Standardized Active Middle-Ear Implant Coupling to the Short Incus Process.
Mlynski, Robert; Dalhoff, Ernst; Heyd, Andreas; Wildenstein, Daniela; Rak, Kristen; Radeloff, Andreas; Hagen, Rudolf; Gummer, Anthony W.; Schraven, Sebastian P., 2015-08-05 08:00:00 AM
Introduction: Active middle-ear implants with floating-mass transducer (FMT) technology are used to treat mild-to-severe sensorineural hearing losses. The standard surgical approach for incus vibroplasty is a mastoidectomy and a posterior tympanotomy, crimping the FMT to the long incus process. An alternative fixation side with less surgical trauma might be the short incus process and incus body. The aim of this study was to develop and test a short incus process coupling device for its functional properties in temporal bone preparations and clinical practice. Materials and Methods: An extended antrotomy and a posterior tympanotomy were performed in 10 fresh human temporal bones. As a control for normal middle-ear function, the tympanic membrane was stimulated acoustically, and the vibration of the stapes footplate was measured using laser Doppler vibrometry. FMT-induced vibration responses of the stapes were then measured for standard attachment at the long process and for 2 types of couplers designed for attachment at the short process of the incus (SP1 and SP2 coupler). Additionally, the functional outcome in 2 patients provided with an SP2 coupler was assessed postoperatively at 2 weeks, 3 months, and then 11 months, using pure-tone audiometry, auditory thresholds for frequency-modulated (warble) tones, vibroplasty thresholds, and speech audiometry in quiet and noise. Results: For the SP2 coupler, velocity-amplitude responses in temporal-bone preparations showed generally similar mean amplitudes as compared with the standard coupling of the FMT to the long process but with clearly increased mean amplitudes between 0.7 and 1.5 kHz and with reduced interindividual variation between 0.5 and 3 kHz. The clinical data of 2 patients with mild-to-severe sensory hearing loss showed good vibroplasty thresholds and convincing results for speech audiometry in quiet (Freiburger monosyllables at 65 dB SPL, 23 +/- 31% unaided versus 83 +/- 4% aided) and noise (Hochmair-Schulz-Moser-test at 65 dB SPL at 10 dB SNR, 32 +/- 45% unaided and 42 +/- 29% aided). Conclusion: The attachment of the FMT to the short incus process with the SP2 coupler leads to good mechanical and functional coupling in an experimental setup and clinical practice. Copyright (C) 2015 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart CompanyGDP Matters: Cost-Effectiveness of Cochlear Implantation and Deaf Education in Sub-Saharan Africa.
Emmett, Susan D.; Tucci, Debara L.; Smith, Magteld; Macharia, Isaac M.; Ndegwa, Serah N.; Nakku, Doreen; Kaitesi, Mukara B.; Ibekwe, Titus S.; Mulwafu, Wakisa; Gong, Wenfeng; Francis, Howard W.; Saunders, James E., 2015-08-05 08:00:00 AM
Hypothesis: Cochlear implantation and deaf education are cost effective in Sub-Saharan Africa. Background: Cost-effectiveness of pediatric cochlear implantation has been well established in developed countries but is unknown in low resource settings, where access to the technology has traditionally been limited. With incidence of severe-to-profound congenital sensorineural hearing loss 5 to 6 times higher in low/middle-income countries than the United States and Europe, developing cost effective management strategies in these settings is critical. Methods: Costs were obtained from experts in Nigeria, South Africa, Kenya, Rwanda, Uganda, and Malawi using known costs and published data, with estimation when necessary. A disability adjusted life years (DALY) model was applied using 3% discounting and 10-year length of analysis. Sensitivity analysis was performed to evaluate the effect of device cost, professional salaries, annual number of implants, and probability of device failure. Cost-effectiveness was determined using the WHO standard of cost-effectiveness ratio/gross domestic product per capita (CER/GDP) less than 3. Results: Cochlear implantation was cost effective in South Africa and Nigeria, with CER/GDP of 1.03 and 2.05, respectively. Deaf education was cost effective in all countries investigated, with CER/GDP ranging from 0.55 to 1.56. The most influential factor in the sensitivity analysis was device cost, with the cost effective threshold reached in all countries using discounted device costs that varied directly with GDP. Conclusion: Cochlear implantation and deaf education are equally cost effective in lower-middle and upper-middle income economies of Nigeria and South Africa. Device cost may have greater impact in the emerging economies of Kenya, Uganda, Rwanda, and Malawi. Copyright (C) 2015 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart CompanyMeniere's Syndrome or Disease: Time Trends in Management and Quality of Evidence Over the Last Two Decades.
Syed, Mohammed Iqbal; Ilan, Ophir; Leong, Annabelle C.; Pothier, David D.; Rutka, John A., 2015-08-05 08:00:00 AM
Objective: To evaluate the evidence and trends in published literature on the treatment of Meniere's syndrome or disease (MS/D) by comparing studies published in the last two decades. Data Sources: A literature search was performed on AMED, EMBASE, HMIC, MEDLINE, PsycINFO, BNI, CINAHL, HEALTH BUSINESS ELITE, CENTRAL and Cochrane Ear, Nose and Throat disorders groups trials register using a combination of MeSH. The date of last search was October 2014. Study Selection and Data Extraction: Two hundred five studies (104 in decade I and 101 in decade II) were evaluated to report trends in the management of this condition, the differing levels of evidence published for each treatment modality, evaluate whether the guidelines published by the AAOHNS-Committee on Hearing and Equilibrium had been correctly employed, and whether the randomized controlled trials (RCTs) were compliant with the CONSORT guidelines. Results: The number of published RCTs almost tripled from decade I (1994-2003) to decade II (2004-2103). There was a significant decline in the use of surgical intervention (p = 0.013); however, the number of studies involving the use of intratympanic injection remained largely unchanged. There was a shift in the level of evidence in published studies; studies with level 1 evidence tripled from decade I to II (4.8 to 17.8%, respectively) (p = 0.03); however, compliance with the AAOHNS-CHE criteria for reporting treatment outcomes and the CONSORT checklist was still poor. Conclusion: Although the evidence base on published literature on MS/D has improved over the last decade with an increase in emphasis on RCTs and quality of life (QoL) studies, a significant number of studies failed to follow AAOHNS-CHE criteria for reporting treatment outcome and the CONSORT criteria for reporting RCTs. Copyright (C) 2015 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart CompanyHistopathologic Findings of an Aberrant Internal Carotid Artery in the Temporal Bone with Fatal Complication.
Kimura, Yurika; Makino, Nao; Sawabe, Motoji; Kitamura, Ken, 2015-08-05 08:00:00 AM
Refractory Positional Vertigo with Apogeotropic Horizontal Nystagmus After Labyrinthitis: Surgical Treatment and Identification of Dysmorphic Ampullae.
Ahmed, Sameer; Heidenreich, Katherine D.; McHugh, Jonathan B.; Altschuler, Richard A.; Carender, Wendy J.; Telian, Steven A., 2015-08-05 08:00:00 AM
Objectives: To describe the rationale, intraoperative details, and histopathologic findings discovered when treating an unusual case of apogeotropic horizontal canal positional vertigo with a transmastoid labyrinthectomy. Patient: A single case report. Intervention: Therapeutic. Main Outcome Measures: Resolution of apogeotropic nystagmus and improvement of positional vertigo. Results: The apogeotropic variant of horizontal canal positional vertigo can be a difficult entity to treat. This report describes a patient who developed profound sensorineural hearing loss and vertigo after an acute left labyrinthitis. Ten months later, she developed vertigo with apogeotropic positional nystagmus involving the left horizontal semicircular canal. Particle repositioning maneuvers and vestibular physical therapy were unsuccessful. In addition, she developed intermittent positional vertigo affecting the ipsilateral vertical semicircular canals. Given the persistence of her vertigo, multiple canal involvement, and patient preference for definitive treatment, a transmastoid labyrinthectomy was performed. Intraoperatively, the ampulla of the horizontal canal as well as that of the other canals was grossly abnormal as later confirmed on histology. After surgery, her apogeotropic nystagmus and vertigo resolved, and her balance ability gradually improved to a highly functional level. Conclusion: This case illustrates a unique form of positional vertigo that developed and persisted after acute labyrinthitis. Conservative measures were unsuccessful and a transmastoid labyrinthectomy documented dense inflammatory tissue involving all three ampullae. We postulate that the post-labyrinthitic inflammatory changes resulted in mass loading of the membranous ampullae, causing abnormal nystagmus patterns and positional vertigo, which resolved after the labyrinthectomy. Copyright (C) 2015 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart CompanyCERVICAL SPINE DYSFUNCTIONS IN PATIENTS WITH CHRONIC SUBJECTIVE TINNITUS.
