance, 2) telephone use, 3) communication at work, 4) ‘hearing’ in noise, 5) in groups, and 6) in large room settings. Study Design: Based upon Guttman scaling properties, the CIFI elicits implanted respondent’s functional level with auditory independence from Level 1 (still requiring signing) to level 4 (without any help beyond CI). A blinded, retrospective questionnaire is anonymously answered by cochlear implant recipients. Setting: CI centers of tertiary care medical centers, CI support group, and an interactive web page of a hearing and speech center in a large metropolitan region. Subjects: 245 respondents from a varied adult CI population implanted for one month to 19 years prior to answering the questionnaire. Intervention An assessment tool of CI function. Main Outcome Measure: A coefficient of reproducibility (CR) for the Guttman scale format equal or greater than 0.90, indicating good scalability. Results CR in the CIFI was above 0.90. Effective scalability and mean scores from 2.5 to 3.5 for the six areas examined (l.OO-4-.OO) were achieved. Conclusion: The psychometric properties of this user friendly survey demonstrate consistently good scalability. Based on these findings, the CIFI provides a validated tool that can be used for systematic comparisons between groups of patients or for folbw-up outcomes in patients who use cochlear implants. Further study is indicated to correlate CIFI scores with sound and speech perception scores.
– id: J0205511, year: 2009, vol: 10, page: 70, stat: Journal Article,

Reconstruction of Congenital Microtia-Atresia Outcomes With the Medpor/Bone-Anchored Hearing Aid Approach

Romo, T; Morris, LGT; Reitzen, SD; Ghossaini, SN; Wazen, JJ; Kohan, D
2009 APR;62(4):384-389, Annals of plastic surgery
Ideal surgery for congenital microtia-atresia would offer excellent cosmetic and hearing rehabilitation, with minimal morbidity. Classic approaches require multiple procedures, including rib cartilage harvest and aural atresia repair. Our facial plastic and otologic team approach incorporates a high-density porous polyethylene (Medpor, Porex Surgical, Newnan, GA) auricular framework, followed by single-stage bone-anchored hearing aid (BAHA) implantation. We evaluated the efficacy, safety, and morbidity of this 2-stage dual system approach. A prospective database of microtia patients was used to identify patients undergoing combined Medpor/BAHA auricular reconstruction and hearing rehabilitation between 2003 and 2006. The first stage involves placement of a Medpor framework beneath a temporoparietal fascia flap, followed by a second-stage procedure for lobule transposition and BAHA implantation. Twenty-five patients (28 ears) were evaluated. Aesthetic quality of the implants was excellent, with a high degree of framework detail visible, and a postauricular crease created in all patients. All patients were satisfied with the cosmetic result. There were no major Medpor complications such as infection, extrusion, loss of implant, or flap necrosis, and a 10.7% incidence of minor complications requiring operative revision. BAHA significantly improved hearing in all patients, with a complication rate of 31.8%, mainly skin overgrowth and cellulitis. The Medpor/BAHA dual plastic-otologic approach to microtia-atresia has produced excellent cosmetic results and hearing outcomes, which compare favorably to traditional microtia-atresia repair. This is a 2-stage aesthetic and functional protocol with an acceptably low rate of complications, which safely and efficiently achieves both aesthetic and functional goals
– id: J0165013, year: 2009, vol: 62, page: 384, stat: Journal Article,

Single-stage BAHA implantation in adults and children: is it safe?

Kohan, Darius; Morris, Luc G T; Romo, Thomas 3rd
2008 May;138(5):662-6, Otolaryngology, head & neck surgery
OBJECTIVE: Most surgeons perform pediatric bone-anchored hearing aid (BAHA) implantation in two stages. This study examined the safety and efficacy of single-stage BAHA implantation in adults and children. METHODS: Retrospective review of 32 ears: 18 pediatric (ages 6 to 13 years) and 14 adult patients who underwent single-stage BAHA surgery between 2002 and 2006. RESULTS: A total of eight (25%) ears experienced complications. Overall, four (13%) ears required revision in the operating room. In the pediatric group, there were three (16.7%) ears with skin complications; two required operative revision. In the adult group, there were five (36%) ears with skin complications; two required operative revision. CONCLUSIONS: In both adults and children, the single-stage technique for BAHA implantation is safe and efficient. All complications were related to skin reaction. Safety profiles for 1- and 2-stage surgery are similar, although the single-stage procedure is more cost effective, avoids a second procedure, and provides for earlier hearing rehabilitation
– id: J0140626, year: 2008, vol: 138, page: 662, stat: Journal Article,

