Otology Neurotology 2020-09-01

Book Review

Hernandez, Stephen

Publicatie 01-09-2020


No abstract available

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Necrotizing Otitis Externa: A Systematic Review and Analysis of Changing Trends

Byun, Young Jae; Patel, Jaimin; Nguyen, Shaun A.; Lambert, Paul R.

Publicatie 01-09-2020


Objective: To assess for changes in trends of the disease process, management, and outcomes of necrotizing otitis externa (NOE) over the last decade.Data Sources: Articles in English, published between January 2011 and June 2019, were searched in PubMed, Scopus, Web of Science, ScienceDirect, and the Cochrane Database.Study Selection: Inclusion criteria: 1) reported evidence of NOE, 2) details on patient demographic and underlying medical disorder, 3) details on treatments, 4) documented outcomes, and 5) greater than 10 cases.Data Extraction: Study demographics, underlying conditions, infectious etiology, treatments, signs and symptoms, and outcomes.Data Synthesis: Ten studies, totalling 284 patients with a mean age of 67.8 years, were included. The time period of collected patient data ranged from 2000 to 2018. Temporal subgroup analysis was conducted before and after 2009. Cure rate was lower in the post-2009 group (76.0 versus 94.1%, p < 0.01) while disease-specific mortality remained stable. Increases in proportions of diabetes and culture negative results (p < 0.01) were also observed in this latter group. Rate of extensive surgery and the use of ciprofloxacin decreased (p < 0.01), while the use of ceftazidime increased in the post-2009 group (p < 0.01).Conclusion: A decrease in cure rate of NOE patients was observed in the setting of an increase in prevalence of diabetes. Various antipseudomonal agents are being used and an increase in culture negative results is seen.

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Systematic Review of Surgical Outcomes Following Repair of Patulous Eustachian Tube

Ikeda, Ryoukichi; Hidaka, Hiroshi; Kikuchi, Toshiaki; Ohta, Nobuo; Kawase, Tetsuaki; Katori, Yukio; Kobayashi, Toshimitsu

Publicatie 01-09-2020


Objective: To perform a systematic review and meta-analysis of surgical outcomes following repair of patulous Eustachian tube (PET).Data Sources: Analysis of cases collected from studies published between January 1990 and December 2018 and identified using PubMed, Google Scholar, and Cochrane databases.Study Selection: Articles addressing interventions to treat PET were selected.Data Extraction: The database was searched using the keywords “patulous Eustachian tube treatment” and yielded 1,370 studies. Twenty studies were eligible for inclusion.Data Synthesis: A total of 914 cases were evaluated for surgical approach, patient outcomes, and complications. The reported techniques were categorized by the procedure type, including ventilation tube insertion, mass loading of the tympanic membrane, ET injection, plug surgery, shim surgery, tuboplasty, and ET closure. Overall PET symptom improvement were reported for ventilation tube insertion (79 cases, mean: 58%, 95% CI: 47–69%), mass loading of the tympanic membrane (43 cases, mean: 50%, 95% CI: 32–69%), ET injection (139 cases, mean: 47%, 95% CI: 38–56%), plug surgery (386 cases, mean: 81%, 95% CI: 77–85%), shim surgery (122 cases, mean: 62%, 95% CI: 53–70%), tuboplasty (105 cases, mean: 41%, 95% CI: 31–51%), and ET closure (40 cases, mean: 66%, 95% CI: 49–80%). A low incidence of minor complications was reported.Conclusions: This systematic review describes clinical outcome data following surgical management of PET. Plug surgery and shim surgery show relatively high effectiveness and safety. Further prospective studies that compare surgical approaches for PET are needed.

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Hearing Outcomes of Treatment for Acute Noise-induced Hearing Loss: A Systematic Review and Meta-analysis

Koochakzadeh, Sina; Gupta, Avigeet; Nguyen, Shaun A.; McRackan, Theodore R.; Kil, Jonathan; Bhenswala, Prashant N.; Lambert, Paul R.

Publicatie 01-09-2020


Objective: To determine the efficacy of various treatment modalities used for acute noise-induced hearing loss (aNIHL) from acute acoustic trauma (AAT) via a systematic review and meta-analysis.Data Sources: PubMed, Cochrane, and Scopus databases.Study Selection: The scientific literature was searched up to October 2018 for articles evaluating hearing outcomes after treatment of aNIHL.Data Extraction: The following were extracted: Oxford level of evidence, number of patients, mean age, time to presentation, source of noise exposure, method of treatment/intervention, baseline hearing threshold, posttreatment hearing threshold, hearing gain, proportion of patients with no recovery, partial recovery, or complete recovery, and treatment complications.Data Synthesis: Sixteen studies with 932 patients met inclusion criteria for systematic review and four studies with 187 patients were included in the meta-analysis.Conclusions: Treatment modalities identified were steroids, vascular agents, nootropics, antioxidants, vitamins, cell apoptosis inhibitors, and hyperbaric oxygen therapy. Meta-analysis demonstrated significant improvement in mean hearing threshold for patients with high-frequency hearing loss, those treated within 48 hours, and those receiving treatment with a nootropic agent. Significant heterogeneity was present in experimental design among included studies and many were of lower levels of evidence. More prospective, large scale, randomized, double-blinded, placebo-controlled clinical trials are required to determine optimal treatment regimens for patients suffering from aNIHL caused by AAT.

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Quality of Otology and Neurotology Research in Otolaryngology Journals

Socolovsky, Leandro D.; Krishnan, Pavan; Ramraj, Rahul; Retnam, Reuben; Sima, Adam; Bauschard, Michael J.; Coelho, Daniel H.

Publicatie 01-09-2020


Objective: To identify trends in the quality of otology studies published in general otolaryngology journals over a 20-year period.Study Design: Retrospective analysis.Methods: Otologic and neurotologic papers from 1997, 2007, and 2017 were identified in the three general otolaryngology journals with the highest Eigenfactor scores: the Laryngoscope, European Archives of Otorhinolaryngology, and Otolaryngology–Head and Neck Surgery. The studies were reviewed and assigned level of evidence (LoE) based on standards set by the Centres for Evidence Based Medicine (CEBM). One-way analysis of variance were calculated with a 95% bootstrap sensitivity analysis performed.Results: A total of 786 otology articles were reviewed for level of evidence, of which 557 (70.8%) were original, clinical research, eligible for LoE assignation. Total publications increased for each year in all three journals. Both the absolute number and proportion of high evidence studies (level of evidence 1 and 2) increased with respect to time in all three journals. Lower evidence studies (level of evidence 3, 4, or 5) made up 66.8% of total publications in 2017. There was a reduction in average level of evidence (towards higher quality evidence) by 0.431 units from 1997 to 2017 (Diff = –0.431 between 1997 and 2017, p < 0.001). There was no significant difference in rate of change of level of evidence between 1997 and 2007 and 2007 and 2017 (0.033, p = 0.864).Conclusion: Over a 20-year period the number of total publications increased with time. The majority of otology publications in 2017 were lower evidence studies, though significant increases in the number and proportion of high evidence studies in general otolaryngology journals were observed throughout the study period.

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Hearing Disabilities and the Effectiveness of Rehabilitation in Different Age Groups

Jolink, Casper; Lansbergen, Simon E.; Dreschler, Wouter A.

