Arriaga, Moises
Publication date 15-02-2024
No abstract available
Pubmed PDF WebAhmad, Jumah G.; Lovin, Benjamin D.; Lee, Anna; Nader, Marc-Elie; Gidley, Paul W.
Publication date 15-02-2024
Objective To determine if cochlear implant (CI) is safe and effective in patients with radiation therapy (XRT)-induced sensorineural hearing loss and to discuss considerations in this population through a retrospective cohort review, systematic review, and meta-analysis.
Databases Reviewed Pub Med, Cochrane Library, and Embase.
Methods We retrospectively reviewed all CI cases after head and neck (HN) XRT at our institution, noting intraoperative findings, postoperative complications, and hearing outcomes. Change in speech discrimination scores (SDSs) was the primary outcome measure. Systematic review was performed to identify all cases of CI after HNXRT. A meta-analysis was performed to assess SDS change.
Results The retrospective cohort review identified 12 patients who underwent CI after HNXRT. One patient with HN cancer (HNC) and one with central nervous system pathology (CNSP) received bilateral implants. Six had HNC, three had CNSP, and one had Langerhans cell histiocytosis. Eleven had abnormal findings during CI. There were no postoperative complications. Twenty articles with an additional 97 patients were suitable for systematic review inclusion. Of the 109 patients, 67 (61.5%) had HNC and 18 (16.5%) had CNSP. Abnormal intraoperative findings were common (30.3%), most frequently in the mastoid (66.7%). Postoperative complications, including wound dehiscence and infection with some requiring explantation, occurred in 10.1% of patients. Sixty-six patients were included in the meta-analysis. All demonstrated SDS improvement (mean increase, 56.2%).
Conclusion Patients with prior HNXRT benefit from CI. Paying careful attention to surgical planning and technique, postoperative care, and patient expectations is imperative, as complications are not uncommon.
Raymond, Mallory J.; Ottinger, Allie; Rowley, M. Andrew; Bobian, Michael; Dornhoffer, Jim; Brennan, Emily; Rizk, Habib G.
Publication date 28-02-2024
Objective To examine the otologic and neurotologic symptoms, physical examination findings, and imaging features secondary to hematologic malignancies.
Methods Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, databases, including Pub Med, Scopus, and CINAHL, were searched for articles including patients with otologic manifestations of leukemia, lymphoma and multiple myeloma. Data collected included patient and study demographics, specific hematologic malignancy, timing and classification of otologic symptoms, physical examination findings, imaging features and methods of diagnosis. Pooled descriptive analysis was performed.
Results Two hundred seventy-two articles, of which 255 (93.8%) were case reports and 17 (6.2%) were case series, reporting on 553 patients were identified. Otologic manifestations were reported on 307 patients with leukemia, 204 patients with lymphoma and 42 patients with multiple myeloma. Hearing loss and unilateral facial palsy were the most common presenting symptoms for 111 reported subjects with leukemia (n = 46, 41.4%; n = 43, 38.7%) and 90 with lymphoma (n = 38, 42.2%; n = 39, 43.3%). Hearing loss and otalgia were the most common presenting symptoms for 21 subjects with multiple myeloma (n = 10, 47.6%; n = 6, 28.6%). Hearing loss and unilateral facial palsy were the most common otologic symptoms indicative of relapse in subjects with leukemia (n = 14, 43.8%) and lymphoma (n = 5, 50%).
Conclusion Hearing loss, facial palsy, and otalgia might be the first indication of a new diagnosis or relapse of leukemia, lymphoma, or multiple myeloma. Clinicians should have a heightened level of suspicion of malignant etiologies of otologic symptoms in patients with current or medical histories of these malignancies.
Walters, Rameen K.; Durrant, Frederick G.; Nguyen, Shaun A.; Meyer, Ted A.; Lambert, Paul R.
Publication date 15-02-2024
Objective To quantify the placebo effect in randomized clinical trials treating tinnitus with oral or intratympanic placebo treatment.
Data Sources CINAHL, Pub Med, and Scopus were searched for articles from conception to October 2022. MESH and key terms such as “tinnitus,” “placebo,” and “medication” were used to find randomized, placebo-controlled trials. The search was limited to articles in English.
Methods Randomized controlled trials with adult subjects evaluating tinnitus pretreatment and posttreatment with an oral or intratympanic medication versus a placebo arm were included. Crossover studies, studies involving middle/inner ear operations or devices, and studies that exclusively included nonidiopathic etiologies of tinnitus were excluded. Mean tinnitus symptom survey scores for the Tinnitus Handicap Inventory (THI), Tinnitus Severity Index, Tinnitus Functional Index, Tinnitus Handicap Questionnaire, and Visual Analog Scales for tinnitus Intensity/Loudness (VAS-L), Annoyance (VAS-An), and Awareness (VAS-Aw) were extracted for both placebo and experimental groups.
Results 953 studies were screened with 23 studies being included in the final analysis. Meta-analysis of mean difference (MD) was calculated using Rev Man 5.4. MD between pretreatment and posttreatment THI scores of the placebo arms was 5.6 (95% confidence interval, 3.3–8.0; p < 0.001). MD between pretreatment and posttreatment VAS scores of the placebo groups for Loudness, Annoyance, and Awareness were 0.8 (0.0 to 1.6, p = 0.05), 0.2 (−0.2 to 0.5, p = 0.34), and 0.3 (−0.0 to 0.7, p = 0.08), respectively.
Conclusions Placebo treatment has shown effectiveness in improving patient-reported evaluations of tinnitus when using some standardized metrics such as THI and VAS-L; however, the improvement is not as substantial as nonplacebo treatment.
Angeli, Simon Ignacio; Brown, C. Scott; Holcomb, Meredith A.; Velandia, Sandra L.; Eshraghi, Adrien A.; Chiossone-Kerdel, Juan Armando; Hoffer, Michael E.; Sanchez, Chrisanda; Telischi, Fred F.
Publication date 15-02-2024
Objective To investigate if pharmacological treatment with prednisone and L-N-acetylcysteine (STE + NAC) influence functional hearing preservation in cochlear implant (CI) surgery.
Study Designs Preimplantation and postimplantation longitudinal case–control study.
Setting Tertiary referral center.
