Otology Neurotology 2024-03-01

Book Review: Third Mobile Window Syndrome of the Inner Ear-Superior Semicircular Canal Dehiscence and Associated Disorders. GJ Gianoli and P Thomson, eds.; Cham, Switzerland: Springer Nature, 2023

Arriaga, Moises

Publication date 30-01-2024


No abstract available

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Book Review: Imaging Handbook on Anatomy of Cochlea. Neeraj Suri, Thieme, Delhi, 2024

Arriaga, Moises

Publication date 30-01-2024


No abstract available

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A Systematic Review of Cochlear Implant-Related Magnetic Resonance Imaging Artifact: Implications for Clinical Imaging

Berry, Joseph M.; Tansey, James B.; Wu, Lin; Choudhri, Asim; Yawn, Robert J.; MacDonald, Charles Bruce; Richard, Celine

Publication date 17-01-2024


Objective To conduct a systematic review of the existing literature with the aim of evaluating and consolidating the present understanding of strategies for mitigating magnetic resonance imaging (MRI) artifacts related to cochlear implants in adult and pediatric patients, covering both in-vivo and ex-vivo investigations.
Data Sources A systematic review of MEDLINE-Ovid, Embase, Google Scholar, The Cochrane Library, and Scopus was performed from inception through April 2022. The protocol was registered with PROSPERO before commencement of data collection (CRD CRD42022319651).
Review Methods The data were screened and collected by two authors independently, and eligibility was assessed according to Cochrane Handbook and Preferred Reporting Items for Systematic Review and Meta-Analysis recommendations, whereas the quality of the articles was evaluated using the NIH Study Quality Assessment.
Results The search yielded 2,354 potentially relevant articles, of which 27 studies were included in the final review. Twelve studies looked at 1.5-T MRI, four studies looked at 3-T MRI, eight studies looked at both 1.5 and 3 T, one study looked at 0.2 and 1.5 T, and one study looked at 3- and 7.0-T MRI. Nineteen studies focused on MRI sequences as a means of artifact reduction, nine studies focused on implant magnet positioning, two studies focused on head positioning, and one study focused on both magnet and head positioning. In terms of MRI sequences, diffusion-weighted imaging produced larger artifacts compared with other sequences, whereas fast spin echo/turbo spin echo sequences and fat suppression techniques produced smaller artifacts. The position of the magnet was also found to be important, with a magnet position more than 6.5 cm posterior to the external auditory canal producing the best images with the least distortion. The angle at which the magnet is placed also affects visibility of different brain structures.
Conclusion Proper head positioning, magnet placement at a distance of over 6.5 cm from the external auditory canal, use of spin echo sequences, and fat suppression techniques reduce the size and shape of MRI artifacts.

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Management of Fallopian Canal Spontaneous CSF Leaks, Implications of Elevated Intracranial Pressure: Case Report and Systematic Review of the Literature

Saltagi, Abdul K.; Saltagi, Mohamad Z.; Kedo, Mahmood; Shah, Mitesh V.; Nelson, Rick F.

Publication date 07-02-2024


Objectives Describe the diagnosis and management of a spontaneous cerebrospinal fluid leak (sCSF-L) through the facial nerve fallopian canal and determine the role of intracranial hypertension (IH).
Study Design Retrospective case study and systematic review of the literature.
Methods Reviewed patient characteristics, radiographic findings, and management of the facial nerve canal CSF leak and postoperative IH. Conducted systematic literature review according to the PRISMA guidelines for surgical management and rates of IH.
Results A 50-year-old female with bilateral tegmen defects and temporal encephaloceles underwent left middle cranial fossa (MCF) repair. Intraoperative CSF egressed from the temporal bone tegmen defects. Facial nerve decompression revealed CSF leak from the labyrinthine segment. A nonocclusive temporalis muscle plug was placed in the fallopian canal, and tegmen repair was completed with bone cement. A ventriculoperitoneal shunt was placed for IH. Postoperative facial nerve function and hearing were normal. A total of 20 studies met inclusion criteria with a total of 25 unique patients. Of 13 total adult cases of fallopian canal CSF leak, there is a 46% recurrence rate, and 86% of patients had documented IH when tested.
Conclusions Fallopian canal CSF leaks are rare and challenging to manage. Assessment of intracranial hypertension and CSF diversion is recommended along with MCF skull base repair to preserve facial nerve function and conductive hearing.

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Comparison of Quality of Life Outcomes for Percutaneous Versus Transcutaneous Implantable Hearing Devices: A Systematic Review and Meta-analysis

Gutierrez, Jorge A. III; Shannon, Christian M.; Nguyen, Shaun A.; Meyer, Ted A.; Lambert, Paul R.

Publication date 24-01-2024


Objective To compare quality of life (QOL) outcomes of percutaneous and transcutaneous bone conduction devices (pBCD and tBCD, respectively).
Databases Reviewed Pubmed, Scopus, CINAHL.
Methods A systematic review was performed searching for English language articles from inception to March 15, 2023. Studies reporting QOL outcomes measured using a validated tool following implantation of either pBCDs or tBCDs were considered for inclusion. QOL outcomes included scores for Glasgow Benefit Inventory, Glasgow Childrens Benefit Inventory, Abbreviated Profile of Hearing Aid Benefit, and the Speech, Spatial, and Qualities of Hearing Scale. A meta-analysis of continuous measures was performed.
Results A total of 52 articles with 1,469 patients were included. Six hundred eighty-nine patients were implanted with pBCDs, and the remaining 780 were implanted with tBCDs. Average Glasgow Benefit Inventory scores for the tBCD group (33.0, 95% confidence interval 22.7–43.3) were significantly higher than the pBCD group (30.9 25.2–36.6) (Δ2.1 1.4–2.8, p < 0.0001). Mean Glasgow Childrens Benefit Inventory scores (Δ3.9 2.0–5.8, p = 0.0001) and mean gain in Abbreviated Profile of Hearing Aid Benefit scores (Δ5.6 4.8–6.4, p < 0.0001) were significantly higher among patients implanted with tBCDs than those implanted with pBCDs. Patients implanted with tBCDs also had significantly higher gains on the Speech (Δ1.1 0.9–1.3, p < 0.0001), Spatial (Δ0.8 0.7–0.9, p < 0.0001), and Qualities of Hearing (Δ1.2 1.1–1.3, p < 0.0001) portions of the Speech, Spatial, and Qualities of Hearing Scale than those implanted with pBCDs.
Conclusions Patients implanted with transcutaneous devices had better QOL outcomes than those implanted with percutaneous devices.

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Variability in Manual Segmentation of Temporal Bone Structures in Cone Beam CT Images

Lee, Julian W.; Andersen, Steven Arild Wuyts; Hittle, Bradley; Powell, Kimerly A.; Al-Fartoussi, Hagar; Banks, Laura; Brannen, Zachary; Lahchich, Mariam; Wiet, Gregory J.

Publication date 07-02-2024


Purpose Manual segmentation of anatomical structures is the accepted “gold standard” for labeling structures in clinical images. However, the variability in manual segmentation of temporal bone structures in CBCT images of the temporal bone has not been systematically evaluated using multiple reviewers. Therefore, we evaluated the intravariability and intervariability of manual segmentation of inner ear structures in CBCT images of the temporal bone.
Methods Preoperative CBCTs scans of the inner ear were obtained from 10 patients who had undergone cochlear implant surgery. The cochlea, facial nerve, chorda tympani, mid-modiolar (MM) axis, and round window (RW) were manually segmented by five reviewers in two separate sessions that were at least 1 month apart. Interreviewer and intrareviewer variabilities were assessed using the Dice coefficient (DICE), volume similarity, mean Hausdorff Distance metrics, and visual review.
Results Manual segmentation of the cochlea was the most consistent within and across reviewers with a mean DICE of 0.91 (SD = 0.02) and 0.89 (SD = 0.01) respectively, followed by the facial nerve with a mean DICE of 0.83 (SD = 0.02) and 0.80 (SD = 0.03), respectively. The chorda tympani had the greatest amount of reviewer variability due to its thin size, and the location of the centroid of the RW and the MM axis were also quite variable between and within reviewers.
Conclusions We observed significant variability in manual segmentation of some of the temporal bone structures across reviewers. This variability needs to be considered when interpreting the results in studies using one manual reviewer.

