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Objective: To evaluate the safety and outcomes of cochlear implantation (CI) in patients with ventriculoperitoneal (VP) shunts to inform clinical practice. Study Design: Historical cohort study. Setting: Tertiary referral centers. Methods: A multi‐institutional historical cohort of patients with VP shunts and CI was identified and analyzed. Results: A total of 46 patients (median age 8 years [interquratile range, IQR: 2‐46]) with VP shunts and CI were identified. Of these, 41 (89%) patients had a VP shunt prior to CI. Based on institutional preference and individual patient factors, CI was performed contralateral to a pre‐existing VP shunt in 24 of these 41 cases (59%) and ipsilateral in 17 (41%). Furthermore, pre‐CI relocation of the VP shunt was performed in 3 cases (7%), and 2 patients (5%) underwent planned revision of their VP shunt concurrent with CI. In total, 2 of 27 pediatric patients (7%) required unanticipated revision shunt surgery, both contralateral to CI device placement, given VP shunt malfunction. One of 19 adult patients (5%) required shunt revision during CI due to shunt damage noted intraoperatively. Among 43 patients with available follow‐up, 38 (88%) are regular CI users, with a median consonant‐nucleus vowel‐consonant word: score of 58% (IQR: 28‐72). Conclusion: CI can be performed at low risk, either contralateral or ipsilateral, to a VP shunt, and does not mandate shunt revision in most cases. Additional considerations regarding CI receiver‐stimulator placement are necessary with programmable shunts to mitigate device interaction. Preoperative planning, including coordination of care with neurosurgery, is important to achieving optimal outcomes. [ABSTRACT FROM AUTHOR]

Objective: To present the surgical and quality of life (QOL) outcomes of patients who underwent blind sac closure of the external auditory canal (EAC) via a modified Rambo approach. Study Design: Retrospective case review. Setting: Tertiary academic referral center. Methods: All patients who underwent EAC closure with a modified Rambo approach between 2015 and 2021 were evaluated. Complication rates, QOL estimations from a validated survey, and subjective cosmetic reports were analyzed. Results: Thirty‐five ears were closed in 31 patients. The most common indication for surgery was related to cochlear implantation and cochlear malformation or cholesteatoma (31.4%). No case involved an immediate complication requiring revision surgery, and 4 ears (11.4%) were suspected of having cholesteatoma within the surgical cavity at a mean 28.6‐month follow‐up. Adults (≥18 years) had significantly higher QOL scores than children in the medical resource subscale of the Chronic Ear Survey (P <.01), and patients undergoing concurrent EAC closure and skull base tumor removal scored higher than others (P =.04). Females reported higher cosmetic scores than males (P =.04). QOL and cosmetic scores compared favorably to previously published data involving the management of otologic disease. Conclusions: Ear canal closure can be a useful technique for select adult and pediatric patients. Patient and surgeon concerns regarding QOL and cosmesis in ear canal closure should be explored prior to employing this surgical technique, though the present data suggest that the modified Rambo approach to closure is generally associated with reasonable outcomes in both areas. [ABSTRACT FROM AUTHOR]