Surgical management of complications after hearing aid fitting

Kohan, Darius; Sorin, Alexander; Marra, Stephen; Gottlieb, Marc; Hoffman, Ronald
2004 Feb;114(2):317-22, Laryngoscope
OBJECTIVES: Standard procedures for hearing aid fitting performed in accordance with established guidelines are well tolerated, safe, and effective. In this article, we present unusual complications after hearing aid fitting that required surgical management. METHODS: Four otologists at a major university center with a combined 65 years of experience performed a retrospective analysis of their surgical practice. Six patients were identified that had encountered severe complications from improper earmold fitting that required surgical intervention. RESULTS: One patient had a perforation of the tympanic membrane with earmold material found to have migrated into the middle ear cleft. The tympanic membrane healed spontaneously, resulting in persistent otalgia and a maximum air-bone gap. The earmold cast was successfully removed by means of a tympanomastoidectomy. Two patients with presbycusis and normal ear canals developed eardrum perforations and conductive hearing deficits. In both patients, earmold material was found partially occupying the middle ear cleft and removed by way of a transcanal approach. Three patients with prior canal wall down mastoidectomy defects and narrow external ear canals required microtoscopy under general anesthesia or canaloplasty for removal of impacted material. CONCLUSION: Proper fitting of hearing aids performed by well-trained medical professionals results in a very low incidence of significant complications. Perforation of the tympanic membrane with impaction of earmold material in the middle ear or mastoid bowl may occur and can be successfully managed by standard otologic surgical techniques
– id: J0067166, year: 2004, vol: 114, page: 317, stat: Journal Article,

Revision stapes surgery: the malleus to oval window wire-piston technique

Kohan, Darius; Sorin, Alexander
2003 Sep;113(9):1520-4, Laryngoscope
OBJECTIVE: To determine the effectiveness of the malleus to oval window wire-piston revision stapes surgery technique. STUDY DESIGN: A retrospective analysis of 243 stapes procedures performed by the senior author over a 10-year period identified 15 revisions. Five patients underwent a malleus to oval window wire-piston technique. All patients were followed for at least 6 months. The surgical outcome including audiologic data and complications are noted. METHODS: Stapes surgery was performed on an ambulatory basis by way of a transcanal approach under local anesthesia with monitored sedation by the same surgeon using a laser technique and a stapes wire-piston prosthesis. RESULTS: Among revision stapes procedures, there was no significant difference in the air-bone gap closure or complication rate between the incus to oval window and the malleus to oval window techniques. The average preoperative air-bone gap in all revisions was 32 dB, whereas the mean postoperative gap was 10 dB hearing loss. CONCLUSIONS: In experienced hands, revision stapes surgery using the malleus to oval window stapes wire-piston prosthesis is safe and effective
– id: J0053086, year: 2003, vol: 113, page: 1520, stat: Journal Article,

Otologic surgery in patients with HIV-1 and AIDS

Kohan D; Giacchi RJ
1999 Oct;121(4):355-60, Otolaryngology, head & neck surgery
Otologic disease in patients infected with HIV occurs frequently and usually represents rhinologic disease and associated eustachian tube dysfunction rather than manifestations of HIV infection. As in all patients, the decision to operate on an HIV-infected individual who would benefit from major otologic surgery is a balance between the risks of the procedure and the possible benefits to the patient. Many concerns regarding wound infection and healing have been raised. The objective of this study is to evaluate the outcome of otologic procedures in this population. The charts of 9 men and 4 women were reviewed. Seven patients (54%) met the Centers for Disease Control and Prevention criteria for AIDS. Patients with chronic otitis media (46%) underwent tympanomastoidectomies, and the cases of acute mastoiditis (31%) were managed with simple mastoidectomies. Other procedures included repair of cerebrospinal fluid leak (15%) and stapedectomy (8%). Two patients had early complications and died during their hospitalizations. Three patients had prolonged hospital courses requiring long-term antibiotics. These 5 patients underwent urgent procedures and were severely immunocompromised. Of the remaining 8 patients only 2 had AIDS, and all had an uncomplicated postoperative course. Six of these patients were followed up for more than 1 year, and only 2 developed subsequent otologic disease
– id: J0009302, year: 1999, vol: 121, page: 355, stat: Journal Article,