Bhatt, Jay; Ghavami, Yaser; Lin, Harrison W.; Djalilian, Hamid, 2015-08-05 08:00:00 AM
Prevention of Postoperative Cerebrospinal Fluid Leaks After Translabyrinthine Tumor Resection with Resorbable Mesh Cranioplasty.
Hunter, Jacob B.; Sweeney, Alex D.; Carlson, Matthew L.; Wanna, George B.; Rivas, Alejandro; Weaver, Kyle D.; Chambless, Lola B.; Thompson, Reid S.; Haynes, David S.; Bennett, Marc L., 2015-08-05 08:00:00 AM
Objectives: To evaluate the effectiveness of resorbable mesh cranioplasty at reducing postoperative cerebrospinal fluid (CSF) leak and pseudomeningocele formation after translabyrinthine tumor resection. Study Design: Case series with chart review. Setting: Tertiary academic referral center. Patients: Fifty-three consecutive cases using a resorbable mesh cranioplasty after translabyrinthine tumor resection were reviewed. Intervention: Temporal bone defects were repaired with a dural substitute, layered fat graft, and a resorbable mesh plate secured with screws. Main Outcome Measures: Primary outcome measures included the incidence of postoperative CSF wound leak or rhinorrhea, pseudomeningocele formation, and surgical site infection. Results: Fifty-three cases (average age, 54.0 yr; range, 19.3-75.1 yr) were analyzed. The average body mass index was 30.8 kg/m2 (range, 17.9-48.3 kg/m2), and the average tumor size was 18.8 mm (range, 8-38 mm). One patient (1.9%) experienced CSF rhinorrhea on postoperative Day 16, which resolved after transmastoid middle ear and eustachian tube packing. One patient (1.9%) experienced a surgical site infection requiring surgical debridement and mesh removal 4 months after surgery. Compared with 1,441 prior translabyrinthine surgeries analyzed from our institution using a traditional fat graft closure without mesh, the rate of postoperative CSF leak was significantly less using the resorbable mesh cranioplasty technique (p = 0.0483). Conclusion: Resorbable mesh cranioplasty is a safe and effectivemethod to reduce postoperative CSF leak and pseudomeningocele formation after translabyrinthine craniotomy for tumor excision. Copyright (C) 2015 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart CompanyPulmonary Embolism and Infarct After Bilateral Cochlear Implantation in a Patient with Newly Diagnosed Sickle/[beta]+ Thalassemia.
Tang, Shan; Nickel, Christopher; Lalwani, Anil K., 2015-08-05 08:00:00 AM
Objective: To heighten awareness of increased postoperative thromboembolic complications in patients with [beta]-hemoglobinopathies. Patient: A 42-year-old African American woman with previously undiagnosed [beta]-hemoglobinopathies suffers from sensorineural hearing loss caused by bacterial meningitis and undergoes bilateral cochlear implantation. Intervention(s): Diagnostic: hemoglobin electrophoresis. Therapeutic: cochlear implantation, anticoagulation. Main Outcome Measure(s): Risk of thromboembolic event. Results: Five days after surgery, the patient developed pulmonary embolism and infarct in the right lower lobe, which was treated with a 4-month course of anticoagulation. Hemoglobin electrophoresis showed that the patient had a previously undiagnosed rare [beta]-hemoglobinopathy known as sickle/[beta]+ thalassemia. Conclusion: [beta]-Hemoglobinopathies are associated with a higher incidence of thromboembolism; thus, they should be managed aggressively to prevent or treat perioperative thrombosis. Copyright (C) 2015 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart CompanyUnresectable Recurrent Squamous Cell Carcinoma of the Temporal Bone Treated by Induction Chemotherapy Followed by Concurrent Chemo-Reirradiation: A Case Report and Review of the Literature.
Kun, Ma; Xinxin, Zhang; Feifan, Zhao; Lin, Ma, 2015-08-05 08:00:00 AM
Objective: To report a rare case of recurrent temporal bone carcinoma encasing the carotid artery. Patient: A 54-year-old man underwent mastoidectomy combined with adjuvant chemoradiotherapy of squamous cell carcinoma of the temporal bone. He developed metastatic disease and received parotidectomy and lymph node dissection. Three months later, the magnetic resonance imaging scan showed that the tumor had relapsed and invaded the carotid artery. Intervention: The patient completed TPF-C induction chemotherapy (docetaxel, cisplatin, 5-fluorouracil, cetuximab), followed by concurrent chemotherapy with reirradiation. Results: Magnetic resonance imaging revealed a complete response of tumor 1 month after treatment. The patient had no detectable recurrence after 53 months of follow-up. Conclusion: Concurrent chemotherapy with reirradiation is a potential curative treatment option for patients who have unresectable recurrent squamous cell carcinoma of the temporal bone. Copyright (C) 2015 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart CompanyTemporal Cortical Plasticity in Single-Sided Deafness: A Functional Imaging Study.
Pross, Seth E.; Chang, Jolie L.; Mizuiri, Danielle; Findlay, Anne M.; Nagarajan, Srikantan S.; Cheung, Steven W., 2015-08-05 08:00:00 AM
Hypothesis: To refine and extend the knowledge on cortical plasticity in single-sided deafness (SSD) by assessing magnetoencephalographic imaging in a well-defined group of subjects. Background: SSD causes difficulties with directional hearing, signal extraction in noise, and multispeaker identification and separation. In SSD, the ipsilateral auditory cortex is never powerfully driven by sound, which may lead to plastic change and contribute to higher-order psychoacoustic dysfunction beyond loss of a peripheral sound sensor. Study Design: A cross-sectional study on 12 subjects with long-term, adult-onset, nontraumatic SSD and 12 normal-hearing controls was conducted using magnetoencephalographic imaging, magnetic resonance imaging, and validated hearing instruments. Pure-tone stimuli at five frequencies were presented to each hearing ear individually. M100 activation peak times of the ipsilateral and contralateral auditory cortices were analyzed. Results: Controls showed an M100 interhemispheric mean latency difference of 6.6 milliseconds. In contrast, subjects with SSD exhibited a mean of 1.7 milliseconds. This loss of interhemispheric latency difference was statistically significant (p < 0.05, analysis of variance with repeated measures). SSD subjects confirmed degraded hearing function on both Hearing Handicap Inventory for Adults (p < 0.001) and Speech, Spatial, and Qualities of Hearing Scale instruments (p < 0.001). Conclusion: SSD disrupts M100 latency difference between the two hemispheres to sound stimulation. This finding may represent maladaptive temporal cortical plasticity because of loss of a peripheral sensor. Based on this premise, a new generation of neurophysiologically inspired auditory treatments to correct or mitigate central consequences of SSD may be considered to optimize hearing in individuals with only one functional ear. Copyright (C) 2015 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart CompanyInitial UK Experience With a Novel Magnetic Transcutaneous Bone Conduction Device.
Carr, Simon D.; Moraleda, Javier; Procter, Vicky; Wright, Kay; Ray, Jaydip, 2015-08-05 08:00:00 AM
Objective: To assess outcomes with a new transcutaneous bone conduction hearing aid. Patients: Patients that underwent implantation with the transcutaneous bone conduction device between November 2013 and May 2014. Intervention: Hearing rehabilitation using the BAHA Attract. Main Outcome Measures: Quality of life measures using Glasgow benefit inventory (GBI) and clinically oriented scale of improvement (COSI). Audiological outcome using word discrimination score. Results: Ten patients were implanted. Significant improvement in GBI and COSI scores comparing preimplantation and postimplantation. An increase in word discrimination scores at 30 dBA, with an increase from 0% unaided to a mean of 50% with the magnetic transcutaneous bone conduction aid and at 50 dBA with an increase from a mean of 31.7% to 88.3%. However, the word discrimination score increase at 30, 50, and 60 dBA was not statistically significant (p = 0.25; Wilcoxon). Conclusion: There was a high level of satisfaction with the device with significant increases in GBI and COSI scores in patients who were previously aided with an acoustic aid. The absence of daily skin hygiene appealed to patients. Copyright (C) 2015 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart CompanyDose Effect of Intratympanic Dexamethasone for Idiopathic Sudden Sensorineural Hearing Loss: 24 mg/mL Is Superior to 10 mg/mL.