Patients Pediatric and adult recipients of CI with preimplantation functional hearing defined as an average of air-conducted thresholds at 125, 250, and 500 Hz (low-frequency pure-tone average LFPTA) <80 dB.
Interventions Preimplantation and postimplantation audiometry. Weight-adjusted oral prednisone and L-N-acetylcysteine starting 2 days before surgery (Miami cocktail). Prednisone was continued for 3 days and L-N-acetylcysteine for 12 days after surgery, respectively. Cochlear implantation with conventional length electrodes.
Main Outcome Measures Proportion of patients with LFPTA <80 dB, and LFPTA change at 1-year postimplantation.
Results All 61 patients received intratympanic and intravenous dexamethasone intraoperatively, with 41 patients receiving STE + NAC and 20 patients not receiving STE + NAC. At 1-year postimplantation, the proportion of functional hearing preservation was 83% in the STE + NAC group compared with 55% of subjects who did not receive STE + NAC (p = 0.0302). The median LFPTA change for STE + NAC-treated and not treated subjects was 8.33 dB (mean, 13.82 ± 17.4 dB) and 18.34 dB (mean, 26.5 ± 23.4 dB), respectively (p = 0.0401, Wilcoxon rank test). Perioperative STE + NAC treatment resulted in 10 dB of LFPTA better hearing than when not receiving this treatment. Better low-frequency preimplantation hearing thresholds were predictive of postimplantation functional hearing. No serious side effects were reported.
Conclusion Perioperative STE + NAC, “The Miami Cocktail,” was safe and superior to intraoperative steroids alone in functional hearing preservation 1-year after cochlear implantation.
"Patro, Ankita; Lindquist, Nathan R.; Holder, Jourdan T.; Freeman, Michael H.; Gifford, René H.; Tawfik, Kareem O.; OMalley, Matthew R.; Bennett, Marc L.; Haynes, David S.; Perkins, Elizabeth L."
Publication date 28-02-2024
Objective To report speech recognition outcomes and processor use based on timing of cochlear implant (CI) activation.
Study Design Retrospective cohort.
Setting Tertiary referral center.
Patients A total of 604 adult CI recipients from October 2011 to March 2022, stratified by timing of CI activation (group 1: ≤10 d, n = 47; group 2: >10 d, n = 557).
Main Outcome Measures Average daily processor use; Consonant-Nucleus-Consonant (CNC) and Arizona Biomedical (Az Bio) in quiet at 1-, 3-, 6-, and 12-month visits; time to peak performance.
Results The groups did not differ in sex (p = 0.887), age at CI (p = 0.109), preoperative CNC (p = 0.070), or preoperative Az Bio in quiet (p = 0.113). Group 1 had higher median daily processor use than group 2 at the 1-month visit (12.3 versus 10.7 h/d, p = 0.017), with no significant differences at 3, 6, and 12 months. The early activation group had superior median CNC performance at 3 months (56% versus 46%, p = 0.007) and 12 months (60% versus 52%, p = 0.044). Similarly, the early activation group had superior median Az Bio in quiet performance at 3 months (72% versus 59%, p = 0.008) and 12 months (75% versus 68%, p = 0.049). Both groups were equivalent in time to peak performance for CNC and Az Bio. Earlier CI activation was significantly correlated with higher average daily processor use at all follow-up intervals.
Conclusion CI activation within 10 days of surgery is associated with increased early device usage and superior speech recognition at both early and late follow-up visits. Timing of activation and device usage are modifiable factors that can help optimize postoperative outcomes in the CI population.
"Garcia-Matte, Raimundo J.; ONeil, Luke M.; Chase, Carl; Leeming, Pia; Clack, Rachel; Rodrigues, Steve; Kuthubutheen, Jafri"
Publication date 01-04-2024
Objective To assess cochlear implant (CI) sound processor usage over time in children with single-sided deafness (SSD) and identify factors influencing device use.
Study Design Retrospective, chart review study.
Setting Pediatric tertiary referral center.
Patients Children with SSD who received CI between 2014 and 2020.
Outcome Measure Primary outcome was average daily CI sound processor usage over follow-up.
Results Fifteen children with SSD who underwent CI surgery were categorized based on age of diagnosis and surgery timing. Over an average of 4.3-year follow-up, patients averaged 4.6 hours/day of CI usage. Declining usage trends were noted over time, with the first 2 years postactivation showing higher rates. No significant usage differences emerged based on age, surgery timing, or hearing loss etiology.
Conclusions Long-term usage decline necessitates further research into barriers and enablers for continued CI use in pediatric SSD cases.
Lee, Andrew Y.; Lee, Diana Y.; Saunders, James E.
Publication date 01-04-2024
Objective To determine the utility of computed tomography (CT) and magnetic resonance imaging (MRI) in cochlear implant candidates.
Study Design Retrospective case review.
Setting Tertiary referral hospital.
Patients A total of 207 cochlear implanted patients with CT and/or MRIIntervention(s) N/A.
Main Outcome Measure(s) Age versus abnormal radiologic findings, imaging abnormality versus postoperative outcomes, postoperative outcomes versus electrode design, Cambridge Cochlear Implant Protocol (CCIP) status for imaging abnormalities, sensitivity and specificity of CT and MRI for round-window/cochlear occlusion, and MRI for incomplete partitions.
Results A total of 207 patients with CT, MRI, or both were reviewed retrospectively. Less than half (15.5%) of CT scans had findings that might affect surgical intervention compared with 5.9% of MRI. No significant difference was found between children and adults for relevant imaging abnormalities (grade 4 or higher) with either CT (p = 0.931) or MRI (p = 0.606). CCIP status correlated with cochlear abnormalities (p = 0.040); however, only 46.2% of radiographic abnormalities on CT would be identified by these criteria. For detecting cochlear occlusion requiring surgical intervention, the sensitivity and specificity for CT were 40% (4 of 10; 95% confidence interval CI, 12.16–73.76) and 95.73% (95% CI, 91.40–98.27), respectively. For MRI, the sensitivity and specificity were 33.33% (1 of 3; 95% CI, 0.84–90.57) and 96.97% (63 of 65; 95% CI, 89.32–99.63), respectively. There was no difference for postoperative Az Bio scores for higher-grade imaging abnormalities (p = 0.6012) or for electrode designs (p = 0.3699).