Objectives: To determine the incidence and impact of monopolar cautery use in a cohort of pediatric cochlear implant (CI) users. Study Design: Case series from a retrospective chart review and a systematic review of the literature. Setting: Tertiary academic referral center. Methods: CI patient charts from 2012 to 2021 were reviewed from a single pediatric hospital system to determine if monopolar cautery was used during a subsequent surgical procedure. In addition, a systematic review of the literature was performed to identify additional, relevant patients. Postoperative CI function was the primary outcome measure. Results: In total, 190 patients underwent a surgical procedure following cochlear implantation in a single pediatric hospital system. Fifteen patients (7.9%) and 17 distinct surgical procedures were identified in which monopolar cautery was used. Seven of these 17 cases (41.2%) involved the head and neck, and 10 were performed below the clavicles. No patients experienced a device failure or a decline in CI performance following surgery. A systematic review identified an additional 4 patients who underwent a surgery that used monopolar cautery following cochlear implantation, and no change in CI function was identified. Conclusions: The present study adds additional support to the notion that monopolar cautery does not necessarily injure CI functionality. While the most risk adverse strategy when planning a surgical procedure for a CI patient is to avoid monopolar cautery use altogether, the use of cautery should not immediately be associated with implant dysfunction. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: To determine the value of standard clinic screening questions and vital signs in predicting abnormal vestibular function, indicated by standard objective diagnostic tests.Study Design: Retrospective records review.Methods: We reviewed electronic medical records of 150 patients seen by the neurotologists or the physician assistant they supervised, in an out-patient tertiary care clinic, between June 2018 and March 2020, and subsequently referred for the complete objective vestibular test battery (VB).Results: Of standard questions asked during the initial exam about vertigo, disequilibrium, lightheadedness and oscillopsia, only vertigo predicted an abnormal response on the VB. More males than females had abnormal VB responses, P < .05. Pulse was not related to VB score. Significantly more subjects with blood pressure in the range for stage 2 hypertension (blood pressure [BP] stage 2) had abnormal than normal results on the VB, P < .00001. Subjects with BP stage 2 had high rates of diabetes (34.2%) and hypertension (68.4%) as diagnosed by their primary care physicians or cardiologists.Conclusion: Complaints of subjective vertigo and BP in the range of hypertension stage 2 are most likely to predict abnormal findings on the VB. Therefore, during an examination of a patient who comes in complaining of dizziness, two measures may be the most useful for screening: BP in the range of hypertension type 2, when BP is taken by a nurse, and a question to determine whether or not the patient has true vertigo.Level Of Evidence: 3 Laryngoscope, 131:1382-1385, 2021. [ABSTRACT FROM AUTHOR]

Objective: To ascertain the prevalence of and associations with distress and professional burnout among academic otolaryngology attending physicians.Study Design: Cross-sectional survey.Setting: Twelve US academic otolaryngology programs.Methods: A questionnaire was administered that encompassed sociodemographic and professional features, the Expanded Physician Well-being Index for distress, the 2-item Maslach Burnout Inventory for professional burnout, the Patient Health Questionnaire-2 screen for major depressive disorder, and the Generalized Anxiety Disorder-2 screen for generalized anxiety disorder.Results: The survey response rate was 56% and included 186 attending physicians. The average respondent age was 47 years; 72% were men; 93% were married or partnered; and 86% had children. Distress was present in 40%, professional burnout in 26%, positive depression screening in 8%, and positive anxiety screening in 11%. In a univariable setting, age, hours worked in a typical week, nights on call in a typical week, and years of practice were significantly associated with distress, although in a multivariable setting, only hours worked in a typical week remained significantly associated with a positive Expanded Physician Well-being Index screen (odds ratio for each 10-hour increase, 2.61; 95% CI, 1.73-3.93; P < .001). In a univariable setting, hours worked in a typical week was significantly associated with a positive Maslach Burnout Inventory screen.Conclusion: Distress or professional burnout occurs in more than a quarter of academic otolaryngology attending physicians, whereas the prevalence of depression or anxiety is approximately 10%. The number of hours worked per week had the strongest association with distress and burnout. These findings may be used to develop and implement programs to promote physician well-being and mitigate professional burnout. [ABSTRACT FROM AUTHOR]

