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Benefit of cochlear implantation in a patient with Myhre syndrome
  1. Tiziana Di Cesare1,
  2. Giorgia Rossi1,
  3. Giorgia Girotto2,3 and
  4. Walter Di Nardo1
  1. 1Otorhinolaryngology, Foundation Polyclinic University A. Gemelli IRCCS, Rome, Lazio, Italy
  2. 2Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Friuli-Venezia Giulia, Italy
  3. 3Medical Genetics, Institute for Maternal and Child Health, IRCCS, Burlo Garofolo, Trieste, Friuli-Venezia Giulia, Italy
  1. Correspondence to Dr Tiziana Di Cesare; tizianadicesare90{at}


Myhre syndrome is a rare disorder characterised by short stature, skeletal anomalies, facial dysmorphism and hearing loss (HL), resulting from heterozygous mutations of the SMAD4 gene. We describe the benefits of cochlear implant (CI) in a patient with sensorineural HL carrying a mutation (NM_005359.6: c.1498A>G; p.lle500Val) within the SMAD4 gene, detected by whole-exome sequencing. The CI was inserted through the round window despite otospongiotic abnormalities. Pure-tone audiometry improved up to 20 dBHL. Speech perception in noise (Simplified Noise Reduction - SNR +10) increased from 0% pre implantation with hearing aids to 50% post implantation. The postoperative setting of the electrical stimulation limits yielded an asymmetric map, with lower levels for central electrodes and higher levels for lateral ones. Action potential could not be evoked via medial electrodes, suggesting a cochlear nerve dysfunction. Outcomes related to quality of life and cognitive impairment improved. CI was shown to be an effective auditory rehabilitation strategy.

  • ear
  • nose and throat/otolaryngology
  • genetics
  • neuro-otology
  • head and neck surgery
  • otolaryngology/ENT

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  • Contributors All the authors followed the patient in the preoperative and postoperative period, discussed the result and commented on the manuscript contributing to its final version. TDC and GR wrote the manuscript in consultation with WDN.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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