Otology Neurotology

Otology Neurotology

Book Review: Atlas of Cavityless Cholesteatoma Surgery: Vol I by K.P. Morwani, Madhuri Mehta

01-10-2019 – Sevy, Alexander B. G.

No abstract available

Non-contrast Magnetic Resonance Imaging for Diagnosis and Monitoring of Vestibular Schwannomas: A Systematic Review and Meta-analysis

01-10-2019 – Kim, Do Hyun; Lee, Seoungmin; Hwang, Se Hwan

Journal Article

Objective: This study aimed to evaluate the diagnostic accuracy of high-resolution T2-weighted magnetic resonance imaging (T2wi) in terms of detecting vestibular schwannoma compared with gadolinium-enhanced T1-weighted MRI (Gd
T1wi).
Data Sources: Five databases (PubMed, SCOPUS, Embase, the Web of Science, and the Cochrane database).
Data Selection: Two authors independently searched five databases up to January 2019 on diagnosis of vestibular schwannomas via T2wi.
Data Extraction: In the included studies, tumor diameters reported using T2wi were compared with those revealed by Gd
T1wi and correlation coefficients were calculated. Data on true-positives, true-negatives, false-positives, and false-negatives were extracted from the relevant articles. Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Inter-rater agreement among different observers and intra-rater agreement among different measurements made by a single observer was assessed.
Data Synthesis: Outcomes subjected to analysis included diagnostic accuracy (the diagnostic odds ratio); summary receiver operating characteristic curve and area under the curve values. The summary intra-class correlation coefficient was used for various random-effects models. The quality of each study was analyzed using the Quality Assessment of Diagnostic Accuracy Studies 2 tool.
Conclusions: T2wi performed without the use of a contrast agent is a highly accurate diagnostic and monitor tool compared with Gd
T1wi and also demonstrated high reliability. However, further studies are required to confirm the results of this study.

Reducing Artifacts in Intracochlear Pressure Measurements to Study Sound Transmission by Bone Conduction Stimulation in Humans

01-10-2019 – Borgers, Charlotte; Fierens, Guy; Putzeys, Tristan; van Wieringen, Astrid; Verhaert, Nicolas

Journal Article

Hypothesis: Intracochlear pressure (ICP) measurements during bone conduction (BC) stimulation may be affected by motion of the pressure sensor relative to the cochlear promontory bone, demonstrating the need to cement the sensor firmly to the cochlear bone.
Background: ICP is a promising measurement tool for investigating the cochlear drive in BC transmission, but its use is not yet standardized. Previous ICP studies have reported artificially increased pressure due to motion of the sensor relative to the temporal bone. The artifact can be reduced by firmly cementing the sensor to the bone, but this is destructive for the sensor. Previous studies used a custom-made sensor; the use of commercially available sensors, however, is more generic, but also more challenging to combine with the cement. Therefore, the goals of the current study are: firstly, to evaluate a non-destructive cementing method suitable for a commercially available sensor, and secondly, to investigate ICP measurements during BC stimulation in more detail.
Methods: To study the effect of sensor cementing, three fixation conditions were investigated on six fresh-frozen temporal bones: 1) alginate, 2) alginate and dental composite, 3) alginate and dental composite, released from micromanipulators. Pressures in scala tympani and vestibuli were measured simultaneously, while velocity measurements were performed on the cochlear promontory and sensor. The ratio between sensor and promontory bone velocity was computed to quantify the relative motion.
Results: For air conduction stimulation, results were in line with those from previous ICP studies, indicating that baseline measurements were valid and could be used to interpret the results obtained with BC stimulation. Results showed that cementing the sensors and releasing them from the micromanipulators is crucial for valid ICP measurements. When the sensors were only sealed with alginate, the pressure was overestimated, especially at low and mid-frequencies. When the sensors were cemented and held in the micromanipulators, the pressure was underestimated. Compared with the scala tympani measurements, ICP measurements showed a lower scala vestibuli pressure below 1 k
Hz, and a higher pressure above 1 k
Hz.
Conclusion: Dental composite is effective as a cement to attach commercially available sensors to the cochlear promontory bone. When sensors are firmly attached, valid ICP measurements can be obtained with BC stimulation.

An Exploratory Study on the Use of Event-Related Potentials as an Objective Measure of Auditory Processing and Therapy Effect in Patients With Tinnitus: A Transcranial Direct Current Stimulation Study

01-10-2019 – Jacquemin, Laure; Mertens, Griet; Van de Heyning, Paul; Vanderveken, Olivier M.; Topsakal, Vedat; De Hertogh, Willem; Michiels, Sarah; Beyers, Jolien; Moyaert, Julie; Van Rompaey, Vincent; Gilles, Annick

Journal Article

Objective: Treatment effect in tinnitus research is commonly evaluated by use of self-report questionnaires. As this is a solely subjective assessment method, the need for an objective measurement is paramount to genuinely evaluate the effects of therapeutic interventions. The current study explores the value of event-related potentials (ERPs) in the evaluation of high-definition transcranial direct current stimulation (HD-t
DCS) for tinnitus treatment.
Study Design: Prospective exploratory study.
Setting: Tertiary referral center.
Patients: Twenty-two chronic tinnitus patients.
Intervention: HD-t
DCS.
Main Outcome Measures: ERPs.
Results: The results show a significant shortening of the N1, P2, N2, and P3 latencies after HD-t
DCS treatment. Moreover, the increased amplitude of the P2 and N2 peaks result in more salient and clear peaks, with the amplitude of N2 being significant larger after HD-t
DCS. However, the ERP changes are not significantly correlated with the change in tinnitus functional index (TFI) total score.
Conclusions: The current study was the first to explore ERPs as objective measure in a study with HD-t
DCS in tinnitus patients. Adding ERPs to the outcome measures in tinnitus research may lead to a better understanding of the therapeutic effect in the future. The results showed a shortening of ERP latencies and an increased N2 amplitude, possibly reflecting more effective sound processing with higher recruitment of synchronized neurons in the auditory cortex. Future studies should elaborate on these results, by collecting control data and adding a sham group, to provide a better insight in the underlying mechanism of the ERP changes after tinnitus treatment.