Objective: To assess the prevalence of distress and burnout in otolaryngology trainees, including associations with relevant sociodemographic and professional factors, and to compare these results with those of attending otolaryngologists.Study Design: A cross-sectional survey of trainees and attending physicians.Setting: Twelve academic otolaryngology programs.Methods: Distress and burnout were measured with the Expanded Physician Well-being Index and the 2-item Maslach Burnout Inventory. The Patient Health Questionnaire-2 and Generalized Anxiety Disorder-2 were used to screen for depressive disorders and anxiety disorders, respectively. Associations with sociodemographic and professional characteristics were assessed.Results: Of the 613 surveys administered to trainees and attending physicians, 340 were completed (56%). Among 154 trainees, distress was present in 49%, professional burnout in 35%, positive depressive disorder screening in 5%, and positive anxiety disorder screening in 16%. In univariable analysis, female gender, hours worked in a typical week (HW), and nights on call in a typical week (NOC) were significantly associated with distress. In multivariable analysis, female gender (odds ratio, 3.91; P = .001) and HW (odds ratio for each 10 HW, 1.89; P = .003) remained significantly associated with distress. Female gender, HW, and NOC were significantly associated with burnout univariably, although only HW (odds ratio for each 10 HW, 1.92; P = .003) remained significantly associated with burnout in a multivariable setting. Attending physicians had less distress than trainees (P = .02) and felt less callous and less emotionally hardened than trainees (P < .001).Conclusion: Otolaryngology trainees experience significant work-place distress (49%) and burnout (35%). Gender, HW, and NOC had the strongest associations with distress and burnout. [ABSTRACT FROM AUTHOR]

Objective: IgG4-related disease (IgG4-RD) is a recently recognized disease characterized by fibroinflammatory infiltrates rich in IgG4+ plasma cells that can present as isolated tumor-like lesions of the head and neck. The objective of the current study was to describe the cranial base manifestations of IgG4-RD.Methods: Review of all cases at three tertiary-referral centers since disease description in 2003.Results: Eleven patients were identified at a median age at presentation of 58 years (IQR, 38-65; 55% male). Ten (91%) patients had isolated skull base masses without systemic disease. Cranial neuropathies were commonly observed in the abducens (45%), trigeminal (18%), and facial nerves (18%). Lesions frequently involved the cavernous sinus (55%; 6/11) with extension to the petroclival junction in 50% (3/6). Infiltration of the internal auditory canal was present in 27% (3/11) with one case demonstrating erosion of the bony labyrinth. Preliminary clinical diagnoses commonly included nasopharyngeal cancer, pituitary macroadenoma, cholesteatoma, and meningioma / multiple meningioma syndrome. Local biopsy demonstrated >30 IgG4-positive plasma cells per high-powered field or an IgG4:IgG ratio greater than 40% in all cases. Rapid and durable clinical improvement was seen in 91% following corticosteroid and rituximab therapy.Conclusions: IgG4-RD nonspecifically presents as a rare cause of the skull base mass. Often presenting without concomitant systemic disease, local diagnostic biopsies are required. Obtaining adequate tissue specimen is complicated by densely fibrotic cranial base lesions that are frequently in close proximity to critical neurovascular structures. Primary medical therapy with corticosteroids and rituximab is effective in most patients.Level Of Evidence: 4 Laryngoscope, 130:2574-2580, 2020. [ABSTRACT FROM AUTHOR]