Conclusions Significant radiographic abnormalities were relatively uncommon in cochlear implant patients on either CT or MRI at our single-center institution. If present, abnormal imaging findings rarely translated to management changes. CCIP status does not reliably predict which patients are likely to have abnormalities. Both MRI and CT have low sensitivity for round-window or cochlear occlusion, but detection likely leads to changes in surgical management.
Aebischer, Philipp; Weder, Stefan; Vischer, Mattheus; Mantokoudis, Georgios; Caversaccio, Marco; Wimmer, Wilhelm
Publication date 09-02-2024
Objectives The aim of this study is to improve our understanding of the mechanics involved in the insertion of lateral wall cochlear implant electrode arrays.
Design A series of 30 insertion experiments were conducted by three experienced surgeons. The experiments were carried out in a previously validated artificial temporal bone model according to established soft surgery guidelines. The use of an in vitro setup enabled us to comprehensively evaluate relevant parameters, such as insertion force, intracochlear pressure, and exact electrode array position in a controlled and repeatable environment.
Results Our findings reveal that strong intracochlear pressure transients are more frequently caused during the second half of the insertion, and that regrasping the electrode array is a significant factor in this phenomenon. For choosing an optimal insertion speed, we show that it is crucial to balance slow movement to limit intracochlear stress with short duration to limit tremor-induced pressure spikes, challenging the common assumption that a slower insertion is inherently better. Furthermore, we found that intracochlear stress is affected by the order of execution of postinsertion steps, namely sealing the round window and posterior tympanotomy with autologous tissue and routing of the excess cable into the mastoid cavity. Finally, surgeons’ subjective estimates of physical parameters such as speed, smoothness, and resistance did not correlate with objectively assessed measures, highlighting that a thorough understanding of intracochlear mechanics is essential for an atraumatic implantation.
Conclusion The results presented in this article allow us to formulate evidence-based surgical recommendations that may ultimately help to improve surgical outcome and hearing preservation in cochlear implant patients.
Dang, Sabina; Kallogjeri, Dorina; Dizdar, Karmela; Lee, David; Bao, James W.; Varghese, Jordan; Walia, Amit; Zhan, Kevin; Youssef, Stephanie; Durakovic, Nedim; Wick, Cameron C.; Herzog, Jacques A.; Buchman, Craig A.; Piccirillo, Jay F.; Shew, Matthew A.
Publication date 28-02-2024
Objective To examine the association between preoperative comorbidities and cochlear implant speech outcomes.
Study Design Retrospective cohort.
Setting Tertiary referral center.
Patients A total of 976 patients who underwent cochlear implantation (CI) between January 2015 and May 2022. Adult patients with follow-up, preoperative audiologic data, and a standardized anesthesia preoperative note were included.
Exposure Adult Comorbidity Evaluation 27 (ACE-27) based on standardized anesthesia preoperative notes.
Main Outcome Measures Postoperative change in consonant–nucleus–consonant (CNC) score, Az Bio Sentence score in quiet, and Az Bio + 10 dB signal-to-noise ratio (SNR). Sentence score of the implanted ear at 3, 6, and 12 months.
Results A total of 560 patients met inclusion criteria; 112 patients (20%) had no comorbidity, 204 patients (36.4%) had mild comorbidities, 161 patients (28.8%) had moderate comorbidities, and 83 patients (14.8%) had severe comorbidities. Mixed model analysis revealed all comorbidity groups achieved a clinically meaningful improvement in all speech outcome measures over time. This improvement was significantly different between comorbidity groups over time for Az Bio Quiet (p = 0.045) and Az Bio + 10 dB SNR (p = 0.0096). Patients with severe comorbidities had worse outcomes. From preop to 12 months, the estimated marginal mean difference values (95% confidence interval) between the no comorbidity group and the severe comorbidity group were 52.3 (45.7–58.9) and 32.5 (24.6–40.5), respectively, for Az Bio Quiet; 39.5 (33.8–45.2) and 21.2 (13.6–28.7), respectively, for Az Bio + 10 dB SNR; and 43.9 (38.7–49.0) and 31.1 (24.8–37.4), respectively, for CNC.
Conclusions Comorbidities as assessed by ACE-27 are associated with CI performance. Patients with more severe comorbidities have clinically meaningful improvement but have worse outcome compared to patients with no comorbidities.
Zhang, Lichun; Schmidt, Florian Herrmann; Oberhoffner, Tobias; Ehrt, Karsten; Cantré, Daniel; Großmann, Wilma; Schraven, Sebastian P.; Mlynski, Robert
Publication date 09-02-2024
Objective Accurate positioning of the electrode array during cochlear implant (CI) surgery is crucial for achieving optimal hearing outcomes. Traditionally, postoperative radiological imaging has been used to assess electrode position. Transimpedance matrix (TIM) measurements have also emerged as a promising method for assessing electrode position. This involves utilizing electric field imaging to create an electric distance matrix by analyzing voltage variations among adjacent electrodes. This study aimed to investigate the feasibility of using intraoperative TIM measurements to estimate electrode position and monitor postoperative changes.
Study Design Retrospective cohort study.
Setting University Medical center, tertiary academic referral center.
Patients Patients undergoing CI (CI622) surgery between January 2019 and June 2022.
Intervention CI electrode positions and maximal angular insertion depths (maxAID) were determined using X-ray imaging according to Stenvers projection. The mean gradient phase (MGP) was extracted from the TIM, and a correlation between the MGP and maxAID was examined. A model was then built to estimate the maxAID using the MGP, and changes in electrode location over time were assessed using this model.
Main Outcome Measures Twenty-four patients were included in this study. A positive correlation between the maxAID and the MGP (R = 0.7, p = 0.0001) was found. The established model was able to predict the maxAID with an accuracy of 27.7 ± 4.4°. Comparing intraoperative and postoperative TIM measurements, a decrease of 24.1° ± 10.7° in maxAID over time was observed.
Conclusion TIM measurements are useful for estimating the insertion depth of the electrode and monitoring changes in the electrodes position over time.
Yüksel, Mustafa; Çiprut, Ayça
Publication date 28-02-2024
Objective This study aimed to investigate the influence of the number of channels and channel interaction on timbre perception in cochlear implant (CI) processing. By utilizing vocoder simulations of CI processing, the effects of different numbers of channels and channel interaction were examined to assess their impact on timbre perception, an essential aspect of music and auditory performance.