Publicatie 01-09-2020


Objective: To assess differences in hearing disabilities between different age groups and the effectiveness of rehabilitation with hearing aids.Study Design: Retrospective chart review.Setting: First line hearing aid dispensers.Patients: First-time hearing aid users divided in a younger group aged 18 to 65 years (119 subjects) and an elderly group aged 70 years and older (213 subjects).Intervention(s): Rehabilitative.Main Outcome Measure(s): Weighted pure tone averages (PTA) were calculated using the binaural impairment model. The patient-reported outcome measures (PROMs) Amsterdam Questionnaire for Auditory Disabilities (AVAB), and client oriented scale of improvement (COSI) were collected pre- and post-fitting. To analyze whether age group, weighted PTA, and type of auditory dimension influences AVAB, linear regression and two-way ANalysis Of VAriance models were used.Results: The weighted PTA of the young group was significantly lower than of the elderly group. In the regression model differences between age groups were found to be significant for pre-AVAB and for AVAB benefit. The two-way ANalysis Of VAriance showed that the effect of age on pre- and post-AVAB scores was not influenced by PTA or the type of auditory dimension.Conclusions: Younger first-time hearing aid users experience more auditory disabilities, despite better hearing levels than their elderly counterparts. Their disabilities are rehabilitated more effectively by hearing aids.

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Can You Hear Me Now? The Impact of Hearing Loss on Patient Health Literacy

Tolisano, Anthony M.; Fang, Lilly B.; Isaacson, Brandon; Kutz, Joe Walter Jr; Hunter, Jacob B.

Publicatie 01-09-2020


Objective: To elucidate the impact of hearing loss on patient health literacy.Study Design: Prospective, cross-sectional study.Setting: Academic otology practice at a university hospital.Patients: Consecutive, adult, English-speaking patients.Main Outcome Measures: Inadequate health literacy, defined as a composite score of less than or equal to nine on the brief health literacy screen (BHLS), was compared with patient hearing data utilizing the American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS) hearing classification. Secondary outcome measures included comparisons of inadequate BHLS scores according to patient demographic and clinical information.Results: There were 300 consecutive adult (>18 years old) patients evaluated with the BHLS at a university otology practice between February and March 2019. The median patient age was 60-years (range, 18–91 yr), a slight majority (160, 53.3%) were women, and most patients were White (241, 86.7%) and non-Hispanic (260, 91.6%). Overall, 9.7% of patients were found to have inadequate health literacy. Men had higher rates of inadequate health literacy as compared with women (13.6% versus 6.3%, odds ratio OR = 2.35, 95% confidence interval CI 1.06–5.25). Audiometric data was available for 284 (95%) patients, of which 235 (82.7%) had class A or B hearing and 49 (17.3%) had class C or D hearing. Patients with Class C or D hearing had a lower median composite BHLS score compared with patients with Class A or B hearing (11.6 versus 13.6, p < 0.0001) and an increased rate of inadequate health literacy (28.6% versus 4.7%, OR = 8.15, 95% CI 3.42–19.37). Increased age, female sex, and better hearing were independent predictors of higher BHLS scores on multivariable analysis.Conclusions: Hearing loss is an independent risk factor for inadequate health literacy. Providers should be aware of this risk and consider implementing strategies to improve counseling for this at-risk group of patients.

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The Potential Added Value of Novel Hearing Therapeutics: An Early Health Economic Model for Hearing Loss

Mandavia, Rishi; Horstink, Yvette M.; Grutters, Janneke P.C.; Landry, Evie; May, Carl; Rovers, Maroeska; Schilder, Anne G.M.; Scholte, Mirre

Publicatie 01-09-2020


Objective: To construct an early health economic model to assess the potential added value of novel hearing therapeutics, compared with the current standard of care. We use idiopathic sudden sensorineural hearing loss (ISSNHL) as a case example, because it is a lead indication for several emerging hearing therapeutics.Methods: A decision analytic model was developed to assess the costs and effects of using novel hearing therapeutics for patients with ISSNHL. This was compared to the current standard of care. Input data were derived from literature searches and expert opinion. The study adopted a healthcare perspective of the UK National Health Service. Four analyses were conducted: 1) headroom, 2) scenario, 3) threshold, 4) sensitivity.Results: The decision analytic model showed that novel therapeutics for ISSNHL have potential value both in terms of improved patient outcomes, as well as incremental net monetary benefit (iNMB). The base case analysis revealed an iNMB of £39,032 for novel therapeutics compared with the current standard of care. Results of the threshold and scenario analysis revealed that age of treatment and severity of ISSNHL are major determinants of iNMB for novel therapeutics.Conclusion: This article describes the first health economic model for novel therapeutics for hearing loss; and shows that novel hearing therapeutics can be cost-effective under NICEs cost-effectiveness threshold, with considerable room for improvement in the current standard of care. Our model can be used to inform the development of cost-effective hearing therapeutics; and help decision makers decide which therapeutics represent value for money.

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Early Detection of High-frequency Presbycusis Among Normal Hearing Individuals

Aziz, Azliana; Md Daud, Mohd Khairi; Nik Othman, Nik Adilah; Abd Rahman, Normastura

Publicatie 01-09-2020


Background: Presbycusis is an age-related sensorineural hearing loss and it may reduce quality of life. We conducted a study to establish the prevalence of high-frequency presbycusis in normal hearing individuals and to validate the role of extended high-frequency distortion product otoacoustic emission (DPOAE) in the screening.Method: A cross-sectional study was conducted among 205 normal hearing adult participants with an age range between 25 and 54 years old. Hearing analysis with extended high-frequency pure-tone audiometry (PTA) and high-frequency DPOAE was carried out for all eligible participants. High-frequency presbycusis was considered to be present when the impairment of more than 25 dB occurs at higher than 8 kHz frequencies on both ears.Results: : Prevalence of high-frequency presbycusis using extended PTA was 31.7 (95% CI: 25.3, 38.1) and using high-frequency DPOAE was 57.4 (95% CI: 50.7, 64.4). The sensitivity and specificity of high-frequency DPOAE in detecting high-frequency presbycusis were 72.3 and 49.3% respectively with positive predictive value of 39.8% and negative predictive value of 79.3%. The association between age and high-frequency presbycusis was significant based on high-frequency DPOAE (p = 0.029).Conclusions: : The prevalence of high-frequency hearing loss is higher with increasing in age. High-frequency DPOAE may be used as a screening tool followed by confirmation using extended PTA. The early detection of presbycusis is important so that measures can be taken to prevent more severe problems developing.

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Pain After Cochlear Implantation Without Signs of Inflammation: A Systematic Review

Sethi, Mantegh; Hammond-Kenny, Amy; Vijendren, Ananth; Borsetto, Daniele; Barker, Eleanor J.; Tysome, James R.; Donnelly, Neil; Axon, Patrick; Bance, Manohar

Publicatie 01-09-2020


Objectives: This review summarizes current evidence on causes and management strategies for delayed pain post-cochlear implantation (CI) surgery, without clinical evidence of inflammation or infection.Methods: The systematic review was undertaken in line with Preferred Reporting Items for Systematic review and Meta-Analysis Protocols 2015 guidelines. A literature search was undertaken, with inclusion of patients who underwent CI and presented with delayed pain (>3 months post-operatively) around their device site without an identifiable cause. Analysis was undertaken using MATLAB (MathWorks, Natick, MA) and the R-software package (www.r-project.org).Results: 4 articles (48 patients), all retrospective case series, met inclusion criteria. The mean onset of pain post-CI was 60 months and mean follow-up was 15.8 months, there was no difference in the prevalence of pain between device brands (p=0.13). The majority (90%) did not have any hearing deterioration, and investigations did not reveal a cause for the pain in any of the patients. In terms of management, medical therapies, including oral therapy (analgesia, non-steroidal anti-inflammatories, antibiotics) and local treatments (topical, injections) resolved pain in 41% and 63%, respectively. Surgical intervention (explantation, magnet replacement, tympanic neurectomy), where undertaken, resolved pain in 100%. A minority had an identifiable infective microorganism cultured from intra-operative soft tissue or biofilm samples.Conclusions: Evidence for the causes and management of delayed pain post-CI without clinical evidence of inflammation is scarce. A stepwise approach is deemed best, with decisions being made on an individual basis, evaluating each patients specific circumstances and priorities. Further evaluation of explanted devices would allow for better understanding of the causes and treatment of this group of patients.

