Arriaga, Moises
Publicatie 01-01-2025
No abstract available
Pubmed PDF WebPlontke, Stefan K.; Lloyd, Simon K.W.; Freeman, Simon R.M.; Kösling, Sabrina; Arnoldner, Christoph; Biggs, Nigel; Borsetto, Daniele; Gubbels, Samuel; Hess-Erga, Janette; Koo, Ja-Won; Lohse, Christine M.; Marinelli, John P.; di Micco, Riccardo; Nassiri, Ashley M.; Rahne, Torsten; Scheffler, Jonas; Cayé-Thomasen, Per; Carlson, Matthew L.
Publicatie 28-10-2024
Over the past two decades, there has been increasing interest in the diagnosis and management of schwannomas of the inner ear including hearing rehabilitation with cochlear implants. However, tumor nomenclature and classification within the literature have been variable and oftentimes cumbersome. The term “intralabyrinthine schwannoma” is in common use when describing these tumors but is a potential source of confusion given that people often use the term “labyrinth” or “labyrinthine” to refer to the vestibular component of the inner ear only (i.e., labyrinthectomy or the translabyrinthine approach).During the Ninth Quadrennial Conference on Vestibular Schwannoma and Other Cerebellopontine Angle Lesions in Bergen, Norway, in May 2023, a multidisciplinary group of conference participants met and discussed issues pertaining to current terminology and classifications to enhance clarity and to reflect recent advances in tumor management and hearing rehabilitation.Although a variety of terms have been previously used to describe inner ear schwannomas, consensus was achieved on the term “inner ear schwannoma (IES)” to describe eighth nerve schwannomas of the cochlea, vestibule, or semicircular canals. Subgroups under this term comprise intravestibular, intracochlear, or intravestibulocochlear inner ear schwannomas (low complexity tumors), inner ear schwannomas with transfundal extension into the internal auditory canal but without modiolar involvement (intermediate complexity tumors), and inner ear schwannomas with transfundal extension with modiolar involvement (high complexity tumors).The details of the recommendations for an updated and simplified tumor nomenclature centered around tumor control and hearing rehabilitation with cochlear implantation are presented.
Pubmed PDF WebMarinelli, John P.; Rahne, Torsten; Dornhoffer, James R.; Lohse, Christine M.; Cottrell, Justin; Thomas Roland, J. Jr; Thompson, Nicholas J.; Brown, Kevin D.; Lucas, Jacob C.; Babu, Seilesh C.; Lindquist, Nathan R.; Perkins, Elizabeth L.; Tan, Donald; Lane, John I.; Hunter, Jacob B.; Harvey, Erin; Deep, Nicholas L.; Cerasiello, Samantha Y.; Kircher, Matthew L.; Espahbodi, Mana; Tooker, Evan L.; West, Niels Cramer; Caye-Thomasen, Per; Carlson, Matthew L.; Plontke, Stefan K.
Publicatie 01-01-2025
Objective To evaluate cochlear implant speech perception among patients with sporadic inner ear schwannoma who underwent ipsilateral implantation.Study Design Retrospective multi-institutional cohort study.Setting Eleven tertiary academic medical centers across Germany, Denmark, and the United States.Patients One hundred six patients with sporadic inner ear schwannoma who received an ipsilateral cochlear implant from 2011 to 2022.Interventions Ipsilateral cochlear implantation with observation, stereotactic radiosurgery, or microsurgery for tumor management.Main Outcome Measures Monosyllabic speech perception testing scores and rates of open-set speech perception.Results Among 106 patients studied, 101 (95%) achieved open-set speech perception with a median of 24 months (interquartile range IQR 12–42 mo) of audiometric follow-up. Median ipsilateral monosyllabic speech perception testing achieved was 72% (IQR 54–85%), and median ipsilateral AzBio in quiet was 75% (IQR 46–90%). Most (91 of 106 86%) underwent microsurgery for tumor control, with cochlear implantation performed simultaneously in 98% (89 of 91) of these patients. The ability to achieve gross total resection significantly differed by tumor complexity, with 97% of low-complexity tumors, 100% of intermediate complexity, and 0% of high-complexity tumors undergoing gross total resection (p < 0.001). However, among patients managed with microsurgery, there was not a statistically significant difference in post-cochlear implantation monosyllabic speech perception scores across complexity groupings, with median scores of 75 and 70% for patients with tumors of low or intermediate complexity and those with tumors of high complexity, respectively (p = 0.5). Eight of 102 patients (8%) assessed experienced deterioration in cochlear implant performance over time. Among the subset of 39 patients with available MRI to review, the region of surveillance interest could be visualized postoperatively on MRI in all cases.Conclusions Open-set speech perception is achieved in most patients with inner ear schwannoma undergoing ipsilateral cochlear implantation. Although cochlear implantation in high-complexity inner ear schwannomas is only possible with incomplete tumor resection, long-term open-set speech perception outcomes are similar to lower-complexity tumors.
Pubmed PDF WebPak, Kaitlynne Y.; Cutri, Raffaello M.; Nadeem, Wasiq; Kothari, Dhruv; Wong, Yu-Tung; Wu, Arthur W.; Miller, Mia E.