Study Design, Setting, and Patients Fourteen CI recipients, with at least 1 year of CI device use, and two groups (N = 16 and N = 19) of normal hearing (NH) participants completed a timbre recognition (TR) task. NH participants were divided into two groups, with each group being tested on different aspects of the study. The first group underwent testing with varying numbers of channels (8, 12, 16, and 20) to determine an ideal number that closely reflected the TR performance of CI recipients. Subsequently, the second group of NH participants participated in the assessment of channel interaction, utilizing the identified ideal number of 20 channels, with three conditions: low interaction (54 dB/octave), medium interaction (24 dB/octave), and high interaction (12 dB/octave). Statistical analyses, including repeated-measures analysis of variance and pairwise comparisons, were conducted to examine the effects.
Results The number of channels did not demonstrate a statistically significant effect on TR in NH participants (p > 0.05). However, it was observed that the condition with 20 channels closely resembled the TR performance of CI recipients. In contrast, channel interaction exhibited a significant effect (p < 0.001) on TR. Both the low interaction (54 dB/octave) and high interaction (12 dB/octave) conditions differed significantly from the actual CI recipients performance.
Conclusion Timbre perception, a complex ability reliant on highly detailed spectral resolution, was not significantly influenced by the number of channels. However, channel interaction emerged as a significant factor affecting timbre perception. The differences observed under different channel interaction conditions suggest potential mechanisms, including reduced spectro-temporal resolution and degraded spectral cues. These findings highlight the importance of considering channel interaction and optimizing CI processing strategies to enhance music perception and overall auditory performance for CI recipients.
Yamazaki, Hiroshi; Moroto, Saburo; Yamazaki, Tomoko; Tamaya, Rinko; Fujii, Naoko; Sasaki, Ichiro; Fujiwara, Keizo; Naito, Yasushi
Publication date 01-04-2024
Objective This study focused on the intensities of cochlear implant (CI) stimulation in pediatric CI users with inner ear malformation or cochlear nerve deficiency (CND). In this population, CI programming is difficult because a large intensity of CI stimulation is required to achieve sufficient hearing, but the excess CI stimuli often induce facial nerve stimulation. We aimed to assess whether the results of intraoperative electrically evoked auditory brainstem responses (EABRs) testing predict maximum current levels of CI stimuli (cC levels) optimized by a behavioral-based method after long-term CI use.
Study Design A retrospective case review.
Setting A tertiary referral CI center.
Patients A total of 116 ears with malformations (malformation group) and 63 control ears (control group) from patients younger than 18 years who received CI. The malformation group comprised 23 ears with a common cavity (CC), 26 with incomplete partition type 1 (IP-1), 26 with incomplete partition type 2 (IP-2), and 41 with CND.
Intervention(s) Diagnostic.
Main Outcome Measure(s) Correlation between intraoperative EABR results and cC levels determined by the behavioral-based CI programming after long-term CI use.
Results The CC, IP-1, and CND ears required significantly larger cC levels than the IP-2 ears and control groups. However, the cC levels increased to reach the plateau 1 year after surgery in all groups. Among the malformation group, 79 ears underwent intraoperative EABR testing. Greater than 80% of the CC, IP-1, and IP-2 ears and 54.8% of the CND ears exhibited evoked wave V (eV) and were included in the eV-positive category. Myogenic responses but no eV were observed in 18.2, 15.0, and 35.5% of the CC, IP-1, and CND ears, defined as the myogenic category. No eV or myogenic response was elicited in 9.7% of the CND ears. We focused on minimum current levels that elicited eV (eV levels) in the eV-positive category and maximum current levels that did not elicit any myogenic responses (myogenic levels) in the myogenic category. A significant relationship was detected between the eV levels and the cC levels. When analyzed in each malformation type, the eV levels significantly correlate with the cC levels in the CC and CND ears but not in the IP-1 and IP-2 ears, probably because of slight variation within the IP-1 group and the small number of the IP-2 group. The myogenic category did not show a significant relationship between the myogenic levels and cC levels, but the cC levels were similar to or smaller than the myogenic levels in most ears.
Conclusions This study confirmed that intraoperative EABR testing helps predict the optimal cC levels in malformation ears. EABR-based CI programming immediately after cochlear implantation, followed by behavioral-based CI programming, may allow us to achieve early postoperative optimization of CI maps even in young children with severe malformations.
"Tan, Eren; Bester, Christofer; Collins, Aaron; Razmovski, Tayla; OLeary, Stephen"
Publication date 01-04-2024
Introduction Preservation of residual hearing after cochlear implantation allows for electroacoustic stimulation, which leads to better music appreciation, noise localization, and speech comprehension in noisy environments. Real-time intraoperative electrocochleography (rt-ECochG) monitoring has shown promise in improving residual hearing rates. Four-point impedance (4PI) is being explored as a potential biomarker in cochlear implantation that has been associated with fibrotic tissue response, hearing loss, and dizziness. In this study, we explore whether monitoring both rt-ECochG intraoperatively and postoperative 4PI improves predictions of the preservation of residual hearing.
Methods This was a prospective cohort study. Adults with residual acoustic hearing underwent cochlear implantation with intraoperative intracochlear electrocochleography (ECochG) monitoring. The surgeon responded to a drop in ECochG signal amplitude of greater than 30% by a standardized manipulation of the electrode with the aim of restoring the ECochG. At the end of the procedure, the ECochG signal was categorized as being maintained or having dropped more than 30%. 4PI was measured on 1 day, 1 week, and 1 and 3 months after cochlear implantation. Residual hearing was measured by routine pure-tone audiogram at 3 months postoperatively. The ECochG category and 4PI impedance values were entered as factors in a multiple linear regression predicting the protection of residual hearing.
Results Twenty-six patients were recruited. Rt-ECochG significantly predicted residual hearing at 3 months (t test; mean difference, 37.7%; p = 0.002). Inclusion of both 1-day or 3-month 4PI in a multiple linear regression with rt-ECochG markedly improved upon correlations with residual hearing compared with the rt-ECochG–only model (rt-ECochG and 1-d 4PI model, R2 = 0.67; rt-ECochG and 3-mo 4PI model, R2 = 0.72; rt-ECochG–only model, R2 = 0.33).