Cognitive Performance in Chronic Tinnitus Patients: A Cross-Sectional Study Using the RBANS-H

01-10-2019 – Cardon, Emilie; Jacquemin, Laure; Mertens, Griet; Van de Heyning, Paul; Vanderveken, Olivier M.; Topsakal, Vedat; De Hertogh, Willem; Michiels, Sarah; Van Rompaey, Vincent; Gilles, Annick

Journal Article

Objective: Many tinnitus patients report cognitive deficits such as concentration and attention difficulties. The aim of this study was to comprehensively assess cognitive functioning in tinnitus patients using a standardized test battery, the repeatable battery for the assessment of neuropsychological status adjusted for hearing impaired individuals (RBANS-H).
Study Design: Cross-sectional study.
Setting: Tertiary referral center.
Participants: Twenty-eight chronic tinnitus patients and 28 control participants, matched for sex, age, hearing loss, and education level.
Intervention: Diagnostic.
Main Outcome Measures: All participants completed the RBANS-H, which includes subtests probing immediate and delayed memory, visuospatial capabilities, language, and attention. The tinnitus patients completed the tinnitus functional index (TFI), a visual analogue scale (VAS) measuring subjective mean tinnitus loudness and the hyperacusis questionnaire (HQ).
Results: The total RBANS-H scores did not differ between tinnitus patients and controls. However, on the language subscale, mean scores of the tinnitus group (97.6 ± 11.0) were significantly lower than those of controls (104.4 ± 12.0), with correction for sex, age, hearing level, and education level (general linear model: p = 0.034). Post hoc t tests revealed a specific deficit concerning the semantic fluency subtest (tinnitus: 19.5 ± 6.2; control: 23.1 ± 5.9; p = 0.015). VAS scores for tinnitus loudness were negatively correlated to scores on the RBANS-H attention subscale (r = –0.48, p = 0.012).
Conclusions: The current study successfully employed the RBANS-H to provide a broader view on cognitive functioning in tinnitus patients. The results showed a specific negative influence of tinnitus on verbal fluency, which could be related to a deficit in executive cognitive control. Moreover, patients experiencing louder tinnitus performed worse on specific subtests concerning attention.

Neuropathological Findings of Dementia Associated With Subjective Hearing Loss

01-10-2019 – Neff, Ryan M.; Jicha, Gregory; Westgate, Philip M.; Hawk, Greg S.; Bush, Matthew L.; McNulty, Beth

Journal Article

Objective: The relationship between hearing loss and cognitive decline is of great importance with growing evidence of hearing loss as an independent modifiable risk factor for dementia. Our goal was to evaluate for differences in dementia neuropathology between subjective normal hearing and hearing loss subjects, as well as subjects who wore hearing aids.
Study Design: Retrospective database.
Setting: Tertiary academic center.
Patients: Brain tissue analyzed from our Center on Aging. Demographics, subjective hearing status, hearing aid use, cognitive status, and dementia neuropathology documented.
Interventions: Dementia neuropathology analyzed in brains of normal hearing and hearing loss subjects.
Main Outcome Measures: Differences in dementia neuropathology between hearing groups. Groups were compared using logistic regression and analysis of covariance (ANCOVA).
Results: Two-hundred and seventy-three subjects were included, 189 normal hearing and 84 subjective hearing loss subjects. No significant difference demonstrated in Alzheimers disease neuropathology (p > 0.05) or pathologic stage (p = 0.2471). No significant difference observed in neuropathology of other major dementia types, specifically, presence of Lewy bodies (p > 0.05), Lewy body disease pathologic stage (p = 0.9778), or presence of micro-infarcts, macro-infarcts, or arteriosclerosis (p > 0.05). Hearing aid-wearing subjects had a lower prevalence of clinical dementia (39.1% versus 57.9%; p = 0.0208) with no significant difference in dementia neuropathology (p > 0.05).
Conclusion: Subjective hearing loss was not found to be associated with significantly different dementia neuropathology, which counters hypotheses on hearing loss causing permanent neurodegeneration and cognitive decline. Hearing aid users were found to have a lower prevalence of dementia for similar levels of neurodegeneration, suggesting a potential neuroprotective effect of hearing aids.

High Dose of Intratympanic Steroids for Sudden Sensorineural Hearing Loss Salvage

01-10-2019 – Taha, Ahmed; Shlamkovitch, Nathan; Abu-Eta, Rani; Yeheskeli, Eyal; Muallem-Kalmovich, Limor; Gavriel, Haim; Pitaro, Jacob

Journal Article

Objective: Intratympanic (IT) steroid administration for sudden sensorineural hearing loss is offered as salvage to patients who failed systemic steroid treatment. Our objective was to study the audiometric and clinical outcomes of patients given salvage therapy with high-dose IT steroids instilled via ventilation tube.
Study Design: Retrospective case review.
Setting: Academic secondary medical center.
Patients: One hundred three patients >18 years of age with sudden sensorineural hearing loss who failed systemic steroids and received IT treatment between 2010 and 2018.
Intervention: Following ventilation tube insertion, 1 ml of 10 mg/ml dexamethasone was instilled, twice daily, for 7 days.
Outcome Measures: Hearing assessment immediately before and after treatment. Tinnitus and vertigo complaints and risk factors were also retrieved.
Results: Tinnitus had improved in 53 (52%) patients, vertigo in 4 (4%), and aural fullness sensation in 56 (55%) (p < 0.001, p = 0.344, p < 0.001, respectively). The mean pure-tone threshold difference across frequencies following treatment was between 0 and 6 d
B. A significant improvement was observed at 250, 500, 1000 Hz (p < 0.001 in all), and at 2000 Hz (p = 0.035). No significant difference was found at 4000 and 8000 Hz (p = 0.055, p = 0.983 respectively). Mean pure-tone average improvement of 4.5 d
B was detected in 61 (59%) patients (p = 0.001). The mean speech discrimination score improved by 7% (p = 0.001). Four (22%) diabetic and nine (20%) hypertensive patients had pure-tone average ≥10 d
B improvement (p = 0.759, p = 0.852 respectively).
Conclusion: Although more than half of the patients improved clinically, the significance of the slight audiometric improvement should be weighed against the treatment protocols complications.

Early Magnetic Resonance Imaging for Patients With Idiopathic Sudden Sensorineural Hearing Loss in an Emergency Setting

01-10-2019 – Conte, Giorgio; Di Berardino, Federica; Zanetti, Diego; Iofrida, Elisabetta Francesca; Scola, Elisa; Sbaraini, Sara; Filipponi, Eliana; Cinnante, Claudia; Gaini, Lorenzo Maria; Ambrosetti, Umberto; Triulzi, Fabio; Pignataro, Lorenzo; Capaccio, Pasquale

Journal Article

Objective: The role of magnetic resonance (MR) imaging in idiopathic sudden sensorineural hearing loss (ISSHL) is controversial due to the inhomogeneity of clinical and MR protocols. The aim of this work is to relate early MR findings obtained immediately after the admission, with the clinical presentation, the audiological findings, and the outcomes of treatment.
Study Design: Prospective observational study.
Setting: Tertiary referral university center.
Patients: Forty-seven patients (22 M, 25 F; age: 54.4 ± 17.5 yr) consecutively referred to the Department of Emergency for ISSHL.
Interventions: All patients underwent the diagnostic and therapeutic work-up for ISSHL, and MR imaging within 72 hours from the admission, independently of the symptoms onset. All patients received the same treatment (systemic steroid therapy, intratympanic steroid injection, and hyperbaric oxygen therapy).
Main Outcome Measure(s): MR patterns, clinical, and laboratory findings.
Results: MR imaging was positive in 25 of 47 cases (53%), with a perfect agreement between clinical and MR examinations (Cohen K = 1) upon the affected ear. Three different radiological patterns were observed: labyrinthine haemorrhage (n = 5), acute inflammatory process (n = 14), isolated blood–labyrinth barrier breakdown (n = 6). By binary logistic regression, only vertigo was associated with a positive MR imaging B = 2.8; p = 0.011; OR = 9.5 (95% CI: 2.2–40.8) and the latter was the only variable associated with an unfavorable outcome (B = 2.8; p = 0.02 OR = 12.8 (95% CI: 2.9–56.7).
Conclusion: Patients affected by ISSHL with associated vertigo show a higher likelihood of having a positive MR imaging, which, in turn, seems to predict an unfavorable outcome.