Publicatie 01-01-2025
Introduction GLP-1 receptor agonists (GLP-1 RAs) have gained traction in the management of obesity. There is limited literature on the implications of GLP-1 RAs in the field of otolaryngology.Methods We explore the association between GLP-1 RAs with eustachian tube dysfunction (ETD) and patulous ETD (PETD) by review of cases, literature, and the FDA adverse event database (FAERS). We also performed a systematic review using the PRISMA guidelines.Results We present autophony and aural fullness following GLP-1 agonist use. In both cases, nasal endoscopy confirmed significant loss of tissue bulk of the anterior and posterior ET cushions. The total number of adverse events (AEs) with GLP-1 RAs was 97,237. The proportion of otologic AEs was 958 (0.99%): 515 hypoacusis, 203 vertigo, 97 deafness, 93 tinnitus, 22 ear pain, 21 motion sickness, 5 hyperacusis, 2 ear fullness, and 0 autophony. The largest number of potential ETD-related AEs occurred with dulaglutide (417). The greatest proportion of potential ETD-related AEs occurred with exenatide (1.52%) followed by semaglutide (1.17%) and liraglutide (1.16%). The systematic review using PRISMA guidelines yielded 1,490 initial articles, of which 937 were screened and 10 met the inclusion criteria. The top 3 identified otologic side effects included nasopharyngitis, sinusitis, unspecified dizziness.Discussion Ear complaints due to GLP-1 RAs have been reported previously. However, this is the first report of PETD associated with GLP-1 RAs. While literature on GLP-1 RAs and PETD is currently limited, the mechanism is well established as reports of PETD after rapid weight loss, especially in bariatric surgery, are well known. Given the rising use of GLP-1 RAs for weight loss, clinicians should be vigilant in screening for otolaryngologic side effects, especially PET, in this population.Conclusion Otolaryngologists should be aware and monitor for possible otolaryngologic side effects, particularly PETD, with GLP-1 RA use.
Pubmed PDF WebBerezovsky, Anna N.; Espahbodi, Mana; LaPrade, Samantha L.; Friedland, David R.; Harris, Michael S.
Publicatie 21-11-2024
Objectives To assess the relationship of cardiovascular disease (CVD) and sensorineural hearing loss (SNHL).Databases Reviewed Ovid MEDLINE, Web of Science, Scopus, and Cochrane.Methods A systematic review was performed. Studies were identified using Ovid MEDLINE, Web of Science, Scopus, and Cochrane from 1946 to 2023. Per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, abstracts were screened for primary review. Full texts were reviewed for secondary review.Results There were 3,440 unique abstracts screened. After primary review of abstracts and secondary full text review, 68 articles were included. The relationship between SNHL and the following CVDs, risk factors, and interventions were ascertained: coronary artery bypass graft (CABG) surgery, coronary artery disease (CAD), carotid stenosis (CS), myocardial infarction (MI), percutaneous coronary intervention (PCI), other arteriosclerosis, cerebral small vascular disease, cerebrovascular accident (CVA), transient ischemic attack (TIA), peripheral vascular disease (PVD), hyperlipidemia (HLD), hypertension (HTN), and diabetes mellitus (DM). CABG and CAD were consistently associated with SNHL. DM was associated with SNHL, but HTN and HLD were not consistently associated.Conclusions There is a complex relationship between CVDs and SNHL. CABG and CAD were consistently associated with SNHL. DM was associated with SNHL, but other CVD risk factors (HTN and HLD) did not appear to consistently correlate with SNHL, raising consideration that SNHL is a later finding in those with CVD.
Pubmed PDF WebZhang, Long Long; Wang, JingHan; Gao, Zi Wen; Lv, Jun; Jiang, Luo Ying; Cui, Chong; Wang, Zi Jing; Wang, Da Qi; Chen, Yu Xin; Fan, Xin Tai; Ye, Cheng; Wang, Hui; Chen, Bing; Wang, Wu Qing; Li, Hua Wei; Shu, Yi Lai
Publicatie 06-11-2024
Background To create and develop a delivery approach for clinical inner ear gene therapy, we conducted a study of trans-round window membrane (RWM) microinjection using a pipetting microneedle via transcanal endoscopic ear surgery (TEES).Methods The implementation of the trans-RWM microinjection surgery involved seven cadaveric specimens, and the surgical procedures and the pipetting microneedle were developed and optimized. The TEES procedures included tympanic cavity visualization, RWM exposure, stapes footplate perforation, and trans-RWM microinjection. The feasibility of different pipetting microneedles was evaluated during microinjection.Results Exposure of the RWM microinjection site could be easily achieved in TEES, and the soft-connected pipetting microneedle was most suitable for the trans-RWM microinjection. The fluid outflow from stapes perforation could be visibly observed during the microinjection, which indicated inner ear drug delivery was successful. This inner ear drug delivery approach was successfully applied in the clinical trial.Conclusion The trans-RWM microinjection via the soft-connected pipetting microneedle in TEES was proved to be a feasible delivery approach of the inner ear gene therapy.