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Intermediate Cervical Plexus Block in the Management of Refractory Somatosensory Tinnitus Following Whiplash: Prospective Series in 30 Patients

Kukreja, Yuvraj; Lee, Hayun; Morsy, Mohamed; Niraj, G

Publication date 07-02-2024


Objective Whiplash-associated disorder comprises of a constellation of persistent symptoms after neck trauma. Tinnitus that develops postwhiplash is termed somatosensory tinnitus. The objective is to assess the role of intermediate cervical plexus block (iCPB) in patients with somatosensory tinnitus secondary to whiplash.
Methods Prospective service evaluation in adults with whiplash-associated disorder and concomitant somatosensory tinnitus. Patients underwent specialist otorhinolaryngology review before pain clinic referral. Patients were offered ultrasound-guided iCPB with steroids. Intensity of tinnitus was recorded on a numerical rating scale at baseline, 3 and 6 months posttreatment. Brief Pain Inventory Short Form and Hospital Anxiety Depression Scale questionnaires were also completed.
Results Over a 36-month period, 32 patients with refractory somatosensory tinnitus following whiplash were offered iCPB(s). Two patients refused because of needle phobia. iCPB(s) was performed in 30 patients as an outpatient procedure. One patient (1/30, 3.3%) was lost to follow-up. Twenty-three patients (23/30, 77%) reported clinically significant reduction in intensity of tinnitus at 3 months postprocedure. Nineteen patients (19/30, 63%) reported ongoing benefit at 6-month follow-up. Six patients failed to report any benefit (6/30, 20%).
Conclusion The cervical plexus could play a significant role in the development of somatosensory tinnitus after whiplash. iCPB may have a role in the management of somatosensory tinnitus in this cohort.

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Hearing Impairment and Severe Attention Deficit/Hyperactivity Disorder: A Nationwide Study

Tsur, Nir; Zloof, Yair; Rittblat, Mor; Reuven, Yonatan; Simchoni, Maya; Derazne, Estela; Yitzchaki, Ziv; Adler, Lior; Shlaifer, Amir; Manuva, Omer; Beer, Zivan

Publication date 17-01-2024


Background The association between hearing impairment and attention-deficit/hyperactivity disorder (ADHD) is unclear. Therefore, we aimed to assess this association in Israels national sample of over 1.1 million adolescents.
Methods We conducted a nationwide, population-based, cross-sectional study of all Israeli adolescents (n = 1,175,534, 58% males; mean age, 17 yrs) who were examined before mandatory military service during 2004 to 2020. Board-certified specialists confirmed diagnoses of hearing impairment and severe ADHD.
Main Outcomes and Measures We compared the prevalence of severe ADHD in adolescents with and without hearing impairment. Associations were analyzed using logistic regression models and sensitivity analyses accounting for hearing impairment type (sensorineural vs. conductive) and severity.
Results Of the 8,769 adolescents with hearing impairment, 57 were diagnosed with severe ADHD (prevalence = 0.65%). Of the 1,166,765 adolescents without hearing impairment, 3,936 were diagnosed with severe ADHD (prevalence = 0.29%). We found a significant association between hearing impairment and severe ADHD (odds ratio = 1.93 95% confidence interval, 1.47–2.49), which persisted in a multivariable model adjusted to age, sex, socioeconomic status, educational status, cognitive performance, and immigration status (odds ratio = 1.70 95% confidence interval, 1.29–2.20). The association also persisted when stratified by hearing impairment type (sensorineural vs. conductive) and severity.
Conclusions Adolescents with hearing impairment had 70% increased odds of severe ADHD. Study findings suggest that active screening of patients with hearing impairment for ADHD should be considered.

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Caffeine Ameliorates Age-Related Hearing Loss by Downregulating the Inflammatory Pathway in Mice

Zhang, Xiaolin; Cao, Ruijuan; Li, Changye; Zhao, Hongchun; Zhang, Ruyi; Che, Juan; Xie, Jinwen; Tang, Na; Wang, Yanfei; Liu, Xiuzhen; Zheng, Qingyin

Publication date 02-02-2024


Objective Age-related hearing loss (ARHL), also known as presbycusis, is a debilitating sensory impairment that affects the elderly population. There is currently no ideal treatment for ARHL. Long-term caffeine intake was reported to have anti-aging effects in many diseases. This study is to identify whether caffeine could ameliorate ARHL in mice and analyze its mechanism.
Methods Caffeine was administered in drinking water to C57BL/6J mice from the age of 3 months to 12 months. The body weight, food intake and water intake of the mice were monitored during the experiment. The metabolic indicators of serum were detected by ELISA. The function of the hearing system was evaluated by ABR and hematoxylin and eosin staining of the cochlea. Genes expression were detected by Q-PCR, immunofluorescencee and Western blot.
Results The results showed that the ARHL mice exhibited impaired hearing and cochlear tissue compared with the young mice. However, the caffeine-treated ARHL mice showed improved hearing and cochlear tissue morphology. The expression of inflammation-related genes, such as TLR4, Myd88, NF-κB, and IL-1β, was significantly increased in the cochleae of ARHL mice compared with young mice but was down-regulated in the caffeine-treated cochleae.
Conclusions Inflammation is involved in ARHL of mice, and long-term caffeine supplementation could ameliorate ARHL through the down-regulation of the TLR4/NF-κB inflammation pathway. Our findings provide a new idea for preventing ARHL and suggest new drug targets for ARHL treatment.

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Military and Nonmilitary TBI Associations with Hearing Loss and Self-Reported Hearing Difficulty among Active-Duty Service Members and Veterans

Hughes, Charlotte Kaplan; Thapa, Samrita; Theodoroff, Sarah M.; Carlson, Kathleen F.; Schultz, James D.; Grush, Leslie D.; Reavis, Kelly M.

Publication date 01-03-2024


Objective Identify associations between self-reported history of military and nonmilitary traumatic brain injury (TBI) on hearing loss and hearing difficulty from the Noise Outcomes in Servicemembers Epidemiology (NOISE) study.
Study Design Cross-sectional.
Setting Multi-institutional tertiary referral centers.
Patients Four hundred seventy-three Active-Duty Service members (ADSM) and 502 veterans.
Exposure Self-reported history of no TBI, military TBI only, nonmilitary TBI only, both military and nonmilitary TBI.
Main Outcome Measures Pure-tone hearing thresholds, Speech Recognition In Noise Test (SPRINT), Hearing Handicap Inventory for Adults (HHIA), and Speech, Spatial and Qualities of Hearing Scale (SSQ)-12.
Results 25% (120/473) of ADSM and 41% (204/502) of veterans self-reported a TBI. Military TBI was associated with poorer hearing thresholds in all frequency ranges in veterans (adjusted mean difference, 1.8 dB; 95% confidence interval CI, 0.5–3.0; 3.3, 0.8–5.8; 5.1; 1.7–8.5, respectively), and in the high frequency range in ADSM (mean difference, 3.2 dB; 95% CI, 0.1–6.3). Veterans with military TBI only and nonmilitary TBI only had lower odds of correctly identifying speech in noise than veterans with no TBI (odds ratio OR, 0.78; 95% CI, 0.72–0.83; 0.90; 0.84–0.98). ADSM with a military TBI (OR, 5.7; 95% CI, 2.6–12.5) and veterans with any TBI history (OR, 2.5; 95% CI, 1.5–4.3; OR, 2.2; 95% CI, 1.3–3.8; OR, 4.5; 95% CI, 2.1–9.8) were more likely to report hearing difficulty on HHIA. SSQ-12 results corroborated HHIA findings.
Conclusions Military TBI was associated with poorer hearing thresholds in veterans and ADSM, and poorer SPRINT scores in veterans. Military TBI was associated with poorer self-perceived hearing ability in ADSM. All types of TBI were associated with poorer self-perceived hearing ability in veterans, although the strength of this association was greatest for military TBI.