Factors Influencing Pediatric Cochlear Implant Outcomes: Carolina Sibling Study

01-10-2019 – Selleck, Anne Morgan; Park, Lisa R.; Brown, Kevin D.

Journal Article

Objective: To determine the correlation between speech perception performance between pediatric sibling pairs with severe to profound sensory hearing loss receiving cochlear implants, and in cases of discordance in performance, determine which variables negatively impacted performance.
Study Design: Retrospective chart review.
Setting: Tertiary academic referral center.
Subjects: Eighty-nine pediatric subjects, 43 sibling groups, under the age of 18 with severe to profound sensory hearing loss who received a cochlear implant with a sibling who also received a cochlear implant.
Intervention: Cochlear implantation.
Main Outcome Measures: Speech perception scores, consonant-nucleus- consonant score.
Results: A statistically significant correlation was found between speech perception performance of pediatric siblings. Depth of insertion is positively correlated with better speech perception in siblings with discordant results. There was no significant relationship with either electrode type, unilateral/bilateral status, or age of implantation.
Conclusion: Pediatric siblings have a high correlation in speech perception outcomes following cochlear implantation, suggesting family environment plays a strong role. In circumstances in which outcomes between siblings are substantially different, greater depth of implant insertion is correlated with better consonant-nucleus- consonant word scores.

Hearing Preservation With the Use of Flex20 and Flex24 Electrodes in Patients With Partial Deafness

01-10-2019 – Skarzynski, Piotr H.; Skarzynski, Henryk; Dziendziel, Beata; Rajchel, Joanna J.; Gos, Elzbieta; Lorens, Artur

Journal Article

Objective: To evaluate the impact of electrode length on hearing preservation (HP) in Partial Deafness Treatment–Electrical Complement (PDT-EC) subjects.
Study Design: Retrospective case review.
Setting: Tertiary referral center.
Patients: Twenty-three PDT-EC patients (with preoperative air-conduction thresholds ≤30 d
B up to 500 Hz) were divided into two groups: Flex20 electrode (Med-EL Gmb
H, Innsbruck, Austria) (12 patients) and Flex24 electrode (Med-EL Gmb
H, Innsbruck, Austria) (11 patients).
Interventions: All participants were subjected to minimally invasive cochlear implantation using the round window approach.
Main Outcome Measure(s): Pure tone audiometry (125–8000 Hz) was performed preoperatively and at 1, 6, 12, and 24 months postoperatively. HP was established using the HEARRING group formula. Speech understanding was assessed preoperatively and at 12 and 24 months postoperatively.
Results: Analysis of HP for every individual indicates that more than half the patients with Flex20 and Flex24 had complete HP at 6 months follow-up. None of the patients from either group had complete loss of hearing. At activation, average air-conduction thresholds for low frequencies (125–500 Hz) were slightly better for the short electrode (M = 29.03) than for the long (M = 39.10) but the difference was not statistically significant (p = 0.067). The effect of electrode (Flex20 versus Flex24) was not significant in terms of pure tone audiometry and speech recognition at long-term follow-up.
Conclusions: In the early postoperative period, complete HP was possible in a majority of patients from both groups, but slightly better HP outcomes were achieved by Flex20. In the long term, the length of the electrodes does not affect the degree of HP or speech understanding.

Matched Cohort Comparison Indicates Superiority of Precurved Electrode Arrays

01-10-2019 – Holder, Jourdan T.; Yawn, Robert J.; Nassiri, Ashley M.; Dwyer, Robert T.; Rivas, Alejandro; Labadie, Robert F.; Gifford, René H.

Journal Article

Objective: Characterize differences in adult cochlear implant outcomes and programming parameters for a straight (CI422/522) and a precurved (CI532) electrode array.
Setting: Cochlear implant (CI) program at a tertiary otologic center.
Patients: Fifty-eight adults were included in the study; 29 were implanted with CI422 or CI522 and 29 were implanted with CI532. Each CI532 recipient was matched to a CI422/522 recipient in terms of age and preoperative hearing thresholds for comparison purposes.
Main Outcome Measures: Consonant-Nucleus-Consonant (CNC) words, Az
Bio sentences, residual audiometric thresholds, and Speech Spatial Qualities (SSQ) questionnaire collected 6 months postoperatively were used to characterize outcomes. Pulse duration, maxima, impedances, and overall charge measurements were used to characterize programming parameters.
Results: Postoperative unaided low frequency pure-tone average (LFPTA) was significantly better for the CI532 group. CNC scores were significantly better for the CI532 group. Impedances and pulse duration were significantly lower for the CI532 group, but there was no difference in overall charge between the groups.
Conclusion: The CI532 group showed either similar or statistically superior results on all measures when compared with the CI422/522 suggesting that the CI532 electrode may be an advantageous substitute for the CI522.

Anatomical Correlates and Surgical Considerations for Localized Therapeutic Hypothermia Application in Cochlear Implantation Surgery

01-10-2019 – Perez, Enrique; Viziano, Andrea; Al-Zaghal, Zaid; Telischi, Fred F.; Sangaletti, Rachele; Jiang, Weitao; Dietrich, William Dalton; King, Curtis; Hoffer, Michael E.; Rajguru, Suhrud M.

Journal Article

Hypothesis: Application of localized, mild therapeutic hypothermia during cochlear implantation (CI) surgery is feasible for residual hearing preservation.
Background: CI surgery often results in a loss of residual hearing. In preclinical studies, local application of controlled, mild therapeutic hypothermia has shown promising results as a hearing preservation strategy. This study investigated a suitable surgical approach to deliver local hypothermia in patients utilizing anatomical and radiologic measurements and experimental measurements from cadaveric human temporal bones.
Methods: Ten human cadaveric temporal bones were scanned with micro-computed tomography and anatomical features and measurements predicting round window (RW) visibility were characterized. For each bone, the standard facial recess and myringotomy approaches for delivery of hypothermia were developed. The St. Thomas Hospital (STH) classification was used to record degree of RW visibility with and without placement of custom hypothermia probe. Therapeutic hypothermia was delivered through both approaches and temperatures recorded at the RW, RW niche, over the lateral semicircular canal and the supero-lateral mastoid edge.
Results: The average facial recess area was 13.87 ± 5.52 mm2. The introduction of the cooling probe through either approach did not impede visualization of the RW or cochleostomy as determined by STH grading. The average temperatures at RW using the FR approach reduced by 4.57 ± 1.68 °C for RW, while using the myringotomy approach reduced by 4.11 ± 0.98 °C for RW.
Conclusion: Local application of therapeutic hypothermia is clinically feasible both through the facial recess and myringotomy approaches without limiting optimal surgical visualization.

