Otology Neurotology 2021-08-01

Prevalence of Otological Disease in Turner Syndrome: A Systematic Review

Geerardyn, Alexander; Willaert, Annelore; Decallonne, Brigitte; Desloovere, Christian; Verhaert, Nicolas

Publication date 01-08-2021


Introduction: Girls and women with Turner syndrome (TS) present with multiple ear and hearing problems, ranging from external morphologic abnormalities to sensorineural or conductive hearing loss. The exact pathophysiology behind these otological diseases is not yet completely understood. The aim of this study is to provide a systematic review on the prevalence of otological disease in TS.
Methods: We conducted a systematic review according to the PRISMA guidelines. A database search was performed in Pub Med, Embase, Web of Science, and Cochrane library.
Results: The prevalence of otological disease as external ear deformities (20–62%), recurrent otitis media (24–48%), and hearing loss (36–84%) is high in TS. The auditory phenotype in TS is complex and seems to be dynamic with CHL due to middle ear disease at young age and sensorineural hearing loss later in life.
Conclusion: This systematic review of the literature confirms that otological disease is definitely part of the widely variable phenotype in Turner patients. Strong evidence is lacking on the exact prevalence numbers, emphasizing the need for more prospective data gathering. Growing insights in its pathophysiology will help in the understanding and management of hearing problems in TS across lifespan.

Pubmed PDF Web

Cochlear Implant Fixation Techniques: A Systematic Review of the Literature

Markodimitraki, Laura M.; Strijbos, Ruben M.; Stegeman, Inge; Thomeer, Hans G. X. M.

Publication date 01-08-2021


Objective: Given the lack of consensus on fixation techniques of the cochlear implant, this review aims to create an up-to-date overview of intra- and postoperative complications, focusing on migration of the internal receiver/stimulator (R/S) device and the electrode array.
Data Sources: On June 29, 2020 we conducted a search in Pub Med, Embase, Cochrane, Web of Science, and CINAHL. Keywords were “Cochlear implant,” “complication,” “migration,” and synonyms.
Study Selection: Studies were considered if: 1) the adult study population consisted of ≥ 10 patients, 2) the R/S device was fixated using the bony well or tight subperiostal pocket technique without bone-anchoring sutures or screws on the implant, and 3) migration of the R/S device or displacement of the electrode array were described as outcomes.
Data Extraction: Study characteristics, interventions, follow-up, and outcomes were extracted. For critical appraisal, an adapted version of the Newcastle-Ottawa quality assessment scale for cohort studies was used.
Data Synthesis: Seven studies were included (n = 430 patients). Migration of the R/S device was reported by three studies. Two studies applying the tight pocket technique reported migration rates ranging from 9.0 to 69.2%. One study using the bony bed technique reported migration of 100%, with an average of 2.5 mm. All studies lacked the required standard for comparability, assessment of outcome, and follow-up.
Conclusions and Relevance: There is currently no evidence of a difference between the bony bed- and tight pocket fixation technique, regarding migration of the R/S device or the electrode array, in adult patients.

Pubmed PDF Web

Virtual Reality for Vestibular Rehabilitation: A Systematic Review

Xie, Michael; Zhou, Kelvin; Patro, Nivedh; Chan, Teffran; Levin, Marc; Gupta, Michael K.; Archibald, Jason

Publication date 01-08-2021


Introduction: Vertigo is a debilitating symptom, leading to increased healthcare utilization and lost patient productivity. Vestibular rehabilitation is used to manage the symptomatic manifestations of vestibular disease. However, vestibular rehabilitation is limited by accessibility and time commitment. Recently, virtual reality has been described as a vestibular rehabilitation tool that may circumvent these barriers to treatment. Despite this, the efficacy of virtual reality for vestibular rehabilitation remains unclear. This study aims to review and summarize the current literature on the effectiveness of virtual reality-based vestibular rehabilitation.
Methods: A systematic review of the MEDLINE, EMBASE, and Alternative and Complementary Medicine databases was conducted for prospective studies describing virtual reality-based vestibular rehabilitation.
Results: Our search identified 382 unique articles. Six randomized controlled trials and four other studies were ultimately included. Study sample sizes ranged from 13 to 70 participants and varied in diagnoses from any unilateral peripheral vertigo to specific pathologies. Different virtual reality interventions were used. Comparator groups ranged from supervised vestibular rehabilitation to independent Cawthorne-Cooksey exercises. Outcomes consisted of validated questionnaires, objective clinical tests, and measurements of balance or reflexes.
Conclusion: The studies reviewed in this study are preliminary evidence to suggest the benefit of virtual reality-based vestibular rehabilitation. However, these studies are limited by their inclusion criteria, heterogeneity, comparator design, and evidence-based clinical outcomes. Further research should address these limitations.

Pubmed PDF Web

Association Between Laryngopharyngeal Reflux and Media Otitis: A Systematic Review

Lechien, Jerome R.; Hans, Stéphane; Simon, Francois; Horoi, Mihaela; Calvo-Henriquez, Christian; Chiesa-Estomba, Carlos M.; Mayo-Yáñez, Miguel; Bartel, Ricardo; Piersiala, Krzysztof; Nguyen, Yann; Saussez, Sven

Publication date 01-08-2021


Objectives: To investigate the relationship between laryngopharyngeal reflux (LPR) and recurrent (ROM) or chronic otitis media with effusion (COME).
Databases: Pub Med, Scopus, and Cochrane Library.
Methods: Three authors searched articles published between January 1980 and September 2020 about the association between LPR and the development of recurrent or chronic otitis media. Inclusion, exclusion, diagnostic criteria, and clinical outcome evaluation of included studies were analyzed using PRISMA criteria. The bias analysis of included studies was evaluated with the Tool to assess Risk of Bias of the CLARITY group.
Results: Twenty-six clinical and three experimental articles met our inclusion criteria, accounting for 1,624 children and 144 adults with COME or ROM. According to the pH study type, the prevalence of LPR and gastroesophageal reflux disease (GERD) in OM patients were 28.7% (range, 8–100%) and 40.7 (range, 18–64%), respectively. The majority of studies identified pepsin or pepsinogen in middle ear effusion, with a range of mean concentrations depending on the technique used to measure pepsin. There was an important heterogeneity between studies regarding definition of COME, ROM, and LPR, exclusion criteria, methods used to measure pepsin/pepsinogen in middle ear secretions and outcome assessments.
Conclusion: The association between LPR and OM is still unclear. Future clinical and experimental studies are needed to investigate the association between LPR and OM in both children and adults through extensive gastric content analysis in middle ear suppurations and impedance-pH monitoring considering acid, weakly acid, and alkaline reflux events.

Pubmed PDF Web

Profound Sudden Sensorineural Hearing Loss in Hematologic Malignancy: A Case for Urgent Cochlear Implantation With Discussion and Systematic Review of the Literature

Dumberger, Lukas D.; Hwa, Tiffany P.; Panara, Kush; Husain, Solomon; Yver, Christina; Bigelow, Douglas C.

Publication date 01-08-2021


Objective: To perform a systematic review of sensorineural hearing loss (SNHL) in hematologic malignancy; to describe an illustrative case of urgent cochlear implantation for bilateral profound SNHL and vestibular hypofunction in hyperviscosity syndrome; to suggest an approach to management of hyperviscosity syndrome-associated deafness with cochlear implantation.
Data Sources: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, systematic search of Pub Med and Embase databases was undertaken for articles detailing clinical information about SNHL caused directly by hematologic malignancies.
Results: A total of 37 studies from 1989 to 2020 were qualitatively reviewed, the majority of which were case studies or case series. Causes of hearing loss in hematologic malignancy were found to include hyperviscosity syndrome, labyrinthine hemorrhage, infiltration, and infection. Patients with profound SNHL in hematologic malignancies from hyperviscosity syndrome may be candidates for cochlear implantation, and are also at increased risk for cochlear ossification. We review previous cases for their diagnostic approach, treatment paradigm, and outcomes data, and propose an approach to management.
Conclusion: Bilateral sudden profound SNHL and vestibular hypofunction is a presenting symptom of hyperviscosity syndrome in hematologic malignancy. Although this entity is rare and previous reports have suggested improvement in hearing with oncologic treatment, cases with profound hearing loss are unlikely to recover serviceable hearing. We advocate for early magnetic resonance imaging with attention to fluid signal in the inner ear and serial audiometric follow-up to guide clinical decisions. We advise early consideration for cochlear implantation.

Pubmed PDF Web

Robotics for Cochlear Implantation Surgery: Challenges and Opportunities

Panara, Kush; Shahal, David; Mittal, Rahul; Eshraghi, Adrien A.

Publication date 01-08-2021


Objectives: Recent advancements in robotics have set forth a growing body of evidence for the clinical application of the robotic cochlear implantation (RCI), with many potential benefits. This review aims to summarize these efforts, provide the latest developments in this exciting field, and explore the challenges associated with the clinical implementation of RCI.
Data Sources: MEDLINE, Pub Med, and EMBASE databases.
Study Selection: A search was conducted using the keywords “robotics otolaryngology,” “robotic cochlear implant,” “minimally-invasive cochlear implantation,” “minimally-invasive mastoidectomy,” and “percutaneous cochlear implant” with all of their synonyms. Literature selection criteria included articles published in English, and articles from 1970 to present.
Results: The use of robotics in neurotology is a relatively new endeavor that continues to evolve. Robotics is being explored by various groups to facilitate in the various steps of cochlear implant surgery, including drilling a keyhole approach to the middle ear for implants, inner ear access, and electrode insertion into the cochlea. Initial clinical trials have successfully implanted selected subjects using robotics.
Conclusions: The use of robotics in cochlear implants remains in its very early stages. It is hoped that robotics will improve clinical outcomes. Although successful implants with robots are reported in the literature, there are some challenges that need to be addressed before this approach can become an acceptable option for the conventional cochlear implant surgery, such as safety, time, efficiency, and cost. However, it is hoped that further advancements in robotic technology will help in overcoming these barriers leading to successful implementation for clinical utility.