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Factors Influencing Aberrant Facial Nerve Stimulation Following Cochlear Implantation: A Systematic Review and Meta-analysis

Van Horn, Adam; Hayden, Chistopher; Mahairas, Anthony D.; Leader, Preston; Bush, Matthew L.

Publicatie 01-09-2020


Objective: The purpose of this study was to systematically evaluate the literature to evaluate the rate of and associated factors with aberrant facial nerve stimulation (AFNS) following cochlear implantation. Additionally, management strategies for AFNS were assessed.Data Sources: A systematic search was performed in PubMed, Cochrane Database of Systematic Reviews, and Web of Science to identify peer reviewed research.Study Selection: Eligible studies were those containing peer-reviewed research in English addressing AFNS following cochlear implantation. Studies with paired data were included in the meta-analysis.Data Extraction: Three investigators independently reviewed all articles and extracted data. Bias was assessed using the National Institutes of Health Study Quality Assessment Tool.Data Synthesis: Thirty-seven articles were included, representing 5,694 patients. The overall reported AFNS rate was 5.6% (range, 0.68–43%). Array type demonstrated a significant association with AFNS with lateral wall electrodes having a higher odds ratio than perimodiolar electrodes (odds ratio OR = 3.92, 95% confidence interval CI 1.46–10.47, p = 0.01). CI recipients with otosclerosis were also more likely to experience AFNS compared with non-otosclerosis pathology (OR = 13.73, 95% CI 3.57–52.78, p < 0.01). Patients with cochlear malformations had an overall AFNS rate of 28% (range, 5.3–43%) and those with otosclerosis had an overall rate of 26% (range, 6.25–75%). Reprogramming with or without electrode deactivation was successful for AFNS elimination. Four patients of 3,015 required explantation.Conclusion: Array type and underlying cochlear pathology are associated with AFNS and implant reprogramming is an overall successful management strategy. Further research is needed to elucidate mechanism of AFNS and develop management strategies that limit impact on hearing outcomes.

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Hearing Preservation Outcomes With Standard Length Electrodes in Adult Cochlear Implantation and the Uptake of Electroacoustic Stimulation

Harrison, Laura; Manjaly, Joseph G.; Ellis, Wayne; Lavy, Jeremy A.; Shaida, Azhar; Khalil, Sherif S.; Saeed, Shakeel R.

Publicatie 01-09-2020


Background: Cochlear implantation with preservation of residual low-frequency hearing enables patients to utilize acoustic and electrical stimulation. It is widely accepted that preservation of residual low-frequency hearing is beneficial in both background noise and for music appreciation. The extent to which patients may benefit is not fully understood, but the importance of these concepts is reflected in electrode design developments and also refinement of surgical technique. Greater understanding is needed around factors that may affect hearing preservation. This study reports experience in adults using standard length cochlear implant arrays.Objective: The study reviews hearing preservation outcomes using the HEARRING GROUP method for factors such as gender, electrode type, insertion depth, laterality, preoperative hearing level, and time between surgery and audiogram. Furthermore, the study reviews rates of electroacoustic stimulation use in those with postoperative functional residual low-frequency hearing.Methodology: Retrospective case series. Inclusion criteria: preoperative ≤ 85 dB HL at 250 Hz and aged ≥ 18 years. The hearing preservation percentages were calculated using the HEARRING group formula S=1 − ((PTApost − PTApre)/(PTAmax − PTApre))∗100%. Preservation of > 75% was considered complete, 25 to 75% partial, and 1 to 25% minimal. Standardized operative technique with facial recess approach, posterior tympanotomy, and minimally traumatic round window insertion was performed for each implant.Results: Fifty-three implantations in 52 patients met the inclusion criteria. The mean age at implantation was 55.5 years. The average time since the last audiogram was 10 months. The mean average total pre and postoperative pure-tone averages were 92.4 dB, 99.2 dB, respectively, using minimum reporting standards for adult cochlear Implant (CI). Thirty percent demonstrated complete hearing preservation, 35.8% partial hearing preservation, and 20.8% minimal hearing preservation. Overall, mean hearing preservation was 52.9%. Sex, age at implantation, insertion depth, lateral versus perimodiolar electrode, and preoperative hearing level did not statistically significantly affect rates of hearing preservation in our study. There was a statistically significant deterioration in hearing preservation outcomes difference at 3 months compared with 12 months postoperatively. Only two patients within our study out of 17 with functional postoperative hearing went on to use electroacoustic stimulation.Conclusion: Hearing preservation varies between patients and postoperative outcomes are difficult to predict. This study adds to existing literature in terms of likelihood of hearing preservation following cochlear implantation. In turn, this improves our ability to counsel patients as to the chances of preserving residual low-frequency hearing postoperatively and their ability to use electroacoustic stimulation.

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Insertion Depth for Optimized Positioning of Precurved Cochlear Implant Electrodes

Banalagay, Rueben A.; Labadie, Robert F.; Chakravorti, Srijata; Noble, Jack H.

Publicatie 01-09-2020


Hypothesis: Generic guidelines for insertion depth of precurved electrodes are suboptimal for many individuals.Background: Insertion depths that are too shallow result in decreased cochlear coverage, and ones that are too deep lift electrodes away from the modiolus and degrade the electro-neural interface. Guidelines for insertion depth are generically applied to all individuals using insertion depth markers on the array that can be referenced against anatomical landmarks.Methods: To normalize our measurements, we determined the optimal position and insertion vector where a precurved array best fits the cochlea for each patient in an IRB-approved, N = 131 subject CT database. The distances from the most basal electrode on an optimally placed array to anatomical landmarks, including the round window (RW) and facial recess (FR), was measured for all patients.Results: The standard deviations of the distance from the most basal electrode to the FR and RW are 0.65 mm and 0.26 mm, respectively. Owing to the high variability in FR distance, using the FR as a landmark to determine insertion depth results in >0.5 mm difference with ideal depth in 44% of cases. Alignment of either of the two most proximal RW markers with the RW would result in over-insertion failures for >80% of cases, whereas the use of the third, most medial marker would result in under-insertion in only 19% of cases.Conclusions: Normalized measurements using the optimized insertion vector show low variance in distance from the basal electrode position to the RW, thereby suggesting it as a better landmark for determining insertion depth than the FR.

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Hearing Preservation With a New Atraumatic Lateral Wall Electrode

Lenarz, Thomas; Buechner, Andreas; Lesinski-Schiedat, Anke; Timm, Max; Salcher, Rolf

Publicatie 01-09-2020


Introduction: Many individuals have some residual hearing which should be preserved with cochlear implantation. To achieve this goal electrode arrays must fulfil certain design requirements. A new thin lateral wall electrode array (HiFocus SlimJ) was systematically designed on the basis of μCT studies of human cochlea anatomy. The primary objective of this study was to report on initial retrospective hearing preservation results from a cohort of subjects consecutively implanted with this electrode. Secondary objectives were to report on insertion depth and speech perception results for this new array.Methods: Twenty subjects with considerable residual hearing in low frequencies were consecutively implanted with the SlimJ electrode array. The electrode was inserted slowly through the round window and the insertion process was controlled by intracochlear electrocochleography measuring cochlear microphonics through the cochlear implant.Postoperative cone beam computed tomography was conducted and precise scalar location and angular insertion depth was estimated following image fusion with the preoperative images.Results: Low frequency hearing at 1 month postsurgery was preserved within 30 dB HL in 85% of subjects and within 15 dB HL in 50% of subjects. Mean angular insertion depth was 393 degrees (SD 62 degrees) with a range from 294 to 520 degrees. All electrode contacts in all subjects were identified within scala tympani.Conclusion: The SlimJ electrode array is easy to handle for atraumatic insertion through the round window, adjusted insertion depth controlled by electrocochleography measurements, and reliable fixation at the posterior tympanotomy. Hearing preservation rates are encouraging on the short term. We aim to further report on larger data sets and long-term outcomes.

