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Objectives: To understand the presence of transient autophony symptoms in patients being treated for severe anorexia nervosa (AN), and whether those symptoms were due to patulous eustachian tube (PET). Methods: A prospective observational study was performed in patients requiring admission for treatment of severe AN. All enrolled patients completed The Eustachian Tube Dysfunction Questionnaire (ETDQ‐7) and were screened for symptoms of autophony. If patients reported autophony and had a score of ≥14.5 on the ETDQ‐7 they were asked to undergo comprehensive audiological testing and an evaluation with an otolaryngologist. Results: Of the 73 patients enrolled in the study, 35 patients (44%) reported autophony and 36 (49%) scored 14.5 or higher on the ETDQ‐7. Of the 16 (22%) patients who had both autophony and an ETDQ‐7 score of 14.5 or higher, 7 patient s (representing 11 symptomatic ears) underwent evaluations by audiology and otolaryngology. Every evaluation of a symptomatic ear revealed objective evidence of PET. Nine of 11 (81.8%) symptomatic ears had subjectively resolved within 12 days of admission after nutritional rehabilitation and weight gain. Conclusion: Transient autophony in severe AN patients is due to PET, and was present in at least 8% of patients within our cohort. Further study is warranted to understand the quality of life impact and pathophysiology of transient PET in this patient population. [ABSTRACT FROM AUTHOR]

Objective: To compare outcomes for patients undergoing a transmastoid approach versus a middle fossa craniotomy approach with plugging and/or resurfacing for repair of superior semicircular canal dehiscence. Outcome measures include symptom resolution, hearing, operative time, hospital stay, complications, and revision rates.Study Design: Multicenter retrospective comparative cohort study.Settings: Three tertiary neurotology centers.Subjects and Methods: All adult patients undergoing repair for superior canal dehiscence between 2006 and 2017 at 3 neurotology centers were included. Demographics and otologic history collected by chart review. Imaging, audiometric data, and vestibular evoked myogenic potential measurements were also collected for analysis.Results: A total of 68 patients (74 ears) were included in the study. Twenty-one patients underwent middle fossa craniotomy repair (mean age, 47.9 years), and 47 underwent transmastoid repair (mean age, 48.0 years). There were no significant differences in age or sex distribution between the groups. The transmastoid group experienced a significantly shorter duration of hospitalization and lower recurrence rate as compared with the middle fossa craniotomy group (3.8% vs 33%). Both groups experienced improvement in noise-induced vertigo, autophony, pulsatile tinnitus, and nonspecific vertigo. There was no significant difference among symptom resolution between groups. Additionally, there was no significant difference in audiometric outcomes between the groups.Conclusion: Both the transmastoid approach and the middle fossa craniotomy approach for repair of superior canal dehiscence offer symptom resolution with minimal risk. The transmastoid approach was associated with shorter hospital stays and lower recurrence rate as compared with the middle fossa craniotomy approach. [ABSTRACT FROM AUTHOR]

Objectives: To translate and validate the Zurich Chronic Middle Ear Inventory (ZCMEI‐21) for the English language in order to provide an English instrument to assess health‐related quality of life in chronic otitis media (COM). Design: Pilot translation study including cognitive debriefings, prospective multicentre cross‐sectional psychometric validation study. Setting: Four tertiary referral centres in three different English‐speaking countries (UK, USA and Australia). Participants: Adult patients suffering from COM. Main outcome measures: The English translation of the ZCMEI‐21 (ZCMEI‐21‐E) and the five‐level version of the EQ‐5D questionnaire. The EQ‐5D, which constitutes a generic measure of health‐related quality of life, consists of a descriptive system score and a visual analogue scale. Statistical outcomes included single‐item descriptive statistics, internal consistency (Cronbach's α) as an indicator of reliability, as well as construct validity. Results: A total of 124 patients suffering from COM were included. The mean age was 50.1 years (SD 16.9 years), and 72 (58.1%) were males. The Cronbach's α of the ZCMEI‐21‐E was 0.91, suggesting an excellent internal consistency. The Spearman's correlation coefficient of the ZCMEI‐21‐E total score was 0.55 (P < 0.0001) for convergent construct validity with EQ‐5D descriptive system score and 0.57 (P < 0.0001) with the EQ‐5D visual analogue scale. Conclusions: The ZCMEI‐21‐E is a new validated questionnaire that provides clinicians with a short, comprehensive and reliable instrument to quantify health‐related quality of life in patients suffering from COM. The ZCMEI‐21‐E may be of use in clinical routine as well as in outcome research and monitoring. [ABSTRACT FROM AUTHOR]