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The Effect of Electrode Position on Behavioral and Electrophysiologic Measurements in Perimodiolar Cochlear Implants

Collins, Aaron; Foghsgaard, Søren; Druce, Edgar; Margani, Valerio; Mejia, Olivia; O’Leary, Stephen

Publication date 01-03-2024


Background The shape and position of cochlear implant electrodes could potentially influence speech perception, as this determines the proximity of implant electrodes to the spiral ganglion. However, the literature to date reveals no consistent association between speech perception and either the proximity of electrode to the medial cochlear wall or the depth of insertion. These relationships were explored in a group of implant recipients receiving the same precurved electrode.
Methods This was a retrospective study of adults who underwent cochlear implantation with Cochlear Ltd.’s Slim Perimodiolar electrode at the Royal Victorian Eye and Ear Hospital between 2015 and 2018 (n = 52). Postoperative images were obtained using cone beam computed tomography (CBCT) and analyzed by multi-planar reconstruction to identify the position of the electrode contacts within the cochlea, including estimates of the proximity of the electrodes to the medial cochlear wall or modiolus and the angular depth of insertion. Consonant-vowel-consonant (CVC) monosyllabic phonemes were determined preoperatively, and at 3 and 12 months postoperatively. Electrically evoked compound action potential (ECAP) thresholds and impedance were measured from the implant array immediately after implantation. The relationships between electrode position and speech perception, electrode impedance, and ECAP threshold were an analyzed by Pearson correlation.
Results Age had a negative impact on speech perception at 3 months but not 12 months. None of the electrode-wide measures of proximity between electrode contacts and the modiolus, nor measures of proximity to the medial cochlear wall, nor the angular depth of insertion of the most apical electrode correlated with speech perception. However, there was a moderate correlation between speech perception and the position of the most basal electrode contacts; poorer speech perception was associated with a greater distance to the modiolus. ECAP thresholds were inversely related to the distance between electrode contacts and the modiolus, but there was no clear association between this distance and impedance.
Conclusions Speech perception was significantly affected by the proximity of the most basal electrodes to the modiolus, suggesting that positioning of these electrodes may be important for optimizing speech perception. ECAP thresholds might provide an indication of this proximity, allowing for its optimization during surgery.

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Intracochlear Trauma and Local Ossification Patterns Differ Between Straight and Precurved Cochlear Implant Electrodes

Geerardyn, Alexander; Zhu, MengYu; Verhaert, Nicolas; Quesnel, Alicia M.

Publication date 17-01-2024


Hypothesis Trauma to the osseous spiral lamina (OSL) or spiral ligament (SL) during cochlear implant (CI) insertion segregates with electrode type and induces localized intracochlear ossification and fibrosis.
Background The goal of atraumatic CI insertion is to preserve intracochlear structures, limit reactive intracochlear tissue formation, and preserve residual hearing. Previous qualitative studies hypothesized a localized effect of trauma on intracochlear tissue formation; however, quantitative studies failed to confirm this.
Methods Insertional trauma beyond the immediate insertion site was histologically assessed in 21 human temporal bones with a CI. Three-dimensional reconstructions were generated and virtually resectioned perpendicular to the cochlear spiral at high resolution. The cochlear volume occupied by ossification or fibrosis was determined at the midpoint of the trauma and compared with regions proximal and distal to this point.
Results Seven cases, all implanted with precurved electrodes, showed an OSL fracture beyond the immediate insertion site. Significantly more intracochlear ossification was observed at the midpoint of the OSL fracture, compared with the −26 to −18 degrees proximal and 28 to 56 degrees distal to the center. No such pattern was observed for fibrosis. In the 12 cases with a perforation of the SL (9 straight and 3 precurved electrodes), no localized pattern of ossification or fibrosis was observed around these perforations.
Conclusion OSL fractures were observed exclusively with precurved electrodes in this study and may serve as a nidus for localized intracochlear ossification. Perforation of the SL, in contrast, predominantly occurred with straight electrodes and was not associated with localized ossification.

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Correlation of Scalar Cochlear Volume and Hearing Preservation in Cochlear Implant Recipients with Residual Hearing

Räth, Mareike; Schurzig, Daniel; Timm, Max E.; Lenarz, Thomas; Warnecke, Athanasia

Publication date 24-01-2024


Objective Preservation of residual hearing is one of the main goals in cochlear implantation. There are many factors that can influence hearing preservation after cochlear implantation. The purpose of the present study was to develop an algorithm for validated preoperative cochlear volume analysis and to elucidate the role of cochlear volume in preservation of residual hearing preservation after atraumatic cochlear implantation.
Study design Retrospective analysis.
Setting Tertiary referral center.
Patients A total of 166 cochlear implant recipients were analyzed. All patients were implanted with either a MED-EL (Innsbruck, Austria) FLEXSOFT (n = 3), FLEX28 (n = 72), FLEX26 (n = 1), FLEX24 (n = 41), FLEX20 (n = 38), or FLEX16 (n = 11, custom made device) electrode array through a round window approach.
Main outcome measures: Cochlear volume as assessed after manual segmentation of cochlear cross-sections in cone beam computed tomography, and preservation of residual hearing 6 months after implantation were analyzed. The association between residual hearing preservation and cochlear volume was then assessed statistically.
Results Rapid and valid cochlear volume analysis was possible using the individual cross-sections and a newly developed and validated algorithm. Cochlear volume had the tendency to be larger in patients with hearing preservation than in those with hearing loss. Significant correlations with hearing preservation could be observed for the basal width and length of the basal turn.
Conclusions Preservation of residual hearing after cochlear implantation may depend on cochlear volume but appears to be influenced more strongly by other cochlear dimensions.

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Estimation of Cochlear Implant Insertion Depth Using 2D-3D Registration of Postoperative X-Ray and Preoperative CT Images

Liu, George S.; Cooperman, Shayna P.; Neves, Caio A.; Blevins, Nikolas H.

Publication date 24-01-2024


Objective To improve estimation of cochlear implant (CI) insertion depth in postoperative skull x-rays using synthesized information from preoperative CT scans.
Study Design Retrospective cohort.
Setting Tertiary referral center.
Patients Ten adult cochlear implant recipients with preoperative and postoperative temporal bone computed tomography (CT)scans and postoperative skull x-ray imaging.
Interventions Postoperative x-rays and digitally reconstructed radiographs (DRR) from preoperative CTs were registered using 3D Slicer and MATLAB to enhance localization of the round window and modiolus. Angular insertion depth (AID) was estimated in unmodified and registration-enhanced x-rays and DRRs in the cochlear view. Linear insertion depth (LID) was estimated in registered images by two methods that localized the proximal CI electrode or segmented the cochlea. Ground truth assessments were made in postoperative CTs.
Main Outcome Measure(s) Errors of insertion depth estimates were calculated relative to ground truth measurements and compared with paired t tests. Pearson correlation coefficient was used to assess inter-rater reliability of two reviewer’s measurements of AID in unmodified x-rays.
Results In postoperative x-rays, AID estimation errors were similar with and without registration enhancement (−1.3 ± 20.7° and −4.8 ± 24.9°, respectively; mean ± SD; p = 0.6). AID estimation in unmodified x-rays demonstrated strong interrater agreement (ρ = 0.79, p < 0.05) and interrater differences (−15.0 ± 35.3°) comparable to estimate errors. Registering images allowed measurement of AID in the cochlear view with estimation errors of 14.6 ± 30.6° and measurement of LID, with estimate errors that were similar between proximal electrode localization and cochlear segmentation methods (−0.9 ± 2.2 mm and −2.1 ± 2.7 mm, respectively; p = 0.3).
Conclusions 2D-3D image registration allows measurement of AID in the cochlear view and LID using postoperative x-rays and preoperative CT imaging. The use of this technique may reduce the need for postimplantation CT studies to assess these metrics of CI electrode position. Further work is needed to improve the accuracy of AID assessment in the postoperative x-ray view with registered images compared with established methods.

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Radioclinical Assessment of Posterior Tympanotomy Difficulties during Ordinary Cochlear Implantation: A Prospective Case-Series Study

Barbara, Maurizio; Margani, Valerio; Covelli, Edoardo; Romano, Andrea; Bozzao, Alessandro; Lotfy, Rasha; Mandour, Mahmoud; Swaid, Ali; Soltan, Islam; Elzayat, Saad; Elfarargy, Haitham H.