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Cochlear Implantation for Treatment of Tinnitus in Single-sided Deafness: A Systematic Review and Meta-analysis

Levy, Dylan A.; Lee, Joshua A.; Nguyen, Shaun A.; McRackan, Theodore R.; Meyer, Ted A.; Lambert, Paul R.

Publicatie 01-09-2020


Objective: Quantify the benefit of cochlear implantation (CI) for tinnitus relief among individuals with single-sided deafness (SSD).Data Sources: PubMed, Scopus, and Cochrane databases were searched through July 10, 2019. Search strategies used a combination of subject headings (e.g., MeSH in PubMed) and keywords for the following three concepts: single-sided deafness, cochlear implantation, and tinnitus.Study Selection: English articles that reported the preintervention (baseline) tinnitus-related patient-reported outcome measures (e.g., Tinnitus Handicap Inventory THI and Visual Analog Scale VAS for loudness) in patients with SSD that underwent CI were included.Data Extraction: Number of patients, mean age, etiology of hearing loss, duration of deafness, baseline and follow-up THI and VAS scores.Data Synthesis: A total of 17 studies met inclusion criteria encompassing 247 patients with SSD receiving a cochlear implant (mean age 50.2 yr, range 23–71). For THI, CI resulted in a mean difference of –35.4 points 95% CI –55.8 to –15.0, p < 0.001. VAS decreased by –4.6 points CI –6.0 to –3.3, p < 0.001. A weighted proportion of 14.9% CI 6.4–26.1 of patients experienced complete resolution of tinnitus, while 74.5% CI 63.1–84.5 experienced partial improvement; 7.6% CI 4.1–12.6 of patients had no change in severity, and 3.0% CI 1.0–6.7 experienced worsening of their tinnitus.Conclusions: On both THI and VAS, patients reported significant reduction in their scores, representing an overall improvement in tinnitus severity while wearing the cochlear implant. Most patients with SSD will experience partial improvement or complete resolution of tinnitus with a cochlear implant.

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Predicting Postoperative Cochlear Implant Performance Using Supervised Machine Learning

Crowson, Matthew G.; Dixon, Peter; Mahmood, Rafid; Lee, Jong Wook; Shipp, David; Le, Trung; Lin, Vincent; Chen, Joseph; Chan, Timothy C. Y.

Publicatie 01-09-2020


Objectives: To predict postoperative cochlear implant performance with heterogeneous text and numerical variables using supervised machine learning techniques.Study Design: A supervised machine learning approach comprising neural networks and decision tree-based ensemble algorithms were used to predict 1-year postoperative cochlear implant performance based on retrospective data.Setting: Tertiary referral center.Patients: One thousand six hundred four adults who received one cochlear implant from 1989 to 2019. Two hundred eighty two text and numerical objective demographic, audiometric, and patient-reported outcome survey instrument variables were included.Outcome Measures: Outcomes for postoperative cochlear implant performance were discrete Hearing in Noise Test (HINT; %) performance and binned HINT performance classification (“High,” “Mid,” and “Low” performers). Algorithm performance was assessed using hold-out validation datasets and were compared using root mean square error (RMSE) in the units of the target variable and classification accuracy.Results: The neural network 1-year HINT prediction RMSE and classification accuracy were 0.57 and 95.4%, respectively, with only numerical variable inputs. Using both text and numerical variables, neural networks predicted postoperative HINT with a RMSE of 25.0%, and classification accuracy of 73.3%. When applied to numerical variables only, the XGBoost algorithm produced a 1-year HINT score prediction performance RMSE of 25.3%. We identified over 20 influential variables including preoperative sentence-test performance, age at surgery, as well as specific tinnitus handicap inventory (THI), Short Form 36 (SF-36), and health utilities index (HUI) question responses as the highest influencers of postoperative HINT.Conclusion: Our results suggest that supervised machine learning can predict postoperative cochlear implant performance and identify preoperative factors that significantly influence that performance. These algorithms can help improve the understanding of the diverse factors that impact functional performance from heterogeneous data sources.

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OTOPLAN in Cochlear Implantation for Far-advanced Otosclerosis

Lovato, Andrea; Marioni, Gino; Gamberini, Lisa; Bonora, Chiara; Genovese, Elisabetta; de Filippis, Cosimo

Publicatie 01-09-2020


Aim: To evaluate OTOPLAN software in the surgical planning of far-advanced otosclerosis (FAO) candidates to cochlear implant (CI) were considered. We aimed to preliminarily investigate if this software could influence the electrode length choice, or predict surgical difficulties.Methods: We reviewed the outcome of five consecutive FAO patients that underwent unilateral CI. OTOPLAN was used to evaluate preoperative computed tomography imaging. A comparison was made with historical data (eight FAO patients).Results: The mean cochlear duct length estimated by OTOPLAN was 32.4 mm. Evaluating OTOPLAN reconstructed images, we ruled out cochlear lumen fibrosis/ossification in three FAO patients and the longest electrodes according to cochlear dimensions were preferred. We disclosed fibrosis in the middle and apical turns of two patients. These findings allowed us to change surgical plans, choosing a shorter electrode (24 and 28 mm instead of 31 mm) to avoid incomplete insertion due to cochlear fibrosis. OTOPLAN reconstructed images identified preoperatively the two patients with round window niche ossification that required additional drilling during surgery. In the present series, we experienced no incomplete insertion. In two cases out of eight historical FAO patients, array insertion (24 mm) was incomplete. One years after unilateral CI, the mean speech reception threshold and disyllabic word recognition score of the five considered FAO patients were 36 dB and 94%, respectively (39 dB and 84% for the eight historical patients). There was no facial nerve stimulation or any other complication during the 1-year follow-up.Conclusion: According to our preliminary results, OTOPLAN was useful for the appropriate choice of array length.

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Impedance Values Do Not Correlate With Speech Understanding in Cochlear Implant Recipients

Prenzler, Nils K.; Weller, Tobias; Steffens, Melanie; Lesinski-Schiedat, Anke; Büchner, Andreas; Lenarz, Thomas; Warnecke, Athanasia

Publicatie 01-09-2020


Objective: To evaluate a possible correlation between impedance values and speech perception after cochlear implantation.Study Design: Retrospective chart review.Setting: Tertiary referral center.Patients and Intervention: All patients implanted with a MedEl Flex28 device in our department with complete audiometric data (Freiburger monosyllabic testing at 65 dB, Hochmaier–Schulz–Moser testing in quiet and in 10 dB noise) and impedance measurements at the 1-year refitting appointment were enrolled in this study. Further inclusion criteria were age > 17 years, native speakers, and no use of electric-acoustic-stimulation.Main Outcome Measures: Mean values for impedances were calculated over all electrode contacts and separately for basal, medial, and apical regions. These data were correlated statistically (Pearsons correlation) with speech testing results. Furthermore, groups of patients with extreme values were built and compared against each other and against the rest of the collective.Results: Impedance values did not correlate significantly with speech performance in any of the audiometric tests neither for all electrode contacts nor for specific clusters of contacts. Patients with the lowest impedances did not perform statistically different than patients with the highest impedances in any condition.Conclusion: To our knowledge, this is the first data on a possible correlation between impedances and speech perception. The extent of the impedances as a benchmark for a good performance in speech discrimination tests could not be verified. Further prospective studies, possibly with more precise diagnostic tools, should be carried out to define the value of impedance measurements for cochlear implantation provision.

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T-tubes Through Cartilage Tympanoplasty: Is It Worth the Perforation Risk?

Gibson, Anna Celeste; Page, Joshua Cody; Jervis-Bardy, Joshua; King, DeAnne; Dornhoffer, John L.