Objectives: To test the hypothesis that bipolar electrical impedance measurements in perimodiolar cochlear implants (CIs) may be used to differentiate between perimodiolar insertion technique favoring proximity to the modiolus or lateral wall.Study Design and Methods: Bipolar impedances are a measure of electrical resistance between pairs of electrode contacts in a CI. Stimulation is through biphasic pulses at fixed frequency. Impedance measurements were made in real time through sequential sampling of electrode pairs. Perimodiolar electrodes were inserted in temporal bones using one of two techniques: 1) In the standard insertion technique (SIT), the electrode array slides along the lateral wall during insertion. 2) In the Advance Off Stylet (Cochlear Ltd. Sydney) technique (AOS), the electrode maintains modiolar contact throughout the insertion process. A set of 22 insertions were performed in temporal bone specimens using perimodiolar electrode arrays with both AOS and SIT. Buffered saline was used as a substitute for natural perilymph based on similar electrical conductivity properties. Impedance with and without stylet removal were recorded with a 30-second sampling window at final insertion depth.Results: There is a significant difference in bipolar impedance measures between AOS and SIT, with impedances rising in measurements with stylet removal. Evaluation was based on two-sided analysis of variance considering technique and electrode with P < 0.025.Conclusion: Bipolar electrical impedance can be used to detect relative motion toward the modiolus inside the cochlea. This detection method has the potential to optimize intraoperative placement of perimodiolar electrode arrays during implantation. We anticipate that this will result in lower excitation thresholds and improved hearing outcome.Level Of Evidence: NA. Laryngoscope, 127:1413-1419, 2017. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: To highlight the phenomenon of cholesteatoma arising from the vascular strip following tympanoplasty and tympanomastoidectomy.Study Design: Multi-institutional retrospective chart review.Methods: Consecutive adult and pediatric patients evaluated between 2000 and 2015 with acquired cholesteatoma arising from the skin of a prior vascular strip were identified. Patients with evidence of residual or recurrent cholesteatoma elsewhere in the middle ear, mastoid, or ear canal were excluded.Results: Seventeen cases (71% female, 53% right-sided) were identified, and the mean age at presentation was 39.2 years. Patients presented on average 12.9 years following prior otologic surgery, which was most commonly tympanoplasty without mastoidectomy (59%). However, younger patients presented with symptoms sooner following prior surgery (r = 0.61, r2 = 0.37, P = 0.0095). The most common presenting symptom was otorrhea (76%). All patients were found to have mastoid cholesteatoma with bony erosion, and three patients exhibited additional tegmen or posterior fossa bone defects. The middle ear was not involved with cholesteatoma in any case. A canal wall down procedure was performed due to extensive bony canal erosion in 29% of cases.Conclusion: The vascular strip is an uncommon source of iatrogenic cholesteatoma that can present years following an otherwise uncomplicated otologic surgery. The findings presented herein highlight the importance of careful vascular strip orientation at the conclusion of otologic surgery.Level Of Evidence: 4. Laryngoscope, 127:698-701, 2017. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: To estimate the impact of race on disease presentation and treatment of vestibular schwannoma (VS) in the United States.Study Design: Analysis of a national population-based tumor registry.Methods: Analysis of the Surveillance, Epidemiology, and End Results database was performed, including all patients identified with a diagnosis of VS. Associations between race, disease presentation, treatment strategy, and overall survival were analyzed in a univariate and multivariable model.Results: A total of 9,782 patients with VS were identified among 822 million person-years. Of these, 7,400 (75.6%) claimed white, 807 (8.2%) Hispanic, 755 (7.7%) Asian, 397 (4.1%) black, and 423 (4.3%) patients reported other race. The median annual incidence of disease was lowest among black (0.43 per 100,000 persons) and Hispanic populations (0.45 per 100,000 persons) and highest among white (1.61 per 100,000 persons) populations (P < 0.001). Overall, Hispanic patients were diagnosed at the youngest age, and white patients were diagnosed at the oldest age (mean of 50.0 vs. 56.0 years, respectively; P < 0.001). Compared to white populations, black, Hispanic, and Asian populations were more likely to present with larger tumors (P < 0.001). After controlling for tumor size, age, and treatment center in a multivariable model, Hispanic patients were more likely than white patients to undergo surgery (P = 0.010); however, there were no differences between white, black, and Asian populations with regard to treatment modality. Hispanic and black patients had the poorest overall survival following surgery compared to other groups.Conclusion: Racial differences among patients with VS exist within the United States. Further studies are required to determine which factors drive differences in tumor size, age, annual disease incidence, and overall survival between races.Level Of Evidence: 3. Laryngoscope, 126:2128-2133, 2016. [ABSTRACT FROM AUTHOR]