Publication date 07-02-2024


Objectives This study proposes a preoperative radiologic scoring system for predicting posterior tympanotomy (PT) and mastoidectomy-associated difficulties during cochlear implantation (CI).
Study design It was a prospective case-series study.
Settings The included CI surgeries were performed at tertiary referral institutions from October 2022 to April 2023.
Subjects We included 73 CI candidates performed via the PT approach Intervention The proposed radiologic score, composed of 13 items, was fulfilled and evaluated before each CI surgery.
Main outcome measure We correlated this score with the intraoperative difficulty and surgical duration.
Results The operation was straightforward in 42 patients with a score of 3.87 ± 1.72 and challenging in 31 patients with a score of 10.66 ± 1.73. The radiologic score was strongly correlated with the surgical difficulty and duration (p < 0.0001).
Conclusions Our proposed radiologic score was a valid, reliable, and precise tool to predict intraoperative difficulty during cochlear implantation. Chorda-facial angle was the strongest predictor, significantly affecting the difficulty, surgical duration, and preoperative radiologic score. A score equal to or more than 7.5 was expected to be associated with surgical difficulty.

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Use of Soft Cervical Collar Improves Surgeon Ergonomics During Simulated Otologic Surgery

Gidumal, Sunder; Saade, Mia; Schwam, Zachary G.; Govindan, Aparna; Mavrommatis, Maria; Wong, Kevin; Perez, Enrique R.; Wanna, George B.; Cosetti, Maura K.

Publication date 17-01-2024


Objective To determine whether surgeon use of a soft cervical collar during endoscopic and microscopic otologic surgery is feasible and impacts surgeon ergonomics as measured by inertial sensors.
Study Design Prospective crossover trial.
Setting US-based otolaryngology training program.
Patients Otolaryngology residents and fellows.
Interventions Therapeutic—use of a soft cervical collar during simulated otologic surgery.
Main Outcome Measures Time spent in high-risk angles of neck and back flexion and extension; average angle of neck flexion, extension, rotation, and lateral bending; validated assessment of neck pain; average daily phone use.
Results Fifteen subjects met criteria for inclusion. Ten of 15 (67%) were male. Seven of 15 (47%) were postgraduate year 1–2. Seven of 15 (47%) reported a history of neck pain. None reported prior spinal steroid injections or surgery. Across all subjects, use of the soft cervical collar significantly reduced time spent in high-risk angles of neck flexion/extension during both endoscopic (56% vs. 35%, p < 0.05) and microscopic (60% vs. 32%, p < 0.05) otologic surgery. There was no effect on back flexion or extension. There was no difference in time spent in high-risk neck or back angles between endoscopic and microscopic surgery. Average angles of neck or back flexion, extension, lateral bending, and rotation were not significantly different for subgroups with more operative experience, increased phone use, perception of good posture, or history of neck pain.
Conclusions Use of a soft cervical collar during simulated otologic surgery significantly reduced time spent in high-risk neck positions. These data support feasibility of soft collar use during otologic surgery and hold promise for reduction in the high rates of neck pain reported by neurotologists.
Professional Practice Gap and Educational Need Improving surgeon ergonomics for otologic surgery.
Learning Objective To identify a therapeutic intervention to mitigate neck pain in surgeons caused by assumption of high-risk cervical neck flexion and extension.
Desired Result To demonstrate that use of a readily available soft cervical collar reduces risk of neck pain in otologic surgeons.
Level of Evidence II.
Indicate IRB or IACUC Exempt.

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Surgical Treatment for Troublesome Mastoid Cavities: Canal Wall Reconstruction With Bony Obliteration Versus Subtotal Petrosectomy

Kemps, Glen; Geven, Leontien; Kunst, Henricus; Mylanus, Emmanuel; Mulder, Jef; Lanting, Cris; Pennings, Ronald

Publication date 24-01-2024


Introduction A chronically discharging modified radical mastoid cavity may require surgical intervention. We aim to explore two techniques.
Objective To compare outcomes of subtotal petrosectomy (STP) and canal wall reconstruction with bony obliteration technique (CWR-BOT).
Study Design Retrospective cohort study.
Setting A tertiary referral center.
Patients All patients with a chronically discharging mastoid cavity surgically treated at the Radboud University Medical Center by STP or CWR-BOT in 2015 to 2020, excluding patients with preoperative cholesteatoma.
Main Outcome Measures Dry ear rate, audiometry, and rehabilitation.
Secondary Outcome measures Healing time, number of postoperative visits, complications, cholesteatoma, and need for revision surgeries.
Results Thirty-four (58%) patients underwent STP, and 25 (42%) CWR-BOT. A dry ear was established in 100% of patients (STP) and 87% (CWR-BOT). The air–bone gap (ABG) increased by 12 dB in STP, and decreased by 11 dB in CWR-BOT. Postoperative ABG of CWR-BOT patients was better when preoperative computed tomography imaging showed aerated middle ear aeration. ABG improvement was higher when ossicular chain reconstruction took place. Mean follow-up time was 32.5 months (STP) versus 40.5 months (CWR-BOT). Healing time was 1.2 months (STP) versus 4.1 months (CWR-BOT). The number of postoperative visits was 2.5 (STP) versus 5 (CWR-BOT). Cholesteatoma was found in 15% (STP) versus 4% (CWR-BOT) of patients. Complication rate was 18% (STP) and 24% (CWR-BOT) with a need for revision in 21% (STP) and 8% (CWR-BOT), including revisions for cholesteatoma.
Conclusion STP and CWR-BOT are excellent treatment options for obtaining a dry ear in patients with a chronically discharging mastoid cavity. This article outlines essential contributing factors in counseling patients when opting for one or the other. Magnetic resonance imaging with diffusion-weighted imaging follow-up should be conducted at 3 and 5 years postoperatively.

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A Novel Technique of Reduction Meatoplasty for Correction of Very Large Meatus from a Previous Canal Wall-Down Mastoidectomy

Tawk, Karen; Umemoto, Kayla K.; Al-Seraji, Abdula; Mazhari, Najva; Abouzari, Mehdi; Djalilian, Hamid R.

Publication date 17-01-2024


Objective To evaluate the efficacy of reduction meatoplasty, a novel technique aiming to improve the usage of molded hearing aids and ear plugs in patients undergoing mastoid obliteration of a previous canal wall-down (CWD) mastoidectomy, complicated with a very large meatus.
Patients Twenty-six patients from a tertiary care neurotology clinic with a very large meatus from a previous CWD mastoidectomy, who were unable to use molded hearing aids or ear plugs for water protection.
Intervention Reduction meatoplasty after mastoid obliteration (cartilage strips and bone pate) of the CWD mastoidectomy. The procedure involves removing a wedge of skin and underlying soft tissue superiorly in the meatus.
Main Outcome Measures Reduction in meatus size, enabling usage of hearing aids and ear plugs.
Results Twenty-six patients underwent mastoid obliteration and reduction meatoplasty to reduce meatus size. Patients were followed up for an average of 22 months postoperation. After operation, the meatus size was significantly reduced in all patients, enabling usage of over-the-counter ear plugs. In addition, all six patients with hearing aids could use standard occlusive hearing aid domes without requiring molded hearing aids. No patients showed symptoms of chronic infection in the mastoid cavity during the follow-up period.
Conclusions Results of reduction meatoplasty showed significant improvements in functionality of the external auditory meatus, indicating that this technique is effective in reducing meatus size and improving the normal meatal anatomy after mastoid obliteration.

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Microstructural Changes in the Brainstem Auditory Pathway in Children With Hearing Loss

Moon, Peter K.; Ward, Kristina M.; Din, Taseer F.; Saki, Sara; Cheng, Alan G.; Yeom, Kristen W.; Ahmad, Iram N.

Publication date 07-02-2024


Objective To assess the utility of diffusion tensor imaging of the auditory pathway in children with sensorineural hearing loss (SNHL).
Study Design Retrospective cohort study.
Setting A single academic tertiary childrens hospital.
Patients Sixteen pediatric patients with bilateral SNHL of at least moderate severity in the poorer ear (eight male; mean age, 5.3 ± 4.9 yrs). Controls consisted of age- and sex-matched children with normal hearing who were imaged for nonotologic, non-neurologic medical concerns and found to have normal magnetic resonance imaging (MRI).
Interventions Three Tesla MRI scanners were used for diffusion tensor imaging.
Main Outcome Measures Quantitative diffusion tensor metrics were extracted from the superior olivary nucleus (SON), inferior colliculus (IC), and ipsilateral fiber tracts between the SON and IC delineated by tractography.
Results We identified differences in fractional anisotropy of the SON between the SNHL cohort and controls (0.377 ± 0.056 vs. 0.422 ± 0.052; p = 0.009), but not in the IC. There were no differences in the mean diffusivity (MD) values in the IC and SON. Among younger children (≤5 yrs), MD was decreased in the SNHL cohort compared with controls in the IC (0.918 ± 0.051 vs. 1.120 ± 0.142; p 5 yrs), there were no differences in MD (1.124 ± 0.198 vs. 0.997 ± 0.103; p = 0.119). There were no differences in MD or fractional anisotropy in the white matter fibers of the IC–SON tract.
Conclusions Our results suggest abnormal neural tracts along the central auditory pathway among children with SNHL. Longitudinal studies should assess the prognostic value of these MRI-based findings for assessing long-term outcomes and determining intervention efficacy.