Pubmed PDF Web

Evidence of Cochlear Synaptopathy and the Effect of Systemic Steroid in Acute Idiopathic Tinnitus With Normal Hearing

Park, Euyhyun; Song, Insik; Jeong, Yong Jun; Im, Gi Jung; Jung, Hak Hyun; Choi, June; Rah, Yoon Chan

Publication date 01-08-2021


Objective: To evaluate the electrophysiologic evidence of cochlear synaptopathy and the effects of systemic steroids in acute idiopathic tinnitus with normal hearing.
Study Design: Retrospective review of medical data.
Setting: Tertiary referral center.
Patients: Fifty-nine patients who experienced acute-onset idiopathic tinnitus (within 12 weeks) with normal hearing and the same number of age- and pure-tone threshold-matched control groups.
Intervention: Electrophysiologic studies of the auditory pathway, oral steroids, and ginkgo biloba.
Main Outcome Measures: Pure-tone thresholds, wave I and wave V amplitudes of the auditory brainstem response (ABR), tinnitus handicap inventory (THI), and visual analog scale (VAS).
Results: Significantly reduced ABR wave I amplitude and wave I/wave V ratio were found in the tinnitus group compared with the no tinnitus group. Age and pure-tone threshold were significantly correlated with reduced wave I amplitude and small wave I/wave V ratio. The THI and VAS scores were decreased at 3 and 12 weeks after steroid administration; however, overall changes in THI and VAS scores were not significantly different between the steroid and ginkgo biloba groups.
Conclusion: Potential cochlear synaptopathy was suspected in the early stage of acute idiopathic tinnitus, even in patients with normal hearing. Age and hearing threshold were potentially associated with the development of cochlear synaptopathy. Low-dose oral steroids and ginkgo biloba induced early subjective relief of tinnitus, which maintained up to 12 weeks, however, those changes did not differ between groups.

Pubmed PDF Web

Combined Electric and Acoustic Stimulation (EAS) in Children: Investigating Benefit Afforded by Bilateral Versus Unilateral Acoustic Hearing

Roberts, Jillian B.; Stecker, G. Christopher; Holder, Jourdan T.; Gifford, René H.

Publication date 01-08-2021


Purpose: Electric and acoustic stimulation (EAS) with preserved hearing in the implanted ear provides benefit for speech understanding, spatial hearing, and quality of life in adults. However, there is limited research on EAS outcomes in children. The aims of this study were to estimate the magnitude of EAS-related benefit on speech understanding in children with preserved acoustic hearing and to determine what role acoustic interaural time difference (ITD) sensitivity may have on said EAS benefit.
Methods: Six children with acoustic hearing preservation and 20 children with normal hearing (NH) were recruited to participate. Speech recognition was assessed via an eight-loudspeaker array with speech presented from one loudspeaker at 0 degree and restaurant noise from all other loudspeakers (45–315 degrees). ITD thresholds were measured for a 250-Hz signal presented acoustically via insert earphones.
Results: Only one EAS listener demonstrated significant benefit from bilateral acoustic hearing as compared with acoustic hearing from a single ear. ITD thresholds were poor in the range of 302 to 1000+ ms and were considerably poorer than ITD thresholds for the NH group.
Conclusion: These data suggest that children with acoustic hearing preservation may not exhibit initial EAS benefit for speech recognition in semi-diffuse noise; however, because none exhibited a decrement in performance with bilateral acoustic stimulation, EAS fittings are recommended to provide binaural acoustic access allowing for EAS adaptation to binaural cues over time. Future research should address the emergence of EAS benefit, binaural cue sensitivity, and the role of EAS experience in children and adults.

Pubmed PDF Web

Stapes and Stapes Revision Surgery: Preoperative Air-Bone Gap Is a Prognostic Marker

Sharaf, Kariem; Grueninger, Ivo; Hilpert, Annalena; Polterauer, Daniel; Volgger, Veronika; Manz, Kirsi; Canis, Martin; Hempel, John Martin; Müller, Joachim

Publication date 01-08-2021


Objective: Stapes surgery is considered an effective treatment in otosclerosis, but controversy remains regarding predictors of surgical outcome.
Study Design: Retrospective cohort study.
Setting: Tertiary referral center.
Patients: One hundred sixty three cases of stapes surgery between 2012 and 2019 were reviewed.
Main Outcome Measures: Primary outcome measures were relative hearing improvement (relHI), defined as preoperative minus postoperative air conduction divided by preoperative air-bone gap (ABG), as well as relative ABG closure (relABGc), defined as preoperative ABG minus postoperative ABG divided by preoperative ABG. Univariate and multivariate linear regression analyses were performed to determine independent predictors for these outcomes.
Results: Higher preoperative bone conduction (BC) and primary surgery (compared with revision) were independently associated with increased relHI (p = 0.001 and p = 0.004, respectively). Lower preoperative BC, higher preoperative ABG, primary surgery, and age were independently associated with increased relABGc (p = 0.0030, p 30 dB preoperative ABG, p = 0.0292, Fishers exact test). This tendency was not significant for relHI (p = 0.074).
Conclusions: Our findings demonstrate that calculating HI and ABGc in relation to preoperative ABG can reliably predict outcomes of stapes surgery. Both primary and revision stapes surgery are effective treatment options, but relative improvement is higher in primary cases. Preoperative BC, preoperative ABG, and age predict surgical outcomes as well. Otosclerosis patients with low preoperative ABG, especially less than 20 dB, should be counseled and selected cautiously regarding stapes surgery.

Pubmed PDF Web

Exclusive Endoscopic Laser-Stapedotomy: Feasibility of an Ovine Training Model

Beckmann, Sven; Yacoub, Abraam; Fernandez, Ignacio Javier; Niederhauser, Laura; Fermi, Matteo; Caversaccio, Marco; Bonali, Marco; Anschuetz, Lukas

Publication date 01-08-2021


Objective: Stapedotomy is an effective treatment for conductive hearing loss associated with otosclerosis. However, the procedure, especially using the endoscopic technique requires extensive training and experience for optimal results. Due to limited training options in endoscopic stapes surgery, we aim to develop an ovine stapedotomy model and assess its feasibility for surgeons at different training levels.
Methods: A fully endoscopic ovine laser-stapedotomy model was developed and described. During repetitive dissections, surgical time required for the different steps to assess the training curve and associated intraoperative complications were recorded in three surgeons of different training level. Additionally, subjective feedback was assessed.
Results: Successful endoscopic laser-stapedotomy was performed in 25 cases in the ovine model. Assessment of surgical time revealed a stable curve for the experienced surgeon (mean 15:01 min) for the whole training with no intraoperative complications. The fellow showed a gradual reduction of surgical time from 27:21 (first five cases) to 24:10 minutes (last five cases) and the resident a reduction from 42:38 to 21:08 minutes respectively. The assessed learning curve for the trainees revealed a significant association between the operative time and observed intraoperative complications.
Discussion: In this study, an ex-vivo model for exclusively endoscopic laser-stapedotomy was developed and tested for feasibility. We suggest the ovine model as a cost-effective, easily available, and realistic training model for future otologic surgeons. The surgeons were able to improve their performance with satisfactory results despite the small number of cases.

Pubmed PDF Web

Stapedotomy Removing Only the Stapes Head and Not the Entire Stapes Superstructure: Long-term Results

Malafronte, Giuseppe; Trusio, Antonio; Motta, Giovanni; Filosa, Barbara

Publication date 01-08-2021


Objective: To describe a new stapedotomy in which is removed only the stapes head not the entire stapes superstructure and its long-term results.
Study Design: Prospective study.
Patients: The study was started on January 2015 and ended on September 2020. Seventy patients with otosclerosis were included in the study. They underwent stapedotomy from January 2015 to April 2016. The main follow-up for the study group was (5.1 yrs). The study group was divided into two groups (A and B) according the short hearing results (1 yr) and long hearing results (5.1 yrs). Group A including short hearing results. Group B including long hearing results. For all patients in groups A and B, the surgeon (M.
G.), microscope, the anesthesia (local), the approach (transcanal), the prostheses (piston-type), and the new stapedotomy (removal of the stapes head only and not of the entire stapes superstructure), were identical.
Results: No patients exhibited postoperative dizziness or worsening of bone conduction. Cutting the stapes neck never caused bleeding or footplate complications. The average time to perform the new stapedotomy was 15 minutes. Air-bone gap (ABG) closure to within 10 dB was achieved in 66 of 70 (94.28%) cases in group A and in 65 of 70 (92.85%) cases in group B. This difference was not statistically significant.
Conclusion: The Malafrontes stapedotomy is an easy, safety, minimally invasive, and fast surgical technique. Its hearing outcomes are good and stable over time.

Pubmed PDF Web

Treatment of Long-term Sudden Sensorineural Hearing Loss as an Otologic Migraine Phenomenon

Goshtasbi, Khodayar; Chua, Janice T.; Risbud, Adwight; Sarna, Brooke; Jamshidi, Shahrnaz; Abouzari, Mehdi; Djalilian, Hamid R.

Publication date 01-08-2021


Objectives: To describe a cohort of patients presenting with long-term sudden sensorineural hearing loss (SSNHL) treated with prophylactic migraine and intratympanic steroid therapy.
Methods: Patients presenting to a neurotology clinic at least 6 weeks from SSNHL onset were included. All patients received migraine prophylactic medication (nortriptyline, topiramate, and/or verapamil) and lifestyle changes for at least 6 weeks, as well as intratympanic steroid injections, if appropriate.
Results: Twenty-one patients (43% female) with a mean age of 64 ± 11 years who presented 9 ± 8 months (median = 5) from symptom onset were included. Posttreatment hearing thresholds were significantly improved compared with pretreatment thresholds at 500 Hz (49 ± 19 dB versus 55 ± 20 dB, p = 0.01), 1000 Hz (52 ± 19 dB versus 57 ± 21 dB, p = 0.03), low-frequency pure-tone average (53 ± 15 dB versus 57 ± 17 dB, p = 0.01), and speech-frequency pure-tone average (57 ± 13 dB versus 60 ± 15 dB, p = 0.02). Posttreatment word-recognition-score (WRS) and speech-recognition-threshold (SRT) were also significantly improved (45 ± 28% versus 70 ± 28% and 57 ± 18 dB versus 50 ± 16 dB, respectively, both p 50% WRS with an average improvement of 39 ± 9%.
Conclusions: Migraine medications in addition to intratympanic steroid injections significantly improved SRT and hearing frequencies in 40% and 29% of SSNHL patients, respectively, while significant WRS recovery was observed in most (68%) patients. This suggests SSNHL may be an otologic migraine phenomenon, which may be at least partially reversible even after the traditional 30-day postonset window.