Publicatie 01-09-2020


Objective: To review a single surgeons experience with T-tube placement through cartilage tympanoplasty versus native tympanic membrane for long-term ventilation of the chronic ear and residual perforation rates following tube removal.Study Design: Retrospective chart review.Setting: Two tertiary referral centers.Patients: One hundred sixteen patients (4–71 yr of age) who underwent either total island cartilage tympanoplasty or posterior palisade cartilage tympanoplasty with T-tube placement primarily or secondarily from 1998 to 2016.Main Outcome Measures: Long-term outcome of each T-tube was recorded with respect to retention and patency, and tympanic membrane status following either tube removal or extrusion. Audiometric data, age, sex, diagnosis, and procedure(s) performed were considered.Results: There were 116 patients (122 total ears and 139 total T-tubes) included: 57 ears underwent total island cartilage tympanoplasty with tube placed through cartilage and 65 ears underwent posterior island graft with tube placed through native tympanic membrane. Sixty-eight T-tubes were placed in the total island cartilage group with three (4.4%) residual perforations following removal. Seventy-one T-tubes were placed in the posterior palisade graft group with six residual perforations (8.5%) following removal or extrusion. The mean retention rate for the T-tubes was 3.93 years for the total island tympanoplasty group and 3.58 years for the posterior palisade tympanoplasty group. The mean follow-up for total island tympanoplasty and posterior palisade tympanoplasty was 5.36 and 5.66 years, respectively.Conclusion: Our data suggest that T-tube placement through cartilage tympanoplasty is worthwhile providing long-term ventilation to the middle ear and portends no higher risk for residual perforation than T-tube placement through native tympanic membrane.

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Tympanoplasty With or Without Balloon Eustachian Tuboplasty for Chronic Suppurative Otitis Media With Obstructive Eustachian Tube Dysfunction

Hsieh, Cheng-Yu; Chang, Chan-Jung; Sun, Chuan-Hung; Lee, Chee-Yee; Gotamco, Giselle L.; Hsu, Chuan-Jen; Wu, Hung-Pin

Publicatie 01-09-2020


Objective: To further elucidate the role of balloon Eustachian tuboplasty (BET) in tympanoplasty, we conducted a study to compare the outcomes of tympanoplasty with and without BET for the treatment of chronic suppurative otitis media (CSOM) with obstructive Eustachian tube dysfunction (OETD).Study Design: Case control study.Setting: Tertiary referral center.Patients: A total of 70 ears diagnosed with CSOM (tubotympanic type) and OETD were included in this study. Thirty-five patients were prospectively enrolled for BET and tympanomastoidectomy between February 2018 and June 2019. Thirty-five control subjects were matched by sex and age and retrospectively enrolled for tympanomastoidectomy between July 2016 and January 2018.Interventions: BET, tympanomastoidectomy.Main Outcome Measures: The graft take rate, hearing levels, and Eustachian tube function test results.Results: The graft take success rate was higher in the BET group (80.0%; 28/35) than in the control group (68.6%; 24/35). However, the difference was not statistically significant. The average air-bone gap (ABG) improvement was 10.93 ± 7.70 dB in the BET group and 7.11 ± 8.08 dB in the control group, with a statistically significant between-group difference (p = 0.033).Conclusions: Our findings suggest that BET can objectively and subjectively improve the Eustachian tube function, with a slight but significant improvement in ABG despite the lack of a clinically significant improvement overall. However, it does not affect the graft take rate. In summary, BET could be used as an adjunctive procedure in the treatment of CSOM with OETD.

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The National Landscape of Acute Mastoiditis: Analysis of the Nationwide Readmissions Database

Schwam, Zachary G.; Ferrandino, Rocco; Kaul, Vivian Z.; Omorogbe, Aisosa; Bu, Daniel; Faddoul, Daniel-Georges; Cosetti, Maura K.; Wanna, George B.

Publicatie 01-09-2020


Objective: To determine risk factors for readmission, prolonged length of stay, and discharge to a rehabilitation facility in patients with acute mastoiditis. Trends in treatment and complication rates were also examined.Study Design: Retrospective cohort study.Setting: Nationwide Readmissions Database (2013, 2014).Patients: Pediatric and adult patients in the Nationwide Readmissions Database with a primary diagnosis of acute mastoiditis.Interventions: Medical treatment, surgical intervention.Outcome Measures: Rates of and risk factors for readmission, prolonged length of stay, and discharge to a rehabilitation facility. Procedure and complication rates were also examined.Results: Four thousand two hundred ninety-five pediatric and adult admissions for acute mastoiditis were analyzed. The overall rates of readmission, prolonged length of stay, and discharge to a rehabilitation facility were 17.0, 10.4, and 10.2%, respectively. Children 4 to 17 years of age had the highest rates of intracranial complications, and children ≤3 years were most likely to undergo operative intervention. Any procedure was performed in 31.2% of cases, and undergoing myringotomy or mastoidectomy was associated with lower rates of readmission but higher rates of prolonged length of stay. Those with intracranial complications and subperiosteal abscesses had the highest surgical intervention rates.Conclusions: Readmission, prolonged length of stay, and discharge to a rehabilitation facility are common in patients with acute mastoiditis with various sociodemographic and disease-related risk factors. While once a primarily surgical disease, a minority of patients in our cohort underwent procedures. Undergoing a surgical procedure was protective against readmission but a risk factor for prolonged length of stay.

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Uniform Registration Agreements on Cholesteatoma Care: A Nationwide Consensus Procedure

ten Tije, Fleur A.; Pauw, Robert J.; Braspenning, Jozé C.; Hemler, Raphael J. B.; ter Schiphorst, Annette J.; Hensen, Erik F.; van der Putten, Lisa; Kramer, Sophia E.; Merkus, Paul

Publicatie 01-09-2020


Background: To coordinate and align the content for registration of cholesteatoma care.Methods: Systematic Delphi consensus procedure, consisting three rounds: two written sessions followed by a face-to-face meeting. Before this procedure, input on important patient outcomes was obtained. Consensus was defined as at least 80% agreement by participants. Hundred-thirty-six adult patients who had undergone cholesteatoma surgery and all ENT surgeons of the Dutch ENT Society were invited. The consensus rounds were attended by ENT surgeons with cholesteatoma surgery experience. Feasibility and acceptability of outcome measures and reporting agreements were assessed in round 1 by 150 ENT surgeons. In round 2 definitions were narrowed and context information to interpret outcome measure were questioned. In round 3, the results, amendments, and the open-ended points were discussed to reach agreement.Results: Most important outcome measures are: 1) the presence or absence of a cholesteatoma in the first 5 years after surgical removal of cholesteatoma, 2) hearing level after surgical removal of cholesteatoma, and 3) the documented assessment of patients complaints with a validated patient reported outcome measures questionnaire (PROM). Furthermore, consensus was reached on the registration of cholesteatoma type (residual/recurrent), localization of cholesteatoma, and reporting of the presence of cholesteatoma in the follow-up.Conclusion: Consensus was reached on the content and method of registration of cholesteatoma care based on patients and ENT surgeons input. Three outcome measures were defined. National agreements on the method and content of registration will facilitate monitoring and feedback to the ENT surgeon about the cholesteatoma care.

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Trends in Opioid Usage Following Tympanoplasty and Mastoidectomy

Mahairas, Anthony D.; Neff, Ryan; Craker, Nikki; McNulty, Beth N.; Shinn, Jennifer B.; Bush, Matthew L.

