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Objective: Placing a middle ear prosthesis is considered a key competency for the general otolaryngologist, but surgeons struggle to obtain and maintain this skill. The current study aims to characterize pre‐coronavirus disease 2019 trends in stapedectomy and ossiculoplasty. Study Design: Database review. Setting: Tricare beneficiaries are treated at civilian and military facilities. Methods: The Department of Defense beneficiary population of more than nine million persons per year was reviewed for patients undergoing either stapedectomy or ossiculoplasty between 2010 and 2019, identified by the current procedural terminology code. Results: A total of 3052 stapedectomies and 7197 ossiculoplasties were performed. Over the 10‐year study period, stapedectomy decreased by 23%, with an average annual rate of −2.7% per year (Pearson r = −.91, P =.0003). Ossiculoplasties declined by 18%, an average annual rate of −1.9% (r = −.8, P =.006). In combination, cases declined by 20%, an average annual rate of −2.2% (r = −.87, P =.001). Conclusion: While declines in stapedectomy surgery have been well reported, here we show steady declines in ossiculoplasty as well. If these trends continue, more cochlear implantations may be performed annually than stapedectomy and ossiculoplasty combined, with cochlear implantation likely to overtake ossicular chain surgery in the near future. These changes in surgical volume have a direct implication on resident education and general otolaryngology expectations after graduation. Strong consideration should be made to replace "Stapedectomy/Ossiculoplasty" as resident key indicator with "Cochlear Implantation," a more professionally meaningful skill. [ABSTRACT FROM AUTHOR]

Objective: Ubiquitous throughout the literature and during patient counseling, vestibular schwannoma is often quoted to affect about 1 per 100,000 people. Yet, reports from distinct international populations suggest that the incidence is likely much higher. The objective of the current work was to systematically characterize the global incidence of sporadic vestibular schwannoma. Data Sources: Scopus, Embase, and PubMed. Review Methods: Population-based studies reporting incidence rates of sporadic vestibular schwannoma between January 2010 and August 2020 were searched with language restrictions requiring reports to be published in Chinese, English, German, Italian, or Spanish. The protocol was registered with PROSPERO (CRD42021228208) prior to commencement of data collection. PRISMA guidelines for transparent reporting of systematic reviews were followed. Results: Among 424 citations, 6 publications covering 4 distinct populations from Denmark, the Netherlands, Taiwan, and the United States met inclusion criteria. Most recent incidence rates of among all ages ranged between 3.0 and 5.2 per 100,000 person-years. Highest incidence rates were reported among patients aged ≥70 years, peaking at 20.6 per 100,000 person-years. One study from the United States reported the incidence of asymptomatic, incidentally diagnosed tumors at a rate of 1.3 per 100,000 person-years from 2012 to 2016. Conclusions: Recent international incidence rates of sporadic vestibular schwannoma exceed the commonly quoted "1 per 100,000" figure by up to 5-fold among all ages and by up to 20-fold among age groups at highest risk. Based on modern incidence rates, the lifetime prevalence of developing sporadic vestibular schwannoma likely exceeds 1 per 500 persons. [ABSTRACT FROM AUTHOR]

Stapedectomy remains a joint key-indicator case with ossiculoplasty for otolaryngology residents in the United States. Yet, residents consistently report feeling inadequately prepared to perform stapes surgery following graduation. Applying recently described age- and sex-standardized incidence rates of surgically confirmed cases of otosclerosis to the US populace, upper and lower estimates of residents' case exposure to stapedectomy can be approximated. With this, uppermost projections estimate 6484 new cases of stapes surgery are performed annually nationwide. With approximately 1424 otolaryngology residents nationally, the average case exposure is 7.8 stapedectomies throughout their training, with upper and lower estimates of 17.1 and 4.2 cases, respectively. As such, proficiency in stapedectomy is no longer a realistic expectation for US graduating residents. This reality supports the removal of "stapedectomy" from the list of 14 key-indicator case requirements, leaving ossiculoplasty as its own key-indicator case, thereby reinforcing true competence in this fundamental procedure for the graduating otolaryngologist. [ABSTRACT FROM AUTHOR]