Uncommon lesions presenting as tumors of the internal auditory canal and cerebellopontine angle

Kohan D; Downey LL; Lim J; Cohen NL; Elowitz E
1997 May;18(3):386-392, American journal of otology
OBJECTIVE: The aim of this study was to identify distinguishing characteristics of uncommon lesions of the cerebellopontine angle (CPA) and internal auditory canal (IAC) in order to attain the correct diagnosis and thus formulate an appropriate therapeutic protocol. STUDY DESIGN: A retrospective chart analysis was performed on all patients with surgically managed lesions of the IAC and CPA referred to neuropathology from January 1985 to April 1996. SETTING: All patients were treated by New York University faculty at a tertiary referral center. PATIENTS: Among 426 surgical cases identified, 384 patients (90.1%) with acoustic neuromas and 18 patients (4.2%) with meningiomas were excluded. The remaining 24 cases, involving 17 women and seven men with a median age of 34 years, were analyzed. INTERVENTION: Most patients underwent audiovestibular evaluations, as well as magnetic resonance imaging (MRI) and computed tomographic (CT) scanning, and all patients underwent neurotologic surgery as part of their management protocol. MAIN OUTCOME MEASURES: Correlating patient presentation, preoperative imaging, and surgical findings often identified distinguishing characteristics of unusual CPA and IAC lesions. RESULTS: Unusual lesions identified at the CPA and IAC included: four epidermoids, four lipomas, two facial neuromas, two arachnoid cysts, two choroid plexus papillomas, two metastatic adenocarcinomas, one metastatic neuroblastoma, one ependymoma, one lymphoma, one cholesterol cyst, one angioleiomyoma, one venous hemangioma, one cavernous angioma, and one pontine glioma. CONCLUSIONS: Preoperative tumor differentiation based on the patient history, physical examination, audiovestibular testing, CT, and MRI help the surgeon to formulate an appropriate treatment protocol
– id: J0002137, year: 1997, vol: 18, page: 386, stat: Journal Article,

Madelung’s disease: case reports and literature review

Kohan D; Miller PJ; Rothstein SG; Kaufman D
1993 Feb;108(2):156-9, Otolaryngology, head & neck surgery
– id: J0011511, year: 1993, vol: 108, page: 156, stat: Journal Article,

Cochlear implants in the management of bilateral acoustic neuromas

Hoffman RA; Kohan D; Cohen NL
1992 Nov;13(6):525-8, American journal of otology
Multichannel cochlear implants currently provide the only modality for successful auditory rehabilitation of patients with bilateral profound sensorineural hearing loss who derive no benefit from amplification. We have developed a protocol for patients with neurofibromatosis and bilateral acoustic neuromas in which every effort is made to preserve hearing in at least one ear. Failing that, the cochlear nerve is spared, potentially allowing for the insertion of a cochlear implant. We present our data on one such patient whose auditory function was restored with a Nucleus mini 22-channel cochlear implant following removal of his acoustic neuroma
– id: J0011692, year: 1992, vol: 13, page: 525, stat: Journal Article,


1992 MAY-JUN;6(3):115-118, American journal of rhinology
Sinusitis in the immunocompromised person can be a fulminant or even fatal illness. Aggressive treatment with intravenous antibiotics and surgery is often warranted. We report 13 cases of sinusitis in immunocompromised patients who, having failed medical treatment, required surgical management of their sinus disease. Among the patients whose sinuses were cultured intraoperatively, 63% grew Staphylococcus aureus. Most of the patients showed improvement in their infections, and none had complications of surgery
– id: J0089328, year: 1992, vol: 6, page: 115, stat: Journal Article,

Emergencies in AIDS patients: the otolaryngologic perspective

Rothstein SG; Schneider KL; Kohan D; Persky MS; Holliday R
1991 Apr;104(4):545-8, Otolaryngology, head & neck surgery
– id: J0012812, year: 1991, vol: 104, page: 545, stat: Journal Article,