Conclusions Both rt-ECochG and 4PI predict preservation of residual hearing after cochlear implantation. These findings suggest that the biological response of the cochlea to implantation, as reflected in 4PI, is an important determinant of residual hearing, independent of the acute effects on hearing during implant surgery seen with rt-ECochG. We speculate that 4PI relates to inflammation 1 day after implantation and fibrosis at 3 months.
Arends, Sebastiaan R.S.; Briaire, Jeroen J.; Geiger, Stephan; Nauwelaers, Tim; Frijns, Johan H.M.
Publication date 20-02-2024
Objective To evaluate the clinical applicability of a semiautomatic radiological tool for scalar translocation detection.
Study Design Retrospective study.
Setting Tertiary care academic center.
Patients We included 104 patients implanted with 116 Hi Focus Mid-Scala electrode arrays between January 2013 and September 2016.
Intervention Cochlear implantation.
Main Outcome Measures The tools scalar position assessments were compared with manual ones by calculating intraclass coefficient (ICC) for individual contacts and sensitivity and specificity for translocation detection of the whole array. In addition, ICC was calculated for diameters A and B, ratio A/B, and angular insertion depth (AID).
Results Nine-one percent of cases could be processed, which took 5 to 10 minutes per case. Comparison of manual and semiautomatic scalar position showed for individual contacts an ICC of 0.89 and for the whole array a sensitivity of 97% and a specificity of 96%. ICCs for A, B, and A/B were 0.82, 0.74, and 0.39 respectively. For AID, ICC of each of the 16 contacts was 0.95 or higher.
Conclusions The semiautomatic radiological tool could analyze most cases and showed good to excellent agreement with manual assessments for translocation detection, diameter A, diameter B, and AID. The variability between semiautomatic and manual measurements is comparable to interobserver variability, indicating that clinical implementation of the tool is feasible.
Schwam, Zachary G.; Mavrommatis, Maria; Gidumal, Sunder; Carrasquilla, Alejandro; Shrivastava, Raj; Perez, Enrique R.; Cosetti, Maura K.; Wanna, George B.
Publication date 15-02-2024
Objective To examine the role of lumbar drains (LDs) in the success of spontaneous temporal cerebrospinal fluid (CSF) leak and encephalocele repair.
Study design Retrospective cohort study.
Setting Tertiary academic health system.
Patients Patients undergoing repair of spontaneous temporal lobe encephaloceles or middle fossa CSF leaks during years 2017 to 2023.
Interventions Transmastoid, middle fossa craniotomy, or combination approaches to CSF leak repair.
Outcome measures Failure rate, complication rate, length of stay (LOS), readmission.
Results Sixty-nine patients were included, with a combination approach performed in 78.3%, transmastoid in 17.4%, and isolated middle fossa craniotomy in 4.3%. Mean body mass index was 33.2, mean bony defect size width was 6.51 mm, and defect locations included the epitympanum, antrum, mastoid, and petrous apex. Multilayer closure with three or more layers was performed in 87.0%. LD was used in 73.9% of cases for a mean duration 2.27 days and was associated with longer LOS (3.27 vs. 1.56 d, p = 0.006) but not with failure rate, complications, discharge destination, or readmission. Only one major complication occurred as a result of the drain, but low-pressure headache was anecdotally common.
Conclusions Use of LD in the repair of spontaneous CSF leaks and temporal lobe encephaloceles is associated with longer LOS but not failure rates or other admission-level outcomes.
Lee, Jung Woo; Kim, Jia; Kim, Hwabin; Kong, Soo-Keun; Choi, Sung-Won; Oh, Se-Joon
Publication date 28-02-2024
Objectives The operating microscope (OM) commonly used in ear surgeries has several disadvantages, including a low depth of field, a narrow field of view, and unfavorable ergonomic characteristics. The exoscope (EX) was developed to overcome these disadvantages. Herein, we compared OM and EX during mastoidectomy and found out the feasibility of the EX.
Study Design Prospective randomized comparative study.
Setting Tertiary academic medical center.
Patients Patients who had mastoidectomy for chronic otitis media with or without cholesteatoma between January 2022 and April 2022.
Intervention Canal wall-up mastoidectomy (CWUM) or canal wall-down mastoidectomy (CWDM) using OM or EX without endoscope.
Main Outcome Measures Operative setting time (the time between the end of general anesthesia and incision), operative time (from incision to suture), postoperative audiologic outcomes, perioperative complications, and the decision to switch from EX to OM.
Results Of 24 patients who were diagnosed with chronic otitis media or cholesteatoma, 12 each were randomly assigned to the OM or EX group. The mean operation time was 175 ± 26.5 minutes and 172 ± 34.6 minutes in the EX and OM group, respectively, which was not significantly different (p = 0.843). The procedures in the EX group were successfully completed using a three-dimensional (3D)-EX without conversion to OM. All surgeries were completed without any complications. The postoperative difference in the air and bone conduction was 11.2 and 12.4 dB in the EX and OM groups, respectively, which was not significantly different (p = 0.551).
Conclusions EX is comparable to OM in terms of surgical time, complications, and audiologic outcomes following mastoidectomy. The EX system is a potential alternative to OM. However, further improvements are required to overcome some drawbacks (deterioration of image resolution at high magnification, requirement of an additional controller for refocusing).
Liu, Shanshan; Tang, Tiantian; Liu, Wei; Chen, Min; Qi, Kemin; Ni, Xin; Zhang, Jie
Publication date 15-02-2024
Hypothesis The present study was conducted to explore the role of the NOD-like receptor family pyrin domain-containing 3 (NLRP3) inflammasome in mouse otic barotrauma models.
Background Previous studies suggest that the NLRP3 inflammasome plays an important role in the pathogenesis of middle ear disease. However, whether middle ear negative pressure injury underlies NLRP3 inflammasome activation remains unclear.
Methods Wild-type and Nlrp3−/− mice were randomly assigned to control and pressure injury groups, respectively. Pressure loading was performed using a pressure cabin with the pressure level set to 20 k Pa higher than that of the ambient atmosphere. This was achieved in approximately 15 seconds and maintained for 10 minutes. Hematoxylin and eosin staining was performed to detect morphological changes of the middle ear mucosa, tissue IL-1β was measured via an enzyme-linked immunosorbent assay, and cleaved caspase-1 was detected by Western blot.