Pubmed PDF WebDerks, Laura S.M.; Kamalski, Digna M.A.; Thomeer, Hans G.X.M.; Grolman, Wilko; Stokroos, Robert J.; Wegner, Inge
Publicatie 29-11-2024
Objective To evaluate the difference in overall, hospital, and out-of-hospital cost difference of day-case stapes surgery, compared with inpatient stapes surgery, while maintaining equal hearing outcomes and quality of life (QoL).Study design A single-center, nonblinded, randomized controlled trial in a tertiary referral center.Methods A total of 112 adult patients planned for primary or revision stapes surgery for clinically suspected otosclerosis were randomly assigned to either the day-case or inpatient treatment group. An evaluation was performed of the difference in total health care–related costs (hospital and out-of-hospital costs) from a hospital and patient perspective over the course of 1 year. Audiometric measurements included pure-tone audiometric measurements and speech audiometry measured at 2 months and 1 year postoperatively. QoL was assessed at 3 months and 1 year postoperatively, using the EQ-5D and HUI3 questionnaires.Results A total of 109 cases (100 patients) were analyzed due to three dropouts. The total health care–related costs were €16,586 in the inpatient group (n = 54) and €16,904 in the day-case group (n = 55). The mean postoperative hospital stay was 0.9 days (mean costs of €854) in the inpatient group and 0.5 days (mean costs of €561) in the day-case group (both mean differences statistically significant), with a crossover rate from day-case to the inpatient group of 36% (n = 20) and a crossover rate from inpatient to the day-case group of 11% (n = 6). There were no differences in postoperative complications and objective hearing outcomes. Besides an increased number (0.2) of postoperative telephone consultations in the day-case group, there were no statistically significant differences in postoperative hospital and out-of-hospital costs or visits. The QoL showed no statistically significant differences.Conclusion A day-case approach in primary or revision stapes surgery does not result in a statistically significant reduction of health care–related hospital and out-of-hospital costs compared with an inpatient approach. It also does not affect the surgical outcome (objective audiometric measurements and complication rate), QoL, and postoperative course (number of postoperative hospital and out-of-hospital visits).Level of evidence: 1.
Pubmed PDF WebKhandalavala, Karl R.; Ostlie, Sarah E.; Wallerius, Katherine P.; Lohse, Christine M.; Lohmann, Amanda R.; Ladsten, Max M.; Carlson, Matthew L.
Publicatie 08-11-2024
Objective To report the feasibility and potential utility of monitoring acoustic hearing on awake patients using intraoperative behavioral responses to threshold and suprathreshold stimuli while undergoing cochlear implantation (CI) under local anesthesia, without any form of sedation.Study Design Retrospective review of the first five cases performed by one surgeon.Setting Tertiary care academic medical center.Patients Adult patients with residual acoustic hearing undergoing CI.Interventions CI under local anesthesia, without any form of sedation.Main Outcome Measures Procedural tolerance, reliability of intraoperative pure tone threshold and suprathreshold audiometry, and correlation of intraoperative findings with early postoperative residual hearing.Results Five ears in four patients underwent CI, including three males and one female, with a median age of 61 years. Intraoperatively, patients reported reliable behavioral responses to pure tone threshold and suprathreshold stimuli and provided real-time feedback on perceived stimulus change to the surgeon just prior to, during, and immediately following electrode insertion. All patients were able to complete the operation under local anesthesia. During electrode insertion, three cases reported no change and two cases reported diminished stimulus perception that reversed with limited electrode pull back near terminal insertion. Immediate postoperative audiograms demonstrated preservation of bone conduction thresholds within 10 dB of their preoperative baseline for all cases, suggesting hearing preservation. Three-month postoperative AzBio in quiet scores were available for two patients, measuring 45% and 94%, respectively.Conclusions This report describes the feasibility of intraoperative behavioral audiometry during CI under local anesthesia, using patient feedback during electrode insertion to optimize hearing preservation surgery. Akin to other surgical subspecialties that use real-time patient feedback where objective intraoperative measures of neurofunction are imperfect, we demonstrate feasibility and potential utility of live acoustic monitoring during CI.
Pubmed PDF WebFreeman, Michael H.; Patro, Ankita; Lindquist, Nathan R.; Berg, Katelyn A.; Holder, Jourdan T.; O’Malley, Matthew R.; Tawfik, Kareem O.; Jan, Taha A.; Perkins, Elizabeth L.; Moberly, Aaron C.; Haynes, David S.; Bennett, Marc L.
Publicatie 21-11-2024
Objective To assess the factors that drive a patient’s selection of cochlear implant (CI) manufacturer.Study Design Prospective survey study.Setting Tertiary referral center.Patients One hundred twenty-eight adult patients undergoing primary CI.Interventions Survey administered in the preoperative area.Main Outcome Measures Sources of information regarding CI manufacturer offerings, factors that were most important in deciding on a manufacturer, and manufacturer ultimately selected.Results One hundred twenty-eight patients were included (average age, 63.7 years; 97% White). The most cited source of information that patients used to choose a device was his/her audiologist (80.5% of patients). When asked his/her number 1 reason for choosing their CI manufacturer, the most commonly cited reason was technology (e.g., battery life, device pairing), regardless of manufacturer. When asked about specific technology offerings, hearing aid pairing was rated as the most important. The numbers 2 and 3 reasons for choosing a manufacturer were cosmetics/structure of the wearable portion of the device and audiologist recommendation of that manufacturer, respectively. The relative weight given to each of the top 3 reasons differed significantly across the three manufacturers (p = 0.017).Conclusions Audiologists are by far the leading source of information used by patients choosing a CI manufacturer. Patients prioritize technology most when choosing an implant manufacturer, but audiologist recommendation and the cosmetics and structure of the wearable device are also important. CI manufacturers should be mindful of patient priorities when designing and marketing their devices.
Pubmed PDF WebCarlson, Matthew L.; Daher, Ghazal S.; Khandalavala, Karl R.; Lohse, Christine M.; Neff, Brian A.; Driscoll, Colin L. W.; Peris-Celda, Maria; Van Gompel, Jamie J.; Link, Michael J.; Saoji, Aniket A.