Alexander, Thomas H.; Harris, Jeffrey P.; Nguyen, Quyen T.; Vorasubin, Nopawan, 2015-08-05 08:00:00 AM
Objective: To compare outcomes in patients with idiopathic sudden sensorineural hearing loss (ISSNHL) treated with intratympanic (IT) dexamethasone (DEX) at either 10 mg/mL or 24 mg/mL. Study Design: Retrospective case series. Setting: Tertiary referral center. Patients: Thirty-seven adults with ISSNHL. Interventions: In addition to concurrent prednisone taper, patients received a series of IT DEX injections for 2 weeks with either 10 mg/mL or 24 mg/mL. Main Outcome Measure: Greater than 30-dB improvement in pure-tone average (PTA). Results: Baseline characteristics were similar between groups. Mean follow-up was 10 weeks. Ten (53%) of 19 patients treated with 24 mg/mL had greater than 30-dB improvement in PTA compared with 3 (17%) of 18 treated with 10 mg/mL (p = 0.0382, Fisher's exact test). There was a trend toward improved word recognition score outcome with 24 mg/mL. The interval between onset and initiation of IT DEX significantly affected outcome, with earlier treatment resulting in greater improvement in PTA and word recognition score. Multivariate logistic regression confirmed that IT DEX dose and interval to starting treatment were both independent predictors of PTA outcome. Change in PTA was not significantly affected by age, sex, pretreatment hearing levels, or concurrent treatment with hyperbaric oxygen. Conclusion: To our knowledge, this is the first demonstration of superiority of IT DEX at 24 mg/mL for the treatment of ISSNHL, with significantly better recovery of PTA. Our data suggest that treatment should be initiated as soon as possible. A prospective randomized trial to confirm the optimal dose is warranted. Copyright (C) 2015 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart CompanyRESPONSE TO LETTER TO THE EDITOR: "CERVICAL SPINE DYSFUNCTIONS IN PATIENTS WITH CHRONIC SUBJECTIVE TINNITUS".
Michiels, Sarah; De Hertogh, Willem; Van de Heyning, Paul, 2015-08-05 08:00:00 AM
Correlations of External Landmarks With Internal Structures of the Temporal Bone.
Piromchai, Patorn; Wijewickrema, Sudanthi; Smeds, Henrik; Kennedy, Gregor; O'Leary, Stephen, 2015-08-05 08:00:00 AM
Hypothesis: The internal anatomy of a temporal bone could be inferred from external landmarks. Background: Mastoid surgery is an important skill that ENT surgeons need to acquire. Surgeons commonly use CT scans as a guide to understanding anatomical variations before surgery. Conversely, in cases where CT scans are not available, or in the temporal bone laboratory where residents are usually not provided with CT scans, it would be beneficial if the internal anatomy of a temporal bone could be inferred from external landmarks. Methods: We explored correlations between internal anatomical variations and metrics established to quantify the position of external landmarks that are commonly exposed in the operating room, or the temporal bone laboratory, before commencement of drilling. Mathematical models were developed to predict internal anatomy based on external structures. Results: From an operating room view, the distances between the following external landmarks were observed to have statistically significant correlations with the internal anatomy of a temporal bone: temporal line, external auditory canal, mastoid tip, occipitomastoid suture, and Henle's spine. These structures can be used to infer a low lying dura mater (p = 0.002), an anteriorly located sigmoid sinus (p = 0.006), and a more lateral course of the facial nerve (p < 0.001). In the temporal bone laboratory view, the mastoid tegmen and sigmoid sinus were also regarded as external landmarks. The distances between these two landmarks and the operating view external structures were able to further infer the laterality of the facial nerve (p < 0.001) and a sclerotic mastoid (p < 0.001). Two nonlinear models were developed that predicted the distances between the following internal structures with a high level of accuracy: the distance from the sigmoid sinus to the posterior external auditory canal (p < 0.001) and the diameter of the round window niche (p < 0.001). Conclusion: The prospect of encountering some of the more technically challenging anatomical variants encountered in temporal bone dissection can be inferred from the distance between external landmarks found on the temporal bone. These relationships could be used as a guideline to predict challenges during drilling and choosing appropriate temporal bones for dissection. Copyright (C) 2015 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart CompanyUsher's Syndrome: Evaluation of the Vestibular System with Cervical and Ocular Vestibular Evoked Myogenic Potentials and the Video Head Impulse Test.
Magliulo, Giuseppe; Iannella, Giannicola; Gagliardi, Silvia; Iozzo, Nicola; Plateroti, Rocco; Plateroti, Pasquale; Re, Massimo; Vingolo, Enzo Maria, 2015-08-05 08:00:00 AM
Objective: The Usher's syndrome (USH) is composed of a group of inherited disorders characterized by a dual sensory impairment of the audiovestibular and visual systems. Despite the established hearing loss, few authors have investigated vestibular dysfunction in these patients. The aim of this article is to investigate otolith or ampullary dysfunction in a group of patients affected by USH by means of a diagnostic protocol using caloric vestibular tests, cervical vestibular evoked myogenic potentials (C-VEMPs), ocular vestibular evoked myogenic potentials (O-VEMPs), and video head impulse test (v-HIT) to show any selective damage of the vestibular nerve and also to identify if it is present in patients with a previous diagnosis of USH Type II. Study Design: Prospective study with C-VEMPs, O-VEMPs, and v-HIT. Setting: Tertiary referral center. Patients: Fifteen patients with USH. Intervention: Evaluation of otolith dysfunction with caloric test, C-VEMPs, and O-VEMPs and the measurement of the vestibular-ocular reflex using the v-HIT. Results: Only three cases showed normal values of all the vestibular tests performed. O-VEMPs and C-VEMPs appeared pathologic in nine and seven cases, respectively. V-HITs showed ampullary dysfunction in 10 patients. In our study, eight of the 11 patients belonging to the group of USH Type II showed a pathologic response to at least one of the vestibular tests performed. Conclusion: Today, in patients affected by USH, any vestibular diagnostic protocol must include VEMPs and v-HIT to confirm the vestibular damage, identify selective deficit of the vestibular nerve, and provide useful information for a correct classification of USH. Copyright (C) 2015 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart CompanyImpact of Intrascalar Electrode Location, Electrode Type, and Angular Insertion Depth on Residual Hearing in Cochlear Implant Patients: Preliminary Results.
Wanna, George B.; Noble, Jack H.; Gifford, Rene H.; Dietrich, Mary S.; Sweeney, Alex D.; Zhang, Dongqing; Dawant, Benoit M.; Rivas, Alejandro; Labadie, Robert F., 2015-08-05 08:00:00 AM
Objective: To evaluate the relationship between intrascalar electrode location, electrode type (lateral wall, perimodiolar, and midscala), and angular insertion depth on residual hearing in cochlear implant (CI) recipients. Setting: Tertiary academic hospital. Patients: Adult CI patients with functional preoperative residual hearing with preoperative and postoperative CT scans. Intervention: Audiological assessment after CI. Main Outcome Measures: Electrode location, angular insertion depth, residual hearing post-CI, and word scores with CI (consonant-nucleus-consonant [CNC]). Results: Forty-five implants in 36 patients (9 bilateral) were studied. Thirty-eight electrode arrays (84.4%) were fully inserted in scala tympani (ST), 6 (13.3%) crossed from ST to scala vestibuli (SV), and 1 (2.2%) was completely in SV. Twenty-two of the 38 (57.9%) with full ST insertion maintained residual hearing at 1 month compared with 0 of the 7 (0%) with non-full ST insertion (p = 0.005). Three surgical approaches were used: cochleostomy (C) 6/44, extended round window (ERW) 8/44, and round window (RW) 30/44. C and ERW were small group to compare with RW approaches. However if we combine C + ERW, then RW has higher chance of full ST insertion (p = 0.014). Looking at the full ST group, neither age, sex, nor electrode type demonstrated statistically significant associations with hearing preservation (p = 0.646, p = 0.4, and p = 0.929, respectively). The median angular insertion depth was 429[degrees] (range, 373[degrees]-512[degrees]) with no significant difference between the hearing and nonhearing preserved groups (p = 0.287). Conclusion: Scalar excursion is a strong predictor of losing residual hearing. However, neither age, sex, electrode type, nor angular insertion depth was correlated with hearing preservation in the full ST group. Techniques to decrease the risk of electrode excursion from ST are likely to result in improved residual hearing and CI performance. Copyright (C) 2015 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart CompanyCost Effectiveness of Childhood Cochlear Implantation and Deaf Education in Nicaragua: A Disability Adjusted Life Year Model.