Results We found that the maturation of caspase-1 and IL-1β production in the middle ear significantly increased after otic barotrauma. In Nlrp3−/− mice, inflammasome activation is downregulated and mucosal hyperplasia is reduced compared with those of wild-type mice during recovery.
Conclusion The NLRP3 inflammasome likely plays an important role in the pathogenesis of otic barotrauma. Controlling activation of the NLRP3 inflammasome may promote middle ear recovery after negative pressure injury.
Akella, Deepthi S.; Ghezavati, Alireza; Siddiqui, Huma A.; Erbele, Isaac D.
Publication date 01-04-2024
Objective Tophaceous lesions of the middle ear from calcium pyrophosphate deposition disease (CPPD, or pseudogout) and gout are infrequently reported. Recognizing its characteristic findings will allow clinicians to accurately narrow the differential diagnosis of bony-appearing middle ear lesions and improve management.
Patients Two consecutive cases of tophaceous middle ear lesions presenting to a tertiary care center between January 2021 and December 2021. Neither with previous rheumatologic history.
Interventions Surgical excision of tophaceous middle ear lesions.
Main Outcome Measure Improvements in facial weakness and conductive hearing loss.
Results The first case was a 66-year-old gentleman with progressive conductive loss, ipsilateral progressive facial weakness over years, and an opaque, irregular-appearing tympanic membrane anterior to the malleus found to have CPPD on surgical pathology, with immediate postoperative improvement of facial function. The second was a 75-year-old gentleman with progressive conductive loss and similar appearing tympanic membrane as case 1, previously diagnosed with tympanosclerosis, found to have gout on surgical pathology. In both cases, the CT showed a heterogenous, bony-appearing lesion in the middle ear, and both tophaceous lesions were a of gritty, chalky consistency intraoperatively.
Conclusion Tophaceous lesions of the middle ear are rare but have similar findings. Notably, the tympanic membrane can appear opaque and irregular, and the CT demonstrates a radiopaque, heterogeneous appearance. Facial weakness is an unusual finding. Specimens of suspected tophi must be sent to pathology without formalin for accurate diagnosis.
Alsayegh, Raihanah; Silver, Jennifer; Agnihotram, Raman; Gurberg, Joshua
Publication date 28-02-2024
Objectives Barochallenge-induced Eustachian tube dysfunction (ETD) is difficult to diagnose because the examination is often normal during clinical assessment. In adults, functional tympanometry testing, performed by asking the patient to Valsalva and Toynbee while measuring the pressure shift, can aid in the diagnosis of ETD. However, standardized values do not exist in children. We aim to determine the age at which children can perform these maneuvers and the normative values in this population.
Methods Patients with a normal basic ear examination 4 years and older, presenting to the pediatric Otolaryngology clinic, were recruited. Otoscopy, baseline tympanometry, followed by Valsalva and Toynbee maneuvers were performed. Because there are no pediatric norms, we hypothesized that children would achieve the same minimum normal pressure shift as cited in the adult literature (+20 da Pa or higher for Valsalva and −20 da Pa or lower for Toynbee). The data were analyzed using receiver operating characteristic curves and logistic regression.
Results One hundred sixty-eight children (276 ears) were assessed. Participants as young as 4 years old were able to perform a Valsalva and Toynbee. Age cut-offs at which children achieved adult norms were 12.5 years (p = 0.016) and 8.5 years (p = 0.071) for Valsalva and Toynbee maneuvers, respectively. Mean pressure shift ranged from +29 to −36 da Pa, and males were 2.5 times more likely to achieve Toynbee compared with females (p = 0.006).
Conclusions Functional tympanometry testing may be used to help diagnose barochallenge-induced ETD in older children.
Del Puppo, Marine; Farinetti, Anne; Roman, Stéphane; Rossi, Marie-Eva; Le Treut, Claire; Nicollas, Richard; Moreddu, Eric
Publication date 28-02-2024
Objective This study aims to analyze the impact of age and other prognostic factors on the success of myringoplasty.
Study design A retrospective case series.
Settings Pediatric ENT department of a tertiary academic center.
Patients Two hundred forty-one children (318 ears) aged 3 to 17 years with tympanic perforation.
Intervention Myringoplasty performed between 2009 and 2019.
Main outcomes measures The rate of tympanic closure, perforation recurrence, revision surgery, and audiometric gain were collected. The impact of age and anatomical and surgical factors was analyzed for each procedure.
Results With a mean follow-up time of 1 year, the tympanic closure rate was 87.7%, the perforation recurrence rate was 18.6%, and 16.7% of ears required reoperation. The mean air–bone gap decreased from 21 dB preoperatively to 12 dB postoperatively (p < 0.0001). We did not find different anatomical and audiometric results for our three groups of patients classified according to age. Audiometric results were associated with the location of the perforation, intraoperative inflammation of the middle ear mucosa, and the surgical technique performed.
Conclusion Myringoplasty in children is associated with excellent anatomical and functional results, even in the youngest patients. It can be proposed whatever the childs age if the patients are well selected before giving the indication.
Kunnath, Ansley J.; Freeman, Michael H.; Witcher, Ryan; Patro, Ankita; Lindquist, Nathan R.; Tawfik, Kareem O.
Publication date 28-02-2024
Objective Comparison of outcomes of microscopic and endoscopic resection of glomus tympanicum (GT) tumors Study Design Retrospective case review.
Setting Single tertiary referral center.
Patients All adult patients undergoing transcanal GT resection without mastoidectomy from 2007 to 2021Interventions Surgical resection—endoscopic versus microscopic approach.
Main Outcome Measures Primary outcomes were tumor recurrence at 1 year and presence of residual tumor at conclusion of surgery. Secondary outcome measures included operative time, postoperative air-bone gap, postoperative symptom resolution, and surgical complications.
Results Thirty-eight patients underwent resection of GT (74% female; mean age, 59 years). Twenty-nine cases were performed microscopically, and nine cases were performed endoscopically. Both endoscopic and microscopic approaches yielded high rates of complete tumor resection (27/29 microscopic cases, 7/9 endoscopic cases). There was no significant difference in mean operative time (2.3 hours for microscopic; 2.6 hours for endoscopic). On average, air-bone gaps (ABGs) decreased by 6.3 dB after endoscopic resection compared with 1.0 dB after microscopic resection (p = 0.064). No patients were found to have tumor recurrence during an average follow-up interval of 21 months.