Publicatie 01-01-2025
Objective To compare the utility of intraoperative electrically evoked auditory brainstem response (eABR) and electrically evoked stapedial reflex testing (eSRT) for cochlear nerve integrity monitoring during simultaneous translabyrinthine resection of vestibular schwannoma (VS) and cochlear implantation.Study design Historical cohort study.Setting Tertiary academic referral center.Patients Eleven patients (12 cases) who underwent translabyrinthine tumor resection with simultaneous placement of a standard, unmodified cochlear implant (CI).Intervention A CI placed at the beginning of the operation before tumor resection to facilitate intraoperative cochlear nerve monitoring through a CI-delivered electrical stimulus.Main outcome measure Correlation of intraoperative monitoring outcomes with postoperative CI performance.Results Among the 12 cases (median age, 47 years), eABR waveforms were present at the conclusion of tumor resection in 10, including 6 that achieved open set speech perception. Of the 2 cases with negative eABR, 1 achieved open set speech perception. By contrast, of the 8 cases with a positive eSRT response, 7 achieved open set speech perception. Of the 4 cases with a negative eSRT response, none achieved open set speech perception. The 3 cases that did not receive auditory stimulation included 2 with positive and 1 with negative eABR; all 3 had a negative eSRT response.Conclusions Intraoperative eSRT using an unmodified CI is a promising new method for monitoring the integrity of the cochlear nerve during simultaneous VS resection. eSRT response at the conclusion of tumor resection strongly correlated with CI open set speech capacity. Although still useful, eABR was less reliable at predicting postoperative hearing outcomes in this series.
Pubmed PDF WebDeVries, Jacquelyn; Birman, Catherine S.; Loundon, Natalie; MacAskil, Melissa; Távora, Nathália Manhães; Tsuji, Robinson Koji; Cheung, Linea; Kari, Elina; Carvalho, Daniela
Publicatie 28-11-2024
Objective Timely diagnosis and management of pediatric sensorineural hearing loss (SNHL) is essential for best outcomes. This study evaluated the differences of health access among cochlear implant (CI) centers of countries with different health care systems.Study Design Retrospective.Setting Multicenter, tertiary pediatric CI referral center in four different countries: United States (USA), France (FR), Australia (AUS), and Brazil (BR).Patients Pediatric (age 0–21 years (0–16 years AUS)) patients receiving CI between January 2017 and December 2019.Intervention(s) CI.Main Outcome Measure(s) Primary outcome measures included age at milestones in CI process and age at implantation.Results There were 1,673 patients who underwent CI surgery at four multinational designated institutions were identified (n = 143 AUS; 153 BRA; 1,158 FR; and 219 USA). Median age at time of hearing loss diagnosis (p < 0.0001), median age at hearing aid (HA) fitting (p < 0.0001), and CI evaluation (p < 0.0001) differed between countries. However, age at CI surgery was not significantly different between countries. Time from diagnosis to HA fitting was impacted by country (p < 0.0001) and language (p = 0.01) but not by private compared with public insurance. There were 512 children with available data regarding onset of hearing loss as prelingual n = 358 (70%) and postlingual n = 154 (30%). In patients with prelingual severe to profound hearing loss, country and race/ethnic origin affected age at diagnosis (p < 0.0001, p = 0.001), HA fitting (p < 0.0001, p < 0.001), candidacy evaluation (p = 0.0001, p = 0.02), and CI surgery (p = 0.0027, p = 0.001).Conclusions Age at pediatric CI was comparable across the CI centers compared in the four countries. This is encouraging given the effect of neuroplasticity on pediatric CI outcomes, despite different health care expenditures and delivery systems in the four countries. Improvement in care access for certain populations may decrease disparities in pediatric CI access worldwide.
Pubmed PDF WebTellioğlu, Burçay; Sennaroğlu, Levent
Publicatie 28-10-2024
Objective The objectives were to determine the interrater agreement of the Skull AP X-ray in measuring angular insertion depth (AID), to provide descriptive information about the insertion depths of different electrodes used in inner ear malformations (IEMs), to investigate the effect of cochlear size and electrode length on AID, and to guide clinicians in electrode selection in IEMs.Study Design Retrospective case review.Setting Tertiary referral center.Patients A total of 198 IEMs (n = 169 patients) and 60 cochleae with normal anatomy (n = 60 patients) were selected from patients with severe mixed or sensorineural hearing loss who presented to our clinic and underwent cochlear implantation (CI) between January 2010 and December 2022.Interventions Three neurotologists independently measured AID on Skull AP X-rays. Basal turn length of the cochlea was measured in axial and coronal oblique reformatted sections on HRCT images.Main Outcome Measures Interrater reliability (ICC) of the AID measurements on Skull AP X-ray, determining the impact of cochlea size and electrode length on AID measurements.Results The interrater reliability (ICC) test showed a high level of consistency in measuring AID in the Skull AP X-ray (R = 0.906, p < 0.001). In the control group, a negative correlation was observed between the AID and the basal turn length of the cochlea, while a positive correlation was found between electrode length and AID (R = 0.947, p < 0.001).Conclusions The Skull AP X-ray appears to be a dependable tool for measuring AID. In cases of IEMs, it is important to select an electrode of appropriate length, considering the dimensions of the cochlea.
Pubmed PDF WebShave, Samantha M.; Saber, Camelia N.; David, Abel P.; Lee, Daniel J.