Objectives (1) Evaluate changes in subjective symptoms in patients following transmastoid canal plugging for superior semicircular canal dehiscence (SSCD) syndrome. (2) Quantify changes in hearing in patients who have undergone transmastoid canal plugging for SSCD syndrome. Study Design Case series with chart review. Setting Single tertiary care institution. Subjects and Methods We retrospectively reviewed patients with SSCD who underwent repair with canal plugging via a transmastoid approach between January 2012 and January 2017. Symptom severity was assessed prospectively (autophony, sound/pressure-induced vertigo, disequilibrium, aural fullness, and pulsatile tinnitus) and after surgery. Pure-tone and speech audiometry were measured before and after surgery. Two-sided Wilcoxon rank-sum tests were used to evaluate changes in subjective symptoms and audiometric outcomes. Results Seventeen patients (19 ears) met inclusion criteria. The superior canal was successfully plugged via the transmastoid approach in all cases. Patients reported a statistically significant improvement in autophony, vertigo, aural fullness, and pulsatile tinnitus ( P < .01), without significant improvement in disequilibrium rating ( P = .06). There were no changes noted in pure-tone average or word recognition score; however, there was a statistically significant improvement in air-bone gap at 250 Hz of 10.9 dB ( P = .04) with 12.9-dB improvement in air conduction thresholds ( P = .02) and no difference (0.9 dB, P = .9) in bone conduction thresholds. Conclusion In our study, patients with SSCD demonstrated excellent hearing outcomes and resolution of most otologic symptoms after surgical repair. Transmastoid canal plugging, which has been described to date only in smaller case series, is a safe and effective alternative to the traditional middle cranial fossa approach. [ABSTRACT FROM AUTHOR]

Objective: To assess long-term complication rate and parental satisfaction of osseointegrated bone conduction hearing implants (OBCHIs).Study Design: Retrospective chart review of children undergoing OBCHIs.Methods: A retrospective chart review of children undergoing OBCHIs for the treatment of conductive, mixed, and single-sided sensorineural hearing loss in children.Results: Forty-five subjects were identified with 0.3 to 10.4 years of follow-up. The mean/median age and age range at implant were 9.0/7.8 and 1.7 to 19.1 years. The underlying hearing loss for the cohort included conductive (N = 30), sensorineural (N = 7), and mixed (N = 8) hearing loss. Conductive hearing loss, caused by aural atresia (62.9), was the most common indication for implantation. Fifty-eight complications occurred in 29 subjects, most related to skin infection or overgrowth. Seventeen events required revision surgery, and 18 required oral antibiotics and/or office-based cauterization. Children under the age of 5 years were more likely to have failure of osseointegration or require revision surgery. Parents of 33 subjects underwent a phone interview; 76% rated the overall satisfaction as satisfied or very satisfied.Conclusion: A large percentage of children undergoing OBCHI develop postoperative complications, and up to 44% require revision surgery-a figure higher than generally reported and higher than in adults. No factors were found to adequately explain the higher complication rates in children compared to adults. Despite the occurrence of complications, parents viewed this device as satisfactory from many perspectives.Level Of Evidence: 4. Laryngoscope, 127:2165-2170, 2017. [ABSTRACT FROM AUTHOR]