Conclusions These results suggest comparable outcomes with both endoscopic and microscopic approaches for GT resection, and decisions regarding preferred approach should be dictated by surgeon preference.
Macielak, Robert J.; Dornhoffer, James R.; Plitt, Aaron R.; Neff, Brian A.; Driscoll, Colin L.W.; Carlson, Matthew L.; Link, Michael J.
Publication date 28-02-2024
Objective To describe the experience and results from coordinated and closely scheduled radiosurgery and cochlear implantation (CI) in a vestibular schwannoma (VS) cohort.
Patients Patients with VS who underwent radiosurgery followed by CI on the same or next day.
Interventions Interventions included sequential radiosurgery and CI.
Main Outcome Measures Tumor control defined by tumor growth on posttreatment surveillance and audiometric outcomes including consonant-nucleus-consonant words and Az Bio sentences in quiet.
Results In total, six patients were identified that met the inclusion criteria, with an age range of 38 to 69 years and tumor sizes ranging from 2.0 to 16.3 mm. All patients successfully underwent radiosurgery and CI on the same or immediately successive day. Postoperatively, all patients obtained open-set speech recognition. Consonant-nucleus-consonant word scores ranged from 40 to 88% correct, and Az Bio scores ranged from 44 to 94% correct. During posttreatment magnetic resonance imaging surveillance, which ranged from 12 to 68 months, all tumors were noted to be adequately visualized, and no tumor progression was noted.
Conclusion Coordinated radiosurgery and CI can be safely performed in patients with VS on the same or next day, serving to decrease burden on patients and increase access to this vital rehabilitative strategy.
Hershey, Emma; Chionis, Lisa; Kazemi, Ruby; Valenzuela, Carla; El-Kashlan, Hussam K.; Basura, Gregory J.; Stucken, Emily Z.
Publication date 15-02-2024
Objective Intralabyrinthine schwannomas (ILSs) are a rare cause of deafness. Patients with ILS confined to the semicircular canals and the vestibule (intravestibular schwannomas) are potential candidates for cochlear implantation for hearing rehabilitation, a new option for patients with unilateral hearing loss since the 2019 FDA approval of cochlear implant (CI) for single-sided deafness. In this report, we describe an evolving management approach for ILSs causing hearing loss.
Patients Adults (≥18 years) who underwent simultaneous ILS resection and CI between January 2019 and June 2023 (n = 3).
Intervention Transmastoid labyrinthectomy with simultaneous cochlear implantation.
Main Outcome Measures Hearing performance with cochlear implantation measured as CNC Word Recognition scores and Az Bio Sentence scores.
Results Three patients with ILS confined to the semicircular canals and vestibule underwent simultaneous tumor resection via labyrinthectomy with CI placement. In all cases, complete tumor resection and full CI insertion were achieved. No patients experienced postoperative complications. Patients 1 and 2 underwent 6- and 9-month postactivation testing, respectively, with CNC scores 64% to 80% and Az Bio 81% to 99% in the implanted ears. Patient 3 scored 0% on CNC and Az Bio testing at 3 months and deferred her 6-month audiometry.
Conclusions Patients with ILS confined to the vestibule and semicircular canals can be considered for simultaneous tumor resection and CI placement.
Filip, Peter; Chiang, Harry; Goldberg, Allison; Khorsandi, Azita S.; Moonis, Gul; Moody Antonio, Stephanie A.; Wanna, George; Cosetti, Maura
Publication date 01-04-2024
Objective To describe the presentations, the diagnosis, our treatment approaches, and the outcomes for 11 patients with fallopian canal meningocele (FCM).
Study Design: Multicenter Retrospective case series.
Setting Tertiary referral centers.
Patients Patients (N = 11) with radiographically or intraoperatively identified, symptomatic FCM.
Interventions Surgical repair of cerebrospinal fluid (CSF) leak and meningocele versus observation.
Main Outcome Measures Presentation (including symptoms, radiographic imaging, and comorbidities), management (including surgical approach, technique for packing, use of lumbar drain), clinical outcomes (control of CSF leak, meningitis, facial nerve function), and revision surgery.
Results Patients presented with spontaneous CSF leak (n = 7), conductive (N = 11) and sensorineural hearing loss (n = 3), nonpositional intermittent vertigo (n = 3), headaches (n = 4), and recurrent meningitis (n = 1). Risk factors in our series included obesity (n = 4), Chiari 1 malformation (n = 1), and head trauma (n = 2). Noncontrast computed tomography of the temporal bone and magnetic resonance imaging were positive for FCM in 10 patients. Eight patients were managed surgically via a transmastoid approach (n = 4), combined transmastoid and middle fossa (N = 3), or middle fossa alone (n = 1); three were managed conservatively with observation. Postoperative complications included worsened facial nerve palsy (n = 1), recurrent meningitis (n = 1), and persistent CSF leak that necessitated revision (n = 1).
Conclusions Facial nerve meningoceles are rare with variable presentation, often including CSF otorrhea. Management can be challenging and guided by symptomatology and comorbidities. Risk factors for FCM include obesity and head trauma, and Chiari 1 malformation may present with nonspecific otologic symptoms, in some cases, meningitis and facial palsy. Layered surgical repair leads to high rates of success; however, this may be complicated by worsening facial palsy.
Ivanauskaite, Jurgita; Ivanauskaite, Justina; Matin-Mann, Farnaz; Giesemann, Anja Maria; Lenarz, Thomas; Lesinski-Schiedat, Anke
Publication date 01-04-2024
Hypothesis Development of a new method for large vestibular aqueduct (LVA)/large endolymphatic sac anomaly (LESA) assessment using magnetic resonance imaging (MRI) and computed tomography (CT)/cone beam CT (CBCT) images. The secondary objective was to compare both modalities.
Background The gold standard for LVA diagnosis is the analysis of CT images using Valvassori and Clemis or Cincinnati criteria. The previous studies showed inconclusive results regarding the correlation between audiological and radiological data.