Glucocorticoid for Hearing Preservation After Cochlear Implantation: A Systemic Review and Meta-analysis of Animal Studies

01-10-2019 – Shaul, Chanan; Venkatagiri, Padmavathi K.; Lo, Jonathon; Eastwood, Hayden T.; Bester, Christofer W.; Briggs, Robert J. S.; O’Leary, Stephen J.

Journal Article

Objectives: To conduct systematic review and meta-analyses of preclinical studies describing the efficacy of glucocorticoids administered via different routes for hearing preservation after cochlear implantation.
Data Sources: A literature search was performed in PubMed to identify peer-reviewed articles published before December 31, 2017, with no language restrictions. Search components were “Cochlear implant,” “Glucocorticoids,” and “Hearing preservation.” The results were specified for animal studies.
Study Selection: Original studies in which glucocorticoids were administered before or during cochlear implantation in animal models and hearing threshold shifts were measured using auditory brainstem response.
Data Extraction: Quality of included studies was assessed using the SYstematic Review Centre for Laboratory animal Experimentation protocol. Threshold Shift reduction between the “study” and “control” groups at 1-month postimplantation was the parameter used to evaluate hearing preservation.
Data Synthesis: The random-effects models were used to combine the results of selected studies. Separate meta-analyses were performed for drug-eluting electrodes, systemic, and local administration.
Conclusions: Administering either systemic or topical glucocorticosteroids had a significant effect on preserving low and high-frequency hearing. Topical administration was equally effective across a range of concentration levels and provided maximal hearing preservation when applied 120 minutes before implantation. The effect of systemic treatment was achieved with high doses, equivalent to 26 mg of dexamethasone per day in humans. No significant effect was found with the use of drug-eluting electrodes and more studies are needed to characterise the utility and efficacy of this administration method.

Outcomes and Predictive Factors of Electroacoustic Stimulation Rehabilitation in Children With Limited Low-Frequency Hearing

01-10-2019 – Nam, Gi-Sung; Song, Mee Hyun; Choi, Jae Young; Jung, Jinsei

Journal Article

Objective: To evaluate the clinical feasibility and auditory benefits of hearing rehabilitation using electroacoustic stimulation (EAS) after cochlear implantation (CI) and to identify the predictive factors for successful EAS rehabilitation in children with limited low-frequency hearing.
Study Design: Retrospective case review.
Setting: Tertiary referral hospital.
Patients: Seventeen children (21 ears) under the age of 15 years with residual low-frequency hearing who underwent CI using hearing preservation techniques.
Intervention: Patients underwent CI using hearing preservation techniques, and the postoperative audiograms were obtained to evaluate the hearing preservation rate. EAS rehabilitation was applied in patients with successful low-frequency hearing preservation.
Outcome Measures: Improvements in speech perception in both quiet and noise conditions were compared between the EAS mode and the CI-only mode. The predictive factors for successful EAS rehabilitation in children were analyzed.
Results: Functional low-frequency residual hearing less than or equal to 85 d
B at 250 and 500 Hz was achieved postoperatively in six of 21 ears, and successful EAS rehabilitation was possible in nine of 21 ears. Better speech perception scores were observed in quiet conditions using the EAS mode compared with the CI-only mode, although the difference did not reach statistical significance. Significantly, better scores were observed in noise conditions with the EAS mode compared with the CI-only mode. Postoperative low-frequency pure-tone average was the only significant predictive factor of successful EAS rehabilitation.
Conclusion: CI surgery using hearing preservation techniques with EAS rehabilitation should be performed in children, even in patients with limited residual hearing, to improve auditory outcomes.

Microbiome Analysis of Cholesteatoma by Gene Sequencing

01-10-2019 – Weiss, Joshua P.; Antonelli, Patrick J.; Dirain, Carolyn O.

Journal Article

Objective: To compare the microbial flora of cholesteatoma and normal middle ears using gene-based sequencing analysis.
Study Design: Controlled ex vivo human study.
Setting: Academic, tertiary medical center.
Subjects and Methods: Brush, swab, and tissue samples were each taken from cholesteatoma matrix and uninvolved tissue in patients with previously untreated, acquired cholesteatoma (n = 19) or middle ear mucosa from patients undergoing cochlear implantation with no history of cholesteatoma or previous middle ear surgery (control; n = 12). DNA was isolated from specimens then 16S r
RNA gene sequencing was performed.
Results: There was no difference in microbial yield between the sampling methods. Cholesteatoma specimens had lower relative abundance of 14 bacterial species compared with controls including Acidovorax sp., Bacillus sp., Masillia sp., Moraxella osloensis, Phenylobacterium conjunctum, Sphingomonas sp., and Staphylococcus epidermidis (all p < 0.05). Alternaria sp. were present on nearly all the specimens. Alternaria sp. and Cladosporium herbarum (both p ≤ 0.05) were lower in the cholesteatoma compared with control group. There was no difference in the relative abundance of any bacteria or fungi between the cholesteatoma matrix and uninvolved middle ear mucosa.
Conclusions: Microbiome of cholesteatoma matrix is largely similar to adjacent mucosa. This differs from healthy ears. Further study is needed to understand if middle ear microbiome may impact cholesteatoma pathogenesis or treatment.

A Prospective Evaluation of Postoperative Opioid Use in Otologic Surgery

01-10-2019 – Qian, Z. Jason; Alyono, Jennifer C.; Woods, Ong-Dee; Ali, Noor; Blevins, Nikolas H.

Journal Article

Objective: To prospectively evaluate opioid consumption following adult outpatient otologic surgery.
Study Design: Prospective observational.
Setting: Single-tertiary referral center.
Patients: Patients scheduled for otologic surgery who did not have a history of chronic opioid use were recruited between February 2018 and February 2019.
Interventions and Main Outcome Measures: Opioid consumption was queried using telephone or in-person surveys administered between postoperative days 5 and 15. Patient demographics, surgical details, and opioid prescription patterns were abstracted from medical records. Opioid distribution was determined by querying records maintained by the California Department of Justice through a state-wide prescription drug monitoring program mandated since 2016.
Results: Seventy patients were prescribed an average of 68.9 ± 31.8 mg of morphine equivalents (MME) and consumed 47.3 ± 42.9 MME over 2.4 ± 2.3 days postoperatively. Patients who received a postauricular incision were prescribed significantly more than those who underwent transcanal procedures (86.2 vs 55.9 MME; t test, p < 0.001), consumed significantly more (72.2 vs 28.6 MME; t test, p < 0.001), and for a significantly longer duration (3.4 vs 1.6 days; t test, p = 0.001). In the postauricular group, there was no significant difference in consumption between mastoidectomy and nonmastoidectomy subgroups (64.9 vs 89.2 MME; t test, p = 0.151). Eighty percent of transcanal patients consumed 50 MME (10 pills) or less, while 80% of postauricular patients consumed 80 MME (16 pills) or less.
Conclusions: Patients in our cohort consumed approximately 3/4 of the prescribed opioids. Those with postauricular incisions used significantly more than those with transcanal incisions. Postoperative opioid prescription recommendations should be tailored according to the extent of surgery.