Objective. To determine the evidence for efficacy of intratympanic (IT) steroid treatment for the management of idiopathic sudden sensorineural hearing loss through a systematic review of the existing literature.Data Sources. Online databases consisting of PubMed, Medline, OVID, Google Scholar, Cochrane Review, and collected additional publications cited in bibliographies.Review Methods. Literature search by both authors with structured criteria to select studies evaluated for systematic review.Results. The authors identified 176 articles, of which 32 represented studies of initial or salvage intratympanic steroid injections for sudden hearing loss that included 6 randomized trials and only 2 randomized controlled trials. Despite the paucity of well-executed trials, the vast majority of studies of intratympanic steroids for salvage treatment in all tiers demonstrated a benefit of intratympanic steroid therapy. A limited meta-analysis of the higher quality studies revealed a mean difference in improvement of 13.3 dB (95% confidence interval [CI], 7.7-18.9; P < .0001). Although statistically significant, it is still unclear if this difference is clinically significant. Initial intratympanic therapy was equivalent to standard therapy in the existing literature of all qualities.Conclusion. Intratympanic steroid treatment as primary treatment for sudden sensorineural hearing loss appears equivalent to treatment with high-dose oral prednisone therapy. As salvage therapy, intratympanic steroids offer the potential for some degree of additional hearing recovery, although it remains uncertain if this improvement is clinically significant and what percentage of patients is likely to show benefit. [ABSTRACT FROM AUTHOR]

Objective: To characterize gene expression in sinonasal polyps and to gain insight into change in expression after oral corticosteroid treatment. Study Design and Methods: Nasal polyps were obtained before and after oral corticosteroid treatment and gene expression was analyzed with a focused gene array technique. Results: Pretreated sinonasal polyps demonstrated high gene expression for chemokine and leukotriene receptor genes (CCR2, CCR5, CX3CL1, and LTB4R) in all patients. After treatment, the global effects of corticosteroids were evident on gene expression. Conclusions: Gene array techniques hold promise as a research method in sinonasal polyposis. The potential benefits, as well as the potential challenges, in using these research methods will be discussed. [Copyright &y& Elsevier]

Objectives: Correlate the findings of preoperative magnetic resonance imaging (MRI) and computed tomography (CT) in temporal bone carcinoma with histopathological findings following lateral temporal bone resection. Methods: In this retrospective review, 11 cases of temporal bone carcinoma over the past 3 years were reviewed at our institution. Preoperative CT and MRI scans were systematically reviewed for tumor involvement in 10 anatomic areas involving and surrounding the temporal bone. These were compared with results found on final histopathology. Results: Among the 11 cases, 30 anatomic areas of tumor involvement identified on CT imaging were also found on MRI and confirmed on final histopathology. Two areas suggestive on tumor involvement on CT and MRI (parotid gland and regional lymph nodes) and 2 areas on MRI alone (mastoid antrum and middle ear) were negative on final histopathology. MRI did not change the preoperative clinical staging in any of the 11 cases, however, examination of the MRI in 1 case suggested temporal lobe involvement that was not seen on CT images and subsequently changed the management of the patient. Conclusions: The addition of MRI in the preoperative evaluation of these patients confirmed the extent of tumor involvement seen on CT and did not identify additional tumor or facial nerve involvement in most cases except for one advanced case. In this case, the addition of the MRI findings changed the treatment plan. While CT remains the imaging gold‐standard for preoperative evaluation and staging, MRI should be obtained in evaluating advanced temporal bone tumors. [ABSTRACT FROM AUTHOR]

Objectives: (1) Examine the efficacy of quick‐setting, hydrophilic formulation of hydroxyapatite cement (HAC) used in cranioplasty for the prevention of cerebrospinal fluid (CSF) leaks and long‐term wound complications following translabyrinthine acoustic neuroma (TLAN) surgery. (2) Review evolution of HAC cranioplasty. Methods: Retrospective case review from 2006 to 2013 in atertiary referral center. Consecutive patients undergoing translabyrinthine approach for acoustic neuroma tumors were operated on by the senior author. Intervention: Therapeutic: Cranioplasty combining a medial abdominal fat graft with hydrophilic hydroxyapatite cement filling the mastoid. Main outcome measures: Incidence of cerebrospinal fluid (CSF) leaks and any wound complications. Results: Forty‐four patients met inclusion criteria. There were no CSF leaks or other wound complications in this series. Conclusions: Hydrophilic HAC appears to be safe and efficacious for cranioplasty following translabyrinthine acoustic neuroma surgery. [ABSTRACT FROM AUTHOR]