ABSTRACTBackground: cochlear implants are electronic devices that convert sound energy into electrical signals to stimulate ganglion cells and cochlear nerve fibers. These devices are indicated for patients with severe to profound sensorineural hearing losses who receive little or no benefit from hearing aids. The implant basically takes over the function of the cochlear hair cells. The implant consists of external components (microphone, speech processor and transmitting coil) and internal components (receiver stimulator and electrode array). The implant is inserted via a trans mastoid facial recess approach to the round window and scala tympani.Objectives: to determine the effectiveness and safety of non fixation method in cochlear implantation.Methods: a prospective study carried out from September 2009 to September 2012 in Gazi Hariri Hospital. Eighty patients with congenital severe –profound sensorineural hearing loss prepared for cochlear implantation involved in the study and divided into 2 groups. Group A includes 40 patients in whom the internal device was fixed to the skull by nylon suture materials through small burr holes on both sides of the well. Group B includes 40 patients in whom the internal device placed in a tight sub pericranial pocket without nylon fixation to the skull. All patients followed postoperatively for 6 months observing wound healing and local complications (hematoma, infection, wound dehiscence, device extrusion and migration).Results: mean age 4.2 years and male-female ratio was 1.3:1.Group A: 1 patient (2.5%) developed minor wound infection treated conservatively. Three patients (7.5%) developedsevere wound infection with wound breakdown and device extrusion despite the use of antibiotics and local rotational flaps, the device was explanted in those 3 patients. Two patients (5%) developed hematoma without history of trauma and treated conservatively. One patient (2.5%) had device migration without affection of its function.Group B: 2 patients developed minor wound infection treated conservatively. One patient (2.5%) had severe wound infection ends up with wound dehiscence and device extrusion despite the use of antibiotics and local rotational flaps. Explantation of the device was done for this patient. Hematoma occurred in one patient (2.5%) without history of trauma and treated conservatively. Another one patient (2.5%) developed device migration without impairment of its function.Conclusion: creation of sub pericranial pocket without internal device fixation by nylon materials is an effective and reliable method in cochlear implantation without compromising the patient safety or device performance.Key words: cochlear implantation, non- fixation, sub pericranial pocket
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- The administration motives in the use of creative accounting methods, some internal motives related to the interests of the administration in maximizing profits to increase incentives and rewards, others are external, such as the impact on stock prices or reduce the am
Abstract
This study aimed to identify the business risks using the approach of the client strategy analysis in order to improve the efficiency and effectiveness of the audit process. A study of business risks and their impact on the efficiency and effectiveness of the audit process has been performed to establish a cognitive framework of the main objective of this study, in which the descriptive analytical method has been adopted. A survey questionnaire has been developed and distributed to the targeted group of audit firms which have profession license from the Auditors Association in the Gaza Strip (63 offices). A hundred questionnaires have been distributed to the study sample of which, a total of 84 where answered and
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Introduction. The coexistence of non-small cell lung cancer (NSCLC) and chronic obstructive pulmonary disease (COPD) is commonly observed, primarily due to overlapping risk factors like smoking and environmental exposures. This dual diagnosis introduces complex clinical scenarios, often associated with worsened outcomes and heightened vulnerability to treatment-related side effects. Immune checkpoint inhibitors, especially atezolizumab, have emerged as pivotal agents in enhancing clinical outcomes for individuals diagnosed with NSCLC. Recent evidence suggests that atezolizumab remains effective and well-tolerated in NSCLC patients with coexisting COPD. This review evaluates the efficacy and safety of atezolizumab in NSCLC patients with coex
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