The Antrum–Malleus–Tegmen Score: A Pilot Study Assessing Preoperative Radiographic Predictors for Transcanal Endoscopic Cholesteatoma Dissection

01-10-2019 – Tolisano, Anthony M.; Killeen, Daniel E.; Hunter, Jacob B.; Kutz, Joe Walter Jr; Isaacson, Brandon

Journal Article

Objective: Identify features on computed tomography (CT) that predict mastoidectomy conversion (MC) during transcanal endoscopic ear surgery (TEES).
Study Design: Retrospective case-control.
Setting: University otology practice.
Patients: Consecutive patients with cholesteatoma.
Intervention: TEES cholesteatoma dissection versus those requiring MC.
Main Outcome Measures: Antrum opacification, depth of scutum involvement, and erosion of the mastoid trabeculae, ossicular chain, and tegmen were evaluated. Univariable and multivariable regression analysis was performed. The Antrum–Malleus–Tegmen (AMT) score was created using receiver operating characteristic curves to assess feasibility of performing TEES for cholesteatoma dissection.
Results: There were 39 TEES and 19 MC cases. Groups had similar age (median 28.5 yr), gender, laterality, and revision surgery status. Median surgical time for MC cases was longer than TEES (231 min vs. 171 min, p < 0.001). Radiographic predictors of MC by multivariable regression included antrum opacification (p = 0.036), malleus erosion (p = 0.044), and tegmen erosion (p = 0.023). The AMT score predicted the feasibility of TEES without MC with a sensitivity of 90% and specificity of 75% when ≥2 of the following conditions were met on preoperative CT: intact tegmen, intact malleus, and absence of antrum opacification.
Conclusions: An aerated antrum, intact malleus, and intact tegmen suggest that TEES cholesteatoma dissection without the need for mastoidectomy is highly likely. A score of ≥2 on the AMT score predicts this with a positive predictive value of 88% and negative predictive value of 78%.

First Pediatric Experience With a Novel, Adhesive Adapter Retained, Bone Conduction Hearing Aid System

01-10-2019 – Osborne, Max Sallis; Child-Hymas, Anne; Gill, Jaspreet; Lloyd, Mark Sheldon; McDermott, Ann Louise

Journal Article

Objectives: To assess the audiological outcomes, practicalities, and impact on quality of life of a new, nonimplantable, adhesive retained bone conduction hearing aid in children.
Study design: A prospective, single-subject repeat measure, cohort study.
Setting: Community and in pediatric assessment center.
Patients: Twenty-one children aged between 5 and 15 years with a conductive hearing loss of >/=25 d
B HL in the better hearing ear.
Intervention: Audiological comparisons were made using pure-tone thresholds; unaided, with a softband aid, and with the new adhesive retained bone conducting system.
Main Outcome Measures: Comparison of hearing threshold levels. Data analysis via paired t-testing, significance set at p value <0.01. Quality of life was assessed via the Glasgow Childrens Benefit Inventory and a 10 cm linear analogue scale. A hearing aid review questionnaire provided insight into practical use.
Results: Statistically significant improvement in thresholds of 7.3 d
B HL (p=0.0001) was demonstrated with the adhesive system as compared with softband aids. After 4 weeks of usage, the mean hearing thresholds for the adhesive hearing system improved from 55 d
B HL ± 2.4 to 31 d
B HL± 7.9 in unaided and aided conditions.
Improvements in QOL were demonstrated with LAS and GCBI. Four children reported mild skin reactions. Eighty-six percent reported improved self-confidence.
Conclusion: The adhesive aid produces comparable audiological results to the commercial softband hearing aids. It provides an excellent alternative in the treatment of conductive hearing loss without the possible complications and costs of a surgical intervention. Furthermore, it preserves skin envelope over the mastoid for those who wish to proceed with an autologous pinna reconstruction in the future.

Lessons From an Analysis of Newborn Hearing Screening Data for Children With Cochlear Implants

01-10-2019 – Lee, Jeon Mi; Lee, Hyun Jin; Jung, Jinsei; Moon, In Seok; Kim, Sung Huhn; Kim, Jin; Choi, Jae Young

Journal Article

Objectives: The aims of the study are to identify the limitations of the current newborn hearing screening (NHS) programs and provide recommendations for better protocols.
Study Design: Retrospective analysis.
Setting: Tertiary referral center.
Patients: The study participants were 185 children who received cochlear implants (CIs) at ≤5 years of age.
Interventions: Therapeutic and rehabilitative.
Main Outcome Measures: The results of NHS, screening tools used, age, and hearing thresholds at which hearing loss was confirmed, causes of the hearing loss, age of CI insertion, aided pure-tone audiogram findings, and language development level were analyzed.
Results: NHS data was available for 109 children, and 24 patients (22.0%) had passed NHS for both ears. Hearing loss was confirmed considerably later in children who had passed NHS than in children who were referred for further evaluation (p < 0.01). The most common cause for hearing loss in the NHS-pass group was SLC26A4 mutations (41.7%). Patients in the NHS-pass group received CIs considerably later than those in the NHS-referred group (p < 0.01). Among patients with SLC26A4 mutations, the language development level was significantly lower in the NHS-pass group than in the NHS-referred group (p < 0.01).
Conclusions: Careful counseling regarding NHS results is necessary for parents to understand that the absence of hearing loss at birth does not mean that the child will not develop hearing loss later in life. Genetic testing for SLC26A4 mutations may be necessary in regions with a high incidence of these mutations, such as East Asia.

“Intraoperative Electrocochleography in Patients With Menières Disease Undergoing Endolymphatic Sac Decompression and Shunt Surgery”

01-10-2019 – Mattingly, Jameson K.; Zhan, Kevin Y.; Hiss, Meghan M.; Harris, Michael S.; Dodson, Edward E.; Moberly, Aaron C.; Adunka, Oliver F.; Riggs, William J.