Publicatie 06-11-2024
Objective To review the management of meningitis, large lateral skull base defect, and meningoencephalocele following pediatric cochlear implant (CI) surgery.Study Design Case report.Methods Patient demographics, medical and surgical history, computed tomography (CT).Results An 8-year-old male with congenital severe to profound sensorineural hearing loss underwent uncomplicated right CI surgery at 18 months of age. He returned to his home country and received a bilateral sequential left ear CI at age 2. Five years following his second CI surgery, he presented to his local emergency room with worsening fever, headache, back pain, and vomiting. Lumbar puncture confirmed bacterial meningitis, and he was managed with intravenous antibiotics. The hospital course was complicated by a right-sided facial nerve paresis, prompting a temporal bone CT. Imaging demonstrated a tegmen defect measuring 15 mm × 10 mm with soft tissue opacification involving the entire mastoid and CI harness. He was then referred by family back to our institution. Intraoperatively, we identified a massive temporal lobe meningoencephalocele involving the entire mastoid cavity and engulfing the entire proximal electrode harness. Following middle cranial fossa craniotomy and revision mastoidectomy, proximal and distal array were separated, encephalocele transected, and remaining temporal lobe reduced. The lateral skull base was reconstructed with calvarial bone, temporalis fascia, and bovine collagen graft. The remnant electrode array was removed, a new CI receiver stimulator was fixed postero-superiorly to the cranial defect, and a new multichannel array inserted. A titanium cranioplasty completed the repair. A lumbar drain was placed for 3 days. Recovery and CI activation occurred uneventfully.Conclusion Risk of encephalocele and meningitis underscores the importance of early identification, adequate repair, and long-term radiologic follow-up of iatrogenic tegmen defects during pediatric CI surgery.
Pubmed PDF WebWalkowiak, Adam; Kontides, Alejandra; Takanen, Marko; Obrycka, Anita; Skarżyński, Piotr; Skarżyński, Henryk; Lorens, Artur
Publicatie 01-01-2025
Introduction The electrically evoked stapedius reflex threshold (eSRT) is an objective measure that helps to fit cochlear implants (CIs). The primary aim of this study was to investigate the relationship between different burst durations to elicit eSRT in pediatric CI users.Materials and Methods Different stimuli burst durations (100–500 ms) were applied to observe the effect in the reflex determination in 11 pediatric CI users. Reflexes were measured in electrode contacts #2, #6, #9, and #11. Testing was conducted at 9 months after CI activation.Results Burst duration and electrode contact site both had a significant effect on eSRT (p < 0.001). The lowest eSRT thresholds were obtained with the longest burst duration. The highest stimulation level was required to elicit a reflex at basal electrode contacts. No significant effect was found for the interaction between electrode contact site and burst duration.Discussion Burst durations of 100 ms yielded significantly larger eSRT thresholds than 300- and 500-ms burst durations. Thresholds obtained with the longest (i.e., traditional) burst durations reflected maximum comfortable loudness (MCL) levels typically found at early post-activation stages. In contrast, 100-ms burst yielded threshold levels similar to MCLs that have stabilized. We therefore consider both short (100 ms) and longer (300 or 500 ms) bursts useful in the clinical practice.Conclusion The best burst duration to use depends on the interval: longer burst durations are useful for estimating MCLs for earlier intervals, whereas shorter burst durations are useful for later intervals. These findings may help clinicians optimize fittings in cases where using behavioral responses is problematic.
Pubmed PDF WebHsieh, Yue-Lin; Liu, Xu; Dai, Fei; Wang, Shenjiang; Gao, Xiuli; Wen, Deyuan; Wang, Wuqing
Publicatie 28-11-2024
Objective To report the first successful surgical treatment of a rare subtype of venous pulsatile tinnitus (PT) caused by aberrant sylvian vein and tegmen dehiscence (SVTD) with a diverticulum and soft tissue enclosing the middle ear ossicles.Patients A 35-year-old female participant presented with more than 10-year left-side PT due to SVTD diverticulum.Intervention(s) The participant underwent transtemporal surgery with a lateral minimally invasive approach to the epitympanum and aditus ad antrum after finding SVTD and diverticulum.Main Outcome Measures Contrast-enhanced CT, various magnetic resonance (MR) techniques, including the 4D-flow MR method, and transcanal recording examinations were utilized. The Tinnitus Handicap Inventory (THI) was employed to quantify the surgical efficacy in treating PT.Results PT was successfully resolved following resurfacing of the diverticulum located on the medial wall of the epitympanic space, with the patient achieving a THI score of 0. The 4D-flow MR indicated that the mean and largest velocities at the dehiscence area were 20.8 cm/s and 54.9 cm/s, respectively. The main frequency of PT fluctuated below 750 hz.Conclusion SVTD diverticulum–induced venous PT can be successfully treated via the transtemporal pathway. Additionally, this finding underscores the importance to carefully examine tegmen dehiscence and the exposed vasculature when managing venous PT.
Pubmed PDF WebAhluwalia, Jatin; Babu, Seilesh; Haupert, Michael; Thottam, Prasad
Publicatie 06-11-2024
Objectives Balloon dilation eustachian tuboplasty (BDET) has gained popularity as a treatment modality for chronic eustachian tube dysfunction (ETD) in both adults and children. Although its safety and efficacy in the adult population have been well described, very few large-sample studies assessing its safety profile have been performed in the pediatric population. This study serves as a follow-up to a previously published analysis assessing the safety of BDET in the pediatric population.Methods Retrospective chart review of 71 pediatric patients (139 ears) aged 11 ± 7 years who underwent BDET from 2019 to 2023. Medical records were reviewed from the extended postoperative period. A standardized grading scale that assesses severity of surgical complications was used.Results A total of five minor complications (7%) were noted. These included transient postoperative tinnitus, hyperacusis, otalgia, nausea, and epistaxis. There were no major complications requiring repeat intervention or need for imaging or hospital admission. In all cases, these symptoms had resolved in the postoperative time frame, with majority of them demonstrating complete resolution before the first postoperative visit.When combining these findings with the previously published paper by the same institution, the overall complication rate is 6.1% with 114 total patients. All complications between both papers are considered minor with no long-term effectsConclusions In this retrospective analysis, BDET is shown to be a relatively safe procedure when performed in the pediatric population. Upon review of the literature, this is the largest safety analysis of exclusively pediatric patients who underwent BDET.Level of evidence 4.