Saunders, James E.; Barrs, David M.; Gong, Wenfeng; Wilson, Blake S.; Mojica, Karen; Tucci, Debara L., 2015-08-05 08:00:00 AM
Introduction: Cochlear implantation (CI) is a common intervention for severe-to-profound hearing loss in high-income countries, but is not commonly available to children in low resource environments. Owing in part to the device costs, CI has been assumed to be less economical than deaf education for low resource countries. The purpose of this study is to compare the cost effectiveness of the two interventions for children with severe-to-profound sensorineural hearing loss (SNHL) in a model using disability adjusted life years (DALYs). Methods: Cost estimates were derived from published data, expert opinion, and known costs of services in Nicaragua. Individual costs and lifetime DALY estimates with a 3% discounting rate were applied to both two interventions. Sensitivity analysis was implemented to evaluate the effect on the discounted cost of five key components: implant cost, audiology salary, speech therapy salary, number of children implanted per year, and device failure probability. Results: The costs per DALY averted are $5,898 and $5,529 for CI and deaf education, respectively. Using standards set by the WHO, both interventions are cost-effective. Sensitivity analysis shows that when all costs set to maximum estimates, CI is still cost-effective. Conclusion: Using a conservative DALY analysis, both CI and deaf education are cost-effective treatment alternatives for severe-to-profound SNHL. CI intervention costs are not only influenced by the initial surgery and device costs but also by rehabilitation costs and the lifetime maintenance, device replacement, and battery costs. The major CI cost differences in this low resource setting were increased initial training and infrastructure costs, but lower medical personnel and surgery costs. Copyright (C) 2015 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart CompanyIN VIVO INNER EAR IMAGING AT 7 T.
van der Jagt, Annerie M. A.; Brink, Wyger M.; Webb, Andrew; Frijns, Johan H. M.; Verbist, Berit M., 2015-08-05 08:00:00 AM
Incidentally Discovered Unruptured AICA Aneurysm After Radiosurgery for Vestibular Schwannoma: A Case Report and Review of the Literature.
Hughes, Joshua D.; Osetinsky, L. Mariel; Jacob, Jeffrey T.; Carlson, Matthew L.; Lanzino, Giuseppe; Link, Michael J., 2015-08-05 08:00:00 AM
Objective: This is a case report and review of the literature of aneurysm formation after stereotactic radiosurgery (SRS) in the posterior fossa. Cerebral aneurysm formation is not a commonly recognized complication of SRS. We present the first case of an unruptured anteroinferior cerebellar artery aneurysm incidentally found at surgery in a patient with trigeminal neuralgia secondary to a vestibular schwannoma (VS) first treated with Gamma Knife radiosurgery. Other cases of posterior fossa aneurysms associated with SRS and the pathogenesis of vascular injury by radiation are discussed. Patient: A 57-year-old woman with medically intractable severe trigeminal neuralgia secondary to a 1.4-cm VS treated with SRS 10 years previously at an outside institution. Intervention: The patient underwent a left retrosigmoid craniotomy for tumor debulking. Main Outcome and Results: During resection, two small aneurysms on the tumor's ventral side arising from the main trunk of the anteroinferior cerebellar artery were encountered and treated with direct clip ligation, sparing the parent vessel. The patient did well after surgery and was discharged home on Hospital Day 4 at her neurologic baseline, with normal facial nerve function and without trigeminal pain. Conclusion: Although aneurysms associated with posterior fossa SRS are rare, there are at least seven reports, including the current case, in the past decade. Because the relationship between radiation and aneurysm formation is unproven and controversial, further study, especially examining long-term effects, is needed. Given the overall rarity and uncertain association between SRS and aneurysm formation, we do not recommend routine aneurysm surveillance screening in patients undergoing Gamma Knife radiosurgery for VS. Surgeons should be aware of the rare possibility of encountering an aneurysm during surgical exploration in patients with VS who fail SRS. Copyright (C) 2015 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart CompanyA Within-Subject Comparison of Bimodal Hearing, Bilateral Cochlear Implantation, and Bilateral Cochlear Implantation With Bilateral Hearing Preservation: High-Performing Patients.
Gifford, René H.; Driscoll, Colin L. W.; Davis, Timothy J.; Fiebig, Pam; Micco, Alan; Dorman, Michael F., 2015-08-05 08:00:00 AM
Objective: To compare speech understanding with bimodal hearing and bilateral cochlear implants (CIs). Study Design: Within-subjects, repeated-measures. Methods: Speech understanding was assessed in the following conditions: unilateral hearing aid (HA) in the non-implanted ear, unilateral CI, bimodal (CI + HA), and bilateral CI. In addition, three participants had bilateral hearing preservation and were also tested with bilateral CIs and bilateral HAs (BiBi). Setting: Tertiary academic CI center. Patients: Eight adult sequential bilateral recipients who, despite achieving incredibly high performance with the first CI, self-selected for bilateral cochlear implantation. Intervention(s): Bilateral cochlear implantation. Main Outcome Measure(s): Speech understanding for the adult minimum speech test battery as well as sentences in semidiffuse noise using the R-SPACE system. Results: Bilateral CIs afforded significant individual improvement in a complex listening environment even for individuals demonstrating near perfect sentence scores with both the first CI alone as well as the bimodal condition. The 3 BiBi participants demonstrated additional significant benefit over the bilateral CI condition-presumably because of the availability of interaural time difference cues. Conclusions: These data suggest that, for noisy environments, adding a second implant can significantly improve speech understanding-even for high-performing unilateral CI with bimodal hearing. In diffuse noise conditions, bilateral acoustic hearing can yield even greater benefits beyond that offered by bilateral implantation. Copyright (C) 2015 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart CompanyPediatric Semicircular Canal Dehiscence: Radiographic and Histologic Prevalence, With Clinical Correlation.
Meiklejohn, Duncan A.; Corrales, C. Eduardo; Boldt, Brian M.; Sharon, Jeffrey D.; Yeom, Kristen W.; Carey, John P.; Blevins, Nikolas H., 2015-08-05 08:00:00 AM
Objectives: To determine the prevalence of radiographic and histologic superior semicircular canal dehiscence (SSCD) and posterior semicircular canal dehiscence (PSCD) and associated changes in temporal bone thickness in children aged 0 to 7 years. Study Design: Retrospective chart review and histopathologic review of cadaveric bone specimens. Setting: Two tertiary referral centers. Patients: Children younger than 7 years who underwent high-resolution computed tomography scan including the temporal bones between 1998 and 2013 and temporal bones harvested from children younger than 7 years. Intervention(s): Two hundred twenty-eight computed tomography studies and 58 temporal bone specimens were reviewed. Available patient demographics were tabulated. Main Outcome Measure(s): Prevalence of SSCD and PSCD and bone thickness over semicircular canals, with comparison across age groups. Clinical data were extracted for patients with radiographic dehiscence. Results: Prevalence by ear of SSCD was 11.9%, 4.9%, 2.8%, and 0% and of PSCD was 16.7%, 2.4%, 1.4%, and 0% in children aged less than 6 months, 6 to 11 months, 12 to 35 months, and 3 to 7 years, respectively. SSCD was statistically more common before 1 year of age and PSCD before 6 months of age. Bone thickness overlying both the SSC and the PSC increased with age. Radiographic PSC bone was significantly thicker than SSC bone in patients older than 12 months. No dehiscences were found in the histologic specimens. Conclusion: Radiographic dehiscence of the canals is common in the first 6 months of life, with thin bone seen histologically. Prevalence decreases with increasing age as the bone overlying the canals increases in thickness. Copyright (C) 2015 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart CompanyComparison of Audiometric and Functional Outcomes Between the Standard and Modified 360 Nitinol Shape Memory Stapes Prostheses.