Objectives: (1) To describe and review a single center's pediatric endoscopic cholesteatoma experience, including surgical and audiologic outcomes. (2) To assess the most common locations of residual cholesteatoma following endoscopic removal.Study Design: Case series with chart review.Setting: Tertiary otologic referral center.Subjects: Patients <19 years of age who underwent cholesteatoma removal with either endoscopic or microscopic visualization.Methods: In a comparison of patients who underwent total endoscopic ear surgery (TEES), combined endoscopic-microscopic surgery, or microscopic surgery, analyzed outcomes included locations and incidence of recurrent and residual cholesteatoma, complications, and audiometric testing.Results: Sixty-six patients (mean age, 10.9 years; range, 4-18 years; 43.4% female) with 76 ears met inclusion criteria. The average overall follow-up was 18.8 months (range, 6.7-48.3). Forty-seven (61.8%) ears underwent microscopic removal of cholesteatoma; 29 (38.1%) ears underwent combined endoscopic-microscopic removal; and 8 (10.5%) ears underwent TEES removal. Significantly more mastoidectomies were completed in microscopic cases as compared with endoscopic cases (P = .049). Though second-look procedures occurred in 15 (51.7%) endoscopic cases and 10 (21.3%) microscopic cases (P = .006), the rate of residual disease was 20.0% and 40.0% in endoscopic and microscopic cases, respectively (P = .38). When controlling for preoperative hearing, only the air-bone gap for TEES demonstrated significant improvement (P = .009). No complications were noted.Conclusion: The present report describes our experience with pediatric endoscopic cholesteatoma surgery, demonstrating similar hearing outcomes, rates of recurrence and residual disease, and complication rates as compared with traditional microscopic techniques. [ABSTRACT FROM AUTHOR]

Objective: To describe the clinical presentation and management of patients with cholesterol granulomas (CGs) that develop following temporal bone surgery.Study Design: Case series with chart review.Setting: Two independent tertiary academic referral centers.Subjects and Methods: A multicenter retrospective review was performed to identify all patients between 2001 and 2014 who were diagnosed with a CG that developed following temporal bone surgery. Patients with a history of idiopathic petrous apex CGs were excluded, as were those with <6 months of follow-up after diagnosis. Demographic and clinical data were recorded at presentation, and the main outcome measure was symptom evolution over time.Results: A total of 20 patients met inclusion criteria (median age, 55.0 years; 70.0% female), and their cases were analyzed. Diagnosis was made, on average, 149.5 months (median, 94.5; range, 13.0-480.0) following a temporal bone operation, which was for chronic ear disease in 75.0% of cases. The most common presenting symptoms were otalgia (55.0%) and otorrhea (40.0%). In patients initially managed with observation, 71.4% required no surgical intervention through a mean of 56.8 months (median, 30; range, 12.0-178.0) of follow-up. For those who initially underwent surgical excision, durable symptom relief was achieved in 66.7% of cases.Conclusion: Postoperative CG formation in the temporal bone is a rare occurrence that can be encountered years following surgery. The present study suggests that conservative management can be appropriate for many cases in which patients are relatively asymptomatic. [ABSTRACT FROM AUTHOR]

Objectives: To analyze factors that influence hearing preservation over time in cochlear implant recipients with conventional-length electrode arrays located entirely within the scala tympani.Study Design: Case series with planned chart review.Setting: Single tertiary academic referral center.Subjects and Methods: A retrospective review was performed to analyze a subgroup of cochlear implant recipients with residual acoustic hearing. Patients were included in the study only if their electrode arrays remained fully in the scala tympani after insertion and serviceable acoustic hearing (≤80 dB at 250 Hz) was preserved. Electrode array location was verified through a validated radiographic assessment tool. Patients with <6 months of audiologic follow-up were excluded. The main outcome measure was change in acoustic hearing thresholds from implant activation to the last available follow-up.Results: A total of 16 cases met inclusion criteria (median age, 70.6 years; range, 29.4-82.2; 50% female). The average follow-up was 18.0 months (median, 16.1; range, 6.2-36.4). Patients with a lateral wall electrode array were more likely to have stable acoustic thresholds over time (P < .05). Positive correlations were seen between continued hearing loss following activation and larger initial postoperative acoustic threshold shifts, though statistical significance was not achieved. Age, sex, and noise exposure had no significant influence on continued hearing preservation over time.Conclusions: To control for hearing loss associated with interscalar excursion during cochlear implantation, the present study evaluated patients only with conventional electrode arrays located entirely within the scala tympani. In this group, the style of electrode array may influence residual hearing preservation over time. [ABSTRACT FROM AUTHOR]