Pubmed PDF WebChoi, Yeonjoo; Lee, Yun Ji; Joo, Hye Ah; Kang, Woo Seok; Ahn, Joong Ho; Chung, Jong Woo; Park, Hong Ju
Publicatie 01-01-2025
Objective To evaluate the audiologic outcomes after cochlear implantation (CI) in prelingually deaf children with comorbid disorders.Study Design Retrospective study.Setting Tertiary care academic center.Patients We enrolled 85 deaf children (111 ears) with comorbid disorders who underwent CI surgery.Main Outcomes and Measures We selected the most common comorbid disorder and compared the categories of auditory performance (CAP) scores of each comorbidity group with those of the control group. Combined cochlear anomalies were also evaluated using temporal bone computed tomography.Results The most common comorbid disorder was CHARGE syndrome (n = 17), followed by developmental delay (n = 13), valvular heart disease (including septal defect) (n = 13), Waardenburg syndrome (n = 8), Down syndrome (n = 6), cerebral palsy (n = 5), and cryptorchidism (n = 5). The CAP scores differed significantly between all the groups and the control group after 6 months (p < 0.001). The differences in the CHARGE syndrome (p = 0.004), cerebral palsy (p = 0.001), and Down syndrome (p = 0.004) groups remained significant 2 years after CI. When comparing the presence or absence of anomalies within the syndromic and nonsyndromic groups, significantly poorer outcomes exist when cochlear anomalies with absent modiolus or cochlear nerve deficits were observed, regardless of the presence of syndromic disorders.Conclusion Compared with those in the control group, the CAP scores in the group with coexisting disabilities increased over time, but their final scores were relatively lower. Combined disabilities as well as the absent modiolus and cochlear nerve deficit may be clinical markers for poor CAP scores.
Pubmed PDF WebJung, Benson T.; Kuthubutheen, Jafri; Sharon, Jeffrey D.; Foster, Alan C.; Erickson, Signe; Peris, Hugo; De Juan, Eugene; Limb, Charles J.; Farinas, Kathleen Cogan; Turner, Jeremy; Henton, Amanda; Salt, Alec
Publicatie 18-11-2024
Objective To use animal pharmacokinetic data and FluidSIM modeling to estimate human dexamethasone perilymph concentrations from plasma concentration measurements over time following a single intratympanic administration of SPT-2101.Study Design Perilymph and plasma dexamethasone concentrations were measured in guinea pigs and African green monkeys over 3 to 6 weeks post-intratympanic administration of SPT-2101. Plasma concentrations of dexamethasone were measured in Ménière’s disease patients post-intratympanic administration of SPT-2101. FluidSIM was trained on the correlations of animal plasma and animal perilymph levels, allowing the human perilymph drug time course for SPT-2101 to be predicted from measured human plasma dexamethasone concentrations.Setting Tertiary care neurotology clinic in Perth, Australia.Patients Nine adults with unilateral definite Ménière’s disease per Barany Society criteria.Intervention Intratympanic SPT-2101, a single injection of a long-acting gel formulation of dexamethasone precisely delivered at the round window.Main Outcome Measure Estimated dexamethasone levels in human perilymph following a single administration of SPT-2101 at the round window over time.Results Perilymph dexamethasone concentrations were above estimated therapeutic levels for up to 35 days in guinea pigs and at least 21 days in African green monkeys. In human subjects, plasma dexamethasone concentrations were detected for 2 weeks post-administration. Animal middle ear, plasma and perilymph drug interrelationships were compared to FluidSIM simulations, providing rationale for correlating dexamethasone concentrations in the respective compartments. Comparable simulations of human plasma concentrations predicted perilymph dexamethasone therapeutic levels in humans for 23–55 days.Conclusions Sustained release dexamethasone from SPT-2101 precisely delivered at the round window provides prolonged and durable estimated perilymph concentrations in clinical subjects.
Pubmed PDF WebMonaghan, Neil P.; Shah, Sunny; Keith, Brian A.; Nguyen, Shaun A.; Newton, Danforth A.; Baatz, John E.; Wagner, Carol L.; Rizk, Habib G.
