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  1. Article ; Online: Cochlear Implantation in Sporadic Vestibular Schwannoma and Neurofibromatosis Type II.

    McClenaghan, Fiona / Freeman, Simon / Lloyd, Simon / Stapleton, Emma

    Otolaryngologic clinics of North America

    2023  Volume 56, Issue 3, Page(s) 587–598

    Abstract: Cochlear implantation offers significantly better hearing outcomes than auditory brainstem implantation in patients with vestibular schwannoma. Neither the primary treatment modality nor the cause of the tumor (neurofibromatosis type 2 related or ... ...

    Abstract Cochlear implantation offers significantly better hearing outcomes than auditory brainstem implantation in patients with vestibular schwannoma. Neither the primary treatment modality nor the cause of the tumor (neurofibromatosis type 2 related or sporadic) seems to have a significant effect on hearing outcome with cochlear implantation. Some uncertainty remains regarding long-term hearing outcomes; however, cochlear implantation in vestibular schwannoma serves to offer patients, with a functioning cochlear nerve, the probability of open set speech discrimination with a consequent positive impact on quality of life.
    MeSH term(s) Humans ; Neurofibromatosis 2/complications ; Neurofibromatosis 2/surgery ; Neuroma, Acoustic/complications ; Neuroma, Acoustic/surgery ; Cochlear Implantation ; Quality of Life ; Hearing/physiology ; Treatment Outcome ; Retrospective Studies
    Language English
    Publishing date 2023-04-03
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 417489-6
    ISSN 1557-8259 ; 0030-6665
    ISSN (online) 1557-8259
    ISSN 0030-6665
    DOI 10.1016/j.otc.2023.02.017
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  2. Article: The Modified Stenver's View for Cochlear Implants - What do the Surgeons Want to Know?

    McClenaghan, Fiona / Nash, Robert

    Journal of the Belgian Society of Radiology

    2020  Volume 104, Issue 1, Page(s) 37

    Abstract: Despite developments in electrophysiological testing, imaging remains the standard method to determine cochlear implant positioning. Whilst cone beam computed tomography is optimal, modified Stenver radiographs are easier to perform and are therefore ... ...

    Abstract Despite developments in electrophysiological testing, imaging remains the standard method to determine cochlear implant positioning. Whilst cone beam computed tomography is optimal, modified Stenver radiographs are easier to perform and are therefore commonly used. With recent debate as to the need for routine imaging in uncomplicated cases, the radiologist is increasingly faced with cases of abnormal anatomy or surgical error. The primary interest is the positioning of the electrode array within the cochlea. This includes evidence of tip roll over or kinking and depth of electrode insertion, as both are independent predictors of hearing outcomes and may necessitate revision surgery.
    Language English
    Publishing date 2020-07-03
    Publishing country England
    Document type Case Reports
    ISSN 2514-8281
    ISSN 2514-8281
    DOI 10.5334/jbsr.2059
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  3. Article ; Online: Does bilateral otosclerosis make pre-operative bone conduction more inaccurate?

    McClenaghan, Fiona / Lavy, Jeremy

    Journal of otology

    2020  Volume 16, Issue 1, Page(s) 1–5

    Abstract: Objectives: To assess whether bilateral otosclerosis renders pre-operative bone conduction more inaccurate by increasing the Carhart effect.: Methods: Retrospective review of a database of pre and post-operative audiograms of 745 ears with ... ...