Lavy, Jeremy; Huins, Charlie; Khalil, Sherif; Hall, Andrew; Hughes, Owain, 2015-08-05 08:00:00 AM
Objective: To compare audiometric and functional outcomes between two designs of heat-activated self-crimping stapes prostheses-a modified shape memory circumferential nitinol-Teflon piston versus its predecessor-in patients with otosclerosis. Study Design: A retrospective analysis of preoperative and postoperative hearing thresholds. Setting: Tertiary referral center and teaching hospital. Patients: One hundred sixty-three consecutive procedures of primary stapes surgery for clinically proven otosclerosis in 108 women and 55 men with an average age of 46 years. Intervention: Stapedotomy and insertion of either a standard or a circumferential stapes prosthesis. Main Outcome Measures: Four-frequency pure-tone average preoperative and postoperative air-bone thresholds were recorded. A secondary outcome measure was stability of the implant, as measured by failure rates. Results: Success of closure of the air-bone gap to within 10 dB was achieved in 97% and comparable in both groups (original prosthesis, 23.6; standard deviation, 7.3, with the average reduction seen in the circumferential prosthesis group being 22.6, standard deviation, 5.6). All the differences were not statistically significant using two-way analysis of variance. Failure rate for the original piston was 6%, with no failures seen with the circumferential piston. Conclusion: Both prostheses showed comparable postoperative hearing outcomes, with the circumferential prosthesis being found to be more stable. Copyright (C) 2015 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart CompanyEffects of Skin Thickness on Cochlear Input Signal Using Transcutaneous Bone Conduction Implants.
Mattingly, Jameson K.; Greene, Nathaniel T.; Jenkins, Herman A.; Tollin, Daniel J.; Easter, James R.; Cass, Stephen P., 2015-08-05 08:00:00 AM
Hypothesis: Intracochlear sound pressures (PIC) and velocity measurements of the stapes, round window, and promontory (VStap/RW/Prom) will show frequency-dependent attenuation using magnet-based transcutaneous bone conduction implants (TCBCIs) in comparison with direct-connect skin-penetrating implants (DCBCIs). Background: TCBCIs have recently been introduced as alternatives to DCBCIs. Clinical studies have demonstrated elevated high-frequency thresholds for TCBCIs as compared with DCBCIs; however, little data exist examining the direct effect of skin thickness on the cochlear input signal using TCBCIs. Methods: Using seven cadaveric heads, PIC was measured in the scala vestibuli and tympani with fiber-optic pressure sensors concurrently with VStap/RW/Prom via laser Doppler vibrometry. Ipsilateral titanium implant fixtures were placed and connected to either a DCBCI or a TCBCI. Soft tissue flaps with varying thicknesses (no flap and 3, 6, and 9 mm) were placed successively between the magnetic plate and sound processor magnet. A bone conduction transducer coupled to custom software provided pure-tone stimuli between 120 and 10,240 Hz. Results: Stimulation via the DCBCI produced the largest response magnitudes. The TCBCI showed similar PSV/ST and VStap/RW/Prom with no intervening flap and a frequency-dependent nonlinear reduction of magnitude with increasing flap thickness. Phase shows a comparable dependence on transmission delay as the acoustic baseline, and the slope steepens at higher frequencies as flap thickness increases, suggesting a longer group delay. Conclusion: Proper soft tissue management is critical to optimize the cochlear input signal. The skin thickness-related effects on cochlear response magnitudes should be taken into account when selecting patients for a TCBCI. Copyright (C) 2015 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart CompanyTemporal Lobe Encephaloceles: A Potentially Curable Cause of Seizures.
Morone, Peter J.; Sweeney, Alex D.; Carlson, Matthew L.; Neimat, Joseph S.; Weaver, Kyle D.; Abou-Khalil, Bassel W.; Arain, Amir M.; Singh, Pradumna; Wanna, George B., 2015-08-05 08:00:00 AM
Objective: Temporal lobe encephaloceles are characterized by protrusion of brain parenchyma through a structural defect in the floor of the middle fossa. They have been reported to cause cerebrospinal fluid (CSF) leaks, conductive hearing loss, meningitis, and seizures. The association between temporal encephaloceles and epileptiform activity is particularly rare. Patients: All patients who presented to a single tertiary referral center between 2011 and 2014 with intractable seizures and radiographic evidence of a middle cranial fossa encephalocele were evaluated. Five patients from this subset who underwent surgical repair of their encephalocele are presented. Intervention(s): Middle cranial fossa approach for encephalocele repair. Main Outcome Measure(s): Postoperative epileptiform activity. Results: Five patients underwent a craniotomy for resection of a temporal lobe encephalocele with repair of a middle fossa floor defect. After surgery, CSF rhinorrhea resolved, when present, and all patients remained seizure-free through their last available follow-up. Range of follow-up time was 3.5 months to 4 years. Average follow-up time was 19.7 months. Conclusion: Temporal lobe encephaloceles are an infrequent cause of seizures. Given that these lesions can be missed with standard imaging modalities, they are likely underdiagnosed upon initial medical evaluation. This diagnosis should be considered in patients with intractable seizures. If an encephalocele is found, focused resection of epileptogenic tissue associated with herniation and repair of the temporal floor defect can provide definitive treatment. Copyright (C) 2015 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart CompanyInflammatory Pseudotumors of the Skull Base: Meta-Analysis.
Alyono, Jennifer C.; Shi, Yangyang; Berry, Gerald J.; Recht, Lawrence D.; Harsh, Griffith R. IV; Jackler, Robert K.; Corrales, C. Eduardo, 2015-08-05 08:00:00 AM
Objective: To describe the presentation, treatment, and outcome of inflammatory pseudotumors (IPs) of the skull base. Data Sources: English-language articles in PubMed, Web of Science, and EMBASE from earliest available through April 2014. Study Selection: Articles were identified using a keyword search for "inflammatory pseudotumor," "inflammatory myofibroblastoma," or "plasma cell granuloma," including a keyword localizing to the skull base. Data Extraction: One hundred papers with 157 cases met inclusion criteria. History, tumor site, initial and subsequent treatment, outcomes, and complications were extracted. Student t test, z test, and analysis of variance were used to analyze demographics, symptoms, sites involved, and outcomes. Odds ratios for site versus initial treatment were calculated. Data Synthesis: At diagnosis, average patient age was 41 years. Approximately 70% of lesions primarily involved the anterior skull base, 29% the lateral skull base, and 1.2% the occiput. The most common initial treatments were steroids (44%), surgery (28%), and surgery with steroids (16%). Anterior lesions were 55.8 times more likely than lateral lesions to be treated initially with steroids (CI, 14.7-212). Seventy-six percent of patients had stable or resolved symptoms after a single course of treatment. Conclusion: Diagnosis of skull base IP requires ruling out other aggressive pathologies, such as malignancy and infection, and maintaining a high index of suspicion. Surgery is favored for lesions that can be removed in toto with minimal morbidity, as well as steroids for those sites where anatomy limits complete resection, such as within the orbit, cavernous sinus, or brain. An option for larger lesions involving vital anatomy is debulking, followed by postoperative steroids. Copyright (C) 2015 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart CompanyRadiation-Induced Necrosis of the Temporal Bone: Diagnosis and Management.