Publicatie 01-09-2020


Objective: Evaluate opioid prescribing patterns following tympanoplasty/mastoidectomy and assess factors associated to recurrent opioid use.Study Design: Retrospective cohort study.Setting: National pharmaceutical database recording opioid fulfillment (Truven Health Marketscan Commercial Claims/Encounters and Medicare Claims/Encounters database).Participants: Patients who 1) underwent tympanoplasty and/or mastoidectomy, 2) filled postoperative opioid prescriptions between 2011 and 2016, and 3) had no opioid prescriptions filled 60 days before surgery. Cohort 1 filled only one prescription and cohort 2 filled more than one prescription in the 12 months following surgery. Univariate/multivariate analysis was performed to assess for associations with recurrent opioid use.Main Outcome Measure(s): Opioid prescription details and recurrent opioid use.Results: The study included 398 patients (cohort 1 = 233, cohort 2 recurrent opioid user = 165). Hydrocodone 5 mg was most frequently used. The average duration opioids were prescribed was 5.8 days with an average quantity of tablets of 36.51. Recurrent opioid use in cohort 2 was associated with total morphine milligram equivalents prescribed/d in the first postoperative week (odds ratio OR = 1.02, p < 0.001), post-op chronic pain disorder (OR = 2.00, p = 0.04), post-op substance abuse (OR = 2.12, p = 0.05), and post-op anxiety (OR = 1.96, p = 0.02).Conclusion: Recurrent opioid use following tympanoplasty/mastoidectomy is associated with the amount prescribed per day but not opioid type or duration of treatment. Postoperative diagnoses such as chronic pain disorder, substance abuse, or anxiety could be predictive of or coexistent with recurrent opioid use. Limiting opioids prescribed per day and use of anti-inflammatory medications could decrease the risk of recurrent opioid use.

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Patient-specific 3D-printed Model-assisted Supracochlear Approach to the Petrous Apex

Takahashi, Kuniyuki; Morita, Yuka; Aizawa, Naotaka; Ogi, Manabu; Nonomura, Yoriko; Kitazawa, Meiko; Yagi, Chihiro; Ohshima, Shinsuke; Izumi, Shuji; Yamagishi, Tatsuya; Horii, Arata

Publicatie 01-09-2020


Objective: To present a case of pediatric cholesteatoma that invaded the petrous apex (PA) and discuss the usefulness of preoperative three-dimensional (3D) surgical simulation on a personal computer (PC) and patient-specific 3D printed model-assisted surgery.Patient: A 5-year-old boy with congenital cholesteatoma underwent a planned two-stage canal wall up mastoidectomy. The cholesteatoma had invaded the PA from a small space anterior to the superior semicircular canal (SSCC). During the removal of this lesion in the first surgery, the tip of a 1-mm round knife broke off and fell into the PA. The surgeon could not remove it, as it was thought that opening the space might damage the SSCC and the facial nerve (FN).Intervention: Before the second surgery, a preoperative 3D surgical simulation on a PC was performed, and an approach to the PA via the triangle surrounded by the SSCC, FN, and middle cranial fossa, namely, the supracochlear approach, was discovered. A patient-specific 3D-printed model, which had been drilled to make each surface of the triangle including the SSCC, FN, and middle cranial fossa visible in the PC simulation surgery, was then created and a 3D-printed model-assisted surgery was planned.Results: By placing the sterilized patient-specific 3D model close to the surgical field, the cholesteatoma and iatrogenic foreign body could be successfully removed from the PA without damaging the important surrounding structures.Conclusions: Preoperative 3D surgical simulations and intraoperative patient-specific 3D-printed model-assisted surgeries are new, powerful tools that aid in performing challenging surgeries on temporal bones.

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Current Management of CPAP After Otologic and Neurotologic Surgery

Cass, Nathan D.; Babu, Seilesh C.

Publicatie 01-09-2020


Background: Obstructive sleep apnea is a highly prevalent disorder often treated with continuous positive airway pressure (CPAP). CPAP transmits high pressures through the Eustachian tube, and has significant implications for patients undergoing surgery of the middle ear, inner ear, and lateral skull base. In such patients, nothing is known regarding the likelihood of surgical complications with CPAP use, or medical complications with its cessation. No consensus or guidelines exist for postoperative management of this vitally important but potentially hazardous therapy.Objective: To gain an understanding of the current state of practice with regards to postoperative CPAP management in patients undergoing middle ear, stapes, cochlear implant, and lateral skull base surgeries.Methods: An electronic survey was sent to all members of the American Neurotology Society via email.Results: The survey was completed by 54 neurotologists. Duration of postoperative CPAP limitation had similar distribution for surgery of the middle ear, stapes, and skull base: fewer surgeons recommend immediate use, with more advising ≤1 week and ≥2 week abstinence. For cochlear implantation, immediate use is most commonly advocated. The rationale for restricting postoperative CPAP use varied by surgery type. Subgroup analysis showed no variations by region; however, surgeons with >15 years of experience tend to advocate for earlier return to CPAP than those with less experience.Conclusion: Current neurotology practice varies widely concerning CPAP management after otologic and neurotologic surgeries, both with regard to duration of CPAP abstinence and in rationale for its limitation.

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Surgical Treatment for Cerebrospinal Fluid Leaks in Patients With Inner Ear Malformations

Bois, Emilie; Demondion, Sophie; Elmaleh, Monique; François, Martine; Teissier, Natacha; Van Den Abbeele, Thierry

Publicatie 01-09-2020


Objective: The aim of this study is to present our technique of surgical closure in a series of patients suffering from cerebrospinal fluid (CSF) leak due to inner ear malformations.Study Design and Setting: We conducted a retrospective study in our tertiary care academic department of pediatric otolaryngology.Patients: We did include all patients who presented a CSF leak or bacterial meningitis (one episode or recurrent) related to a malformation of the inner ear.Intervention(s): Through a retro-auricular or endaural approach we performed a filling of the vestibule cavity with multiple fragments of cartilage with perichondrium introduced through the oval window, after stapedectomy until a near-complete sealing was obtained. After the surgery, all patients received a treatment with acetazolamide during 15 days.Main Outcome Measure(s): We did evaluate our technics with the recurrence of CSF leak.Results: Thirteen patients, from 1 to 14, were operated with our technics. With a follow-up of 4.4 ± 4.7 years, only one patient needed a second intervention. None had a novel episode of meningitis. We observed no complication. The leak was observed in the oval fossa in 11 cases.Conclusions: Our “minimally invasive” technique of vestibular obliteration with cartilage inserted through the oval window after stapedectomy did demonstrate its safety and reliability.

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A 3D-printed Lateral Skull Base Implant for Repair of Tegmen Defects: A Case Series

VanKoevering, Kyle Keith; Gao, Rebecca Weiwei; Ahmed, Sameer; Green, Glenn Edward; Arts, Henry Alexander

Publicatie 01-09-2020


Objective: To determine the feasibility of a patient-specific, three-dimensionally (3D)-printed reconstruction plate for repair of lateral skull base defects.Study Design: Prospective case series and cadaveric study.Setting: A university-based, tertiary care hospital.Patients: Three patients with lateral skull base defects and five cadavers.Main Outcome Measure(s): Caliper gauge fit testing was performed in the cadaver temporal bones to determine the fit of the tegmen plate in engaging the tegmen defect. Additionally, three patients underwent standard of care reconstruction of their middle fossa floor using autografts or allografts. Temporary plate insertion during standard operative repair was performed to gauge feasibility and fit. Operative time required for standard grafting compared with placement of the tegmen plate was examined.Results: Real-time, intraoperative placement of the tegmen plate in our patients under 1 minute compared with nearly 60 minutes for standard surgical repair. Tegmen plates covered the defects and locked into place from contour matching without impinging on critical structures. Fit testing revealed flush-fitting plates to the cadaveric temporal bone surface with all gaps less than 500 μm.Conclusions: Computer modeling and 3D printing can design custom fitted tegmen reconstruction plates for temporal bone defects. Versatility in prefabrication and 3D modeling shows potential in allowing the construct to avoid critical structures and adequately cover defects with high precision to the tegmen surface.

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The Relationship Between Vestibular Migraine and Motion Sickness Susceptibility

Abouzari, Mehdi; Cheung, Dillon; Pham, Tiffany; Goshtasbi, Khodayar; Sarna, Brooke; Tajran, Sarah; Sahyouni, Sammy; Lin, Harrison W.; Djalilian, Hamid R.