Objective: To describe surgical outcomes and perioperative complications in patients taking antiplatelet and anticoagulation medications while undergoing cochlear implantation. Study Design: Case series with chart review. Setting: Two tertiary otologic referral center. Subjects and Methods: Forty-six adult patients (2005-2014) who underwent cochlear implantation while on perioperative antiplatelet and/or anticoagulation therapy without interruption. Outcomes included estimated intraoperative blood loss, perception of increased difficulty secondary to bleeding, and postoperative complications attributable to continuing anticoagulation or antiplatelet therapy. Results: The cases of 46 patients (mean age, 69.5 years; 30.2% female) were analyzed. Of these, 39 patients were taking aspirin, 10 warfarin, and 7 clopidogrel. Aside from 3 (6.5%) patients with postoperative bruising without hematoma and 1 patient (2.2%) who reported self-resolving oral cavity blood, no intraoperative or postoperative complications occurred in any patient that could be ascribed to antiplatelet or anticoagulant use. Conclusion: These data demonstrate that the risk of perioperative complications from continued antiplatelet or anticoagulation therapy is low. For subjects who are at risk of major complications (eg, deep venous thrombosis, pulmonary embolism, myocardial infarction, cerebrovascular accident) from temporary medication cessation, continuing antiplatelet or anticoagulation therapy through the perioperative period is an appropriate strategy. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: Inverting papillomas (IPs) are benign locally invasive tumors that most commonly present within the sinonasal cavity. Temporal bone involvement is exceedingly rare, with fewer than 30 cases reported within the English literature to date.Study Design: Case series and systematic review of the literature.Methods: Four consecutive subjects with temporal bone inverting papilloma (TBIP) were treated, and an additional 28 previously published cases were identified in the literature. Main outcome measures were disease presentation, diagnostic evaluation, management strategy, and outcome.Results: A total of 32 cases were analyzed. The median age at diagnosis was 54 years (mean 54.1; range 19-81 years). Nineteen (59%) patients had synchronous or metachronous sinonasal IP, whereas 13 (41%) had isolated temporal bone disease without sinus involvement. Over half of the patients undergoing microsurgical resection experienced at least one recurrence. Compared to patients with a history of sinus IP, subjects with primary TBIP were younger at time of presentation (44 vs. 58 years; P=0.012); were more commonly female (62% vs. 32%; P=0.15); and were less likely to have intracranial spread (8% vs. 26%; P=0.36), cranial neuropathy (8% vs. 26%; P=0.36), human papillomavirus positivity (11% vs. 57%; P=0.11), or associated carcinoma (0% vs. 47%; P=0.004).Conclusions: Inverting papilloma of the lateral skull base is rare and can pose a significant therapeutic challenge. Primary lesions of the temporal bone appear to follow a less aggressive clinical course when compared to those arising in association with sinonasal disease. Gross total resection is the preferred method of treatment, when feasible, given the high rate of recurrence with subtotal resection and risk of associated malignancy.Level Of Evidence: 4. [ABSTRACT FROM AUTHOR]

The article discusses the Suture "Pull-Through" technique for autograft placement during tegmen repair of patients. It mentions that the surgical approach depends on the size and location of a tegmen defect and adds that solitary lateral lesions such as transmastoid or a middle cranial fossa may provide visualization for repair. It also adds combined transmastoid-subtemporal middle cranial fossa approach for cerebrospinal fluid (CSF) fistula and encephalocele repair.

Objectives: (1) Evaluate the use of subtotal resection as the primary treatment modality for large jugular paragangliomas in patients with intact lower cranial nerves. (2) Evaluate functional outcomes and tumor control following subtotal resection. (3) Identify the utility of salvage radiotherapy for residual progressive disease. Methods: Retrospective series from a tertiary academic referral center evaluating patients who presented with advanced (Glasscock‐Jackson grade 3 to 4) jugular paragangliomas (JP) and normal lower cranial nerve function. Primary outcome measures included extent of resection, long‐term tumor control, need for additional treatment, and postoperative lower cranial nerve function. Results: Fourteen patients seen between 1999 and 2013 (mean age 48.6 years; range, 26‐70) met inclusion criteria. The average maximum preoperative tumor dimension was 3.1 cm. The mean postoperative residual tumor volume was 29.3% (range, 3.5%‐58.4%). When the residual tumor volume was less than 20% of the preoperative volume, no tumor growth occurred through an average of 35.4 months of follow‐up (P <. 01). Four tumors (28.6%) demonstrated serial growth at an average of 22.5 months following resection, 3 of which were treated with salvage stereotactic radiotherapy providing durable control at an average of 12 months of follow‐up. No patient experienced permanent postoperative lower cranial neuropathy. Conclusions: Subtotal resection of JP with preservation of the lower cranial nerves is a viable management strategy. If >80% of the preoperative tumor volume is resected, the residual tumor is less likely to grow. Radiotherapy offers effective treatment for recurrent tumor following subtotal resection. [ABSTRACT FROM AUTHOR]