Publicatie 20-11-2024
Objective To evaluate the levels of inflammatory cytokines and symptom survey scores in patients diagnosed with Menières disease or vestibular migraine from a single center by a single neurotologist compared to control subjects with no history of dizziness or migraine.Study Design Cross-sectional pilot study.Setting Single-center tertiary referral center in Charleston, SC.Patients Patients were recruited from the neurotology clinic at a tertiary referral center. Patients with definite Menières disease or definite vestibular migraine as defined by the Barany consensus criteria were eligible. Control subjects presented to clinic without dizziness, vertigo, fluctuating hearing loss, or a history of migraine.Main Outcome Measures Questionnaire scores include DHI, SF-20, CFQ, PHQ-9, PSWQ, GAD-7, NVI, DCS, VM-PATHI, and MD-POSI. Circulating and in vitro levels of cytokines include ENA-78, GROα, IFN-α2a, IFN-γ, IL-10, IL-1α, IL-1β, IL-1RA, IL-2, IL-4, IL-5, IL-6, IL-8, MCP-1, MCP-2, MDC, MIP-1α, MIP-1β, and TNF-α. Cytokine levels were compared with effect size analysis.Results There were 20 Menières disease, 20 vestibular migraine, and 10 control patients enrolled in this study. Episode frequencies ranged from three per week to two to five per year in the MD group and daily to 1 every 2 to 3 months in the VM group. When patient-derived PBMC samples were compared to vestibular migraine, TNF-α (d = −0.427 −0.879, 0.025) and IFN-γ (d = −0.818 −1.313, −0.323) were found to be higher in Menières disease, whereas ENA-78 (d = −0.652 −1.361, 0.056) was found to be lower. No differences were found when cytokines were measured following stimulation with LPS.Conclusions This pilot study suggests Menières disease patients may have higher levels of TNF-α and IFN-γ and lower levels of ENA-78 than vestibular migraine patients when measured following in vitro release from patient-derived PBMC. Increased sample size, optimized blood draw timing, and more specific PBMC stimulation may help us further elucidate inflammatory pathways implicated in these disorders.
Pubmed PDF WebGerlitz, Matthias; Yildiz, Erdem; Dahm, Valerie; Herta, Johannes; Matula, Christian; Roessler, Karl; Arnoldner, Christoph; Landegger, Lukas D.
Publicatie 01-01-2025
Objective Excessively prescribed opioids promote chronic drug abuse and worsen a highly prevalent public health problem in the era of the opioid epidemic. This study aimed to (a) determine general analgesic prescription patterns after surgery for vestibular schwannoma (VS) with a focus on opioid prescription rates, (b) identify risk factors for receiving narcotics for postoperative pain management, and (c) highlight the feasibility of opioid-free analgesic treatment strategies.Study Design Retrospective chart review.Setting Tertiary referral center.Patients A total of 105 adult inpatients who underwent VS surgery.Interventions Analgesic prescription patterns were evaluated, and factors associated with opioid prescriptions were identified.Main outcome measure Number of prescribed analgesics.Results Metamizole (=dipyrone) and acetaminophen (=paracetamol) were the most frequently prescribed non-opioid drugs. Sixty-three (60%) patients received an opioid with a median intake of 23.2 ± 24 mg of oral morphine equivalents. Only 10 (9.5%) individuals received opioids for longer than postoperative day 1. Subjects with small tumors undergoing middle cranial fossa tumor removal (p = 0.007) were more likely to receive opioid drugs. In contrast, patients undergoing retrosigmoid craniotomy required fewer opioids for pain control (p = 0.004). Furthermore, individuals receiving opioids were prone to obtain higher dosages of acetaminophen (odds ratio 1.054, 95% confidence interval 1.01–1.10, p = 0.022).Conclusions Opioids for acute postoperative analgesia after VS surgery may be necessary in many patients. However, middle- and long-term pain control can be accomplished using non-opioid treatment regimens, resulting in a reduction in opioid prescriptions and the accompanying negative effects on individual and public health.
Pubmed PDF WebBrovold, Brooklyn L.; Lohse, Christine M.; Mehta, Parv M.; Bathla, Girish; Lane, John I.; Breen, Joseph L.; Van Gompel, Jamie J.; Carlson, Matthew L.
Publicatie 29-11-2024
Objective To analyze cases of medial migration of vestibular schwannomas to propose an underlying mechanism.Study Design Retrospective chart review.Patients Ten patients from one institution with sporadic vestibular schwannomas that demonstrated medial migration toward the cerebellopontine angle on serial imaging were reviewed.Interventions Among the 10 patients studied, 8 patients underwent stereotactic radiosurgery and 2 were managed with wait-and-scan. All serial imaging was analyzed throughout follow-up.Main Outcome Measures Volumetric and linear measurements were used to assess vestibular schwannoma growth. The fundal fluid cap length was measured from the most lateral end of the neoplasm within the internal auditory canal to the medial end of the cochlea. Pure tone averages of 0.5, 1, 2, and 3 kHz, word recognition scores, and AAO-HNS hearing class were used to assess levels of hearing loss per patient.Results Tumor growth exhibited a positive correlation with medial migration. Of the 10 patients studied, 9 exhibited tumor volume growth from initial to most recent imaging. Median changes in tumor volumes and fundal fluid cap lengths from initial diagnosis to the most recent imaging regardless of intervention were 130 mm3 (range 1,400–2,970) and 2.8 mm (range 1.8–6.0), respectively. Migration was noted in 4 patients prior to any intervention, in 4 patients postradiosurgery, and in 2 patients before and after radiosurgery. Therefore, half of the tumors studied migrated before an intervention and half migrated postradiosurgery. No correlation of migration and hearing decline was observed.Conclusion Medial migration of vestibular schwannoma is associated with an increase in tumor volume, supporting a “tumor squeeze” mechanism within a conical internal auditory canal toward the wider porus acusticus and cerebellopontine angle.