Pubmed PDF Web

The Actual Incidence and Types of Hearing Losses in Bullous Myringitis: Case Series and Systematic Review

Ungar, Omer J.; Handzel, Ophir; Oron, Yahav; Eta, Rani Abu; Muhanna, Nidal; Warshavsky, Anton; Horowitz, Gilad; Simani, Liam

Publication date 01-08-2021


Objective: To calculate the incidence of sensorineural hearing loss (SNHL; pure or as part of a mixed hearing loss, MHL) among bullous myringitis (BM) patients with a coexisting HL to assess whether steroidal treatment should be initiated even before the findings of a formal audiogram are available.
Methods: Retrospective medical record review in a tertiary referral center and systematic review of the English literature.
Results: The medical records of 81 patients with BM were retrieved among whom 50 patients (62%) had actually sustained a HL, although only 39/81 patients reported a HL when asked. Twenty-four patients had a MHL, 18 had a SNHL, and eight had a conductive HL (CHL).
The systematic review included 106 ears: 17 had no HL, 53 had a MHL, 20 had a SNHL, and 16 had a CHL. The combined published and current results yielded a SNHL and MHL rates of 38/139 (27%) and 77/139 (55%), respectively of all BM patients with confirmed HL.
Conclusion: BM is intuitively associated with a CHL resulting from the impeded function of the affected middle ear. Medical history and physical examination are not sufficient to exclude a SNHL in BM patients, and formal audiometry is mandatory for exclusion/confirmation in this setting. Nevertheless, steroidal treatment should not be delayed until the performance of formal audiometry because the actual rate of pure CHL in this setting is very low.
Level of Evidence: 2

Pubmed PDF Web

Improved Speech Intelligibility in Subjects With Stable Sensorineural Hearing Loss Following Intratympanic Dosing of FX-322 in a Phase 1b Study

McLean, Will J.; Hinton, Ashley S.; Herby, Jenna T.J.; Salt, Alec N.; Hartsock, Jared J.; Wilson, Sam; Lucchino, David L.; Lenarz, Thomas; Warnecke, Athanasia; Prenzler, Nils; Schmitt, Heike; King, Susan; Jackson, Lance E.; Rosenbloom, Jeffrey; Atiee, George; Bear, Moraye; Runge, Christina L.; Gifford, René H.; Rauch, Steven D.; Lee, Daniel J.; Langer, Robert; Karp, Jeffrey M.; Loose, Christopher; LeBel, Carl

Publication date 01-08-2021


Objectives: There are no approved pharmacologic therapies for chronic sensorineural hearing loss (SNHL). The combination of CHIR99021+valproic acid (CV, FX-322) has been shown to regenerate mammalian cochlear hair cells ex vivo. The objectives were to characterize the cochlear pharmacokinetic profile of CV in guinea pigs, then measure FX-322 in human perilymph samples, and finally assess safety and audiometric effects of FX-322 in humans with chronic SNHL.
Study Designs: Middle ear residence, cochlear distribution, and elimination profiles of FX-322 were assessed in guinea pigs. Human perilymph sampling following intratympanic FX-322 dosing was performed in an open-label study in cochlear implant subjects. Unilateral intratympanic FX-322 was assessed in a Phase 1b prospective, randomized, double-blinded, placebo-controlled clinical trial.
Setting: Three private otolaryngology practices in the US.
Patients: Individuals diagnosed with mild to moderately severe chronic SNHL (≤70 dB standard pure-tone average) in one or both ears that was stable for ≥6 months, medical histories consistent with noise-induced or idiopathic sudden SNHL, and no significant vestibular symptoms.
Interventions: Intratympanic FX-322.
Main Outcome Measures: Pharmacokinetics of FX-322 in perilymph and safety and audiometric effects.
Results: After intratympanic delivery in guinea pigs and humans, FX-322 levels in the cochlear extended high-frequency region were observed and projected to be pharmacologically active in humans. A single dose of FX-322 in SNHL subjects was well tolerated with mild, transient treatment-related adverse events (n = 15 FX-322 vs 8 placebo). Of the six patients treated with FX-322 who had baseline word recognition in quiet scores below 90%, four showed clinically meaningful improvements (absolute word recognition improved 18–42%, exceeding the 95% confidence interval determined by previously published criteria). No significant changes in placebo-injected ears were observed. At the group level, FX-322 subjects outperformed placebo group in word recognition in quiet when averaged across all time points, with a mean improvement from baseline of 18.9% (p = 0.029). For words in noise, the treated group showed a mean 1.3 dB signal-to-noise ratio improvement (p = 0.012) relative to their baseline scores while placebo-treated subjects did not (−0.21 dB, p = 0.71).
Conclusions: Delivery of FX-322 to the extended high-frequency region of the cochlea is well tolerated and enhances speech recognition performance in multiple subjects with stable chronic hearing loss.

Pubmed PDF Web

Relationship Between Galvanic Vestibular-evoked Myogenic Potentials and the Prognosis of Unilateral Severe to Profound Idiopathic Sudden Sensorineural Hearing Loss With Vertigo

Chang, Chih-Ming; Lo, Wu-Chia; Young, Yi-Ho; Liao, Li-Jen; Cheng, Po-Wen

Publication date 01-08-2021


Objective: Idiopathic sudden sensorineural hearing loss (ISSNHL) may not only impair cochlear function but also damage vestibular structures, including the saccule, utricle, semicircular canals, and vestibular afferents. Poor recovery often occurs in patient with serious ISSNHL and accompanying vertigo. To define the severity of the disease and to predict prognosis, galvanic vestibular-evoked myogenic potentials (VEMPs) are added to the inner ear test battery.
Study Design: Retrospective case review.
Setting: Tertiary referral center.
Patients: Thirty patients with unilateral severe to profound ISSNHL and accompanying vertigo were enrolled in this retrospective study.
Intervention: Diagnostic.
Main Outcome Measures: All subjects underwent pure tone audiometry, cervical and ocular VEMPs, and caloric tests before the initiation of treatment. The treatment outcome, rates of abnormal responses in the tests, and the characteristic parameters of VEMPs such as latencies and amplitudes, were analyzed.
Results: In affected ears, the rates of abnormal acoustic cVEMPs, vibratory oVEMPs, galvanic cVEMPs, and galvanic oVEMPs were 60, 47, 37, and 20%, respectively. The improvement in the hearing of the affected ear was specified as good recovery or poor recovery. The normal galvanic VEMP group had a significant higher rate of good recovery than abnormal galvanic VEMP group (87% versus 27%; p = 0.003).
Conclusions: Patients with unilateral severe to profound ISSNHL and accompanying vertigo who have normal galvanic VEMPs have a higher likelihood of hearing recovery than those who have abnormal galvanic VEMPs.

Pubmed PDF Web

Identification of a Novel Copy Number Variation of EYA4 Causing Autosomal Dominant Non-syndromic Hearing Loss

Ishino, Takashi; Ogawa, Yui; Sonoyama, Toru; Taruya, Takayuki; Kono, Takashi; Hamamoto, Takao; Ueda, Tsutomu; Takeno, Sachio; Moteki, Hideaki; Nishio, Shin-ya; Usami, Shin-ichi; Nagano, Yuka; Yoshimura, Akiko; Yoshikawa, Kohei; Kato, Mikako; Ichimoto, Masaya; Watanabe, Rina

Publication date 01-08-2021


Objective: Eyes absent 4 (EYA4) is the causative gene of autosomal dominant non-syndromic hereditary hearing loss, DFNA10. We aimed to identify a copy number variation of EYA4 in a non-syndromic sensory neural hearing loss pedigree.
Family and Clinical Evaluation: A Japanese family showing late-onset and progressive hearing loss was evaluated. A pattern of autosomal dominant inheritance of hearing loss was recognized in the pedigree. No cardiac disease was observed in any of the individuals.
Methods: Targeted exon sequencing was performed using massively parallel DNA sequencing (MPS) analysis. Scanning of the array comparative genomic hybridization (aCGH) was completed and the copy number variation (CNV) data from the aCGH analysis was confirmed by matching all CNV calls with MPS analysis. Breakpoint detection was performed by whole-genome sequencing and direct sequencing. Sequencing results were examined, and co-segregation analysis of hearing loss was completed.
Results: We identified a novel hemizygous indel that showed CNV in the EYA4 gene from the position 133,457,057 to 133,469,892 on chromosome 6 (build GRCh38/hg38) predicted as p.(Val124_Pro323del), and that was segregated with post-lingual and progressive autosomal dominant sensorineural hearing loss by aCGH analysis.
Conclusion: Based on the theory of genotype–phenotype correlation with EYA4 mutations in terms of hearing loss and comorbid dilated cardiomyopathy, the region of amino acids 124 to 343 is hypothesized not to be the pathogenic region causing dilated cardiomyopathy. Additionally, the theory of genotype–phenotype correlation about the prevalence of dilated cardiomyopathy is thought to be rejected because of no correlation of deleted amino acid region with the prevalence of dilated cardiomyopathy. These results will help expand the research on both the coordination of cochlear transcriptional regulation and normal cardiac gene regulation via EYA4 transcripts and provide information on the genotype–phenotype correlations of DFNA10 hearing loss.

Pubmed PDF Web

Cochlear Implantation in NF2 Patients Without Intracochlear Schwannoma Removal

Eitutis, Susan T.; Jansen, Thijs; Borsetto, Daniele; Scoffings, Daniel J.; Tam, Yu Chuen; Panova, Tsvetemira; Tysome, James R; Donnelly, Neil P.; Axon, Patrick R.; Bance, Manohar L.