Objectives: Characterize radiologic growth and clinical disease progression in a cohort of observed, previously untreated, jugular paraganglioma tumors (JPT). Methods: Retrospective review evaluating all patients with primary JPTs that were observed with serial clinical examination and imaging between 1993 and 2013. Primary outcome measures included radiographic growth and progression of cranial neuropathy. Results: A total of 16 patients (75% female, median age 65.2 years) met inclusion criteria. One JPT was stage I, 7 stage II, 7 stage III, and 1 stage IV. Primary indications for observation included advanced age, minimal symptoms, contralateral paraganglioma(s), and patient preference. The most common presenting symptoms were hearing loss and pulsatile tinnitus; 6 patients were found to have lower cranial neuropathy at time of diagnosis (2 CN 9, 6 CN 10, 2 CN 11, 1 CN 12). At a mean clinical follow‐up of 67 months, 6 patients endured progressive cranial nerve deficits and 4 tumors demonstrated unequivocal growth; the average rate of tumor growth was 1.2 mm/year. Six patients underwent vocal cord medialization procedures for dysphonia. Notably, no patients required feeding tube placement or tracheostomy and there were no deaths attributable to tumor progression. Conclusions: In the absence of brainstem compression or concern of malignancy, initial observation of JPTs should be considered. A significant number of tumors do not grow after time of diagnosis, and symptoms frequently remain stable for many years. Even with disease progression, most JPTs exhibit indolent growth with slowly progressive cranial neuropathy affording satisfactory physiologic compensation in most patients. [ABSTRACT FROM AUTHOR]

Objectives: (1) Investigate factors that impact low frequency hearing preservation following cochlear implantation. (2) Evaluate the efficacy of a perioperative oral steroid taper in this setting. Methods: Retrospective series from a single surgeon at a tertiary academic referral center. Patients were candidates for a hearing preservation protocol based on their preoperative pure tone thresholds. The tympanic space was bathed in steroids prior to opening the round window membrane in all cases, and all patients were implanted using electrodes designed for atraumatic insertion. One group of patients received a 2‐week oral prednisone taper beginning 3 days prior to surgery. The primary outcome measure was the preservation of low frequency pure tone hearing on a 1‐month postoperative audiogram. Results: Twenty‐two hearing preservation candidates were implanted during an 18‐month period (mean age 50 years; range 3‐80) ending in December 2013. Thirteen patients (59.1%, mean age 45.6 years) received the oral prednisone taper while 9 (40.9%, mean age 56.3 years) did not. There was no significant age difference between the groups (P =. 18). Within the oral prednisone group, 84.6% of patients had at least a partial hearing preservation (23.1% complete preservation) compared with 33.3% (0% complete preservation) in those not taking prednisone (P <. 01). Conclusions: Oral steroids may play a role in low‐frequency hearing preservation following cochlear implantation. Though the optimal protocol has yet to be identified, a 2‐week oral prednisone taper given 3 days before surgery appears to positively impact the rate of and degree of preservation. [ABSTRACT FROM AUTHOR]