    Abstract Objectives: To assess whether bilateral otosclerosis renders pre-operative bone conduction more inaccurate by increasing the Carhart effect.
    Methods: Retrospective review of a database of pre and post-operative audiograms of 745 ears with otosclerosis treated with stapedectomy from 2013 to 2020 in a tertiary centre.
    Main outcome measures: Change in bone conduction after stapedectomy for otosclerosis in: unilateral otosclerosis (U1); bilateral otosclerosis undergoing first side surgery (B1); bilateral otosclerosis undergoing second side surgery (B2). The magnitude of change in bone conduction post-operatively within and between each group.
    Results: The average difference in pre and post-operative bone conduction was significant within in all groups (T-stat > 2 and P-value <0.05) with the greatest change observed in the U1 group. Analysis of average change in bone conduction between groups did not reach statistical significance (P-value = 0.37). Analysis of change per frequency demonstrated the greatest change in bone conduction post-operatively at 2000 Hz in all groups. The magnitude of change at 2000 Hz was the greatest in the bilateral groups; however, it did not reach statistical significance when compared to the unilateral group (P-value = 0.36).
    Conclusions: This is the first study in the literature to assess the accuracy of pre-operative bone conduction in bilateral versus unilateral otosclerosis. There is no evidence that pre-operative bone conduction in bilateral otosclerosis is more inaccurate than in unilateral disease. In order to assess accuracy of pre-operative bone conduction in otosclerosis a reliable method of assessing post-operative bone conduction is required, without assumption of its equivalence to cochlear reserve.
    Language English
    Publishing date 2020-07-20
    Publishing country China
    Document type Journal Article
    ZDB-ID 2621477-5
    ISSN 2524-1753 ; 1672-2930
    ISSN (online) 2524-1753
    ISSN 1672-2930
    DOI 10.1016/j.joto.2020.07.002
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  4. Article ; Online: Primary presentation of sarcoidosis with profound bilateral sensorineural hearing loss.

    Pandey, Gargi / McClenaghan, Fiona / Nash, Robert

    BMJ case reports

    2021  Volume 14, Issue 8

    Abstract: We present a case of a 7-year-old Afro-Caribbean girl presenting with rapidly progressive bilateral sensorineural hearing loss. She was found to have an elevated Angiotensin converting enzyme (ACE) and mediastinal lymphadenopathy containing non-caseating ...

    Abstract We present a case of a 7-year-old Afro-Caribbean girl presenting with rapidly progressive bilateral sensorineural hearing loss. She was found to have an elevated Angiotensin converting enzyme (ACE) and mediastinal lymphadenopathy containing non-caseating granulomas with multinucleate giant cells, in keeping with sarcoidosis. Cranial imaging demonstrated labyrinthitis. She underwent urgent bilateral cochlear implantation with rehabilitation of hearing sufficient to restart education within 1 month.
    MeSH term(s) Child ; Cochlear Implantation ; Female ; Hearing Loss, Bilateral/etiology ; Hearing Loss, Sensorineural/diagnosis ; Hearing Loss, Sensorineural/etiology ; Hearing Loss, Sensorineural/surgery ; Humans ; Labyrinthitis ; Sarcoidosis/complications ; Sarcoidosis/diagnosis
    Language English
    Publishing date 2021-08-25
    Publishing country England
    Document type Case Reports ; Journal Article
    ISSN 1757-790X
    ISSN (online) 1757-790X
    DOI 10.1136/bcr-2021-244140
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  5. Article ; Online: The Modified Stenver’s View for Cochlear Implants – What do the Surgeons Want to Know?

    Fiona McClenaghan / Robert Nash

    Journal of the Belgian Society of Radiology, Vol 104, Iss

    2020  Volume 1

    Abstract: Despite developments in electrophysiological testing, imaging remains the standard method to determine cochlear implant positioning. Whilst cone beam computed tomography is optimal, modified Stenver radiographs are easier to perform and are therefore ... ...

    Abstract Despite developments in electrophysiological testing, imaging remains the standard method to determine cochlear implant positioning. Whilst cone beam computed tomography is optimal, modified Stenver radiographs are easier to perform and are therefore commonly used. With recent debate as to the need for routine imaging in uncomplicated cases, the radiologist is increasingly faced with cases of abnormal anatomy or surgical error. The primary interest is the positioning of the electrode array within the cochlea. This includes evidence of tip roll over or kinking and depth of electrode insertion, as both are independent predictors of hearing outcomes and may necessitate revision surgery.
    Keywords cochlear implant ; hearing rehabilitation ; modified stenver’s radiograph ; otorhinolaryngology ; Medical physics. Medical radiology. Nuclear medicine ; R895-920
    Language English
    Publishing date 2020-07-01T00:00:00Z
    Publisher Ubiquity Press
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  6. Article ; Online: Patient, parental and multi-disciplinary team rationale for non-implantation following the paediatric cochlear implantation assessment.