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Long-Term Results of the Linear Incision Technique With Tissue Reduction Versus Tissue Preservation for Inserting Bone-Anchored Hearing Implants: The Ongoing Optimization in Bone Implant Surgery

Lindeboom, Jantine J.; Labbé, Nilou; Strijbos, Ruben M.; van den Elsen-Hutten, Marjo; van Huffelen, Wim; Teunissen, Emma M.; Hol, Myrthe K.S.; Bom, Steven J.H.

Publication date 07-02-2024


Objective To compare the long-term outcomes of the linear incision technique with tissue reduction (LIT-TR) and the linear incision technique with tissue preservation (LIT-TP) for inserting bone-anchored hearing implants (BAHIs).
Study design Single-center retrospective cohort study.
Setting Large general teaching hospital.
Patients A total of 231 adult patients were included between August 2005 and October 2020, with a minimum follow-up time of 6 months.
Intervention The test group received a BAHI using the LIT-TP (N = 147). The control group underwent surgery using the LIT-TR (N = 84).
Main outcome measures Soft tissue reactions, skin thickening, postoperative complications (e.g., wound dehiscence), and implant loss were compared between the test and control group. Furthermore, Cochlear Bone Anchored Solutions AB (Mölnlycke, Sweden) and Oticon Medical AB (Askim, Sweden) implants/abutments within the LIT-TP cohort were compared. Validated questionnaires were used to quantify patients health-related quality of life (HRQoL).
Results Significantly more cases with wound dehiscence and adverse soft tissue reactions (Holgers ≥2) were observed in the LIT-TR cohort (p 1), and overall HRQoL between the two patient groups. Significant improvement in the patients HRQoL after implementation of a BAHI was found in both techniques. The Ponto Wide implant/abutment showed less frequent skin thickening (requiring treatment) and fewer soft tissue reactions compared with the BIA400 implant/abutment.
Conclusion This large-scale study demonstrates that the LIT-TP shows excellent long-term outcomes, including a low incidence of implant failure.

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The TORP-PORP: A Tympanoplasty Technique for Isolated Defects of the Stapes Suprastructure

Esser, Julia; Klussmann, Jens Peter; Hüttenbrink, Karl Bernd; Luers, Jan Christoffer

Publication date 07-02-2024


Objective Investigating the outcomes of a surgical approach to treat isolated defects of the stapes suprastructure, using a modified total ossicular replacement prosthesis (TORP) prosthesis as a PORP between the footplate and the incus, effectively creating a TORP-PORP configuration.
Patients Eleven patients (mean age, 37.2 years; 36% male and 64% female) between the years 2007 and 2022.
Intervention(s) Therapeutic (ossiculoplasty).
Main Outcome Measure(s) Hearing gain (in dB) in air conduction thresholds at 0.5, 1, 2, 3, and 4 k Hz, stability of bone conduction, revision rate.
Results Significant improvement in air conduction between the preoperative and the postoperative cohorts (p = 0.002) with a mean postoperative hearing level of 30.00 ± 5.25 dB. The bone conduction remained stable. We encountered no perioperative complications, and there were no revisions surgery.
Conclusions The described ossiculoplasty procedure is a safe and effective approach to treat isolated defects of the stapes suprastructure.

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Audiovestibular Findings in Patients with Concurrent Superior Canal Dehiscence and Vestibular Schwannoma

Tozzi, Andrea; Castellucci, Andrea; Ferrulli, Giuseppe; Brandolini, Cristina; Piras, Gianluca; Martellucci, Salvatore; Malara, Pasquale; Ferri, Gian Gaetano; Ghidini, Angelo; Marchioni, Daniele; Presutti, Livio

Publication date 30-01-2024


Objective To describe the clinical-instrumental findings in case of concurrent superior canal dehiscence (SCD) and ipsilateral vestibular schwannoma (VS), aiming to highlight the importance of an extensive instrumental assessment to achieve a correct diagnosis.
Study Design Retrospective case review.
Setting Tertiary referral center.
Patients Five patients with concurrent SCD and VS.
Intervention Clinical-instrumental assessment and imaging.
Main Outcome Measure Clinical presentation, audiovestibular findings, and imaging.
Results The chief complaints were hearing loss (HL) and unsteadiness (80%). Other main symptoms included tinnitus (60%) and pressure-induced vertigo (40%). Mixed-HL was identified in three patients and pure sensorineural-HL in 1, including a roll-over curve in speech-audiometry in two cases. Vibration-induced nystagmus was elicited in all cases, whereas vestibular-evoked myogenic potentials showed reduced thresholds and enhanced amplitudes on the affected side in three patients. Ipsilesional weakness on caloric testing was detected in three patients and a bilateral hyporeflexia in one. A global canal impairment was detected by the video-head impulse test in one case, whereas the rest of the cohort exhibited a reduced function for the affected superior canal, together with ipsilateral posterior canal impairment in two cases. All patients performed both temporal bones HRCT scan and brain-MRI showing unilateral SCD and ipsilateral VS, respectively. All patients were submitted to a wait-and-scan approach, requiring VS removal only in one case.
Conclusion Simultaneous SCD and VS might result in subtle clinical presentation with puzzling lesion patterns. When unclear symptoms and signs occur, a complete audiovestibular assessment plays a key role to address imaging and diagnosis.

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The Role of Motion Sensitivity and Headaches on Vestibular Rehabilitation Outcomes in Pediatric Vestibular Migraines

Vesole, Adam S.; Bachmann, Katheryn R.; Mueller, Gretchen A.; Lavender, Violette H.; Castiglione, Micheal; Greinwald, John H. Jr

Publication date 07-02-2024


Objective To determine the utility of the motion sensitivity quotient (MSQ) in diagnosing pediatric vestibular migraine (VM) and to characterize the role of motion sensitivity and headache control on vestibular rehabilitation (VR) outcomes in pediatric VM.
Study Design Retrospective cohort analysis.
Setting Pediatric tertiary referral center.
Patients Children (≤18 years old) with dizziness who completed vestibular testing from January 2016 to August 2022, diagnosed with either VM or another vestibular disorder.
Interventions VR, which included MSQ testing.
Main Outcome Measures Initial MSQ, number and duration of vestibular physical therapy (PT) sessions, PT goals met, and posttreatment MSQ.
Results Two hundred fifty-seven patients met study criteria. MSQ was not a reliable diagnostic marker in pediatric VM as there was no difference in initial MSQ between VM and non-VM patients (9.4 vs. 7.8 in non-VM, p = 0.014). Both VM (n = 116) and non-VM (n = 141) patients demonstrated significant improvement in MSQ after VR (p = 0.004). However, VM patients tended to be less likely to meet at least one PT goal (60 vs. 77% in non-VM, p = 0.016, d = 0.37), although not significant. VM patients with more frequent headaches had significantly higher initial MSQ (p = 0.008). VM patients with more frequent headaches or higher initial MSQ tended to require increased number and longer duration of VR (small/medium effect size although not statistically significant after Bonferroni correction).
Conclusion VR is an effective treatment for both VM and non-VM pediatric patients. VM patients, especially those with severe motion sensitivity or poorly controlled headaches, may be less responsive to VR and may require increased frequency and duration of VR. Our findings propose the importance of counseling pediatric patients with severe motion sensitivity or uncontrolled migraines regarding realistic expectations of their VR course.