Publicatie 01-09-2020


Objectives: To determine the relationship between vestibular migraine (VM) and motion sickness (MoS) susceptibility and their comorbidity in a large student population, and to assess whether experiencing MoS is associated with higher susceptibility for VM.Methods: Surveys including Motion Sickness Susceptibility Questionnaire (MSSQ) and questions assessing migraine-related symptoms as well as family history of motion sickness and migraine headache were distributed to the university undergraduate students through Facebook and email. Diagnosis of definite VM (dVM) was based on the criteria of the International Classification of Headache Disorders.Results: Of 277 survey responders, 148 (53%) were found to be susceptible to MoS in which 74 (50%) met the criteria for dVM. Only childhood MSSQ score was significantly higher in participants with dVM compared with those without dVM (25.78 ± 15.89 versus 20.77 ± 14.28, p = 0.04); however, its significance faded out by regression analysis. Multivariate logistic regression showed having 1st degree relative with migraine headache (p = 0.02), neck stiffness (p = 0.001), and sinus pain, facial pressure, or headache with wind exposure (p = 0.02) to be independently associated with presence of dVM in MoS subjects.Conclusions: Though participants with MoS and dVM had significantly greater rates of migraine-related symptoms and family history of migraine headache compared with those with MoS only, childhood and adulthood MSSQ scores were similar. This and the high prevalence of dVM in our MoS cohort may suggest an existing association between MoS susceptibility and VM.

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Vestibular Evoked Myogenic Potential (VEMP) Test-retest Reliability in Children

Fuemmeler, Elizabeth; Rodriguez, Amanda I.; Thomas, Megan; Creutz, Tom; Fitzpatrick, Denis; Janky, Kristen L.

Publicatie 01-09-2020


Objective: Vestibular evoked myogenic potentials (VEMPs) are short-latency muscle potentials measured from the neck (cervical VEMP; cVEMP) or under the eyes (ocular VEMP; oVEMP), which provide information regarding function of the saccule and utricle, respectively. VEMPs are reliable when performed in adults; however, reliability of VEMPs in children is unknown. Therefore, the purpose of the study was to determine the test-retest reliability of c- and oVEMP testing in normal control children.Study Design: Prospective.Setting: Hospital.Patients: Ten adults, 14 adolescent children and 13 young children with normal hearing.Interventions: c- and oVEMP testing were completed across two test sessions in response to air-conduction 500 Hz tone-burst and impulse hammer stimuli. Additionally, oVEMP was completed using eyes-open and eyes-closed conditions.Main Outcome Measures: Intraclass correlation coefficients were calculated to determine the reliability of c- and oVEMP outcomes.Results: When using air-conduction stimuli, c- and oVEMP amplitudes are reliable across test sessions in normal control children and adults. With impulse hammer stimuli, cVEMP amplitudes showed high reliability; however, oVEMP amplitudes showed low reliability in both eyes-open and eyes-closed conditions. Comparison between eyes-open and eyes-closed oVEMP conditions revealed shorter latencies and higher peak-to-peak amplitudes in the eyes-open condition.Conclusions: In this small cohort of normal control children, cVEMPs are reliable using air-conduction and impulse hammer stimuli and oVEMPs are reliable using air-conduction stimuli in the eyes-open condition. oVEMP in eyes-closed conditions were less reliable compared with eyes-open conditions and resulted in a large number of absent responses.

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"What Clinicians Should Consider to Determine a More Beneficial Treatment Strategy for Small to Medium Sized Vestibular Schwannoma With Serviceable Hearing: A Single Surgeons Long-term Outcome of Microsurgery and Gamma Knife Radiosurgery"

Han, Moon-Soo; Jung, Shin; Lim, Sa-Hoe; Kim, In-Young; Moon, Kyung-Sub; Jung, Tae-Young; Jang, Woo-Youl

Publicatie 01-09-2020


Objective: The number of small to medium sized vestibular schwannoma (VS) patients presenting with serviceable hearing has steadily increased. There are various treatment strategies for small to medium sized VS, including microsurgery (MS), gamma knife radiosurgery (GKS), and serial observations using magnetic resonance imaging. In this study, we presented the long-term outcomes of patients with small to medium sized VS with serviceable hearing. We also evaluated the potential prognostic factors for hearing preservation and discussed appropriate treatment strategies.Methods: A retrospective review of 504 cases of all VS patients who underwent MS or GKS between 1993 and July 2019 was conducted. Surgical resection was performed on 267 patients using the retro-sigmoid approach and 55 (20.6%) of them were small to medium sized VS. GKS was performed on 237 patients and 175 (73.8%) of them were small to medium sized VS. Small to medium sized VS was defined as less than 25 mm in the greatest dimension. After applying the inclusion and exclusion criteria, 51 patients with small to medium sized VS with serviceable hearing were enrolled in this study and underwent either MS (n = 21) or GKS (n = 30). To define the clinical characteristics of the patients, clinical data at the time of treatment, age, sex, presenting symptoms, tumor location type, preoperative hearing status, posttreatment related complications, recurrence, and hearing loss progression-free survival data were collected.Results: In the MS group, the hearing preservation rate was 71.4% and the tumor control rate was 100%. In the GKS group, the tumor control rate was 93.3% and two patients experienced recurrence at a median interval of 41.5 months. Kaplan–Meier curves showed that the hearing progression-free survival rates at 1-, 3-, and 5-years following GKS were 80, 66.7, and 53.3%, respectively. The MS group had a higher hearing preservation rate at 5 years (71.4 versus 53.3%), but the difference did not reach statistical significance (p = 0.173). Hearing preservation was statistically significant when the preoperative hearing status was class A in the GKS group (p = 0.016), but it was not statistically significant in the MS group (p = 0.777). In the MS group, medial type VS had a higher hearing preservation rate (80%) than the lateral fundal extended type VS (63.6%), and this difference was almost close to statistical significance (p = 0.058). The GKS group had a higher occurrence of postoperative tinnitus (23.3%) than the MS group (9.5%).Conclusion: MS was more suitable for patients who are younger, have good physical status, good preoperative hearing status including AAO-HNS class B, and medial type VS. GKS was more suitable for patients who are elderly, have poor physical status, preoperative AAO-HNS class A hearing.

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MRI Monitoring of Residual Vestibular Schwannomas: Modeling and Predictors of Growth

Fieux, Maxime; Zaouche, Sandra; Rabaste, Sylvain; Riche, Benjamin; Maucort-Boulch, Delphine; Tringali, Stéphane

Publicatie 01-09-2020


Objectives: The aim was to model residual Vestibular Schwannoma (VS) over time to identify prognostic factors of postsurgical growth.Study Design: Multicenter retrospective study.Setting: Tertiary referral centers.Patients: A group of 135 patients who underwent incomplete resection for VS between January 2010 and December 2018. On magnetic resonance imaging (MRI) examinations at baseline (1 year after surgery), patients included were divided into two groups: near-total resection (NTR, 0.05 cm3). The extent of resection is a predictor of tumor growth (odds ratio OR = 4.85; for STR over NTR; p = 0.003), but the growth rate was significantly different between STR and NTR residues (p < 0.001). At first, over 2 years after surgery, STR residues decreased (–1.0% volume per year), whereas NTR ones grew (+8% per year). Then, both residues showed sign of regrowth.Conclusion: Postoperative recommendations should now include the natural history of VS residue after resection: even though the growth rate differs between STR and NTR residues, most VS residues showed no growth.