Objectives: (1) Investigate the results of cochlear implant receiver‐stimulator (RS) placement using the tight postauricular subperiosteal pocket technique. (2) Compare the efficiency of solely using a tight subperiosteal pocket compared to the conventional bone‐recess technique. Methods: Retrospective series from a tertiary academic referral center. All primary and revision cochlear implant patients in whom the RS was placed into a tight subperiosteal pocket without additional fixation were included. Primary outcome measures included RS migration, prevalence of flap complications requiring revision surgery, and time difference comparing the conventional bony well and trough technique to use of a tight subperiosteal pocket. Results: Two hundred consecutive cochlear implants (average age 46.9 years) were analyzed. At a mean follow‐up of 12.8 months, only 1 patient experienced device migration; however, none have required revision to date for complications related to RS placement. One patient experienced a hematoma that was managed with observation, and no other soft‐tissue flap complications occurred. The subperiosteal pocket technique resulted in a 20% reduction in total operative time compared to conventional RS placement methods (P <. 01). Conclusions: The tight subperiosteal pocket is a safe, durable, and time saving technique for RS placement during cochlear implantation. Notably, the prevalence of device migration was exceedingly low, and none have required revision surgery for device drift or flap complications to date. [ABSTRACT FROM AUTHOR]

Objectives: Report surgical management and outcomes among a large cohort of patients with glomus tympanicum (GT) managed by a single tertiary referral group over 4 decades. Methods: Retrospective chart review evaluating all patients that underwent surgical treatment of histopathologically confirmed GT between 1973 and 2013. Pre‐ and postoperative audiometric outcomes were reported according to American Academy of Otolaryngology—Head and Neck Surgery reporting guidelines and tumor stage was described using the Glasscock‐Jackson classification system. Results: A total of 114 patients (90.2% female, mean age 54.0 years) met inclusion criteria. Eleven cases were referred following recurrence, while the remaining 103 patients were treated primarily; 38 (33.3%) GTs were stage I, 52 (45.6%) stage II, 9 (7.9%) stage III, and 15 (13.2%) stage IV. A total of 105 (92.1%) patients underwent gross total removal, while 9 (7.9%) received subtotal resection for advanced disease adherent to the carotid artery and/or facial nerve. Two patients who underwent gross total resection experienced transient facial paresis and one suffered internal carotid injury with stroke. No patients have recurred at a mean follow‐up of 39 months. Conclusions: Surgical approach and extent of resection should be tailored to the patient. Gross total resection can be obtained in over 90% of patients, however leaving adherent tumor remnant on the facial nerve or carotid artery should be considered in patients with advanced infiltrative disease in order to prevent unnecessary morbidity. Microsurgical resection remains the treatment of choice for GT providing a high rate of tumor control and improvement in audiologic symptoms. [ABSTRACT FROM AUTHOR]

Objective: 1) Learn that methicillin‐resistant staphylococcus aureus (MRSA) thyroiditis causing thyrotoxicosis is a rare and potentially life‐threatening condition. 2) Understand the diagnosis and management of suppurative thyroiditis and related thyrotoxicosis. 3) Understand the rising incidence of both community‐acquired and hospital‐acquired MRSA infections. Method: We present a patient with MRSA thyroiditis and thyrotoxicosis who was evaluated by the otolaryngology–head and neck surgery service of an academic, tertiary care hospital in 2012. The literature was also reviewed through a directed PubMed search, and a relevant case was identified and discussed. Results: A patient was transferred from an outside hospital in respiratory failure with a recent history of progressive neck pain and dysphagia. Computed tomography of the neck revealed an enlarged and inflamed thyroid gland, which was causing airway compression. Thyrotoxicosis was subsequently identified. MRSA was cultured in samples from an ultrasound guided thyroid biopsy and a surgical debridement. Antibiotics were started, and the thyrotoxicosis was followed clinically. With this management, the thyrotoxicosis resolved, and hypothyroidism immediately ensued. A literature review revealed only one previously reported case of MRSA thyroiditis and thyrotoxicosis, which resolved with medical management. Conclusion: MRSA thyroiditis with associated thyrotoxicosis represents a rare complication of a bacterium that is becoming more common in community and hospital settings. To our knowledge, this is the second reported case of this particular clinical entity. Prompt identification of a causative organism and thyrotoxicosis can allow for potentially life‐saving interventions. [ABSTRACT FROM AUTHOR]