Publication date 01-08-2021


Objective: To determine if cochlear implantation without removal of inner ear schwannomas (IES) is an effective treatment option for Neurofibromatosis 2 (NF2) patients. To determine how the presence of an intracochlear schwannoma might impact cochlear implant (CI) outcomes and programming parameters.
Study Design: Retrospective chart review.
Setting: Tertiary center for cochlear and auditory brainstem implantation.
Patients: Of 10 NF2 patients with IES, 8 are reported with no previous tumor removal on the implanted ear.
Interventions: Cochlear implant without tumor removal.
Main Outcome Measures: Performance outcomes with CI at least 1-year post intervention. Programming parameters, including impedances, for patients with IES.
Results: All patients had full insertion of the electrode arrays with round window approaches. Performance outcomes ranged from 0 to 100% for Bamford-Kowal-Bench sentences. Impedance measurements for active electrodes for patients with IES were comparable to those measured in patients without vestibular schwannoma (VS). Only patients who had radiation treatment before receiving their implant had elevated threshold requirements for CI programming compared with CI recipients without VS.
Conclusion: Cochlear implantation without tumor removal is an effective option for treating NF2 patients with IES. The presence of an intracochlear tumor did not have an impact on CI performance or programming requirements compared with patients without VS; however, previous treatment with radiation may be related to elevated current requirements in the CI settings.

Pubmed PDF Web

Magnetic Steering of Robotically Inserted Lateral-wall Cochlear-implant Electrode Arrays Reduces Forces on the Basilar Membrane In Vitro

Hendricks, Cameron M.; Cavilla, Matt S.; Usevitch, David E.; Bruns, Trevor L.; Riojas, Katherine E.; Leon, Lisandro; Webster, Robert J. III; Warren, Frank M.; Abbott, Jake J.

Publication date 01-08-2021


Hypothesis: Undesirable forces applied to the basilar membrane during surgical insertion of lateral-wall cochlear-implant electrode arrays (EAs) can be reduced via robotic insertion with magnetic steering of the EA tip.
Background: Robotic insertion of magnetically steered lateral-wall EAs has been shown to reduce insertion forces in vitro and in cadavers. No previous study of robot-assisted insertion has considered force on the basilar membrane.
Methods: Insertions were executed in an open-channel scala-tympani phantom. A force plate, representing the basilar membrane, covered the channel to measure forces in the direction of the basilar membrane. An electromagnetic source generated a magnetic field to steer investigational EAs with permanent magnets at their tips, while a robot performed the insertion.
Results: When magnetic steering was sufficient to pull the tip of the EA off of the lateral wall of the channel, it resulted in at least a 62% reduction of force on the phantom basilar membrane at insertion depths beyond 14.4 mm (p < 0.05), and these beneficial effects were maintained beyond approximately the same depth, even with 10 degrees of error in the estimation of the modiolar axis of the cochlea. When magnetic steering was not sufficient to pull the EA tip off of the lateral wall, a significant difference from the no-magnetic-steering case was not found.
Conclusions: This in vitro study suggests that magnetic steering of robotically inserted lateral-wall cochlear-implant EAs, given sufficient steering magnitude, can reduce forces on the basilar membrane in the first basilar turn compared with robotic insertion without magnetic steering.

Pubmed PDF Web

Cochlear Duct Length Calculation: Comparison Between Using Otoplan and Curved Multiplanar Reconstruction in Nonmalformed Cochlea

Chen, Ying; Chen, Jianqing; Tan, Haoyue; Jiang, Mengda; Wu, Yingwei; Zhang, Zhihua; Li, Yun; Jia, Huan; Wu, Hao

Publication date 01-08-2021


Objective: To describe a new method to measure the cochlear parameters using Otoplan software, and to compare it with the traditional method using curved multiplanar reconstruction (cMPR).
Study Design: Retrospective analysis using internal consistency reliability and paired sample t test.
Setting: Tertiary referral center.
Patients: Thirty-four patients including 68 ears from a clinical trial were retrospectively reviewed.
Main Outcome Measures: The length, width, height (distances A, B, H), and cochlear duct length of each cochlea were measured independently using two modalities: Otoplan and cMPR. Internal consistency reliability of the two modalities was analyzed. The time spent on each measurement was also recorded.
Results: Otoplan software was compatible with all radiological data in this series. Distances A, B, and H showed no significant differences between Otoplan (9.33 ± 0.365, 6.61 ± 0.359, and 2.91 ± 0.312 mm) and cMPR (9.32 ± 0.314, 6.59 ± 0.342, and 2.93 ± 0.250 mm). The average cochlear duct length calculated by Otoplan was 34.37 ± 1.481 mm, which was not significantly different from that calculated by cMPR (34.55 ± 1.903mm, p = 0.215). The measurements with Otoplan had better internal consistency reliability compared with those by cMPR, and measurements with a higher peak kilovoltage (140 k Vp) CT scan showed further higher internal consistency reliability. Time spent on each cochlea by Otoplan was 5.9 ± 0.69 min, significantly shorter than that by cMPR (9.3 ± 0.72 min).
Conclusion: Otoplan provides more rapid and reliable measurement of the cochlea than cMPR. Furthermore, it can be easily used in the laptop computer.

Pubmed PDF Web

Evaluation of Long-term Cholesteatoma Recidivism: Using the JOS, EAONO-JOS, and STAMCO Cholesteatoma Staging Systems

Eggink, Maura C.; de Wolf, Maarten J.F.; Ebbens, Fenna A.; Dikkers, Frederik G.; van Spronsen, Erik

Publication date 01-08-2021


Objective: To assess the prognostic value of the Japanese Otological Society (JOS), EAONO-JOS, and STAMCO classifications in predicting the severity of acquired cholesteatoma and to identify other factors that could influence residual and recurrent cholesteatoma, as well as adverse events (AE).
Method: A retrospective chart review of patients undergoing primary cholesteatoma surgery in our tertiary referral center. Primary outcome measures were based on three groups of follow-up (FU): Group A, studying residual cholesteatoma, FU > 52 weeks of last-look surgery or magnetic resonance imaging, diffusion-weighted imaging; group B, studying recurrent disease, FU > 52 weeks of last outpatient clinic visit; and group C, studying AE, FU > 12 weeks after surgery. Cholesteatomata were staged according to the JOS, EAONO-JOS, and STAMCO classifications. Kaplan–Meier curves were used to determine the prognostic value of the various classifications and to identify other determining factors, while correcting for FU.
Results: FU was found to be a significant confounder. No correlation was found between staging and the occurrence of residual or recurrent disease, nor the occurrence of AE. Type of surgery was a significant determinant of all three primary outcome measures. A higher age was associated with a lower risk of residual disease.
Conclusion: In our population the JOS, EAONO-JOS, and STAMCO classifications have limited prognostic value.
Three main confounders were identified that pose a challenge in developing a universal classification: FU, surgery type, and age. Cholesteatoma staging should be postponed until a system is developed which significantly correlates cholesteatoma stage to cholesteatoma severity, to have implications for management strategies.

Pubmed PDF Web

Secondary Obliteration Surgery for Troublesome Mastoid Cavities: A Prospective Series of 228 Pediatric and Adult Cases

Patil, Sachin; Trinidade, Aaron; Wong, Billy; Yung, Matthew W.

Publication date 01-08-2021


Objective: To present the results of a 15-year longitudinal study in a pediatric and adult population with secondary obliteration of troublesome mastoid cavities.
Study Design: Prospective longitudinal study.
Patients: Children (≤16 yrs) and adults who had obliteration surgery (228 ears) between 2000 and 2017.
Interventions: Therapeutic.
Setting: Tertiary referral center.
Main Outcome Measures: 1) Incidence of recurrent or residual cholesteatoma; 2) creation of a dry ear at 5 years postsurgery; 3) postoperative complications; 4) waterproof status of ear; 5) number of subsequent ear surgery required.
Results: Thirty-one pediatric and 197 adult cases contributed to the study. At 5 years 11 of 98 (10.8%) had been lost to follow-up. Using Kaplan–Meier survival analysis, the residual rate after 5 years was 4.2% (95% CI: 0.3%–8.2%) and the recurrence rate was 1% (95% CI: 0.0%–3.0%). Of the 223 ears available for assessment, 209 (93.7%) achieved a dry state, 6 (2.7%) had intermittent discharge, 6 (2.7%) had flap necrosis requiring flap trimming, and 1 (0.4%) developed meatal stenosis. Using a cross-sectional analysis at 12 months of follow-up, the otorrhea risk was 19.2% and the risk of definitive waterproofing was 10.9%. There was a reoperation risk of 10% within 5 years which included second-stage ossiculoplasty.
Conclusions: Secondary mastoid obliteration is a safe and useful technique in treating the troublesome mastoid cavity in both children and adults. It is associated with a low cholesteatoma recidivism rate and high rate of a trouble-free ear in the long term.

Pubmed PDF Web

Characterization of Ciprofloxacin Resistance Levels: Implications for Ototopical Therapy

Trinh, Katherine V.; Ruoff, Kathryn L.; Rees, Christiaan A.; Ponukumati, Aravind S.; Martin, Isabella W.; O’Toole, George A.; Saunders, James E.

Publication date 01-08-2021


Hypothesis: Ciprofloxacin-resistant pathogens are inhibited by high concentrations of ciprofloxacin found in commercially-available ototopical solutions.
Background: Ciprofloxacin-resistant pathogens in otitis media are currently treated with ototopical ciprofloxacin suspensions. This is done irrespective of laboratory-reported ciprofloxacin susceptibility, under the assumption that the high concentration of ciprofloxacin applied topically is sufficient to overcome antimicrobial resistance.
Methods: We evaluated 34 ciprofloxacin-resistant isolates consisting of Staphylococcus aureus, Pseudomonas aeruginosa, Corynebacterium spp., and Turicella otitidis. Ciprofloxacin minimum inhibitory concentration (MIC) assays and clinical ototopical solution minimum bactericidal concentration (CMBC) assays were performed.
Results: Amongst the ciprofloxacin-resistant isolates, ciprofloxacin MICs ranged from 8 to 256 mcg/ml (mean: 87.1 mcg/ml) and CMBCs ranged from 23.4 to 1500 mcg/ml (mean: 237.0 mcg/ml). There were no significant differences with respect to MIC in comparing P. aeruginosa versus Corynebacterium spp. (mean: 53.3 versus 55.2, p = 0.86), S. aureus versus P. aeruginosa (mean: 128.0 versus 53.3, p = 0.34), and S. aureus versus Corynebacterium spp. (mean: 128.0 versus 55.2, p = 0.09). The correlation between ciprofloxacin MIC and CMBC was poor (Pearsons r = –0.08, p = 0.75).
Conclusions: Ciprofloxacin-resistant pathogens commonly recovered from otitis media exhibit highly variable ciprofloxacin MIC and CMBC levels. Ciprofloxacin was able to inhibit growth in all isolates tested at MIC levels less than or equal to 256 mcg/ml; however, CMBCs up to 1500 mcg/ml were observed within that same group. The clinical relevance of these in vitro MICs is unclear due in part to higher bactericidal concentrations (CMBC) in several strains. Our results suggest that treatment failures may be due to a combination of factors rather than high-level resistance alone.