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Inner Ear Breaches from Vestibular Schwannoma Surgery: Revisiting the Incidence of Otologic Injury from Retrosigmoid and Middle Cranial Fossa Approaches

Ben-Shlomo, Nir; Rahimi, Amina; Abunimer, Abdullah M.; Guenette, Jeffrey P.; Juliano, Amy F.; Starr, Jacqueline R.; Jayender, Jagadeesan; Corrales, C. Eduardo

Publication date 17-01-2024


Objective To assess the rate of iatrogenic injury to the inner ear in vestibular schwannoma resections.
Study Design Retrospective case review Setting Multiple academic tertiary care hospitals.
Patients Patients who underwent retrosigmoid or middle cranial fossa approaches for vestibular schwannoma resection between 1993 and 2015.
Intervention Diagnostic with therapeutic implications.
Main Outcome Measure Drilling breach of the inner ear as confirmed by operative note or postoperative computed tomography (CT).
Results 21.5% of patients undergoing either retrosigmoid or middle fossa approaches to the internal auditory canal were identified with a breach of the vestibulocochlear system. Because of the lack of postoperative CT imaging in this cohort, this is likely an underestimation of the true incidence of inner ear breaches. Of all postoperative CT scans reviewed, 51.8% had an inner ear breach. As there may be bias in patients undergoing postoperative CT, a middle figure based on sensitivity analyses estimates the incidence of inner ear breaches from lateral skull base surgery to be 34.7%.
CONCLUSIONS A high percentage of vestibular schwannoma surgeries via retrosigmoid and middle cranial fossa approaches result in drilling breaches of the inner ear. This study reinforces the value of preoperative image analysis for determining risk of inner ear breaches during vestibular schwannoma surgery and the importance of acquiring CT studies postoperatively to evaluate the integrity of the inner ear.

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Does Location of Intralabyrinthine Vestibular Schwannoma Determine Objective and Subjective Vestibular Function?

West, Niels Cramer; Groth, Jane Bjerg; Cayé-Thomasen, Per

Publication date 30-01-2024


Background and objective The incidence of intralabyrinthine schwannomas is increasing, and a growing attention is given to the detrimental effects on hearing function. On the contrary, the vestibular profile of intralabyrinthine vestibular schwannomas (VSs) is still not well understood. We aimed to investigate and report the observed relationships between the intralabyrinthine location of the schwannomas and objective and subjective vestibular profile of the patients.
Methods Retrospective cohort study of 20 consecutive individuals with sporadic intralabyrinthine schwannomas and grouped according to the intralabyrinthine location of the schwannomas. Vestibular testing consisted of the video head impulse test of all three semicircular canals, the caloric test, cervical and ocular vestibular evoked myogenic potentials, and the dizziness handicap inventory. A nonparametric unpaired t test was performed to compare groups, and Fishers exact test was used for categorical data.
Results The median video head impulse test gains (lateral, anterior, posterior) were 0.40, 0.50, and 0.75 for intravestibular schwannomas and 0.93, 1.52, and 0.91 for intracochlear schwannomas (p = 0.0001, p = 0.009, p = 0.33), respectively. Caloric unilateral weakness had a median of 100% for intravestibular schwannomas and 14% for intracochlear schwannomas (p = 0.0001). The mean dizziness handicap inventory was 21 for intravestibular schwannomas and 1 for cochlear schwannomas (p = 0.02). There were no significant differences in vestibular evoked myogenic potentials according to intralabyrinthine location.
Conclusion By both objective and subjective measures, intralabyrinthine schwannomas with an intravestibular component has significantly worse vestibular function than schwannomas with purely cochlear involvement.

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Establishment of Nomogram for Prediction of Hearing Preservation after Retrosigmoid Approach in Patients with Vestibular Schwannoma

Lu, Qi; Guo, Xiaoyan; Kou, Ting; Chen, Jiyue; Shen, Weidong

Publication date 30-01-2024


Objective To derive and validate a prognostic nomogram for the prediction of hearing preservation (HP) after retrosigmoid approach (RSA) in patients with vestibular schwannoma (VS) and further assist in clinical decision-making.
Study Design Retrospective study.
Setting Tertiary referral center.
Patients A total of 111 patients diagnosed with VS with serviceable hearing from January 2013 to March 2023.
Interventions All patients underwent surgery via RSA, and hearing outcomes were reviewed 2 weeks postoperatively.
Main Outcome Measures Preoperative and postoperative hearing were analyzed and stratified according to the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS).
Results In multivariate analysis of the primary group, preoperative hearing, tumor size, and tumor origin were significantly related to postoperative HP (p = 0.029, p = 0.043, and p = 0.018, respectively). Factors derived from the multivariate analysis were all assembled into the nomogram. The receiver operating characteristic (ROC) curves showed good predictive accuracy of the nomogram model in both primary and validation groups with area under the ROC curve (AUC) values of 0.802 and 0.797, respectively.
Conclusion Independent predictors of postoperative HP in patients with VS were selected to create the nomogram. The nomogram was able to stratify patients into different risk groups and assist in clinical decision making.

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An External Validation Study for Automated Segmentation of Vestibular Schwannoma

Suresh, Krish; Luo, Guibo; Bartholomew, Ryan A.; Brown, Alyssa; Juliano, Amy F.; Lee, Daniel J.; Welling, D. Bradley; Cai, Wenli; Crowson, Matthew G.

Publication date 07-02-2024


Objective To validate how an automated model for vestibular schwannoma (VS) segmentation developed on an external homogeneous dataset performs when applied to internal heterogeneous data.
Patients The external dataset comprised 242 patients with previously untreated, sporadic unilateral VS undergoing Gamma Knife radiosurgery, with homogeneous magnetic resonance imaging (MRI) scans. The internal dataset comprised 10 patients from our institution, with heterogeneous MRI scans.
Interventions An automated VS segmentation model was developed on the external dataset. The model was tested on the internal dataset.
Main Outcome Measure Dice score, which measures agreement between ground truth and predicted segmentations.
Results When applied to the internal patient scans, the automated model achieved a mean Dice score of 61% across all 10 images. There were three tumors that were not detected. These tumors were 0.01 ml on average (SD = 0.00 ml). The mean Dice score for the seven tumors that were detected was 87% (SD = 14%). There was one outlier with Dice of 55%—on further review of this scan, it was discovered that hyperintense petrous bone had been included in the tumor segmentation.
Conclusions We show that an automated segmentation model developed using a restrictive set of siloed institutional data can be successfully adapted for data from different imaging systems and patient populations. This is an important step toward the validation of automated VS segmentation. However, there are significant shortcomings that likely reflect limitations of the data used to train the model. Further validation is needed to make automated segmentation for VS generalizable.

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Expression of Brain-Derived Neurotrophic Factor in Human Spiral Ganglia Neurons after Cochlear Implantation

Wong, Emily C.; Lopez, Ivan A.; Ishiyama, Akira; Ishiyama, Gail

Publication date 17-01-2024


Background Brain-derived neurotrophic factor (BDNF) is an important factor in the development and neuroprotection of afferent auditory pathways. In this study, we investigated the expression of BDNF in the afferent auditory pathway after cochlear implantation (CI), hypothesizing that electrical stimulation after CI stimulates BDNF expression in the afferent auditory pathway.
Methods Archival human temporal bones from eight patients with a history of CI and five patients with normal hearing (ages 65–93 years old) were studied. Temporal bone specimens were immunoreacted with rabbit polyclonal antibodies against BDNF and mouse monoclonal antibodies against pan-neurofilaments. In cases of unilateral CI, the BDNF expression was compared with the contralateral unimplanted ear and normal temporal bones without hearing loss.
Results BDNF immunoreactivity (IR) localized to the spiral ganglion neurons (SGNs) somata and the surrounding satellite cells. BDNF-IR in the spiral ganglia was similar in the apical, middle, and basal hook regions. Neurofilament IR localized to SGN nerve fibers in both implanted and unimplanted cochleae. BDNF-IR in the SGN and satellite cells was significantly increased in the implanted specimens compared with the unimplanted specimens (p < 0.05) and the normal hearing specimens (p < 0.05). BDNF-IR expression was similar in the unimplanted cochlea and in the normal cochlea. BDNF protein expression was increased despite complete loss of the organ of Corti hair cells and supporting cells. Even in the cases of CI with a 6-mm first-generation electrode, BDNF expression was upregulated throughout the cochlea.
Conclusions BDNF expression in the SGN appears to be upregulated by the electrical stimulation from CI. This study provides evidence that the electrical stimulation from CI may stimulate the expression of BDNF, playing a neuroprotective role in the rehabilitation of hearing in the deafened ear.