Pubmed PDF WebMikkelsen, Peter Trier; Sørensen, Mads Sølvsten; Senn, Pascal; Frithioff, Andreas; Andersen, Steven Arild Wuyts
Publicatie 06-11-2024
Objective Assessment is key in modern surgical education to monitor progress and document sufficient skills. Virtual reality (VR) temporal bone simulators allow automated tracking of basic metrics such as time, volume removed, and collisions. However, adequate performance assessment further includes compound rating of the stepwise bony excavation, and exposure and preservation of soft tissue structures. Such complex assessment requires further development of automated assessment routines in the VR simulation environment. In this study, we present the integration of automated mastoidectomy final-product assessment with validation against manual rating.Methods At two international temporal bone courses, 33 ORL trainees performed anatomical mastoidectomies in the Visible Ear (VR) Simulator with automatic performance assessment using a newly implemented rating routine based on the modified Welling Scale. Automated assessment was compared with manual ratings by experts using absolute agreement, intraclass correlation, and generalizability analysis to establish validity and reliability.Results The overall average agreement between manual and automatic assessment was 83.9% compared with the inter-rater agreement of 88.9%. A majority of items (15 out of 26) showed high agreement between automated and manual rating (>85%). Intraclass correlation coefficients were found to be high. Generalizability analysis with D-studies found that five repetitions per participant are needed for a G coefficient >0.8, which is considered necessary for high-stakes assessments.Conclusion We have demonstrated the feasibility, validity, and reliability of an automatic assessment system integrated into a VR temporal bone simulator. This can prove to be an important tool for future self-directed training with skills certification.
Pubmed PDF WebDemirjian, Natalie L.; Grande, David; Imbery, Terence E.; Muelleman, Thomas; Walsh, Erika M.; Wick, Cameron C.; Dewyer, Nicholas A.
Publicatie 08-11-2024
Objective To investigate management practices and outcomes in a retrospective cohort of patients who have sustained temporal bone gunshot wounds (TBGSW).Study Design Retrospective chart review.Setting Five participating hospitals.Patients Twenty-two patients met inclusion criteria: experienced a TBGSW, survived ≥30 days following the injury, and were evaluated and managed by a neurotologist between 2019 and 2023.Interventions No specific interventions were performed for the purposes of this study.Main Outcome Measure(s) Characteristics, evaluation, management, and outcomes of TBGSW survivors.Results Patients were found to have a mean age of 33 ± 18 years and were predominantly male (18/22, 81.8%). Majority of patients (17/22, 77.3%) had mastoid injury. Most patients (14/22, 63.6%) had some evidence for vascular injury, most frequently the internal carotid artery (9/22, 40.9%). Almost three-quarters (17/22, 77.3%) of patients had clinical exam findings of facial nerve injury, which was the most common indication for surgery. Otologic surgery was performed in 72.7% (16/22), with delayed adverse events most commonly including cholesteatoma and external auditory canal stenosis. Though evidence for hearing impairment was clinically present in at least 15 of 22 patients (68.2%), hearing rehabilitation was pursued in only two patients.Conclusion With increasing numbers of TBGSW survivors, there is a growing need for practicing neurotologists to be familiar with the wide spectrum of injury patterns and possible complications to inform clinical management in these patients. Early neurotologic assessment and follow-up beyond the acute period is crucial to minimize morbidity in this high-risk cohort.
Pubmed PDF WebSu, Hui; Huo, Yunyun; Li, Baomin; Lv, Bin; Zhang, Rongju; Du, Zhihua; Liu, Xinfeng; Wang, Jun; Chen, Xing; Cao, Xiangyu
Publicatie 01-01-2025
Objective To investigate the long-term outcomes of stenting for isolated pulsatile tinnitus (PT) caused by cerebral venous sinus stenosis.Study Design Retrospective study.Setting The First Medical Center, Chinese PLA General Hospital.Patients Patients diagnosed to have isolated PT secondary to cerebral venous sinus stenosis at our institution between December 2009 and March 2023.Intervention Cerebral venous sinus stenting.Main Outcome Measure(s) Morphological features of the cerebral venous sinus, endovascular technique, and clinical outcomes.Results The study included 80 patients with a mean age of 39.4 ± 9.6 years and an average body mass index of 23.9 kg/m. The mean age at symptom onset was 35.1 ± 8.7 years. Seventy-five of the patients (93.8%) were women. PT was the primary symptom. All patients reported feeling anxious because PT had severely affected their day-to-day lives. The PT was right-sided in 52 cases (65%). All procedures were technically successful. The mean trans-stenotic pressure gradient decreased from 4.3 ± 3.3 mm Hg before stenting to 0.4 ± 0.9 mm Hg after stent placement. Twenty-one patients (26.3%) experienced poststenting headache. The mean follow-up duration was 80.5 ± 46.3 months, with 26 patients followed for over 120 months. PT resolved in all cases after stenting, and there were no recurrences. Follow-up radiographic examination of 23 patients (28.8%) at a mean of 71.2 ± 43.1 months identified only one case of restenosis.Conclusions Long-term follow-up of these patients confirmed the efficacy and safety of stenting for isolated venous sinus stenosis–related PT.
Pubmed PDF WebDaungsupawong, Hinpetch; Wiwanitkit, Viroj
Publicatie 01-01-2025
No abstract available
Pubmed PDF WebGao, Juanjuan; Yi, Haijin
Publicatie 01-01-2025
No abstract available
Pubmed PDF WebBeckmann, Sven; Fink, Raffael; Tellez, Carlos Buitrago; Huth, Markus; Caversaccio, Marco; Dubach, Patrick
Publicatie 21-10-2024
No abstract available
Pubmed PDF WebNassiri, Ashley M.; Randall, Nicholas R.; Johnson, Brian J.; Carlson, Matthew L.
Publicatie 28-11-2024
No abstract available
Pubmed PDF Web