Objective: Glomus jugulare tumors (GJT) have traditionally been treated by surgery or fractionated external beam radiation therapy (XRT). This study evaluates acute toxicity and short-term efficacy of single-fraction stereotactic radiosurgery (SRS) for the treatment of GJT. Study design and setting: Eight patients (age range 28-74) with GJT underwent SRS (Brainlab linear accelerator) as primary treatment. A nominal dose of 15-16 Gy was prescribed. Results: After undergoing SRS, 7 of 8 patients (87.5%) reported complete resolution of presenting symptoms. Follow-up MRIs showed tumor stabilization in 100% of patients. Transient vertigo occurred in one patient. One patient suffered acute GI upset and transient lower cranial neuropathy. Conclusion: Stereotactic radiosurgery is an effective alternative for patients with GJT in achieving tumor control and resolution of symptoms. EBM rating: C-4 [Copyright &y& Elsevier]

Little is known about the recovery of postural control in patients following acute vestibular loss. This paper reports on the results of moving-platform posturography to assess the recovery of postural stability in 24 patients following vestibular nerve section. Posturography was abnormal prior to surgery in 17% of the patients. Seven days following surgery, 44% of the patients demonstrated vestibular deficit patterns, while 56% of the patients had normal posturography. Posturography was normal in all patients 1 month following surgery. Abnormal posturography was subsequently noted in 21% of the patients between 3 and 20 months following surgery. Each of the patients with abnormal preoperative posturography subsequently demonstrated abnormal late postoperative posturography. These results suggest that perioperative posturography may be useful in the evaluation and counseling of patients considering ablative vestibular surgery. [ABSTRACT FROM AUTHOR]

Galvanic stimulation produces postural sway and eye movements in humans. Since galvanic currents are thought to exert their effect at the trigger zone of the vestibular nerve, an intact vestibular nerve should be necessary to produce a response. We have used galvanic stimulation in humans to test the hypothesis that intact vestibular nerve fibers are required to obtain a postural sway response. Experimental subjects included normal subjects, patients who had undergone resection of an acoustic neuroma, and patients who had undergone vestibular neurectomy and surgical labyrinthectomy. Our results support the hypothesis that an intact vestibular nerve is necessary to produce a response. Moreover, two patients with recurrent vertigo following vestibular neurectomy and labyrinthectomy, who had absent ice-water caloric test responses in the operated ears, were found to have a positive galvanic response. This result suggested that their recurrent vertigo was based on intact residual vestibular nerve fibers. Although previous research has not yielded a routine clinical use for galvanic stimulation, our results suggest that galvanic stimulation of the vestibular system can provide unique and valuable diagnostic information. [ABSTRACT FROM AUTHOR]

Bithermal caloric irrigations, low-frequency rotational chair stimulation, and posturography were performed on 20 patients before and after vestibular nerve section. Twelve patients demonstrated acute postoperative spontaneous nystagmus and rotational vestibulo-ocular reflex (VOR) asymmetry. Eight patients demonstrated minimal acute postoperative spontaneous nystagmus and VOR asymmetry. Four patients had suppression of all vestibular function characterized by an absent contralateral caloric response, low VOR gain, and falls on posturography when required to rely solely on vestibular input to maintain posture. Four patients had a severe preoperative vestibular loss and no acute change in vestibular function following surgery. Over time, 5 patients continued to manifest elevated spontaneous nystagmus, 2 patients manifested a persistent rotational VOR asymmetry, and 5 patients exhibited a return of caloric function in the operated ear. It is suggested that multiple clinical factors contributed to the variable vestibular responses demonstrated in this study. [ABSTRACT FROM AUTHOR]