Phillips, David J.; Njoku, Innocent U.; Brown, Kevin D.; Selesnick, Samuel H., 2015-08-05 08:00:00 AM
Objective: To document our experience with osteoradionecrosis (ORN) of the temporal bone. Study Design: Retrospective case review. Setting: Tertiary care medical center. Patients: Patients who developed exposed necrotic bone of the external auditory canal after radiation therapy to the head and neck. Interventions: Temporal bone ORN was managed conservatively in all patients with a combination of systemic antibiotics, antibiotic ear drops, and in-office debridement. Three patients required surgery, two of which were for a cholesteatoma. Main Outcome Measure: The need for surgical intervention in the management of ORN. Results: Twenty-three patients with ORN of the temporal bone comprise the study group. The average age of patients at the time of diagnosis was 58 years (range, 34-75 yr). The parotid gland was the most common primary tumor site (n = 10). The mean lag time from completion of radiotherapy to diagnosis of ORN was 11 years (range, 2-48 yr). The most common presenting symptom was hearing loss (n = 18), followed by tinnitus (n = 13) and otorrhea (n = 13). All 23 patients were managed conservatively with antibiotic therapy and in-office debridement of necrotic bone. None of the patients required temporal bone resection and/or free-flap reconstruction. Conclusion: ORN of the temporal bone is a rare adverse event that can occur after radiotherapy for a variety of neoplasms of the head, neck, and central nervous system. Conservative management, which includes directed antibiotic therapy and regular in-office debridement of necrotic bone, can adequately control the disease process and symptomatology, thus avoiding more invasive surgical interventions. Copyright (C) 2015 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart CompanyA Novel Radiographic Sign and a New Classifying System in Mastoiditis-Related Epidural Abscess.
Horowitz, Gilad; Fishman, Gadi; Brenner, Adi; Abu-Ghanem, Sara; Derowe, Ari; Cavel, Oren; Fliss, Dan M.; Segev, Yoram, 2015-08-05 08:00:00 AM
Objective: To describe a novel radiographic sign ("halo") and a new classification method of an evolving perisigmoid epidural abscess and present its correlation with intraoperative findings. Study Design: Retrospective and prospective cohort study in a tertiary academic children's hospital. Methods: The retrospective arm (15 children) was conducted between 1998 and 2007 and the prospective arm (11 children) between 2008 and 2013. The computerized tomographic appearance of the perisigmoid region was classified into four groups: Class I, normal; Class II, smooth halo; Class III, nodular halo 4 mm or less in diameter; and Class IV, gross nodular halo more than 4 mm in diameter. Intraoperative findings of the perisigmoid region were compared with the preoperative scan results. Results: The correlation between preoperative imaging and intraoperative findings of the retrospective arm was highly significant (p = 0.007). The correlation between the preoperative imaging studies and intraoperative findings of the prospective arm was also highly significant (p = 0.005). The interobserver agreement for the proposed classification method was high (Cohen kappa score, 0.76; weighted kappa score, 0.84). Conclusion: A novel radiographic sign ("halo") and a new classification method for an evolving perisigmoid epidural abscess in acute mastoiditis are described. A thin and smooth halo sign is not indicative of a true abscess formation. Gross perisigmoid granular changes, however, are highly suggestive of an epidural abscess that warrants surgical intervention. Copyright (C) 2015 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart CompanyDifference in Tinnitus Treatment Outcome According to the Pulse Number of Repetitive Transcranial Magnetic Stimulation.
Park, Joo Hyun; Noh, Tae-Soo; Lee, Jun Ho; Oh, Seung-Ha; Kim, June Sic; Chung, Chun Kee; Suh, Myung-Whan, 2015-08-05 08:00:00 AM
Objective: We aimed to compare the treatment result between 6,000 and 12,000 pulses of low-frequency repetitive transcranial magnetic stimulation (rTMS) and to evaluate the correct location of rTMS in Korean brains compared with that of Caucasians. Study Design: Controlled trial. Setting: Tertiary referral center. Patients: Fourteen patients with chronic essential tinnitus were treated with rTMS on the left auditory cortex (AC) and prefrontal cortex (FC). AC targets were determined using the 10-20 electroencephalographic (EEG) method proposed by Langguth in 2006. Six patients received a total of 6,000 pulses rTMS (AC, 1,000; FC, 1,000; 3-d course; Group 1), and eight patients were given 12,000 pulses (AC, 2,000; FC, 1,000; 4-d course; Group 2). Main Outcome Measures: Treatment results were assessed with pretreatment and posttreatment Tinnitus Handicap Inventory (THI) and self-rating Visual Analog Scale (VAS) of awareness, loudness, annoyance, and effect on daily life of tinnitus at 1, 2, 4, 8, and 12 weeks after treatment. Using the individual subject's magnetic resonance image and Neuronavigation System, the location of primary AC was determined and compared with that of the 10-20 method in four patients. Results: There was no improvement of THI and VAS in Group 1. On the contrary, a substantial decrease of THI scores and VAS scores for awareness, loudness, and effect on daily life was observed in Group 2. Conclusion: Despite the small number of patients, a beneficial effect of rTMS on tinnitus suppression was found in the 12,000-pulse treatment group, whereas no effect was found in the 6,000-pulse treatment group. rTMS localization based on the 10-20 EEG method seems to be valid even in Koreans with a shorter anteroposterior skull diameter. Copyright (C) 2015 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart CompanyHearing Impairment in Children and Adults With Acquired Middle Ear Cholesteatoma: Audiometric Comparison of 385 Ears.
Rosito, Letícia P. S.; Netto, Luciana S.; Teixeira, Adriane R.; da Costa, Sady S., 2015-08-05 08:00:00 AM
Objective: Evaluate hearing impairment in acquired middle ear cholesteatoma and investigate audiometric differences between children and adults. Study Design: Cross-sectional comparative study. Setting: Tertiary hospital. Patients: Three hundred twenty-three consecutive patients diagnosed as having acquired middle ear cholesteatoma in at least one ear (385 ears) between August 2000 and March 2013 and no surgical history (mean [standard deviation {SD}] age, 32.8 [19.4] yr; 54.3% men and 34.8% children). Intervention: Pure-tone audiometry. Main Outcome Measures: Air-conduction (AC) and bone conduction (BC) thresholds and air-bone gaps (ABGs) measured at the pure-tone average (PTA) and individual frequencies. Results: The mean (SD) AC and BC thresholds at the PTA were 46.8 (22.7) and 17.7 (17.5) dB, respectively. The mean (SD) ABG at the PTA was 29.6 (13.4) dB, and that at 500 Hz was significantly greater than the ABGs at the other frequencies. Only 3.6% of the ears had profound hearing loss, without a significant difference between children and adults. The AC and BC thresholds were significantly greater in adults at all the frequencies (p <= 0.05), but the ABGs were not significantly different between the age groups. Conclusion: Acquired middle ear cholesteatoma is associated with significant hearing impairment, although profound hearing loss is rare. Adults have greater AC and BC thresholds than those in children but similar ABGs to children. Copyright (C) 2015 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart CompanyCOCHLEAR IMPLANTATION IN CHILDREN WITH CONGENITAL AND NONCONGENITAL UNILATERAL DEAFNESS.
Távora-Vieira, Dayse; Rajan, Gunesh P., 2015-08-05 08:00:00 AM
The Prevalence of Cochlear Obliteration After Labyrinthectomy Using Magnetic Resonance Imaging and the Implications for Cochlear Implantation.
Charlett, Simon D.; Biggs, Nigel, 2015-08-05 08:00:00 AM
Objectives: The aim of this study was to determine the prevalence of cochlear obliteration after labyrinthectomy. Study Design: Retrospective review of medical records. Setting: Tertiary referral center. Patients: Sixty-five patients who had previously undergone resection of an acoustic neuroma through a translabyrinthine approach. Intervention: The magnetic resonance studies were analyzed as part of the routine surveillance after tumor resection. Main Outcome Measure: To determine whether the cochlear lumen remained fluid filled. Results: Sixty-five cochleas were examined. Forty-four cochleas were patent and, of the remaining 21, 9 were obliterated and 12 were partially obliterated. The average length of follow-up for the patent, partially obliterated, and obliterated cochlea groups was 47, 29, and 77 months, respectively. Conclusion: Obliteration of the cochlea, either partially or completely, occurs in approximately one-third of patients. Time elapsed after labyrinthectomy did not seem to be a predictor of cochlear obliteration. Copyright (C) 2015 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart CompanyEvaluation of Reported Malignant Transformation of Vestibular Schwannoma: De Novo and After Stereotactic Radiosurgery or Surgery.
