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Determine the effect of cochleostomy and facial recess packing on cochlear implant electrode distance from the modiolus.Two otolaryngology residents (PGY5 and PGY6) and one attending ear surgeon performed electrode insertions on a human cochlea model using perimodiolar (Cochlear® Slim Modiolar 532™, CI532) and lateral wall electrodes (Cochlear® Slim Straight 522™, CI522) via a cochleostomy. Packing material was simulated using cotton and placed in the cochleostomy and facial recess under the following conditions: 1) inferior to the electrode, 2) superior, 3) both inferior and superior, and 4) no packing. Distance of the electrode from the modiolus at the proximal, middle, and distal basal turn of the cochlea were measured by photomicrograph analysis.Packing superior to the CI532 resulted in a significant decrease in distance from the modiolus at the middle and distal basal turn compared to the inferior condition, with the largest effect in the middle basal turn (0.25 mm vs. 1.92 mm, respectively, p 0.001). For the CI522, packing superior similarly resulted in decreased distance to the modiolus when compared to the inferior packing condition at the middle and distal basal turn regions, with the largest effect in the middle basal turn (1.25 mm vs. 1.75 mm, respectively, p = 0.002).Packing of the cochleostomy site and facial recess has a significant effect on electrode distance from the modiolus in the middle and distal basal turn using a model of a human cochlea. Effects were more pronounced when using the perimodiolar (CI532) electrode.

Objective: Review the clinical presentation and management of meningeal hemangiopericytomas of the lateral skull base and cerebellopontine angle (CPA), and describe a case of anaplastic hemangiopericytoma of the CPA presenting as a middle ear mass. Study design: Case report and literature review. Case description: A 51-year-old male presented with a one year history of hearing loss, pulsatile tinnitus, and disequilibrium. Physical examination demonstrated a mass in the left middle ear. Magnetic resonance imaging revealed a 4 cm, T1-/T2-isointense, contrast-enhancing mass in the middle cranial fossa. The erosive mass extended into the middle ear and surrounding temporal lobe. A trans-zygomatic approach with a pterional craniotomy exposed a well-encapsulated, highly vascular mass. Manipulation of the tumor resulted in significant hemorrhage. Following removal from the temporal lobe and middle ear, an anterior petrosectomy was performed to remove tumor from the internal auditory canal (IAC) and carotid artery. The facial nerve near the IAC was encased in tumor, and all but a small amount of tumor adherent to the nerve was successfully removed. The final pathologic diagnosis was anaplastic hemangiopericytoma (WHO Grade III). Metastatic workup revealed no extracranial disease, and the patient underwent adjuvant radiation therapy. He continues to do well with only mild disequilibrium at one year follow-up. Conclusions: Hemangiopericytomas are rare, malignant neoplasms that are aggressive and highly vascular. Current management recommendations include excision followed by radiotherapy. Close surveillance is required for patients with anaplastic hemangiopericytoma due to the aggressive nature of this tumor and its propensity for recurrence or metastasis. Keywords: Hemangiopericytoma, Transzygomatic, Skull base, Middle ear mass, Middle cranial fossa, Tumor

Objective To quantify the potential effectiveness of cochlear implantation for tinnitus suppression in patients with single-sided deafness using the Tinnitus Handicap Inventory. Methods The study included 12 patients with unilateral tinnitus who were undergoing cochlear implantation for single-sided deafness. The Tinnitus Handicap Inventory was administered at the patient's cochlear implant candidacy evaluation appointment prior to implantation and every cochlear implant follow-up appointment, except activation, following implantation. Patient demographics and speech recognition scores were also retrospectively recorded using the electronic medical record. Results A significant reduction was found when comparing Tinnitus Handicap Inventory score preoperatively (61.2 ± 27.5) to the Tinnitus Handicap Inventory score after three months of cochlear implant use (24.6 ± 28.2, p = 0.004) and the Tinnitus Handicap Inventory score beyond 6 months of CI use (13.3 ± 18.9, p = 0.008). Further, 45% of patients reported total tinnitus suppression. Mean CNC word recognition score improved from 2.9% (SD 9.4) pre-operatively to 40.8% (SD 31.7) by 6 months post-activation, which was significantly improved from pre-operative scores (p = 0.008). Conclusion The present data is in agreement with previously published studies that have shown an improvement in tinnitus following cochlear implantation for the large majority of patients with single-sided deafness.

Transcanal endoscopic stapes surgery has recently been described as an alternative to the traditional microscopic procedure. The principal advantage cited by proponents of the endoscopic approach is improved visualization, whereas the primary limitation of the endoscopic approach is the need for one-handed surgery, which limits the ability to suction and provide retraction with the nondominant hand. The steps of an endoscopic stapedectomy or stapedotomy are generally no different than with a microscope, though it has been suggested that the endoscope reduces the need for bony removal of the posterosuperior canal wall and decreases manipulation of the chorda tympani nerve. Herein, we describe the perioperative workup and management, surgical technique, and published outcomes of endoscopic stapes surgery.

Dermoid tumors are benign inclusion cysts that are uncommon in the pediatric population. Dermoid tumors of the middle ear are exceedingly rare. A 17-month old female presented with 4-month history of recurrent left otitis media with chronic drainage, speech delay, and worsening episodes of stumbling while walking. A temporal bone CT scan showed complete left middle ear and mastoid air cell opacification. The patient underwent left tympanomastoidectomy for removal of the middle ear mass with pathologic confirmation of a dermoid tumor. The patient continues to do well post-operatively without evidence of disease recurrence. To our knowledge, only thirteen cases of middle ear dermoid tumors have been reported. The clinical and radiographic presentation of dermoid tumors can be similar to congenital cholesteatoma, but they are histopathologically distinct lesions. Surgical removal of the dermoid tumor is an effective treatment strategy as recurrence rates are low.