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COMMENT UPON: MOSHTAGHI ET AL. PAPER THAT APPEARED IN THE JULY 2023 ISSUE OF OTOLOGY & NEUROTOLOGY TITLED “THE EFFECT OF IMMEDIATE MICROSURGICAL RESECTION OF VESTIBULAR SCHWANNOMA ON HEARING PRESERVATION”

Jackler, Robert K.

Publication date 30-01-2024


No abstract available

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RESPONSE TO LETTER: “THE EFFECT OF IMMEDIATE MICROSURGICAL RESECTION OF VESTIBULAR SCHWANNOMA ON HEARING PRESERVATION”

Friedman, Rick A.

Publication date 30-01-2024


No abstract available

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Intraosseous Meningioma Mimicking Fibrous Dysplasia: Imaging Case of the Month

Brennan, Ana; Gutierrez, Claudia N.; Mukherjee, Sugoto; Kesser, Bradley

Publication date 01-03-2024


No abstract available

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Cochlear Otosclerosis and Secondary Hydrops (Ménière’s Syndrome)

Rajan, Dilshan; Cureoglu, Sebahattin; da Costa Monsanto, Rafael

Publication date 07-02-2024


This article discusses a case of cochlear otosclerosis leading to secondary hydrops and near-complete hearing loss. Histopathological examination revealed advanced multifocal otosclerosis in both temporal bones, with specific focus on cochlear invasion and significant bone resorption. The severity of the case ruled out surgical intervention due to the risk of further hearing loss. The article emphasizes the challenges in managing otosclerosis-related hydrops and highlights the potential use of advanced imaging techniques for diagnosis. The study underscores the complexity of otosclerosis-induced hearing loss, contributing to the understanding of this pathology and its impact on auditory function.

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Recurrent Skull Base Meningioma Extending into the Middle Ear

Kons, Zachary A.; West, Emma G.; Coelho, Daniel H.

Publication date 07-02-2024


No abstract available

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AMERICAN OTOLOGICAL SOCIETY 157th Annual Meeting PRELIMINARY PROGRAM May 17–18, 2024 Chicago, IL

Publication date 01-03-2024


No abstract available

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AMERICAN NEUROTOLOGY SOCIETY 59th Annual Spring Meeting PRELIMINARY PROGRAM May 18–19, 2024, Chicago, IL: (ANS Posters will be displayed on Friday & Saturday, May 17–18, 2024)

Publication date 01-03-2024


No abstract available

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Interdisciplinarity: ADANO Conference in Halle (Saale), Germany

Rahne, Torsten; Plontke, Stefan K.

Publication date 01-03-2024


No abstract available

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Comparison of Two Measurement Paradigms to Determine Electrically Evoked Cochlear Nerve Responses and Their Correlation to Cochlear Nerve Cross-section in Infants and Young Children With Cochlear Implant

Schrank, Leonhard; Nachtigäller, Pascal; Müller, Joachim; Hempel, John-Martin; Canis, Martin; Spiegel, Jennifer L.; Rader, Tobias

Publication date 01-03-2024


Introduction Electrically evoked compound action potentials (ECAPs) are used for intra-/postoperative monitoring with intracochlear stimulation of cochlear implants. ECAPs are recorded in MED-EL (Innsbruck, Austria) implants using auditory response telemetry (ART), which has been further developed with automatic threshold determination as AutoART. The success of an ECAP measurement also depends on the number of available spiral ganglion cells and the bipolar neurons of the cochlear nerve (CN). It is assumed that a higher population of spiral ganglion cell implies a larger CN cross-sectional area (CSA), which consequently affects ECAP measurements.
Methods Intraoperative ECAP measurements from 19 implanted ears of children aged 8 to 18 months were retrospectively evaluated. A comparison and correlation of ART/AutoART ECAP thresholds/slopes at electrodes E2 (apical), E6 (medial), E10 (basal), and averaged E1 to E12 with CN CSA on magnetic resonance imaging was performed.
Results A Pearson correlation of the ART/AutoART ECAP thresholds/slopes for E2/E6/E10 and the averaged electrodes E1 to E12 showed a significant correlation. The CN CSA did not correlate significantly with the averaged ART/AutoART ECAP thresholds/slopes across all 12 electrodes.
Summary AutoART provides reliable measurements and is therefore a suitable alternative to ART. No significant influence of CN CSA on ECAP thresholds/slopes was observed. A predictive evaluation of the success of ECAP measurements based on CN CSA for a clinical setting cannot be made according to the present data.

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Perception of Specific Musical Attributes in Dependence of the Insertion Depth of Cochlear Implant Electrodes Using the Montreal Battery of Evaluation of Amusia

Heitkötter, Felix S.; Krämer, Bianca A.; Spiekermann, Christoph O.; Beule, Achim G.; Rudack, Claudia

Publication date 23-12-2023


Hypothesis The insertion angle of the electrode array has an influence on the perception of different musical features.
Background A deeper insertion of the electrodes is associated with a greater coverage of the cochlea with possible stimulus locations. This could lead to an improved or extended perception of pitches and pitch changes as well as to a better perception of contours in musical pieces.
Methods A Montreal Battery of Evaluation of Amusia test battery was conducted with a collective of 19 cochlear implant (CI) users and 9 normal-hearing subjects. For the CI users, the insertion angles of the intracochlear electrode arrays were calculated using Otoplan software.
Results Compared with normal-hearing users, CI users performed worse in the detection of melodic features of music. CI users performed better with temporal features than with melodic features. An influence of the insertion depth of the electrodes on the results of the Montreal Battery of Evaluation of Amusia could be proven neither for Cochlear nor for MED-EL CI users.
Conclusion Deeper insertion of electrode arrays may only better approximate the spatial-frequency map. Alone, it does not have an effect on better detection and identification of pitch and tonality and, consequently, better perception of musical attributes. Anatomy-based calculation of electrode locations and matching to characteristic frequencies will be sought in subsequent studies.

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Influence of the Spread of the Electric Field on Speech Recognition in Cochlear Implant Users

Kopsch, Anna C.; Rahne, Torsten; Plontke, Stefan K.; Wagner, Luise

Publication date 23-12-2023


Objective To investigate the correlation of word recognition with cochlear implant (CI) and spread of the electric field.
Study Design Prospective, noninterventional, experimental study.
Setting A tertiary referral center.
Patients Thirty-eight adult CI users with poor (n = 11), fair (n = 13), and good (n = 16) word recognition performance.
Main Outcome Measure Transimpedances were measured after 37 μs. Word recognition score was recorded at 65 dB SPL for German monosyllables in quiet. Transimpedance half widths were calculated as a marker for spread of the electric field.
Results Narrow and broad spread of the electric field, i.e., small and large half widths, were observed in all word recognition performance groups. Most of the transimpedance matrices showed a pattern of expansion along the diagonal toward the apical electrode contacts. Word recognition was not correlated with transimpedance half widths.
Conclusions The half width of the spread of the electric field showed no correlation with word recognition scores in our study population.

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Localization of Low- and High-Frequency Sounds in Cochlear Implant Recipients Using a Contralateral Hearing Aid

Zelger, Philipp; Zorowka, Patrick; Schmutzhard, Joachim; Galvan, Oliver; Rossi, Sonja; Stephan, Kurt; Seebacher, Josef

Publication date 10-01-2024


Background and Objectives The ability to localize sounds is partly recovered in patients using a cochlear implant (CI) in one ear and a hearing aid (HA) on the contralateral side. Binaural processing seems effective at least to some extent, despite the difference between electric and acoustic stimulation in each ear. To obtain further insights into the mechanisms of binaural hearing in these listeners, localization of low- and high-frequency sounds was tested.
Study Design The study used a within-subject design, where participants were tasked with localizing sound sources in the horizontal plane. The experiment was conducted in an anechoic chamber, where an array of seven loudspeakers was mounted along the 24 azimuthal angle span from −90° to +90°.
Stimuli were applied with different frequencies: broadband noise and high- and low-frequency noise.
Subjects Ten CI recipients participated in the study. All had an asymmetric hearing loss with a CI in the poorer ear and an HA on the contralateral side.
Main Outcome Measures Accuracy of sound localization in terms of angular error and percentage of correct localization scores.
Results The median angular error was 40° in bimodal conditions for both broadband noise and high-frequency noise stimuli. The angular error increased to 47° for low-frequency noise stimuli. In the unilaterally aided condition with an HA, only a median angular error of 78° was observed.
Conclusions Irrespective of the frequency composition of the stimuli, this group of bimodal listeners showed some ability to localize sounds. Angular errors were larger than those reported in the literature for bilateral CI users or single-sided deaf listeners with a CI. In the unilateral listening condition with HA, only localization of sounds was not possible for most subjects.