Previous studies have shown that the activities of the diaphragm and abdominal and upper airway muscles are adjusted during postural changes, including head-up body rotations, and that removal of vestibular inputs alters the responses. However, the effects of vestibular lesions on the movement of air into and out of the lungs have not been ascertained. The present study tested the hypothesis that removal of vestibular inputs reduces the volume, pressure and flow rate of air inspired (I) and expired (E) at the onset of head-up postural changes, due to a loss of compensatory changes in respiratory muscle activity. Experiments were conducted on conscious felines trained to breath through a facemask while rotated head-up by 60°; airflow was recorded during tilts using a Hans-Rudolf pneumotach, and the analysis focused on the first two breaths after reorientation of the body axis. In vestibular-intact animals, head-up tilts resulted in increases in the velocity and intensity of air movement: a 10±1 (SEM) % increase in ventilation, 7±1 increase in E airflow velocity, 11±1% increase in I airflow velocity, 9±1% increase in breathing rate, and an 8±1% increase in the air pressure differential during the breath. In the first week following transection of the VIIIth cranial nerves, all of these parameters were significantly attenuated (two-tailed ANOVA, p<0.05), although recovery occurred over time. These data show that the vestibular system contributes to respiratory adjustments that typically occur during postural alterations. [ABSTRACT FROM AUTHOR]

Vestibular disorders are becoming an increasingly more common medical problem. As society ages and modern entertainment and recreational activities progress the impact of dizziness on the population is become even more significant. Dizziness not only interferes with the performance of daily activities, but it also represents a serious health problem. Over the last several years, many new diagnostic and treatment modalities have been developed to help manage the dizzy patient. Otolaryngologists occupy a prime position in the treatment algorithm. Otolaryngologists are capable of diagnosing disorders of balance, prescribing medical therapy, performing surgical procedures, or directing the patient to the appropriate rehabilitation regimen. As with any field the development of new diagnostic and treatment procedures has been accompanied by controversies. Over the past several years, the equilibrium committee of the academy has been charged with examining these controversies. This symposium will present some of the controversies in the management of the dizzy patient. After the presenters discuss each issue, there will be an opportunity for audience participation. The controversies to be discussed include: the use of vestibular test apparatus in diagnosing the dizzy patient; the role of vestibular rehabilitation therapy in managing the dizzy patient; the role of medicines in treating patients with a variety of vestibular disorders Meniere’s disease; and what to do next when conservative medical therapy fails. [Copyright &y& Elsevier]

Objectives: Cochlear implant array malpositioning is associated with impaired speech perception, vertigo, and facial nerve stimulation. Tip fold-over is a subset of malpositioning that occurs more often with perimodiolar electrodes, but historically it has not been characterized due to lack of knowledge regarding electrode movements of the electrode within the cochlea. The aim of this study was to characterize the mechanics of tip fold-over events and their associated insertion pressure profiles., Methods: Cadaveric human heads were surgically prepared with a mastoidectomy and facial recess. Fiberoptic pressure sensors were inserted into the scala vestibuli and tympani to measure intracochlear pressures. Perimodiolar CI electrodes (Cochlear Slim-Modiolar, CI532) were inserted via round window under fluoroscopy., Results: Three types of tip fold-over events were observed: anterior-posterior C-shaped, medial-lateral C-shaped, and S-shaped roll-overs. The largest transient pressures occurred with anterior-posterior and S-type roll-over, and were associated with rotation or twisting inside the cochlea., Conclusions: Results demonstrate at least three subtypes of tip fold-overs. Elevated pressure transients were noted before and during the tip fold-over event related to electrode twisting. The characterization of tip fold-over into subtypes is novel and may aid identification of tip fold-over events intraoperatively in the future. It remains important to identify tip fold-over events, and they should be recognized early using a multimodal verification system. Further investigation is still required to determine the significance of these changes and other possible patterns of intracochlear electrode movement., Level of Evidence: N/A: Cadaver study Laryngoscope, 2024., (© 2024 The American Laryngological, Rhinological and Otological Society, Inc.)