Maducdoc, Marlon M.; Ghavami, Yaser; Linskey, Mark E.; Djalilian, Hamid R., 2015-08-05 08:00:00 AM
Objective: To critically analyze each reported case of malignant transformation of vestibular schwannoma (VS) after either stereotactic radiosurgery (SRS) or microsurgery (MS). Data Sources: We searched the Pubmed/Medline database using the relevant key words vestibular schwannoma, acoustic neuroma, malignant, transformation, radiation, induced, stereotactic, radiosurgery, malignancy, GammaKnife, and CyberKnife and combinations thereof. Study Selection: Inclusion criteria for malignant transformation of VS after SRS included histopathology of initially benign VS, subsequent histopathology confirming malignant VS, reasonable latency period between malignancy and benign diagnoses. Data Extraction: A neurotologist and a skull base neurosurgeon independently assessed each case report for quality, entry, exclusion criteria, and comparability of extracted data. Data Synthesis: We calculated median age, latency times, and survival times for each case report. Results: Malignant transformation has been documented to occur after either SRS or MS. Eight cases were included that showed histopathologic evidence of malignant transformation after SRS and MS. Four cases of malignant transformation were included that demonstrated malignant transformation after MS only. Malignant transformation of VS can also occur de novo, and de novo malignant VSs are also encountered, which can confound a causal inference from either SRS or MS. Eighteen cases of primary malignant VS were included. Studies that were identified but not included in the review are summarized and tabulated. We found 12 studies of malignant transformation associated with NF2. Conclusion: The potential mechanism leading to malignant transformation of VS seems more obvious for SRS and is less understood for MS. Given a low incidence of de novo malignant schwannoma, the possibility that these are spontaneous events in either setting cannot be ruled out. Risk of malignant transformation of VS after either SRS or MS is not zero; however, the magnitude of this risk is probably minimal based on the evidence from eight histopathologically confirmed cases. Copyright (C) 2015 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart CompanyThe Outcome of Cochlear Implantation for Mitochondrial Disease Patients with Syndromic Hearing Loss.
Yamamoto, Norio; Okuyama, Hideaki; Hiraumi, Harukazu; Sakamoto, Tatsunori; Matsuura, Hitomi; Ito, Juichi, 2015-08-05 08:00:00 AM
Objectives: To evaluate the outcome and to confirm the validity of cochlear implantation for syndromic deafness in patients with mitochondrial disease. Study Design: Retrospective case review. Setting: Tertiary referral center. Patients: We reviewed medical charts of 367 cochlear implantation cases at Kyoto University Hospital between 1987 and 2012. We identified five patients with syndromic mitochondrial disease who underwent cochlear implantation surgery. The mean age of the patients (four women and one man) when they underwent surgeries was 44.4 years (range, 30-64 yr; median, 41 yr). Interventions: Therapeutic and rehabilitative. Main Outcome Measure: In four of five patients, speech perception performance was measured using Japanese vowels, consonant-vowel syllables, and short sentences. Results: Only 1.4% (5 of 367) of cochlear implantation cases at Kyoto University Hospital underwent cochlear implantation surgery because of syndromic mitochondrial diseases. Four of those patients showed significantly improved speech perception outcomes, and the beneficial effects of the intervention continued long after surgery. One patient could not perform speech perception test presumably because of poor cognitive function. Conclusion: Mitochondrial disease patients who underwent cochlear implantation surgery sustained gains in hearing performance even long after surgery. A single patient showed poor postoperative speech perception associated with cognitive problems. Cochlear implantation for mitochondrial disease patients seems to be a viable treatment option in the absence of significant cognitive impairment. Copyright (C) 2015 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart CompanyEfficacy of Computer-Controlled and Modified Roll Maneuver for Treatment of Geotropic Lateral Canal Benign Paroxysmal Positional Vertigo.
Shan, Xizheng; Peng, Xin; Wang, Entong, 2015-08-05 08:00:00 AM
Objective: To evaluate the short-term efficacy of computer-controlled and modified roll maneuver (CMRM) versus conventional roll maneuver (RM) for treatment of geotropic lateral canal benign paroxysmal positional vertigo (BPPV). Study Design: Prospective case-controlled study. Setting: Academic hospital. Patients: One hundred consecutive patients diagnosed as having unilateral idiopathic geotropic lateral canal BPPV with a duration of symptoms of less than 2 weeks. Interventions: Fifty-two patients (aged 32-80 yr; mean, 55.9 yr; 18 men and 34 women) were treated with CMRM that was composed of three sequential 360-degree rotations and 48 patients (aged 30-71 yr; mean, 52.4 yr; 20 men and 28 women) treated with RM that consisted of one 360-degree rotation. Main Outcome Measures: Resolution of vertigo on the supine roll test at 48 hours after initial maneuver and the number of maneuvers required for final resolution of vertigo were main outcome measures to assess the efficacy of treatment. Results: On the supine roll test at 48-hour follow-up after initial maneuver, 44 (84.6%) of 52 CMRM-treated patients and 23 (54.2%) of 48 RM-treated patients had resolution of vertigo (p < 0.01). All patients obtained final resolution of vertigo with a maximum of five maneuvers in each group, but the CMRM group had less mean number of maneuvers required for final resolution of vertigo compared with the RM group (1.23 +/- 0.39 versus 1.63 +/- 0.68, p < 0.05). No significant adverse effects and complications occurred aside from two patients with conversion into posterior canal BPPV in each treatment. Conclusion: The CMRM consisting of three sequential 360-degree rotations for geotropic lateral canal BPPV has a higher initial success rate compared with the conventional RM consisting of one 360-degree rotation. Copyright (C) 2015 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart CompanyVirtual Endoscopy to Plan Transtympanic Approach to Labyrinthine Windows.
Guigou, Caroline; Bardin, Florian; Afifi, Walid Sobhy; Dillenseger, Jean-Philippe; Ricolfi, Frédéric; Grayeli, Alexis Bozorg, 2015-08-05 08:00:00 AM
Objective: The aim of this study was to evaluate the position and the accessibility of labyrinthine windows through the external auditory canal (EAC) by virtual endoscopy based on computed tomographic scan images. Study design: Prospective cross-sectional study. Setting: Tertiary referral center. Patients: Sixty-three high-resolution temporal bone computed tomographic scans were obtained from 34 adult patients undergoing various otologic procedures. Intervention: Images were analyzed by the virtual endoscopy function included in Osirix ( www.osirix-viewer.com). The endoscope was constrained in the EAC. The visible surfaces of target anatomic structures were assessed on multiplanar reconstruction views. Results: The optimal angles of the virtual endoscope position showed a relatively high interindividual variability in the axial plane (64 +/- 2.4 degrees for the oval window [OW] and 60 +/- 2.5 degrees for the round window [RW]) position, but a low interindividual variation was noted in the coronal plane (107 +/- 1.5 degrees for the OW and 112 +/- 1.7 degrees for the RW). The RW was accessible in 87% of cases. The OW accessibility could be staged as follows: 1, invisible stapedial superstructure (10% of cases); 2, stapedial posterior crus partly visible (33%); 3, entire posterior crus and pyramid visible (44%); 4, posterior and anterior crus visible (13%). Conclusion: Virtual endoscopy through the EAC can evaluate the accessibility of the OW or RW via a transcanal route. This technique seems to be helpful in preplanning minimally invasive procedures by this approach such as cochlear implantation. Copyright (C) 2015 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart CompanyLETTER TO THE EDITOR RE: COCHLEAR IMPLANTATION IN CHILDREN WITH CONGENITAL AND NONCONGENITAL UNILATERAL DEAFNESS: A CASE SERIES.
Probst, Rudolf, 2015-08-05 08:00:00 AM
Lateral Semicircular Canal-enlarged Vestibular Aqueduct Fistula Associated With Paroxysmal Positional Nystagmus.
Suzuki, Mitsuya; Ota, Yasushi; Tanaka, Toshitake; Ota, Yutaka, 2015-08-05 08:00:00 AM
Autophony in a Patient With Giant Cell Tumor of the Temporal Bone.
Miller, Mark A.; Kesarwani, Priya; Crane, Benjamin T., 2015-08-05 08:00:00 AM
A Pragmatic Strategy for the Evaluation and Management of Anterior Canal Benign Positional Vertigo.