Pubmed PDF Web

"Aeration of the Human Prussaks Space: A 3D Synchrotron Imaging Study"

Li, Hao; Giese, Dina; Rohani, Seyed Alireza; Zhu, Ning; Ladak, Hanif M.; Agrawal, Sumit; Rask-Andersen, Helge

Publication date 01-08-2021


Objectives: Prussaks space (PS) is an intricate middle ear region which may play an essential role in the development of middle ear disease. The three-dimensional (3D) anatomy of the human PS and its drainage routes remain relatively unknown. Earlier studies have histologically analyzed PS, by micro-dissection and endoscopy. Here, we used synchrotron-radiation phase-contrast imaging (SR-PCI), 3D reconstructions, and modeling to study the framework of the human PS, including aeration pathways. It may lead to increased understanding of development of middle ear pathology.
Design: Nine human temporal bone specimens underwent in-line SR-PCI at the Canadian Light Source in Saskatoon, Saskatchewan, Canada. Data were processed with volume-rendering software to create 3D reconstructions using scalar opacity mapping and segmentations to visualize its walls in fixed, undecalcified human temporal bones.
Results: The PS was found to be an irregular, variably shaped chamber with different aeration systems.
Three different drainage pathways were found: 1) via the posterior malleolar pouch of von Tröltsch in seven of nine ears; 2) directly posterior-inferior into the mesotympanum medial to the posterior malleolar pouch in one ear; and 3) anteriorly in another. The posterior-inferior communications depended on the anatomy of the posterior malleolar fold. In one bilateral case, the aeration differed between the ears. Earlier descriptions of upper ventilation routes between the PS and the epitympanic spaces could not be substantiated.
Conclusions: The 3D anatomy of the membrane folds organizing the PS in humans was demonstrated for the first time using in-line SR-PCI. The PS was always aerated into the mesotympanum, suggesting its relative independence of attic ventilation. The impact of its various drainage routes on middle ear ventilation and disease were discussed.

Pubmed PDF Web

Hearing Outcomes of Stapes Surgery in Children With Stapes Fixation and Ossicular Anomalies

Kang, Byung Chul; Ku, Ja Yoon; Ahn, Joong Ho; Park, Hong Ju; Chung, Jong Woo

Publication date 01-08-2021


Objectives: To investigate hearing outcomes after stapes surgery in children with stapes fixation.
Study Design: Retrospective study.
Setting: Tertiary referral center.
Patients: Forty-nine patients (66 ears) aged less than 15 years who received stapes surgery.
Interventions: Stapes surgery.
Main Outcomes and Measures: Preoperative symptoms, bilateral involvement, pure-tone hearing levels, and perioperative complications were analyzed using paired t test and Mann–Whitney U test.
Results: The chief complaint of all patients was hearing disturbance. Sixteen ears were diagnosed with stapes fixation and an additional congenital ossicular anomaly and 50 ears had only stapes fixation. Preoperative mean bone conduction and air conduction thresholds were 12.0 ± 5.8 dB and 60.9 ± 10.9 dB, respectively. The mean air-bone gap (ABG) was 48.9 ± 12.0 dB in patients with stapes fixation and an ossicular anomaly. The postoperative mean ABG was 23.6 ± 14.5 dB, and the ABG closure was 25.3 ± 18.2 dB. In patients with stapes fixation only, the preoperative mean bone conduction and air conduction thresholds were 14.3 ± 7.5 dB and 49.6 ± 9.5 dB, respectively, and the mean ABG was 35.5 ± 9.6 dB. The postoperative mean ABG was 14.4 ± 10.3 dB, and the ABG closure was 16.2 ± 16.1 dB. The successful results (ABG <20 dB) were 75.8% overall, 56.3% for fixation and an ossicular anomaly, and 82.0% for fixation only.
Conclusions: In children with stapes fixation, hearing loss was worse when the fixation was combined with an ossicular anomaly. Ossicular continuity, especially of the incus, is the most important factor for successful stapes surgery. Appropriate diagnosis and surgical intervention can lead to good results for children with stapes fixation.

Pubmed PDF Web

Tissue Preservation Techniques for Bone-Anchored Hearing Aid Surgery

Holmes, Sean; Hamiter, Mickie; Berry, Camille; Mankekar, Gauri

Publication date 01-08-2021


Objective: Compare outcomes of surgical techniques in percutaneous bone-anchored hearing implant surgery.
Study Design: Matched retrospective cohort study.
Setting: Tertiary referral center.
Patients: Electronic review of adult and pediatric patients who underwent bone conduction device surgery by either the Minimally-invasive Ponto Surgery (MIPS) technique or the linear incision with no soft tissue removal (LnSTR) technique or between August 2015 and April 2018 at our facility.
Intervention: Patients in MIPS group underwent Minimally invasive Ponto Surgery (MIPS) technique, while those in LnSTR group underwent LnSTR technique.
Main Outcome Measure: Major outcome was presence/severity of localized skin reaction. Secondary outcomes included cosmetic outcome, revision surgery, minor adverse events, device utilization, and postoperative aided speech recognition thresholds (SRTs) across 250 to 4000 Hertz (Hz).
Results: Fifty patients met inclusion criteria. There was a significantly lower rate of localized cutaneous reactions for the MIPS group (4.5%) compared with LnSTR group (33.3%; p = 0.026). Rate of revision surgery was significantly less for MIPS (13.6%) compared with LnSTR (20.8%; p = 0.008). Occurrence of poor cosmetic outcome was noted significantly less for the MIPS group (9.1%) compared with LnSTR patients (20.8%; p = 0.005). Minor adverse events and aided SRTs were comparable between groups.
Conclusions: MIPS leads to a statistically significant decrease in localized cutaneous reaction compared with LnSTR. Both the LnSTR and MIPS techniques are safe and effective in the treatment of hearing loss, however MIPS may be superior in certain cases by offering improved healing, decreasing needs for wound care, and possibly decreasing need for frequent follow up.

Pubmed PDF Web

Clinical Performance Assessment of a New Active Osseointegrated Implant System in Mixed Hearing Loss: Results From a Prospective Clinical Investigation

Pla-Gil, Ignacio; Redó, María Aragonés; Pérez-Carbonell, Tomàs; Martínez-Beneyto, Paz; Alborch, Miguel Orts; Ventura, Antonio Morant; Monteagudo, Emilia Latorre; Ribas, Ignacia Pitarch; Algarra, Jaime Marco

Publication date 01-08-2021


Objective: Evaluation of a new active osseointegrated bone-conduction hearing implant in moderate to severe mixed-hearing loss.
Study Design: Prospective observational study of a series of cases.
Setting: Tertial referral center.
Patients: Twenty patients with moderate mixed-hearing loss were evaluated (10 Cochlear Osia group and 10 Baha 5 Power Connect -control group).
Intervention: Rehabilitative.
Main Outcome Measures: Hearing performance in quiet and in noise and quality-of-life were evaluated.
Results: Improvements in audibility, speech-understanding, speech-recognition, and quality-of-sound in noise and quiet were found for the Osia System compared with preoperative unaided hearing and performance was similar to that obtained with Baha 5 Power Connect.
Conclusions: The new active transcutaneous bone conduction system provided a tonal improvement in free-field at middle and high frequencies. The performance in speech recognition in quiet and in noise was similar to control group outcomes.

Pubmed PDF Web

Audiologic Outcomes After Oval and Round Window Reinforcement Surgery

Conway, Robert M.; Tu, Nathan C.; Pinther, Steven; Shareef, Zaid; Hong, Robert S.; Zappia, John J.; Babu, Seilesh C.

Publication date 01-08-2021


Introduction: Oval window (OW) and round window (RW) reinforcement surgery has been used for symptomatic treatment of multiple clinical entities, most commonly perilymphatic fistula and superior semicircular canal dehiscence. Owing to the theoretical acoustically negative effect of stiffening the windows, there has been concern of an unfavorable effect on audiologic outcomes due to the procedure. The purpose of this study is to specifically evaluate audiologic outcomes after OW and RW reinforcement.
Methods: A retrospective review of patients undergoing transcanal OW or RW reinforcement was completed. Patients were evaluated both as a total group and as two groups separated into “third window” and “two-window” groups based on their specific diagnosis. Primary outcomes included changes in individual pure-tone thresholds, pure-tone average (PTA), air-bone gap, speech reception threshold (SRT), and word recognition scores (WRS) between the preoperative and postoperative groups.
Results: Seventy-one patients were included in the study. The combined cohort demonstrated a significant postoperative 2.75 dB increase in the air conduction hearing level at 4000 Hz (p < 0.05). This was almost entirely accounted for by a 2.18 dB increase in the air-bone gap at this frequency (p < 0.05). There were no significant changes in PTA, SRT, or WRS between in the combined group or in the subgroup analysis.
Conclusion: OW and RW tissue reinforcement resulted in a statistically significant but likely clinically insignificant decrease in hearing at the 4000 Hz frequency. There was no worsening of PTA, WRS, or SRT.