Journal Article

Hypothesis: Objective physiologic changes measured using electrocochleography at the round window (ECOGRW) are observable during endolymphatic sac decompression and shunt surgery (ELS).
Background: Limited effective treatment options are available to patients with Menières disease (MD) who have failed conservative management, experience persistent vertigo symptoms, and have substantial residual hearing. ELS is a feasible therapeutic option for these patients. However, the efficacy of this procedure has been questioned, and objective measures assessing inner ear physiologic alterations are lacking.
Methods: ECOGRW was measured in patients with MD undergoing ELS. Stimuli consisted of tone bursts (250, 500, 1000, 2000, 4000 Hz) and 100 μs broadband clicks at various intensities (60–90 d
B n
HL). Cochlear microphonic (CM), summation potential (SP), compound action potential (AP), SP:AP ratio, and CM harmonic distortions were measured.
Results: ECOGRW was completed in 18 patients. The mean SP magnitude at 500 Hz changed significantly from −7.1 μV before to −5.1 μV after ELS (p < 0.05). However, the mean SP:AP ratio in those tested (n = 13) did not significantly change after ELS. CM harmonic magnitudes remained unchanged from pre- to post-ELS (n = 12) across all frequencies.
Conclusion: ECOGRW allows detection of acute electrophysiological changes in the cochlea. However, our results indicate only small objective changes in the low-frequency SP magnitude (500 Hz) immediately after ELS, but not in other frequencies or measures tested (CM, SP:AP, CM harmonic distortions). These results suggest minimal electrophysiological changes occur in the cochlea as a result of ELS.

The Component Structure of the Dizziness Handicap Inventory (DHI): A Reappraisal

01-10-2019 – Van De Wyngaerde, Kelly M.; Lee, Minji K.; Jacobson, Gary P.; Pasupathy, Kalyan; Romero-Brufau, Santiago; McCaslin, Devin L.

Journal Article

Objective.: The Dizziness Handicap Inventory (DHI) is a 25-item self-report questionnaire developed to measure the disabling and handicapping impact of dizziness. The present investigation was conducted in an effort to re-assess the factor structure of the DHI.
Study Design.: Retrospective study.
Setting.: Tertiary care center.
Patients.: Subjects were 1,991 patients who were evaluated in the Mayo Clinic-Rochester Vestibular and Balance Laboratory.
Main Outcome Measures.: Exploratory factor analysis: an exploratory bifactor analysis (EFA) with bifactor rotation was used to analyze a random sample of 999 patients. Analyses were used to determine the dominance of the general factor (i.e., total score) relative to the group factor (i.e., subscales). Confirmatory factor analysis: a confirmatory bifactor graded response model was fit with appropriate item-to-group relationships that was discovered by our exploratory analyses. To validate the bifactor model that was identified with the exploratory analyses, a bifactor model with three grouping factors (i.e., Physical manifestations, Catastrophic impact of dizziness, and the Emotional impact of dizziness) were fit to a different random sample of 992 patients using the new item-to-group factor specifications.
Results.: In the confirmatory analyses, all items had a positive factor loading on the general factor. There were 14 items that loaded on the general factor only. The rest of the items (n = 11) loaded on both the general factor and one of three group factors.
Conclusions.: Conclusions of the study revealed several findings: 1) reporting the result as a total score (i.e., a single general factor) is warranted, and, 2) there is statistical support for the existence of three subscales representing: the Physical manifestations, Catastrophic impact, and Emotional impact of dizziness and vertigo.

Assessment of Health Care Utilization for Dizziness in Ambulatory Care Settings in the United States

01-10-2019 – Dunlap, Pamela M.; Khoja, Samannaaz S.; Whitney, Susan L.; Freburger, Janet K.

Journal Article

Objective: Describe patient and physician characteristics, and physician recommendations for ambulatory care visits for dizziness in the US.
Study Design: Cross-sectional analysis of visits for dizziness from the National Ambulatory Medical Care Survey (2013–2015).
Setting: Ambulatory care clinics in the US.
Patients: 20.6 million weighted adult visits mean age 58.7 (1.0) for dizziness, identified using ICD-9-CM codes (386.00–386.90, 780.40).
Main Outcome Measures: Patient, clinical, and physician characteristics and physician diagnostic and treatment recommendations. Prevalence rates for benign paroxysmal positional vertigo (BPPV), unspecified dizziness, and other vestibular disorders were estimated, and descriptive statistics were used to characterize patients, physicians, and physicians’ recommendations.
Results: The prevalence rate for dizziness visits was 8.8 per 1,000 (95% confidence interval CI: 7.5, 10.3). Most visits were for unspecified dizziness (75%), made by women (65%), whites (79%), and were insured by private insurance (50%). Visits for dizziness were to primary care physicians (51.9%), otolaryngologists (13.3%), and neurologists (9.6%). Imaging was ordered and medication prescription was provided in 5.5% and 20.1% of visits. Physical therapy (PT) was used for a higher percentage of BPPV visits (12.9%), than for other diagnoses (<1.0%). Physician treatment recommendations for vestibular diagnoses varied by physician specialty.
Conclusions: A large percentage of visits had an unspecified diagnosis. A low number of visits for vestibular disorders were referred to PT. There are opportunities to improve care by using specific diagnoses and increasing the utilization of effective interventions for vestibular disorders.

Pressure Transmission to the Inner Ear by Mastoid Palpation After Transmastoid Surgery for Superior Canal Dehiscence

01-10-2019 – Tanavde, Ved A.; Creighton, Francis X.; Ward, Bryan K.; Carey, John P.

Journal Article

Objective: To discuss an effect of transmastoid repair of superior semicircular canal dehiscence and its resolution using a mastoid titanium mesh plate.
Patients: A 53-year-old woman with a history of superior canal dehiscence syndrome (SCDS) and subsequent transmastoid repair experienced dizziness and a loud, drum-like sound in her repaired ear when touching the ear. Palpating the skin over the mastoid defect reproduced the symptoms and could be observed on binocular microscopy as tympanic membrane deformation synchronous with mastoid palpation.
Intervention (s): Surgery to place a titanium mesh cranioplasty plate over the mastoid cavity.
Main Outcome Measure (s): Reduction in dizziness and auditory symptoms when palpating the mastoid.
Results: In follow-up 2 months after surgery, palpation of the left mastoid no longer results in vertigo or hearing a loud sound. Hearing and vestibular function remained unchanged.
Conclusions: Despite resolution of SCDS symptoms after transmastoid plugging and resurfacing of the superior semicircular canal involving mastoidectomy, patients can be bothered by dizziness and vertigo when pressing on the mastoid soft tissue envelope. This acts like a balloon that, when compressed, changes middle ear pressure and moves the tympanic membrane and can even cause alternobaric vertigo. This can be avoided or resolved by rigidly reconstructing the defect in the mastoid bone.

Delayed Tumor Growth in Vestibular Schwannoma: An Argument for Lifelong Surveillance

01-10-2019 – Macielak, Robert J.; Patel, Neil S.; Lees, Katherine A.; Lohse, Christine M.; Marinelli, John P.; Link, Michael J.; Carlson, Matthew L.