Luis, Leonel; Costa, Joao; Yacovino, Dario, 2015-08-05 08:00:00 AM
Imaging Characteristics of Cerebellopontine Angle Chloroma.
Reuther, Marsha S.; Mafee, Mahmood F.; Alexander, Thomas H., 2015-08-05 08:00:00 AM
Spontaneous Otogenic Temporal Lobe Pneumatocele Presenting With Acute Aphasia.
Noud, Meaghan; Sweeney, Alex D.; Carlson, Matthew L.; Bennett, Marc L., 2015-08-05 08:00:00 AM
An Unusual Complication of Stapes Surgery.
Da Costa, Sady Selaimen; Sperling, Neil; Cruz, Oswaldo Laércio Mendonça; Setogutti, Enio Tadashi, 2015-08-05 08:00:00 AM
Eccrine Poroma of the External Auditory Canal.
Zuniga, Steven; Khurana, Jasvir S.; Roehm, Pamela C., 2015-08-05 08:00:00 AM
Cochlear Implantation in Children With Autism Spectrum Disorder.
Eshraghi, Adrien A.; Nazarian, Ronen; Telischi, Fred F.; Martinez, Diane; Hodges, Annelle; Velandia, Sandra; Cejas-Cruz, Ivette; Balkany, Thomas J.; Lo, Kaming; Lang, Dustin, 2015-08-05 08:00:00 AM
Objective: To assess the outcome of cochlear implantation in children with autism spectrum disorder (ASD). Study Design: Retrospective case review and survey. Setting: Tertiary referral center. Patients: Children who meet criteria for cochlear implantation and diagnosis of ASD. Main Outcome Measures: Receptive and expressive language scores and parental survey data. Results: Fifteen patients with history of ASD and cochlear implantation were analyzed and compared with 15 patients who received cochlear implant and have no other disability. Postoperatively, more than 67% of children with ASD significantly improved their speech perception skills, and 60% significantly improved their speech expression skills, whereas all patients in the control group showed significant improvement in both aspects. The top 3 reported improvements after cochlear implantation were name recognition, response to verbal requests, and enjoyment of music. Of all behavioral aspects, the use of eye contact was the least improved. Survey results in regard to improvements in patient interaction were more subtle when compared with those related to sound and speech perception. The most improved aspects in the ASD patients' lives after cochlear implantation seemed to be attending to other people's requests and conforming to family routines. Of note, awareness of the child's environment is the most highly ranked improvement attributed to the cochlear implant. Conclusion: Cochlear implants are effective and beneficial for hearing impaired members of the ASD population, although development of language may lag behind that of implanted children with no additional disabilities. Significant speech perception and overall behavior improvement are noted. Copyright (C) 2015 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart CompanyPersistent Tubotympanic Recess With Eustachian Tube Atresia.
Larem, Aisha; Sheikh, Rashid; Alqahtani, Abdulsalam; Ashkanani, Sara; Haidar, Hassan, 2015-08-05 08:00:00 AM
Otosclerosis Without Stapes Fixation.
Chen, Brian S.; Linthicum, Fred H. Jr., 2015-08-05 08:00:00 AM
Rosai-Dorfman Disease Involving the Ear and Lateral Skull Base.
Douleh, Diana G.; Carlson, Matthew L.; Rinker, Elizabeth B.; Haynes, David S., 2015-08-05 08:00:00 AM
Cerebellopontine Angle Mixed Tumor in Type 2 Neurofibromatosis.
Poletti, Arturo M.; Colombo, Giovanni; Barucca, Filippo; Rognone, Elisa; Fiamengo, Barbara, 2015-08-05 08:00:00 AM
RESPONSE TO ARTICLE: PATIENTS WITH VESTIBULAR LOSS, TULLIO PHENOMENON, AND PRESSURE-INDUCED NYSTAGMUS: VESTIBULAR ATELECTASIS?.
Kaski, Diego; Bronstein, Adolfo Miguel, 2015-08-05 08:00:00 AM
Torticollis: A Symptom in Severe Otitis Media.
Kempfle, Judith Susanne; Friese, Natascha; Breuer, Thomas, 2015-08-05 08:00:00 AM
Inner Ear Inflammatory Pseudotumor With Middle Ear Cholesteatoma.
Jung, Hyo Vin; Choi, Jin Woo; Shin, Jung Eun; Kim, Chang-Hee, 2015-08-05 08:00:00 AM
Intradiploic Epidermoid of Temporal Bone Presenting as Pulsatile Tinnitus.
Lee, Jung Min; Kim, Jae Ki; Yang, Seong Kyeong; Kwon, Joong Keun, 2015-08-05 08:00:00 AM
Barotrauma-induced Pneumolabyrinth and Pneumocephalus Associated with Semicircular Canal Dehiscence.
Ginat, Daniel Thomas; Moonis, Gul, 2015-08-05 08:00:00 AM
Blastomycosis of the Temporal Bone Mimicking Glomus Jugulare Tumor.
Frisch, Christopher D.; Gross, Brian C.; Link, Michael J.; Driscoll, Colin L. W., 2015-08-05 08:00:00 AM
Cochlear Meniere's Disease in Association With a High Jugular Bulb.
Kieran, Stephen M.; Meyer, Ted A., 2015-08-05 08:00:00 AM
A Case of Rotational Vertebral Artery Syndrome.
Lee, Eun Jung; Kang, Ju Won; Chung, Tae-Sub; Son, Eun Jin, 2015-08-05 08:00:00 AM
Minimal Growth of Intracochlear Schwannoma Over 7 Years.
Schoeff, Stephen; Kesser, Bradley W.; Mukherjee, Sugoto, 2015-08-05 08:00:00 AM
Cochlear Implantation in the Setting of Cochlear Ossification as Sequela of Malarial Meningitis.
Svrakic, Maja; Rafii, Benjamin; Roland, J. Thomas Jr., 2015-08-05 08:00:00 AM
WHY NO UNILATERAL VESTIBULAR ATELECTASIS?.
Crane, Benjamin T., 2015-08-05 08:00:00 AM
The Medially Migrating Intracanalicular Vestibular Schwannoma.
Carlson, Matthew L.; Driscoll, Colin L.; Lane, John I.; Link, Michael J., 2015-08-05 08:00:00 AM
Methicillin-Resistant Staphylococcus aureus Otic Capsule and Pontine Infection Masquerading as an Internal Auditory Canal Neoplasm.
Nelson, Rick F.; Hansen, Marlan R.; Hasan, David M., 2015-08-05 08:00:00 AM
HASTE Diffusion-Weighted Magnetic Resonance Imaging of Middle Ear Teratoma.
León, Francisca; Alvo, Andrés; Sanhueza, David; Délano, Paul H.; Stott, Carlos E., 2015-08-05 08:00:00 AM
Cochlear Fistula as a Late Consequence of Tympanomastoidectomy.
Sakaida, Hiroshi; Takeuchi, Kazuhiko, 2015-08-05 08:00:00 AM
Aberrant Course of the Internal Auditory Canal in Unilateral Sensorineural Hearing Loss.
Tsai, Ming-Chou; Chang, Wei-Hsiu, 2015-08-05 08:00:00 AM
Sudden Sensorineural Hearing Loss Associated With Intralabyrinthine Hemorrhage.
Cervantes, Sergio Santino; Barrs, David M., 2015-08-05 08:00:00 AM
Extra-Axial Ependymoma Presenting as a Cerebellopontine Angle Mass.
Gill, Amarbir S.; Taheri, M. Reza; Hamilton, John; Monfared, Ashkan, 2015-08-05 08:00:00 AM
Metastatic Breast Cancer Presenting as a Jugular Foramen Mass.
Peng, Kevin A.; Vorasubin, Nopawan; Sepahdari, Ali R.; Ishiyama, Akira, 2015-08-05 08:00:00 AM
Management of Congenital Incudostapedial Anomalies in Stapes Surgery: Retracted.
Kuhn, Jeffery J.; Lassen, Lorenz F., 2015-08-05 08:00:00 AM
Κυριακή 30 Αυγούστου 2015
Otology & Neurotology
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