Pubmed PDF Web

The Relationship Between the Activities-Specific Balance Confidence Scale and Balance Performance, Self-perceived Handicap, and Fall Status in Patients With Peripheral Dizziness or Imbalance

Herssens, Nolan; Swinnen, Eva; Dobbels, Bieke; Van de Heyning, Paul; Van Rompaey, Vincent; Hallemans, Ann; Vereeck, Luc

Publication date 01-08-2021


Objective: Describe the relationship between the Activities-Specific Balance Confidence (ABC) scale and Dizziness Handicap Inventory (DHI) with balance performance, as well as fall status in patients with peripheral vestibular disorders.
Study Design: Retrospective.
Setting: Outpatient balance clinic, tertiary referral center.
Patients: Data from 97 patients (age: 54.8 ± 12.3 yrs; 48 women) with dizziness or imbalance symptoms of peripheral vestibular origin were used for analysis.
Intervention(s): /Main Outcome Measure(s): ABC-scores, DHI-scores, static and dynamic balance tests, and fall status of the past 4 weeks, 2 months, and 6 months before the time of measurement were collected. Spearmans rho correlations, χ2 with post-hoc testing, and Kruskal–Wallis with post-hoc Mann–Whitney U test results were interpreted.
Results: The ABC- and DHI-scores show moderate correlations with static balance (ABC: r = 0.44; DHI: r = –0.34) and dynamic balance tests (ABC: r = –0.47;0.56; DHI: r = –0.48;0.39) and a strong inverse correlation with each other (ABC: 70 ± 25; DHI: 33 ± 26; r = –0.84). Related to fall status, weak correlations were found (ABC: r = –0.29;–0.21; DHI: r = 0.29;0.33). Additional results show that subjects in the low-level functioning (ABC) or severe self-perceived disability (DHI) categories have a poorer balance assessed by standing balance, Timed-Up-and-Go and Functional Gait Assessment and are more likely to have experienced multiple falls.
Conclusions: The ABC-scale and DHI showed a strong convergent validity, additionally the ABC-scale showed a better concurrent validity with balance performances and the DHI with fall history. In general, patients with peripheral vestibular impairments reporting a lower self-confidence or a more severe self-perceived disability show worse balance performances and a higher fall incidence.

Pubmed PDF Web

Variation in Canalith Repositioning Procedure Use Among Medicare Beneficiaries: Understanding the Role of Geographic Region and Provider Specialty

Zuniga, Steven A.; Marmor, Schelomo; Adams, Meredith E.

Publication date 01-08-2021


Objective: Clinical practice guidelines recommend canalith repositioning procedures (CRPs) for the management of benign paroxysmal positional vertigo (BPPV). As only 10 to 20% of affected individuals receive CRPs, there is concern for guideline adherence and knowledge dissemination to relevant medical specialties. This study aimed to characterize patterns of CRP utilization over time, across all United States regions, and by provider specialty.
Study Design: Cross-sectional analysis with time trends of CRP claims in the Centers for Medicare and Medicaid Service Provider Utilization and Payment database, 2012 to 2017.
Setting: National administrative claims data.
Patients: Fee-for-service Medicare beneficiaries.
Interventions: Canalith repositioning procedures.
Main Outcome Measures: CRP utilization was analyzed by year, hospital referral region (HRR), and provider specialty.
Results: From 2012 to 2017, 253,894 CRPs were performed on 146,139 Medicare beneficiaries and CRP utilization increased 80%. CRP use varied widely by geographic region. In 2017, CRP use per 100,000 beneficiaries varied 113-fold across HRRs (range, 6.0–701.8, interquartile range, 68.4, extremal ratio, 116.9). Most CRPs were performed by otolaryngologists (50.9%) and physical therapists (34.3%) with few by primary care providers (1.3%).
Conclusions: CRP utilization increased substantially suggesting improved dissemination and implementation of BPPV management guidelines. Nevertheless, wide geographic and provider-level variation remained, signifying non-uniform provider practices and access to care. Care for BPPV may thus be improved through education and incentivization of a broader range of providers.

Pubmed PDF Web

Length of the Narrow Bony Channels May Not be the Sole Cause of Differential Involvement of the Nerves in Vestibular Neuritis

Büki, Béla; Ward, Bryan K.

Publication date 01-08-2021


Objective: To measure the vestibular nerve bony channels, applying a 3D measurement to account for the oblique trajectory of the singular nerve.
Background: The clinical syndrome vestibular neuritis affects structures innervated by the superior vestibular nerve more commonly than the inferior vestibular nerve. Anatomical differences such as a longer, narrower bony channel of the superior vestibular nerve may increase its susceptibility to entrapment.
Main Outcome Measure(s): Length of the narrow segment of each vestibular nerve in which the nerve occupies more than 80% of the bony channel was measured.
Results: Forty six normal ears sectioned in the axial plane were measured. The narrow channel for the lateral semicircular canal (SCC, mean SD 2.94 ± 0.54) mm was longer than that of the singular nerve innervating the posterior SCC (1.95 ± 0.58 mm p < 0.0001), which also exceeded that of the utricular nerve (1.45 ± 0.36 mm p < 0.0001). The nerve to the superior part of the saccule (i.e., Voits nerve) was 1.14 ± 0.48 mm and that of the inferior saccule was 0.52 ± 0.37 mm.
Conclusions: The length of the narrow bony channel for the singular nerve is longer than previously reported and exceeds the utricular nerve. Comparing these data with the frequency of clinical lesions in recent literature suggests that, although bony channel length may contribute to differential involvement of the vestibular nerves, other factors may increase susceptibility of the superior vestibular nerve, including redundancy in innervation of the saccule and posterior SCC and anastomoses between the facial nerve and the superior vestibular nerve through which reactivated herpes virus may spread.

Pubmed PDF Web

Predictors of Postoperative Complications in Vestibular Schwannoma Surgery—A Population-Based Study

Alkins, Ryan D.; Newsted, Daniel; Nguyen, Paul; Campbell, Robert J.; Beyea, Jason A.

Publication date 01-08-2021


Objective: To investigate preoperative patient demographics and comorbidities in relation with postsurgical complications following vestibular schwannoma surgery.
Study Design: Retrospective population-based cohort study.
Setting: All hospitals in the Canadian province of Ontario.
Patients: This study includes 1,456 patients who underwent vestibular schwannoma surgery from April 1, 2002 to March 31, 2018 in Ontario, Canada.
Intervention/Outcome Measures: For all surgical patients, the demographic data, preoperative comorbidities, and postoperative complications were evaluated. Postoperative complications were examined immediately following surgery in the hospital as well as 1 year following the hospital discharge.
Results: The most common comorbidities in this cohort were hypertension (30.22%), diabetes (9.48%), asthma (13.53%), and chronic obstructive pulmonary disease (6.73%). Diabetes was the most impactful comorbidity and was associated with higher risk of myocardial infarction (RR = 4.58, p < 0.01), pneumonia (RR = 1.80, p = 0.02), dysphagia (RR = 1.58, p < 0.01), and meningitis (RR = 3.62, p < 0.01). Analysis of surgical approaches revealed that the translabyrinthine approach, compared with the open craniotomy approach, was negatively associated with postoperative complications including pneumonia (RR = 0.43, p < 0.01), urinary tract infection (RR = 0.55, p = 0.01), dysphagia (RR = 0.66, p < 0.01), and readmission (RR = 0.45, p < 0.01).
Conclusion: This study examines patient demographics, preoperative comorbidities, and postoperative complications in patients who have undergone vestibular schwannoma surgery. The results highlight associations between patient characteristics and postoperative outcomes that can aid in preoperative decision-making and counselling.

Pubmed PDF Web

The Relationship Between the Functional Gait Assessment and Quality-of-Life Data in Patients Undergoing Vestibular Schwannoma Resection

Said, Mena; Lee, Jason; Moshtaghi, Omid; Saliba, Joe; Richardson, Alexander J.W.; Ngo, Victoria; Mehranpour, Pasha; Schwartz, Marc S.; Friedman, Rick A.

Publication date 01-08-2021


Objective: To examine the relationship between the Functional Gait Assessment (FGA) and quality of life (QOL) measurements relating to balance before and after vestibular schwannoma (VS) resection and to assess the role of preoperative FGA in predicting postoperative QOL.
Study Design: A prospective clinical study of adult patients undergoing VS resection between September 2018 and December 2019. FGA was administered 1 week before and after surgery. Dizziness Handicap Inventory (DHI) and Penn Acoustic Neuroma Quality of Life (PANQOL) were administered preoperatively and at 3 months postoperatively.
Setting: Single tertiary center.
Patients: Patients (age ≥ 18 years old) with VS undergoing microsurgical resection. Excluded were patient with previous surgery or radiation.
Intervention: VS resection.
Main Outcomes and Measures: Primary outcome: correlation between FGA and QOL surveys.
Secondary outcome: correlation between preoperative measurements of balance and postoperative PANQOL.
Results: One hundred thirty-eight patients were analyzed (mean age: 48 years old, 65.9% female). The translabyrinthine approach was most commonly performed. Under multivariate analysis, preoperative FGA significantly correlated with preoperative PANQOL balance score (p < 0.0001), preoperative PANQOL total score (p = 0.0002), and preoperative DHI (p < 0.0001). However, postoperative FGA did not significantly correlate with postoperative PANQOL balance or total scores (p = 0.446 and p = 0.4, respectively), or postoperative DHI (p = 0.3). Univariate analysis demonstrated that preoperative DHI and preoperative FGA were predictive of changes in postoperative PANQOL balance and total scores. However under multivariate analysis, preoperative FGA did not predict changes in postoperative PANQOL balance or total score (p = 0.24; p = 0.28, respectively). Preoperative DHI remained predictive of changes in postoperative PANQOL balance (p = 0.03) score but not of postoperative PANQOL total score (p = 0.37).
Conclusions: Although FGA and QOL data significantly correlated in the preoperative setting, our results did not suggest that preoperative FGA can be used to determine postoperative QOL. Additionally, the lack of correlation between FGA and QOL measurements in the acute postoperative setting suggests that further research is needed to determine contributors to postoperative QOL.

Pubmed PDF Web

Association of Metformin With Volumetric Tumor Growth of Sporadic Vestibular Schwannomas

Armstrong, Michael F.; Lohse, Christine M.; Lees, Katherine A.; Carlson, Matthew L.