    Hall, Andrew / McClenaghan, Fiona / Nash, Robert / Shaida, Azhar

    Cochlear implants international

    2022  Volume 23, Issue 3, Page(s) 158–164

    Abstract: Objectives: To assess paediatric patients referred to the cochlear implant team, who despite undergoing the assessment, did not receive cochlear implantation. To identify the underlying reasons for this.: Methods: A retrospective case-note review of ... ...

    Abstract Objectives: To assess paediatric patients referred to the cochlear implant team, who despite undergoing the assessment, did not receive cochlear implantation. To identify the underlying reasons for this.
    Methods: A retrospective case-note review of patients was assessed from June 2014 to June 2019 at two separate London teaching hospitals with paediatric cochlear implantation programmes.
    Results: A total of 921 paediatric patients were assessed during the study period across both institutions. And, 196 (21%) did not proceed with the surgery. The decision not to undergo surgery was primarily parental/patient-directed in 114 (61%) and cochlear implant team-directed in 74 (39%). In total, eight (4%) patients exited the programme without a documented reason.
    Discussion: A myriad of factors influenced the decision-making process for clinicians, patients and parents. The most cited parental/patient rationale against implantation was the wish to continue current means of communication 40 (35%), followed by concern regarding the risks of surgery 18 (15.8%) and the wish to allow the patient to make future decisions independently in view of the future technology 7 (6.1%). Cochlear implant team-directed decisions were largely due to being outside of the NICE criteria 27 (36.5%) or the risks of general anaesthesia 19 (25.7%) in addition to communication concerns 11 (14.9%).
    Conclusion: Decision-making in cochlear implantation should not be underestimated. Extensive discussion and exploration of options with the multi-disciplinary team can aid decision-making, but the timescale and appreciation of the consequences of the decision inevitably lead to pressure. Exploration of reasons for non-implantation emphasises the importance of a multi-professional approach to manage these patients.
    MeSH term(s) Child ; Cochlear Implantation ; Cochlear Implants ; Communication ; Humans ; Parents ; Retrospective Studies
    Language English
    Publishing date 2022-02-15
    Publishing country England
    Document type Journal Article
    ZDB-ID 2079515-4
    ISSN 1754-7628 ; 1467-0100
    ISSN (online) 1754-7628
    ISSN 1467-0100
    DOI 10.1080/14670100.2022.2035916
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  7. Article ; Online: Cutis verticis gyrata in a paediatric patient with cochlear implants.

    Patel, Neeti / McClenaghan, Fiona / Konstantinidou, Sevasti / Nash, Robert

    BMJ case reports

    2021  Volume 14, Issue 6

    MeSH term(s) Child ; Cochlear Implantation ; Cochlear Implants ; Humans ; Scalp ; Scalp Dermatoses ; Skin Abnormalities
    Language English
    Publishing date 2021-06-25
    Publishing country England
    Document type Case Reports ; Journal Article
    ISSN 1757-790X
    ISSN (online) 1757-790X
    DOI 10.1136/bcr-2021-244150
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  8. Article ; Online: Stapes surgery in patients with a small air-bone gap.

    Lavy, Jeremy / McClenaghan, Fiona

    Ear, nose, & throat journal

    2018  Volume 97, Issue 7, Page(s) 198–212

    Abstract: The objective of this study was to determine hearing outcomes in patients undergoing stapes surgery with a preoperative air-bone gap (ABG) <21.25 dB. Patients with a unilateral or bilateral preoperative ABG <21.25 dB undergoing primary stapes surgery ... ...