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Dependence of Cochlear Duct Length Measurement on the Resolution of the Imaging Dataset

Spahn, Bjoern; Ilgen, Lukas; Neun, Tilmann; Müller-Graff, Franz-Tassilo; Schendzielorz, Philipp; Hagen, Rudolf; Althoff, Daniel; Zabler, Simon; Rak, Kristen

Publication date 10-01-2024


Hypothesis Measurements of the cochlear duct length (CDL) are dependent on the resolution of the imaging dataset.
Background Previous research has shown highly precise cochlear measurements using 3D-curved multiplanar reconstruction (MPR) and flat-panel volume computed tomography (fpVCT). Thus far, however, there has been no systematic evaluation of the imaging dataset resolution required for optimal CDL measurement. Therefore, the aim of this study was to evaluate the dependence of CDL measurement on the resolution of the imaging dataset to establish a benchmark for future CDL measurements.
Methods fpVCT scans of 10 human petrous bone specimens were performed. CDL was measured using 3D-curved MPR with secondary reconstruction of the fpVCT scans (fpVCTSECO) and increasing resolution from 466 to 99 μm. In addition, intraobserver variability was evaluated. A best-fit function for calculation of the CDL was developed to provide a valid tool when there are no measurements done with high-resolution imaging datasets.
Results Comparison of different imaging resolution settings showed significant differences for CDL measurement in most of the tested groups (p < 0.05), except for the two groups with the highest resolution. Imaging datasets with a resolution lower than 200 μm showed lower intraobserver variability than the other resolution settings, although there were no clinically unacceptable errors with respect to the Bland-Altman plots. The developed best-fit function showed high accuracy for CDL calculation using resolution imaging datasets of 300 μm or lower.
Conclusion 3D-curved MPR in fpVCT with a resolution of the imaging dataset of 200 μm or higher revealed the most precise CDL measurement. There was no benefit of using a resolution higher than 200 μm with regard to the accuracy of the CDL measurement.

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A Novel Diagnostic and Treatment Algorithm for Acute Mastoiditis in Children Based on 109 Cases

Häußler, Sophia Marie; Peichl, Jonathan; Bauknecht, Christian; Spierling, Katja; Olze, Heidi; Betz, Christian; Stölzel, Katharina

Publication date 23-12-2023


Background Acute mastoiditis (AM) is a potentially life-threatening condition primarily affecting children. To date, there are no consistent criteria or valid guidelines for the diagnosis and treatment of pediatric AM. Therefore, this study evaluates the clinical course of AM in terms of clinical signs and treatment. In addition, a novel classification scheme for the disease and a treatment algorithm is being proposed.
Methods Patient records over a 12-year period from a single center were reviewed to identify confirmed cases of AM in children. Data collected included clinical signs, body temperature, and infection parameters during the disease, as well as radiological imaging, antibiotics, and surgical as well as conservative treatment. In addition, a classification of the AM stages was established in accordance with the findings described and practical experience, consisting of four stages (1, mastoidal irritation; 2, mild AM; 3, advanced AM; 4, advanced AM and additional complications) with corresponding treatment recommendations. In the retrospective cohort, those AM cases that were treated alongside the classification were compared with the rest concerning clinical course and outcome.
Results A total of 109 patients (mean age, 3.8 ± 3.8 years) were included. The main symptoms at hospital admission were auricular protrusion (n = 73; 67.0%), fever (n = 56; 51.4%) with a mean temperature of 38.3 ± 1.1°C, and otalgia (n = 28; 25.7%). The mean laboratory-tested levels of leukocytes and C-reactive protein at the time of hospital admission were 15.96 ± 8.7/nl and 59.6 ± 54.0 mg/L, respectively. During winter, there was a higher prevalence of AM, with peak hospital admissions in April (n = 22). The most common pathogen was Streptococcus pyogenes (32 cases). Treatment was purely conservative in four cases, whereas the remaining cases underwent surgery (41× grommet insertion, 64× plus mastoidectomy). The outcome was generally good, but in eight patients a second surgical procedure had to be performed as they showed signs of clinical deterioration. A total of 101 patients were treated according to the proposed algorithm, and all of which had a good outcome without the need for further interventions.
Conclusion Based on clinical experience in a large cohort of pediatric AM patients, a novel diagnostic and treatment algorithm has been developed and successfully tested in a retrospective cohort for AM in children to prevent further complications and to ease its management by pediatricians and otorhinolaryngologists in the emergency setting.

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Immunomodulatory Response of the Middle Ear Epithelial Cells in Otitis Media

Leffers, David; Penxova, Zuzana; Kempin, Thorge; Därr, Markus; Fleckner, Jonas; Hollfelder, Daniela; Ryan, Allen F.; Bruchhage, Karl-Ludwig; Kurabi, Arwa; Leichtle, Anke

Publication date 17-01-2024


Hypothesis The middle ear (ME) epithelium transforms because of changed immunomodulation during infection.
Introduction The epithelial cells of the tympanic cavity represent the first line of defense in the context of otitis media. They can convert from a typical mucosal site into a respiratory epithelium and vice versa. Our goal is to depict the specific immune response of epithelial cells after infection at the molecular level.
Methods The investigations were carried out on healthy and inflamed ME tissue, removed during surgical interventions in mouse and human models, and in a human in-vitro cell model in human ME epithelial cell line. We determined the epithelial localization of the protein expression of Toll- and NOD-like immune receptors and their associated signaling molecules using immunohistochemistry. In addition, we examined growth behavior and gene expression due to direct stimulation and inhibition.
Results We found clinically and immunobiologically confirmed transformation of the inflamed ME epithelium depending on their origin, as well as differences in the distribution of Toll-like receptors and nucleotide-binding oligomerization domain-like receptors in the epithelial cell lining. Dysregulated gene and protein expression of the inflammatory and apoptotic genes could be modulated by stimulation and inhibition in the epithelial cells.
Conclusions The local ME mucosal tissue is believed to modulate downstream immune activity after pathogen invasion via intrinsic cellular mechanism. Using translation approaches to target these molecular pathways may offer more reliable clinical resolution of otitis media in the future.

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In Vivo Thickness of the Healthy Tympanic Membrane Determined by Optical Coherence Tomography

Morgenstern, Joseph; Kreusch, Theodor; Golde, Jonas; Steuer, Svea; Ossmann, Steffen; Kirsten, Lars; Walther, Julia; Zahnert, Thomas; Koch, Edmund; Neudert, Marcus

Publication date 01-03-2024


Objective Tympanic membrane (TM) thickness is an important parameter for differentiation between a healthy and a pathologic TM. Furthermore, it is needed for modeling the middle ear function. Endoscopic optical coherence tomography (eOCT) provides the opportunity to measure the TM thickness of the entire TM in vivo.
Materials and methods A total of 27 healthy ears were examined by eOCT. The system uses a light source with a central wavelength of 1,300 nm. The endoscope with an outer diameter of 3.5 mm provides a field of view of 10 mm and a working distance of 10 mm. Thickness measurements were carried out at 8 points on the TM. Additionally, the existing literature was analyzed, and a mean TM thickness value was determined.
Results The mean thickness of the TM over all measurement points of the pars tensa was 120.2 μm, and the pars flaccida was significantly thicker with a mean thickness of 177.9 μm. Beyond that, there were no significant differences between the single quadrants. The mean TM thickness in the literature was 88.8 μm.
Discussion EOCT provides the possibility for in vivo thickness determination of the TM. The mean thickness seems to be higher than in the previous studies, which were mostly carried out ex vivo. Our study takes the three-dimensional refraction into account and provides a method for the refraction correction.

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