Publication date 01-08-2021


Objective: Recent research demonstrates a potential association between metformin use and reduced sporadic vestibular schwannoma (VS) growth in patients undergoing conservative observation. The current study was designed to elucidate the effect of metformin on tumor growth in sporadic VS using volumetric analyses.
Study Design: Retrospective cohort.
Setting: Tertiary referral center.
Patients: Patients with sporadic VS who elected initial conservative treatment with at least two serial magnetic resonance imaging (MRI) scans were included.
Interventions: Metformin use among patients with observed sporadic VS.
Main Outcome Measures: Tumor growth, defined as an increase in volume of at least 20% from the initial MRI.
Results: A total of 361 patients were evaluated. Thirty-four patients (9%) had a diagnosis of diabetes at baseline. Nineteen patients (5%) were taking metformin at the time of the initial MRI. Metformin use was not significantly associated with a reduced risk of volumetric tumor growth in a univariable analysis in all patients undergoing observation for VS (hazard ratio HR 0.75; 95% confidence intervals CI 0.40–1.42; p = 0.38) or within the diabetic subset (HR 0.79; 95% CI 0.34–1.83; p = 0.58). Additionally, diabetes status, insulin dependence, hemoglobin A1c value, and metformin dose were not significantly associated with volumetric tumor growth.
Conclusion: Despite promising initial results in several previous studies, our data suggest that metformin use does not significantly reduce the risk of volumetric tumor growth in sporadic VS.

Pubmed PDF Web

Cerebellopontine Angle Ewing-like BCOR-rearranged Sarcoma Mimicking Vestibular Schwannoma

Guigou, Caroline; Aubriot Lorton, Marie-Hélène; Lleu, Maxime; Bozorg Grayeli, Alexis

Publication date 01-08-2021


No abstract available

Pubmed PDF Web

Extended Middle Cranial Fossa Approach for Placement of Auditory Brainstem Implants

Shapiro, Scott B.; Lipschitz, Noga; Hammer, Theresa; Wenstrup, Lisa; Zuccarello, Mario; Samy, Ravi N.

Publication date 01-08-2021


Objective: Traditionally, auditory brainstem implants (ABIs) have been placed via the translabyrinthine or retrosigmoid approaches. In select patients, a modified extended middle cranial fossa (xMCF) approach with tentorial ligation may be advantageous for vestibular schwannoma (VS) resection and auditory rehabilitation. This manuscript describes the application of this modification of the MCF approach for simultaneous VS resection and ABI placement.
Patients: Patients with neurofibromatosis type 2, profound bilateral sensorineural hearing loss, single functioning sigmoid/jugular venous system, and giant (>4 cm) VS.
Interventions: Simultaneous VS resection and ABI placement via a modified xMCF approach with tentorial ligation.
Main Outcome Measures: Extent of tumor removal and brainstem decompression, access to lateral recess of the fourth ventricle, functional hearing improvement, surgical complications.
Results: Two patients met indications and underwent surgery. There were no immediate or delayed surgical complications. Both had subtotal tumor removal with significant decompression of the brainstem and ABI placement. One patient achieved voice and environmental sound awareness at 35 to 55 dbHL across frequencies. The second patient presented with failure to thrive and multiple lower cranial neuropathies in addition to the above-listed indications. She was hospitalized multiple times after surgery due to failure to thrive and recurrent aspiration pneumonia. Her device was never activated, and she expired 1 year after surgery.
Conclusions: The xMCF with tentorial ligation is an additional approach for tumor resection and ABI placement in selected patients with neurofibromatosis type 2. Future studies will further define when this approach is most applicable as well as the challenges and pitfalls.

Pubmed PDF Web

Clinical Significance of Middle Cerebellar Peduncle Ischemia After Translabyrinthine Vestibular Schwannoma Resection

Maxwell, Anne K.; Muelleman, Thomas; Barnard, Zachary; Slattery, William H. III; Mehta, Gautam U.; Lekovic, Gregory P.

Publication date 01-08-2021


Objective: To assess clinical symptoms, signs, and radiographic evolution of middle cerebellar peduncle (MCP) diffusion restriction (DR) abnormalities following vestibular schwannoma (VS) resection.
Study Design: Retrospective chart and imaging review.
Setting: Tertiary-referral neurotology and neurosurgery practice.
Patients: All consecutive patients who underwent translabyrinthine VS resection over a 2-year period (August 2017–May 2019).
Intervention: Translabyrinthine craniotomy for VS resection.
Main Outcome Measures: Magnetic resonance imaging (MRI) obtained on postoperative day 1 were reviewed for DR within the pons and cerebellum, with 3 months follow-up MRI to assess for evolution of these vascular changes.
Results: Of the 31 patients who met inclusion criteria, MRI demonstrated MCP DR consistent with acute ischemia in 29% (9/31). Of those, two showed corresponding T2 signal abnormalities on follow up MRI consistent with cerebrovascular accident (CVA) within the MCP. Both had severe gait ataxia and dysmetria requiring acute rehabilitation admission and significantly larger tumors (p = 0.02). The remaining seven were asymptomatic, and DR abnormality resolved without lasting radiographic changes. Brainstem compression was present in 100% of patients with postoperative MCP DR (mean MCP ipsilateral:contralateral ratio 0.59 ± 0.19), and 68.1% of those without (mean MCP ratio 0.71 ± 0.25), a difference that was not statistically significant (p = 0.14). In the two patients with CVA, MCP asymmetry persisted, whereas the asymmetry resolved in all others.
Conclusions: Asymptomatic acute MCP ischemia discovered incidentally does not require intervention. However, when the ischemic area is large and patients are symptomatic, especially if an acute rehabilitation admission is required, surgeons should suspect true CVA.

Pubmed PDF Web

Sunnybrook Facial Grading System: Intra-rater and Inter-rater Variabilities

Cabrol, Camille; Elarouti, Léa; Montava, Anne-Laure; Jarze, Sylvie; Mancini, Julien; Lavieille, Jean-Pierre; Barry, Pauline; Montava, Marion

Publication date 01-08-2021


Objectives: Evaluate intra-rater and inter-rater variabilities of the Sunnybrook Facial Grading System (SFGS) and explore potential factors of variability.
Study Design: Prospective test of hypothesis.
Setting: University tertiary referral center.
Participants/Methods: Facial video recordings of 20 patients with variable degrees of peripheral facial palsy (PFP) were anonymized then presented to 31 independents raters in 2 trials.
The raters were senior and junior professionals involved in the management of PFP: ENT specialists, physiotherapists, and speech therapists. The SFGS was used for grading paralysis.
Main Outcome Measure: Intra-rater and inter-rater variabilities were estimated by intraclass correlation coefficient (ICC 95% confidence interval) for the composite score and the three subscores of the SFGS.
Factors of variability studied were: rater professions and rater experience (senior vs junior).
Results: For the total population, the intra-rater ICC was 0.9150.900–0.929 for the composite score considered to represent almost perfect repeatability. Repeatability was important for symmetry at rest (0.6940.646–0.737), almost perfect for voluntary movements (0.9030.886–0.918), and important to almost perfect for synkinesis (0.8100.778–0.838). The inter-rater ICC for the composite score was 0.8470.755–0.923 indicating important to almost perfect agreement between all raters. Agreement between raters was important to almost perfect for voluntary movements (0.8390.746–0.919), but moderate to important for symmetry at rest (0.5530.408–0.730) and weak to important for synkinesis (0.4760.333–0.666). Some variability was found between raters groups; however, repeatability and agreement were good for all raters.
Conclusions: The SFGS is a reproducible scale. It can be used with good reproducibility by both novices and experts, and by all professionals involved in the management of PFP.

Pubmed PDF Web

Efficacy of Mirror Biofeedback Rehabilitation on Synkinesis in Acute Stage Facial Palsy in Children

Baba, Shintaro; Kondo, Kenji; Yoshitomi, Ai; Kanemaru, Asako; Nakaya, Muneo; Yamasoba, Tatsuya

Publication date 01-08-2021


Objectives: To evaluate the efficacy of mirror biofeedback rehabilitation for synkinesis in severe acute facial paralysis in children.
Methods: Eight pediatric patients with facial paralysis with an initial electroneurography (ENoG) value less than 10% who underwent mirror biofeedback rehabilitation (the child-rehabilitation group) were enrolled. Seven infants (under age 2 yr) who were unable to undergo rehabilitation (the infant-and-toddler control group) and adult patients (n = 13, range, 33–56 yr) who underwent rehabilitation (the adult-rehabilitation group) comprised the control groups. All the patients enrolled were baseline House–Brackmann (H–B) grade VI at onset. The patients began daily facial biofeedback rehabilitation using a mirror at the first sign of muscle contraction on the affected side and were instructed to keep their eyes symmetrically open using a mirror during mouth movements. The training was continued for 12 months after the onset of facial paralysis. The degree of oral-ocular synkinesis was evaluated by the degree of asymmetry in eye opening width during mouth movements. The synkinesis index was calculated as a percentage of the interpalpebral space width (normal side – affected side/normal side). Statistical analyses used non-parametric tests (the Kruskal–Wallis test and Steel–Dwass posthoc test).
Results: The synkinesis index was significantly lower in the child-rehabilitation group than in the infant-and-toddler control group or the adult-rehabilitation group (p < 0.001).
Conclusion: Children who underwent mirror biofeedback rehabilitation had less synkinesis than the infant-and-toddler control group, suggesting that mirror biofeedback rehabilitation is more effective in preventing the exacerbation of synkinesis in children.

Pubmed PDF Web

Pharmacokinetics of Single Dose Lidocaine and Epinephrine Following Iontophoresis of the Tympanic Membrane in a Double-Blinded Randomized Trial

England, Laura J.; Syms, Charles A. III; York, Christopher

Publication date 01-08-2021


Objective: To evaluate local and systemic safety of bilateral iontophoretic administration of lidocaine with epinephrine or lidocaine alone to the tympanic membrane (TM).
Study Design: A randomized, double-blind, two-arm study was conducted at a single center. Healthy adults were randomized to bilateral iontophoretic treatment with 2% lidocaine, 1:100,000 epinephrine, or 2% lidocaine (control). Otoscopy, cranial nerve examination, tympanometry, and audiometry safety evaluations were conducted before and 3-days post-procedure. Systemic safety was evaluated via analysis of vital signs taken before and up to 120 minutes post-iontophoresis, and blood samples collected before and up to 230 minutes post-iontophoresis.
Results: Twenty-five subjects were treated with bilateral iontophoresis of either lidocaine and epinephrine (n = 15 subjects) or lidocaine alone (n = 10). Mean plasma epinephrine concentrations for both groups remained within the normal range for endogenous epinephrine. Mean plasma concentrations of lidocaine were not statistically different between groups, ranging from 0.245 to 2.28 ng/ml after administration of lidocaine with epinephrine (immediate post-iontophoresis to 230 min post-iontophoresis), compared with 1.35 to 2.14 ng/ml after administration of lidocaine alone. The presence of epinephrine slowed the systemic absorption of lidocaine. Lidocaine levels (Cmax 2.24 ng/ml) were approximately 2000-fold lower than the threshold for minor lidocaine toxicity. No device-, procedure- or drug-related adverse events were reported.
Conclusion: The local and systemic safety of bilateral iontophoretic delivery of 2% lidocaine, 1:100,000 epinephrine to the TM was demonstrated by low plasma levels of drug and absence of both serious and non-serious device-, procedure-, or drug-related adverse events.