Methods Retrospective analysis of radiological images from 173 patients (315 ears), who were diagnosed with LVA/LESA based on CT/CBCT and/or MRI images of the temporal bone. The images obtained using both techniques were used to measure the following dimensions of vestibular aqueduct (VA)/endolymphatic duct (ED)/intraosseous endolymphatic sac (ES): width of the opening, length, and width at external aperture. In MRI images, the maximal contact diameters of the extraosseous or intraosseous ES and dura mater were measured as well.
Results LVA has been reported to be bilateral in 82% (142 patients) and unilateral in 18% (31 patients) of cases. Comparison of MRI and CT/CBCT measurements showed a moderate correlation (0.64) in external aperture, a moderate correlation (0.57) in the width of the VA opening, and a weak correlation (0.34) in length measurements (p < 0.05).
Conclusion We developed a new method to identify the heterogeneous pathology of LVA/LESA using reconstruction along the VA/ED/intraosseous ES axis, three measurements on two planes, and focus on the maximal contact diameter between the extraosseous or intraosseous ES and dura mater.
Lee, Kelly; Adamovich-Zeitlin, Richard; Svrakic, Maja
Publication date 28-02-2024
Objective To make recommendations for evaluation, approach to counseling and treatment for patients who present with ear fullness without abnormalities on otomicroscopic examination, standard audiometric studies, or imaging results.
Methods Retrospective chart review of adult patients in a tertiary referral center presenting with ear fullness and/or otalgia without external, middle, and/or inner ear pathologies. Data collected include demographics (age and gender), laterality and duration of symptoms, co-morbid conditions and final diagnoses of temporomandibular joint (TMJ) dysfunction, intermittent Eustachian tube dysfunction (iETD), migraine disorder, and anxiety.
Results In the span of 8 years of a single neurotologists practice, 964 patients presented with ear fullness. After excluding all instances where external, middle, and inner ear disorders were identified and where audiometric and radiologic findings were abnormal, 263 patients had ear fullness and no objective causes. Women were more likely than men to complain of ear fullness and/or otalgia and were also more likely to present with no objective abnormalities (p < 0.05). Patients who reported isolated ear fullness were more likely to be diagnosed with iETD, whereas patients who reported pain were more likely to be diagnosed with TMJ dysfunction (TMJD). Fourteen patients (5.3%) had completely unexplained sensation of ear fullness.
Conclusions There were 94.7% of the patients presenting with unexplained ear fullness were diagnosed as having a possible contribution of TMJ dysfunction, IETD, migraine disorder, anxiety, or a combination of these conditions to their symptomatology. Directing treatments toward these diagnoses may alleviate symptoms of ear fullness or, if unsuccessful, provide an avenue for counseling in the framework of functional neurologic disorders.
Siegbahn, Malin; Jörgens, Daniel; Asp, Filip; Hultcrantz, Malou; Moreno, Rodrigo; Engmér Berglin, Cecilia
Publication date 15-02-2024
Hypothesis Unilateral congenital conductive hearing impairment in ear canal atresia leads to atrophy of the gray matter of the contralateral primary auditory cortex or changes in asymmetry pattern if left untreated in childhood.
Background Unilateral ear canal atresia with associated severe conductive hearing loss results in deteriorated sound localization and difficulties in understanding of speech in a noisy environment. Cortical atrophy in the Heschl’s gyrus has been reported in acquired sensorineural hearing loss but has not been studied in unilateral conductive hearing loss.
Methods We obtained T1w and T2w FLAIR MRI data from 17 subjects with unilateral congenital ear canal atresia and 17 matched controls. Gray matter volume and thickness were measured in the Heschls gyrus using Freesurfer.
Results In unilateral congenital ear canal atresia, Heschls gyrus exhibited cortical thickness asymmetry (right thicker than left, corrected p = 0.0012, mean difference 0.25 mm), while controls had symmetric findings. Gray matter volume and total thickness did not differ from controls with normal hearing.
Conclusion We observed cortical thickness asymmetry in congenital unilateral ear canal atresia but no evidence of contralateral cortex atrophy. Further research is needed to understand the implications of this asymmetry on central auditory processing deficits.
Ottinger, Allie M.; Raymond, Mallory J.; Miller, E. Marin; Meyer, Ted A.
Publication date 28-02-2024
Objective To characterize the opioid prescribing patterns for and requirements of patients undergoing repair of spontaneous cerebrospinal fluid (sCSF) leaks of the lateral skull base.
Study Design Retrospective chart review.
Setting Tertiary referral center.
Patients Adults with lateral skull base sCSF leaks who underwent repairs between September 1, 2014, and December 31, 2020.
Main Outcome Measure Mean morphine milligram equivalents (MMEs) of opioids dispensed to inpatients and prescribed at discharge, additional pain control medications dispensed, and outpatient additional opioid requests were compared between groups.
Results Of 78 patients included, 46 (59%) underwent repair via a transmastoid (TM), 6 (7.7%) via a middle cranial fossa (MCF), and 26 (33.3%) via a combined TM–MCF approach. Inpatients received a mean of 21.3, 31.4, and 37.6 MMEs per day during admission for the TM, MCF, and combined TM–MCF approaches, respectively (p = 0.019, ηp2 = 0.101). Upon discharge, nearly all patients (n = 74, 94.9%) received opioids; 27.3, 32.5, and 37.6 MMEs per day were prescribed after the TM, MCF, and TM–MCF approaches, respectively (p = 0.015, ηp2 = 0.093). Five (6.4%) patients requested additional outpatient pain medication, after which three were prescribed 36.7 MMEs per day. Patients with idiopathic intracranial hypertension required significantly more inpatient MMEs than those without (41.5 versus 25.2, p = 0.02, d = 0.689), as did patients with a history of headaches (39.6 versus 23.6, p = 0.042, d = 0.684).
Conclusions Patients undergoing sCSF leak repair via the MCF or TM–MCF approaches are prescribed more opioids postoperatively than patients undergoing the TM approach. Patients with a history of headaches or idiopathic intracranial hypertension might require more opioids postoperatively.
Rehal, Omnia; Kullar, Peter; Maria, Peter Luke Santa
Publication date 01-04-2024
No abstract available
Pubmed PDF WebPublication date 01-04-2024
No abstract available
Pubmed PDF WebPublication date 01-04-2024
No abstract available
Pubmed PDF Web