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Automatic Facial Recognition System Assisted-facial Asymmetry Scale Using Facial Landmarks

Lee, Se A.; Kim, Jin; Lee, Jeon Mi; Hong, Yu-Jin; Kim, Ig-Jae; Lee, Jong Dae

Publicatie 01-09-2020


Objectives: This study aimed to demonstrate the application of our automated facial recognition system to measure facial nerve function and compare its effectiveness with other conventional systems and provide a preliminary evaluation of deep learning-facial grading systems.Study Design: Retrospective, observational.Setting: Tertiary referral center, hospital.Patients: Facial photos taken from 128 patients with facial paralysis and two persons with no history of facial palsy were analyzed.Intervention: Diagnostic.Main Outcome Measures: Correlation with Sunnybrook (SB) and House–Brackmann (HB) grading scales.Results: Our results had good reliability and correlation with other grading systems (r = 0.905 and 0.783 for Sunnybrook and HB grading scales, respectively), while being less time-consuming than Sunnybrook grading scale.Conclusions: Our objective method shows good correlation with both Sunnybrook and HB grading systems. Furthermore, this system could be developed into an application for use with a variety of electronic devices, including smartphones and tablets.

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"A Structural Analysis of Tympanic Compartments of the Middle Ear in Patients With Downs Syndrome: A Temporal Bone Study"

Nogaki, Taketoshi; Paparella, Michael M.; Cureoglu, Sebahattin

Publicatie 01-09-2020


Hypothesis: There may be findings peculiar to the temporal bones of children with Downs syndrome (DS). The purpose of this study is to investigate the temporal bone histopathology of the children with DS.Background: Otitis media with effusion is a highly prevalent condition with DS. Knowledge of the volume of the tympanic compartments and the area of the tympanic isthmus might be important to find out the pathogenesis of highly prevalent otitis media with effusion in those patients.Methods: We compared the volume of the epitympanum, mesotympanum, and the areas of the tympanic isthmus and tympanic orifice of eustachian tube in temporal bones from patients with DS. We also investigated the eustachian tube histopathologically.Results: The mean volume of the epitympanum and the mesotympanum was significantly smaller in the DS group than the control group. We found no significant difference in the mean diameter of the protympanic opening and tympanic orifice between the two groups. The mean narrowest area of the aerated and bony tympanic isthmus also was not significantly different between the two groups. An immature development of eustachian tube and cartilage was seen. We found mesenchyme remaining at the epitympanum and/or mesotympanum in all specimens in the DS group, and in five specimens in the control group.Conclusion: In the presence of the small middle ear, poorly developed eustachian tube, and tensor muscle, a vicious circle occurs, making otitis media with effusion difficult to resolve.

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Potential Ototopical Antiseptics for the Treatment of Active Chronic Otitis Media: An In Vitro Evaluation

van Straten, Andries Francois; Blokland, Rachel; Loock, James William; Whitelaw, Andrew

Publicatie 01-09-2020


Objectives: Primary: to compare, in vitro, the antimicrobial activity of different antiseptic agents versus quinolone drops, against the common organisms of chronic otitis media.Secondary: to examine the possible role of pH on the antimicrobial activity of the antiseptic solutions.Methods: Three antiseptic powders (boric acid; iodine; and a 1:1 combination of these two) and four solutions (2% boric acid; 2% acetic acid; 3.25% aluminum acetate; and 5% povidone iodine) were tested against five bacteria and two fungi common in chronic otitis media, using both agar plates and the modified broth dilution method. These results were compared with the antimicrobial activity of quinolone drops.The potential role of pH of solutions was tested by reducing the acidity of the agents and repeating the broth dilution.Results: Of the powders, iodine, and iodine/boric acid combined, are very effective against all organisms. Boric acid powder showed moderate effectiveness against all organisms. All solutions performed poorly on the agar plates. 5% povidone iodine has good effectivity when tested with the broth dilution method. 3.25% aluminum acetate had the best activity against Pseudomonas aeruginosa.Conclusion: Boric acid powder and 5% povidone iodine solution show promise for clinical use. Boric acid powder has proven clinical effectiveness. 5% povidone iodine requires further clinical research. Although very effective in vitro, iodine powder is toxic to tissues and cannot be recommended for clinical use. The pH of solutions does not seem to play a significant role in their antimicrobial activity in vitro.

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"Effectiveness of Intratympanic Administration of Gentamicin in Unilateral MeniÈres Disease"

De Luca, Pietro; Ralli, Massimo; Scarpa, Alfonso; Cavaliere, Matteo; Gioacchini, Federico Maria; Cassandro, Ettore; Cassandro, Claudia

Publicatie 01-09-2020


No abstract available

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"Response to Letter to the Editor: “Effectiveness of Intratympanic Administration of Gentamicin in Unilateral meniÈres Disease”"

Yaz, Furkan; Ziylan, Fuat; Smeeing, Diederik P.J.; Thomeer, Hans G.X.M.

Publicatie 01-09-2020


No abstract available

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The Utility of Diffusion-weighted Imaging Sequences to Differentiate Aggressive From Benign Intracranial Neoplasms

Chen, Stephanie Y.; Shew, Matthew; Durakovic, Nedim; Buchman, Craig; Herzog, Jacques

Publicatie 01-09-2020


No abstract available

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Diagnosis of Stapedial Myoclonus Using Endoscopic Visualization

Barber, Samuel R.; Barbarite, Eric; Corrales, C. Eduardo

Publicatie 01-09-2020


Background: Stapedial myoclonus is an uncommon condition involving the rhythmic contraction of the stapedial tendon that may result in a host of symptoms, including tinnitus (1–3). There is a dearth of robust diagnostic modalities to diagnose stapedial myoclonus(4–7), and most patients are treated without definitive diagnosis(8-12). Herein, we hypothesize that stapedial myoclonus can be readily diagnosed by awake otoendoscopy (see Video, Supplemental Digital Content 1, http://links.lww.com/MAO/A997).Case Report: A 21-year-old healthy male professional singer presented with a rhythmic “thumping sound” heard in both ears for 5 years. Symptoms were triggered by singing and were worse on the right side. Work-up, including otologic exam, audiologic testing, and high resolution imaging, was unrevealing. Given symptomatology, stapedial tendon myoclonus was suspected.While awake in the operating room, an inferior myringotomy was made, and both 1.9 mm 0 and 30 degree 3-CCD Hopkins rod endoscopes were used to visualize the middle ear space using a transcanal approach. There was robust movement of the tendon with patient vocalization that corresponded precisely with the timing of tinnitus. The patient subsequently underwent transection of the right stapedial tendon under general anesthesia using otoendoscopic visualization. The pyramidal eminence was also removed to avoid future regeneration. The patient underwent an identical procedure on the contralateral ear 3 months later with complete resolution of symptoms bilaterally.Conclusion: Stapedial myoclonus was diagnosed by transtympanic otoendoscopy in an awake patient. This approach may be readily applied in awake patients suspected of having stapedial myoclonus. Transection of the stapedial tendon in these patients resolves tinnitus.

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Augmented Visualization Surgical Microscope Assisted Microvascular Decompression for Hemifacial Spasm

Roberts, Daniel S.; Parikh, Purven; Kashat, Lawrence; Bulsara, Ketan R.

Publicatie 01-09-2020


Microvascular decompression (MVD) is curative treatment for primary Hemifacial Spasm, in cases where a vascular loop impinges on the facial nerve. Surgical techniques for MVD may be extended to MVD of the glossopharyngeal nerve and trigeminal nerve in cases of primary glossopharyngeal neuralgia and trigeminal neuralgia. Stroke is a rare complication of these procedures that may occur during the separation of a vascular loop from nervous tissue, particularly when materials such as Teflon are used to separate the structures. Use of an augmented visualization surgical microscope and in vivo fluorescence provides the opportunity to perform an intraoperative “angiogram” to confirm vascular integrity after decompression and enhanced visualization of complex neurovascular anatomy. We report the first description of this novel approach to microvascular decompression for Hemifacial Spasm.SDC video link: http://links.lww.com/MAO/A998.Supplemental Digital Content is available in the text© 2020, Otology & Neurotology, Inc.

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