Pubmed PDF Web

The Impact of Superior Canal Dehiscence on Power Absorbance, Otoacoustic Emissions, and Hearing in Fat Sand Rats

Attias, Joseph; Rabinovics, Naomi; Nageris, Benny; Hilly, Ohad

Publication date 01-08-2021


Background: Superior Semicircular Canal Dehiscence (SSCD) may lead to vestibular and auditory impairments.
Objective: To study the effects of power absorbance (PA), Distortion Product Otoacoustic emissions (DPOAE), and hearing thresholds in normal ears of fat sand rats, after a bullotomy, creation and patching.
Methods: SSCD was performed unilaterally in eight normal hearing animals while the contra-lateral un-operated ear was used as a control. Measures included auditory brain stem responses thresholds for air and bone conduction stimuli, DPOAEs and PA at peak pressure.
Results: The normal PA pattern of the animals grossly resembled that of human ears. A bullotomy generated specific, large and significant (p < 0.0001) changes in PA without altering hearing thresholds. SSCD significantly decreased PA at low (p < 0.02) and increased at high frequencies (p < 0.03), but on a smaller scale than the bullotomy. SSCD, induced a mean air-bone gaps of 24.3 for clicks, and 31.2 dB for 1 k Hz TB. SSCD also increased the DPOAEs levels by mean of 10.1 dB SPL (p < 0.03). Patching the dehiscence, reversed partially the PA changes, the auditory threshold shifts, and the DPOAEs levels to pre-SSCD values.
Conclusions: SSCD affects both incoming and emitting sounds from the ear, probably due to its effect on cochlear impedance and stiffness of the middle and inner ear. The presence of DPOAEs and ABGs indicated a “third window” disease, i.e., SSCD. Due to similar PA patterns after bullotomy and SCCD, PA alone has limited diagnostic yield for patients with SCCD.

Pubmed PDF Web

Predictors of Fibrotic and Bone Tissue Formation With 3-D Reconstructions of Post-implantation Human Temporal Bones

Danielian, Arman; Ishiyama, Gail; Lopez, Ivan A.; Ishiyama, Akira

Publication date 01-08-2021


Hypothesis: Years of implantation, surgical insertion approach, and electrode length will impact the volume of new tissue formation secondary to cochlear implantation.
Background: New tissue formation, fibrosis, and osteoneogenesis after cochlear implantation have been implicated in increasing impedance and affecting performance of the cochlear implant.
Methods: 3-D reconstructions of 15 archival human temporal bones from patients with a history of cochlear implantation (CI) were generated from H&E histopathologic slides to study factors which affect volume of tissue formation.
Results: Years of implantation was a predictor of osteoneogenesis (r = 0.638, p-value = 0.011) and total new tissue formation (r = 0.588, p-value = 0.021), however not of fibrosis (r = 0.235, p-value = 0.399). Median total tissue formation differed between cochleostomy and round window insertions, 25.98 and 10.34%, respectively (Mann–Whitney U = 7, p = 0.018). No correlations were found between electrode length or angular insertion depth and total new tissue (p = 0.192, p = 0.35), osteoneogenesis (p = 0.193, p = 0.27), and fibrosis (p = 0.498, p = 0.83), respectively. However, the type II error for electrode length and angular insertion depth ranged from 0.73 to 0.90, largely due to small numbers of the shorter electrodes.
Conclusions: With numbers of cochlear implant recipients increasing worldwide, an understanding of how to minimize intracochlear changes from implantation is important. The present study demonstrates that increasing years of implantation and inserting electrodes via a cochleostomy compared with a round window approach are associated with significantly greater degree of new tissue volume formation. While previous studies have demonstrated increased intracochlear damage in the setting of translocation with longer electrodes, length, and angular insertion depth of CI electrodes were not associated with increased tissue formation.

Pubmed PDF Web

Formations of Host Fibers and Bacteria in Human Temporal Bones With Otitis Media

Tsuprun, Vladimir; Shibata, Dai; Paparella, Michael M.; Cureoglu, Sebahattin

Publication date 01-08-2021


Hypothesis: In temporal bones with otitis media, fibrin and neutrophil extracellular traps (NETs) form a fibrous network with bacteria, which is involved in growth of bacterial clusters/biofilms and chronicity of disease.
Background: NETs and fibrin are important in host defense against pathogens; however, their role in otitis media is not well understood.
Methods: Eight human temporal bones with serous otitis media, 30 with serous-purulent otitis media, 7 with mucoid otitis media, 23 with mucoid-purulent otitis media (OM), 30 with purulent OM, and 30 with chronic otitis media were selected based on histopathologic findings. Fibrous material with bacteria was detected with hematoxylin-eosin, Gram-Weigert, and propidium iodide stains; and its composition was analyzed with immunohistochemistry.
Results: Extensive formations of fibrous material with bacteria were observed in 30% of temporal bones with serous-purulent otitis media, 29% with mucoid otitis media, 50% with mucoid-purulent OM, 57% with purulent OM, and 67% of temporal bones with histological evidence of chronic otitis media. Some of these formations showed large bacterial clusters or biofilms. Immunohistochemical analysis showed that fibrous structures were composed of fibrin or NETs.
Conclusions: Formations of fibrous material with bacteria were detected in human temporal bones with different types of otitis media. Inflammatory cells were observed mostly in areas with low presence of fibrous structures. The network of fibrous material seems to prevent clearance of bacteria by phagocytic cells and thus influences growth of bacterial clusters or biofilms. Fibrin and NETs may be important for the recurrences and chronicity of disease, and contribute to clogging of tympanostomy tubes in children.

Pubmed PDF Web

Endoscopic Anatomy of the Chorda Tympani: Systematic Dissection, Novel Anatomic Classification, and Surgical Implications

Molinari, Giulia; Yacoub, Abraam; Alicandri-Ciufelli, Matteo; Monzani, Daniele; Presutti, Livio; Caversaccio, Marco; Anschuetz, Lukas

Publication date 01-08-2021


Hypothesis: A transcanal endoscopic approach enables visualization of the variable course of the chorda tympani inside the middle ear.
Background: The chorda tympani is the longest intrapetrous branch of the facial nerve. Despite having been investigated in several studies, a description of its tympanic tract from an endoscopic point of view is lacking in the literature.
Methods: We performed transcanal endoscopic dissections of 44 human cadaveric head and ear specimens. The entry point of the chorda tympani into the middle ear was classified into four categories according to its location, and as covered or dehiscent according to its appearance. The chordal eminence (CE) was defined as absent, shallow, intermediate, prominent, or fused, based on its shape and extension. The relationship of the chorda tympani to adjacent bony and ligamental structures was assessed.
Results: The tympanic tract of the chorda tympani was divided into three portions. The periannular segment was dehiscent in 54.5% of specimens, with type II being the most frequent entry point configuration (52.3%). In the interossicular segment, the nerve consistently passed lateral to the incus and medial to the malleus. The course of the intrapetrous segment was independent from the conformation of the tensor fold and supratubal recess.
Conclusion: The transcanal endoscopic approach allows a detailed description of tympanic segment of the chorda tympani. Novel anatomic classifications of the chorda tympani and CE are proposed herein to highlight their possible surgical implications during otologic procedures.

Pubmed PDF Web

INTRALABYRINTHINE HEMORRHAGE IN A PATIENT WITH COVID-19 – A CHALLENGE FOR AN OTOLOGIST

Narozny, Waldemar; Tretiakow, Dmitry; Skorek, Andrzej

Publication date 01-08-2021


No abstract available

Pubmed PDF Web

SUDDEN SENSORINEURAL HEARING LOSS AND COVID-19: AN EVOLVING DISCUSSION

Chern, Alexander; Famuyide, Akinrinola O.; Moonis, Gul; Lalwani, Anil K.

Publication date 01-08-2021


No abstract available

Pubmed PDF Web

Objective Pulsatile Tinnitus Caused by Vascular Anomaly of the Internal Maxillary Artery

Williams, Lauren C.; Moore, Justin M.; Naples, James G.

Publication date 01-08-2021


No abstract available

Pubmed PDF Web

Endoscopic Repair of a Temporal Bone Pneumatocele

Mooney, Craig P.; Patel, Nirmal

Publication date 01-08-2021


Objective: Pneumatoceles of the temporal bone are rare entities. A symptomatic external auditory canal pneumatocele repaired endoscopically is demonstrated.
Methods: A 79-year-old man presented with fluctuating hearing loss and difficulty wearing in-ear hearing aids. The patient had two previous tube insertions which both failed within days. Examination of the left ear revealed a cyst filling the superior aspect of the lateral canal and obscuring the view of the majority of the tympanic membrane. Pre-op audiogram demonstrated a symmetric bilateral mild to moderate sensorineural hearing loss. The patient underwent a transcanal endoscopic composite cartilage myringoplasty. On incising the pneumatocele, a pars flaccida defect was identified in continuity with the pneumatocele. After excising the pneumatocele, a posterosuperior based tympanomeatal flap was raised and the defect repaired with a composite tragal cartilage perichondrial graft.
Results: The patient had an uneventful recovery. On first postoperative review, the tympanomeatal flap had healed and the cartilage graft was intact with partial integration and epithelialization. There was no evidence of pneumatocele recurrence and his existing hearing aids were able to be worn with satisfactory amplification. The formation of the pneumatocele was presumed secondary to a ball-valve effect of skin through the pars flaccida defect and progressive raising of the epithelial layer in continuity with the canal skin.
Conclusion: Surgical repair of temporal bone pneumatoceles is warranted in symptomatic patients. Identifying and addressing the underlying cause of their development is essential to surgical management.
SDC video link: http://links.lww.com/MAO/B267

Pubmed PDF Web

Copyright © KNO-T, 2020 | R/Abma