Journal Article

Objective: Previous research has shown that tumor growth during observation of small-to-medium sized sporadic vestibular schwannomas (VSs) occurs almost exclusively within 3 to 5 years following diagnosis. This has led some to consider ending surveillance after this interval. This study seeks to characterize a cohort of patients with tumors that exhibited late growth.
Study Design: Retrospective cohort study.
Setting: Tertiary referral center.
Patients: Adults with sporadic VSs who initially elected observation with serial magnetic resonance imaging (MRI) surveillance.
Intervention(s): None.
Main Outcome Measure(s): Linear tumor growth was measured in accordance with AAO-HNS reporting guidelines. Delayed growth was defined as growth ≥2 mm in linear diameter that was first detected 5 years or more from the initial MRI.
Results: From a total of 361 patients, 172 experienced tumor growth during the interval of observation. Fourteen of these 172 patients (8.1%) experienced late growth occurring at 5 years or beyond. Among patients with delayed growth, the fastest growth rate after extended quiescence was 1.33 mm/yr, and the longest delay before tumor growth detection was 11.1 years. Additional treatment was recommended for six (42.9%) of the patients with delayed growth. Of 68 tumors that remained in the IAC, 11 (16.2%) demonstrated delayed growth. Of 66 tumors that presented in the CPA, 2 (3.0%) demonstrated delayed growth. Initial size was larger for tumors demonstrating early growth compared with those with delayed growth. For tumors within the IAC, those with early growth had a significantly higher median growth rate than those with delayed growth (1.40 vs. 0.45 mm/yr, p < 0.001).
Conclusions: Delayed growth encompassed 8.1% of growing VSs and 3.9% of all observed tumors. Patients with delayed growth exhibited slower growth rates compared with those who were diagnosed with growth early in their observation course. These findings support the need for lifelong surveillance of untreated VSs given the possibility of clinically significant delayed growth. Increasing the time interval between MRI studies after 5 years is a reasonable concession to balance practicalities of cost and convenience with risk of delayed of tumor growth.

Involvement of the Cochlear Aqueduct by Jugular Paraganglioma Is Associated With Sensorineural Hearing Loss

01-10-2019 – Patel, Neil S.; Link, Michael J.; Driscoll, Colin L. W.; Neff, Brian A.; Van Gompel, Jamie J.; Lane, John I.; Carlson, Matthew L.

Journal Article

Objective: The etiology of sensorineural hearing loss (SNHL) in patients with jugular paraganglioma (JP) whose tumors lack inner ear fistulae or vestibulocochlear nerve involvement is unknown. Recent literature has proposed that occlusion of the inferior cochlear vein may be causative. Herein, we assess the association between radiologic involvement of the cochlear aqueduct (CA) and the development of SNHL.
Study Design: Blinded, retrospective review of imaging and audiometry.
Setting: Tertiary center.
Patients: Adults with JP.
Intervention(s): None.
Main Outcome Measures: Asymmetric SNHL was assessed continuously as the difference in bone conduction pure-tone average (BCPTA) between ears and as a categorical variable (≥15 d
B difference at two consecutive frequencies, or a difference in speech discrimination score of ≥15%). Involvement of the CA was considered present if there was evidence of medial T2 fluid signal loss, contrast enhancement, or bony erosion/expansion.
Results: Of 30 patients meeting inclusion criteria, 15 (50%) had asymmetric SNHL. CA involvement was observed in 87% of patients with asymmetric SNHL compared with 13% in those with symmetric hearing (p = 0.0001). Univariate analysis demonstrated that age, sex, and tumor volume were not associated with asymmetric SNHL. The median difference in BCPTA between ears in patients with CA involvement was 21.3 d
B HL compared to 1.2 d
B HL in those without CA involvement (p < 0.0001). Regression analysis demonstrates that enhancement within the CA is associated with a BCPTA difference of 19.4 d
B HL (p = 0.0006).
Conclusions: Cochlear aqueduct involvement by JP is associated with SNHL in the absence of inner ear fistula, vestibulocochlear nerve involvement, or brainstem compression. Correlation with operative findings or histopathologic evidence of tumor involvement may validate this intriguing imaging finding.

Clinical and Radiological Characteristics of Malignant Tumors Located to the Cerebellopontine Angle and/or Internal Acoustic Meatus

01-10-2019 – Eliezer, Michael; Tran, Hugo; Inagaki, Akira; Vérillaud, Benjamin; Takahashi, Mariko; Marie, Jean-Paul; Hautefort, Charlotte; Herman, Philippe; Murakami, Shingo; Kania, Romain

Journal Article

Objective: Metastatic lesions to the internal auditory meatus (IAM) and/or the cerebellopontine angle (CPA) are rare and may appear like a vestibular schwannoma (VS). We herein raise the issue of the diagnosis and treatment of nine malignant cases of the CPA and IAM among three referral centers in France and Japan. The aim of this study was 1) to report malignant lesions of the CPA, their diagnosis and treatment, 2) to review the literature, 3) to propose criteria of suspicion for malignant tumors of the CPA.
Methods: Nine patients who had malignant lesions of the CPA and/or IAM for whom the final diagnosis was made by surgery, lumbar puncture, or PET scan were included. The main outcomes measured were: rapid onset of symptoms, association of cochlea-vestibular symptoms with facial palsy, and MRI analysis.
Results: Among the nine patients with malignant tumor of the CPA, 8 of them (89%) had a facial palsy associated with cochlea-vestibular symptoms. Rapid growth of the tumor was observed in 77% (7/9) of the cases in a mean time interval of 4.6 months. The initial diagnosis evoked was VS in 44% of the cases (4/9). Atypical MRI aspect was seen in 67% of the cases (6/9) with bilateral tumors in 55% of cases (5/9).
Conclusion: Although rare, malignant tumors of the CPA and/or IAM should be evoked in case of association of cochleovestibular symptoms and facial palsy, rapid onset and atypical MRI aspect.

Electrophysiologic Characteristics of Various Degrees of Selective Outer Hair Cell Loss in Rats

01-10-2019 – Huang, Wenqin; Chen, Shulin; Dong, Chang; Li, Changwu; Sun, Liang; Wang, Xianren; Jiang, Hongyan

Journal Article

Hypothesis: The characteristics of auditory brainstem response (ABR), electrocochleogram (ECoch
G), and distortion product otoacoustic emissions (DPOAE) of different degrees of selective outer hair cells (OHCs) loss may be helpful for clinicians to evaluate the pathogeny, diagnosis, and rehabilitation of individuals’ hearing loss.
Background: How many OHCs are necessary to maintain cochlear amplifier function remains unknown. The electrophysiologic characteristics may indicate different degrees of OHCs loss.
Methods: Electrophysiological characteristics were tested using 8-k
Hz pure-tone stimulus and OHCs counted specifically in the region of the cochlea corresponding to 8-k
Hz. Rat models of selective OHCs loss were established by injecting kanamycin (KM) at various dosages, and the region of 8-k
Hz was obtained by 8-k
Hz pure-tone exposure.
Results: The ABR thresholds were affected slightly with OHCs loss  70%, the cochlear amplification may lose completely, but it is difficult to detect OHCs loss < 30%, because the ABR or DPOAE may reveal “normal” at this level. Moreover, the decreased CAP amplitude or increased SP/AP may be indicators for OHCs loss.