    Abstract The objective of this study was to determine hearing outcomes in patients undergoing stapes surgery with a preoperative air-bone gap (ABG) <21.25 dB. Patients with a unilateral or bilateral preoperative ABG <21.25 dB undergoing primary stapes surgery were identified from a database of all stapes surgeries performed in a tertiary center over 15 years. A total of 254 ears met the inclusion criteria. The primary outcome measure was the degree of closure of the preoperative ABG. A secondary outcome measure was improvement in bone-conduction thresholds at 4 kHz. All patients underwent stapes surgery under local anesthesia. Ossicular reconstruction was achieved using a SMart 360 nitinol fluoroplastic piston (Gyrus ACMI, Inc.; Southborough, Mass.), and complete posterior crurotomy was performed with a KTP laser. Hearing was assessed with clinical voice testing immediately postoperatively and with pure-tone audiometry at 6 weeks postoperatively. A total of 248 ears (97.6%) demonstrated ABG closure to <10 dB. Bone-conduction thresholds showed an increase in 114 (44.9%), no change 74 (29.1%), and a decrease in 66 (26.0%). There is a slight increase in the risk of stapes mobilization in ears with a small ABG when compared to those with larger ABGs; however, this can be overcome by using a laser-assisted technique in combination with good surgical experience. The benefit in terms of hearing aid avoidance and the restoration of symmetrical hearing is both achievable and significant for the patient.
    MeSH term(s) Auditory Threshold ; Bone Conduction/physiology ; Follow-Up Studies ; Hearing ; Humans ; Otosclerosis/physiopathology ; Otosclerosis/surgery ; Postoperative Period ; Preoperative Period ; Retrospective Studies ; Stapes Surgery/methods ; Treatment Outcome
    Language English
    Publishing date 2018-09-27
    Publishing country United States
    Document type Journal Article
    ZDB-ID 750153-5
    ISSN 1942-7522 ; 0145-5613
    ISSN (online) 1942-7522
    ISSN 0145-5613
    DOI 10.1177/014556131809700709
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  9. Article ; Online: Use of tranexamic acid-soaked NasoPore® in the emergency department, to reduce epistaxis admissions.

    Rosario, Eleanor / Sharma, Ekta / Patel, Ankit / Guvensen, Gabrielle / Ashroff, Rizal / McClenaghan, Fiona / Hariri, Ahmad / Joseph, Jonathan

    Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery

    2023  Volume 48, Issue 6, Page(s) 909–914

    Abstract: Objectives: The aim of this study was to assess the efficacy of a new emergency department (ED) intervention for the management of non-traumatic, anterior epistaxis in adult patients, aiming to reduce epistaxis admissions.: Design: A new epistaxis ... ...

    Abstract Objectives: The aim of this study was to assess the efficacy of a new emergency department (ED) intervention for the management of non-traumatic, anterior epistaxis in adult patients, aiming to reduce epistaxis admissions.
    Design: A new epistaxis pathway was introduced for use by ED practitioners. This was disseminated in ED through an educational campaign by the ear, nose and throat team. A tranexamic acid (500 mg/5 mL)-soaked NasoPore® packing step was introduced for epistaxis which did not terminate following 10 min of simple first aid. The pathway was utilised for adult patients presenting with non-traumatic, anterior epistaxis. Pre- and post-implementation periods were defined, and all adults attending ED with non-traumatic, anterior epistaxis were included. Pre- and post-implementation epistaxis treatment interventions, admission rates and re-attendance rates were recorded by retrospective audit and compared.
    Results: In the post-implementation group, epistaxis admissions were 51.7% (p < .05) lower than in the pre-implementation group, as a proportion of the total number attending ED with epistaxis during these periods.
    Conclusions: The significant reduction in epistaxis admissions demonstrates that this ED intervention is beneficial for patient outcomes.
    MeSH term(s) Adult ; Humans ; Emergency Service, Hospital/statistics & numerical data ; Epistaxis/drug therapy ; Epistaxis/epidemiology ; Epistaxis/therapy ; Hospitalization/statistics & numerical data ; Retrospective Studies ; Tranexamic Acid/therapeutic use ; Bandages ; United Kingdom
    Chemical Substances Tranexamic Acid (6T84R30KC1)
    Language English
    Publishing date 2023-08-23
    Publishing country England
    Document type Journal Article
    ZDB-ID 2205891-6
    ISSN 1749-4486 ; 1749-4478 ; 0307-7772 ; 1365-2273
    ISSN (online) 1749-4486
    ISSN 1749-4478 ; 0307-7772 ; 1365-2273
    DOI 10.1111/coa.14093
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  10. Article: The concurrent use of gabapentin and opioid analgesia in burns patients.

    McClenaghan, Fiona

    Archives of trauma research

    2012  Volume 1, Issue 2, Page(s) 81–82

    Language English
    Publishing date 2012-08-21
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 2710716-4
    ISSN 2251-9599 ; 2251-953X
    ISSN (online) 2251-9599
    ISSN 2251-953X
    DOI 10.5812/atr.6636
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