Otologic disease in AIDS patients: CT correlation

Kohan D; Hammerschlag PE; Holliday RA
1990 Dec;100(12):1326-30, Laryngoscope
The contrast-enhanced computed tomographic (CT) scans of the temporal bone and brain in 18 patients with otologic disease and acquired immunodeficiency syndrome (AIDS) were retrospectively reviewed. Seven scans revealed middle ear and mastoid disease; three scans were consistent with central nervous system (CNS) pathology; and eight scans demonstrated no abnormalities. CT scanning was found useful in localizing otopathology and diagnosing CNS toxoplasmosis, aural polyps, osteomyelitis, mastoiditis, and middle ear effusion due to hypertrophic lymphoid tissue. The authors conclude that AIDS patients with sensorineural hearing loss should undergo contrast-enhanced brain CT scans to rule out CNS pathology; AIDS status does not alter criteria for CT scanning in patients with conductive hearing loss; and that images of the nasopharynx should be included on temporal bone CT scans of patients with conductive hearing loss in order to exclude eustachian tube obstruction by hypertrophic lymphoid tissue
– id: J0013108, year: 1990, vol: 100, page: 1326, stat: Journal Article,

Frontal bone reconstruction with split calvarial and cancellous iliac bone

Kohan D; Plasse HM; Zide BM
1989 Nov;68(11):845-6, 848-50, 853-4, Ear, nose & throat journal
An autogenous split-thickness calvarial bone graft that was used to correct a marked depression in the frontal region of the forehead resulted in excellent cosmesis. Cancellous bone from the iliac crest, which was applied between the posterior wall of the frontal sinus and the anterior calvarial bone graft, eliminated the dead space and made infection less likely in an area prone to such infections
– id: J0019966, year: 1989, vol: 68, page: 845, stat: Journal Article,

Rhinomanometric evaluation of two nasal steroid sprays in rhinitis

Kohan D; Jacobs JB; Nass RL; Gonzalez S
1989 Oct;101(4):429-33, Otolaryngology, head & neck surgery
A prospective, randomized study comparing the effectiveness of two nasal steroid sprays, flunisolide and beclomethasone dipropionate, in the treatment of nasal obstruction associated with allergic or vasomotor rhinitis has been conducted at New York University Medical Center-Bellevue Hospital. All patients underwent routine history and physical examinations and a modified radioallergosorbent test. Paranasal sinus films were used to exclude patients with sinusitis. The Rhinotest microprocessor rhinomanometer was used to quantify pretreatment and posttreatment total nasal air flow and resistance during a period of 2 months. These findings were assessed in conjunction with the patients’ subjective complaints. Results demonstrated that anterior rhinomanometric assessment of the nasal airway during inhalant therapy correlated well with the patients’ own subjective impressions of nasal air flow. Both steroid inhalants were effective; however, flunisolide provided for earlier and more substantial symptomatic relief. Beclomethasone dipropionate had milder side effects
– id: J0007024, year: 1989, vol: 101, page: 429, stat: Journal Article,

Otologic disease in patients with acquired immunodeficiency syndrome

Kohan D; Rothstein SG; Cohen NL
1988 Nov-Dec;97(6 Pt 1):636-40, Annals of otology rhinology & laryngology
A 5-year retrospective study evaluating otologic disease in patients with acquired immunodeficiency syndrome (AIDS) was conducted at the New York University Medical Center-Bellevue Hospital Center. Twenty-six patients with documented otologic disease who met the Centers for Disease Control criteria for AIDS were identified and their charts were analyzed according to presenting complaints, physical examination, diagnostic modalities, pathologic condition, management, and outcome. A marked diversity of otologic diseases of varying severity was noted. The majority of patients complained of hearing loss and otalgia during their hospitalization for treatment of AIDS-related opportunistic infections. The most frequent diagnoses were otitis externa, acute otitis media, and otitis media with effusion. Sensorineural hearing loss frequently appeared to be related to ototoxic medications and neurologic infections
– id: J0007682, year: 1988, vol: 97, page: 636, stat: Journal Article,

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