Transvenous Stent-assisted Coil Embolization for Management of Dehiscent High Jugular Bulb With Tinnitus and Contralateral Hypoplastic Venous Sinuses

01-10-2019 – Oh, Se-Joon; Kim, Deoksoo; Lee, Jae Il; Ko, Jun Kyeung; Choi, Sung-Won; Kong, Soo-Keun; Goh, Eui-Kyung; Lee, Tae Hong

Journal Article

Objectives: This study aimed to evaluate the safety and efficacy of transvenous stent-assisted coil embolization for dehiscent high jugular bulb (HJB) with tinnitus and contralateral hypoplastic venous sinus.
Study Design: Case series with chart review.
Setting: Tertiary academic medical center.
Methods: From September 2008 to October 2018, a series of patients with dehiscent HJB presenting with intractable pulsatile tinnitus abated only by ipsilateral jugular vein compression were included. Patients underwent transvenous stent-assisted coil embolization for selective obstruction to the dome of the HJB due to hypoplastic contralateral transverse or sigmoid venous sinus. Technical safety and clinical efficacy were retrospectively analyzed. Clinical outcome measurements included pure-tone audiogram, tinnitus character, and tinnitus handicap inventory and evaluated based on the change during the first 6 months after the procedure.
Results: Subjects included five patients with dehiscent HJB and troublesome pulsatile tinnitus who refused surgery (n = 4), or who experienced recurrence after surgical covering and reinforcement using autologous cartilage (n = 1). The mean age of the five patients (only female) was 45 years. Transvenous stent-assisted coil embolization was technically successful in all patients with symptomatic dehiscent HJB, with no procedure-related complications. Temporary postprocedural headache was observed in two patients, but resolved within 3 days. Symptoms were completely resolved in all cases. There was no recurrence or aggravation of tinnitus during follow-up period.
Conclusions: Transvenous stent-assisted coil embolization for dehiscent HJB with tinnitus and contralateral hypoplastic transverse or sigmoid venous sinus could be a technically safe and clinically effective treatment strategy while preserving cranial venous drainage.

Occipital and Cerebellar Theta Burst Stimulation for Mal De Debarquement Syndrome

01-10-2019 – Cha, Yoon-Hee; Gleghorn, Diamond; Doudican, Benjamin

Journal Article

Background: Individuals with Mal de Debarquement syndrome (Md
DS) experience persistent oscillating vertigo lasting for months or years. Transcranial magnetic stimulation (TMS) can modulate the motion perception of Md
DS.
Materials and Methods: Twenty-six TMS naive individuals received single administrations of continuous theta burst stimulation (c
TBS) over the occipital cortex, cerebellar vermis, and lateral cerebellar hemisphere, in randomized order. A 0–100 point Visual Analogue Scale was used to assess acute changes in oscillating vertigo severity after each session. Repeated treatments were given over the target that led to the most acute reduction in symptoms. All treatments were performed with neuronavigation using the participants own brain MRI. The Dizziness Handicap Inventory (DHI), Md
DS Balance Rating Scale (MBRS), and Hospital Anxiety and Depression Scale (HADS) were assessed weekly at four pretreatment and six posttreatment time points.
Results: Twenty participants chose either the occipital cortex (11) or cerebellar vermis (9) targets as most effective in reducing the oscillating vertigo; one chose lateral cerebellar hemisphere; five chose none. After 10 to 12 sessions of 1,200 pulses over the target of choice, 19 of 25 treatment completers noted ≥ 25% reduction, 12 of 25 ≥50% reduction, and 8 of 25 ≥75% reduction in oscillating vertigo intensity. A one-way repeated measures ANOVA of DHI, MBRS, and HADS scores before and after treatment showed significant reductions in DHI, MBRS, and the HADS Anxiety subscore immediately after treatment with most improvement lasting through posttreatment week 6. There were no significant Depression subscore changes. Participants who had chosen vermis stimulation had comparatively worse balance at baseline than those who had chosen occipital cortex stimulation.
Conclusion: c
TBS over either the occipital cortex or cerebellar vermis is effective in reducing the oscillating vertigo of Md
DS acutely and may confer long-term benefits. Sustained improvement requires more frequent treatments.

Endre Hőgyes (1847–1906), Forgotten Father of the Vestibulo-Ocular Reflex

01-10-2019 – Tamás, László T.; Mudry, Albert

Journal Article

Objective: Throughout the history of vestibular research, the discovery of the vestibulo-ocular reflex in 1881 by Endre Hőgyes (1847–1906) is rarely mentioned. The aim of this study is to review Hőgyes’ vestibular research articles, all originally written in Hungarian and emphasize their epoch-making content.
Main Data Sources: Hőgyes’ vestibular publications, originally written in Hungarian, which describe various eye movements of the rabbit in response to vestibular stimulation by rotation about three axes.
Results: Hőgyes was the first to use a three-axis turntable on an experimental animal, in this case a rabbit. He found that depending on the plane of rotation, different types of binocular eye movements were produced. He then demonstrated by destructive and excitatory experiments, the anatomical pathways and the physiological function producing this phenomenon. Ultimately, he explained the exact connections between the inner ear labyrinth and certain muscle contractions during eye movements. He identified this pathway as the “associating center of the ocular movements,” later defined as the vestibulo-ocular reflex. Hőgyes’ discovery was only superficially noted during his lifetime and ignored after his death.
Conclusion: Hőgyes was the first to demonstrate the vestibulo-ocular reflex. He was forgotten during the ensuing 140 years probably because his articles were appeared only in Hungarian and because a short time later, Róbert Báránys award of the Nobel Prize overshadowed many of Báránys predecessors and contemporaries, including Hőgyes and relegated them to the background.

Auditory and Vestibular Dysfunction in M.3243A>G Carriers

01-10-2019 – Finsterer, Josef

Journal Article

No abstract available

In Response to the Letter to the Editor: Auditory and Vestibular Dysfunction in M. 3243A>G Carriers

01-10-2019 – Inoue, Aki; Iwasaki, Shinichi

Journal Article

No abstract available

MRI Evidence of Vestibular Atelectasis in Bilateral Vestibulopathy and Tullio Phenomenon

01-10-2019 – Eliezer, Michael; Toupet, Michel; Vitaux, Hélène; Guichard, Jean-Pierre; Kania, Romain; Houdart, Emmanuel; Hautefort, Charlotte

Journal Article

No abstract available