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To review the outcomes of cochlear implants (CI) in patients with neurofibromatosis type 2 (NF2) in a large cohort, and identify factors associated with poor hearing benefit.Fifteen-year retrospective national observational case series.United Kingdom regional NF2 multidisciplinary teams.Consecutive patients with NF2 receiving a CI.CI for hearing rehabilitation.1) Audiometric performance at 9 to 12 months after implantation using City University of New York (CUNY) sentence recognition score, and Bamford- Kowal-Bench (BKB) word recognition score in quiet (BKBq), and in noise (BKBn). 2) CI use at most recent review.Sixty four consecutive patients, median age 43 years, were included. Nine to 12 months mean audiometric scores were: CUNY 60.9%, BKBq 45.8%, BKBn 41.6%. There was no difference in audiometric outcomes between VS treatment modalities. At most recent review (median 3.6 years from implantation), 84.9% with device in situ/available data were full or part-time users. Between 9 and 12 months and most recent review there was an interval reduction in mean audiometric scores: CUNY -12.9%, BKBq -3.3%, BKBn -4.9%. Larger tumor size and shorter duration of profound hearing loss were the only variables associated with poorer audiometric scores. Tumor growth at the time of surgery was the only variable associated with CI non-use. Individual patient response was highly variable.CI can provide significant and sustained auditory benefits to patients with NF2 independent of tumor treatment modality, with the majority of those implanted becoming at least part-time users. Larger datasets are required to reliably assess the role of independent variables.

Objectives/hypothesis This study set out to describe the progression of hearing loss in patients with neurofibromatosis type 2 (NF2), treated in a quaternary multidisciplinary clinic. It also aimed to compare hearing loss across patients grouped according to a known genetic severity score to explore its utility for prognostication. Study design Retrospective cohort study. Methods We conducted a study of 147 patients with confirmed NF2 diagnosis for a mean observational period of 10 years. Pure-tone average (PTA), optimum discriminations scores (ODS), and genotype data were collected. Patients were classified according to hearing class (American Academy of Otolaryngology), their candidacy for auditory implantation (UK National NF2 consensus) and grouped by genetic severity as: 1 = tissue mosaic, 2A = mild classic, 2B = moderate classic, and 3 = severe. Survival analysis investigated the effect of genetic severity on the age of loss of serviceable hearing. Results Genetic severity was a significant predictor of hearing outcomes such as ODS, hearing classification, and maximum annual PTA deterioration. Although the overall median age of loss of serviceable hearing was 78 years, there was significant variation according to the genetic severity; the median for severe patients was 32 years compared to a median of 80 for tissue mosaic patients. Conclusions This is the first description of long-term hearing outcomes in a clinical setting across a large heterogeneous cohort of patients with NF2. The results highlight the potential importance and benefit of considering the genetic severity score of patients when undertaking treatment decisions, as well as planning future natural history studies. Level of evidence 2c Laryngoscope, 129:974-980, 2019.

OBJECTIVES/HYPOTHESIS To determine if aspirin intake is associated with reduced growth of vestibular schwannomas (VS). To determine the prevalence of contraindications to regular aspirin in patients with VS. STUDY DESIGN Retrospective, observational case-control study. METHODS The study utilized a postal questionnaire and telephone interviews to determine aspirin exposure. Propensity score matching was used to control for age, sex, and tumor size. Cases were defined as patients with VS proven to have grown on serial magnetic resonance imaging (MRI). Controls were defined as patient with VS stable on serial MRI. Prevalence of regular aspirin use was compared in patients with growing VS versus stable VS. Absolute and relative contraindications to aspirin intake were recorded. RESULTS Six hundred fifty-three patients with VS were contacted, and responses were received by 67% (220 cases and 217 controls). The mean tumor size was 11.3 mm (9.0 mm and 13.3 mm in controls and cases, respectively). Aspirin exposure was more common in stable VS than growing VS (22.1% vs. 17.3%). However, following matching to control for covariates, aspirin was not found to be associated with VS stability (P = .475). Multiple logistic regression (analysis of variance) found tumor size to be the only factor strongly associated with tumor growth (P

Objectives:To measure the thermal properties of operative endoscopes used in otorhinolaryngological practice.Methods:A series of endoscopes of varying diameters and angulations were attached to a light source and temperature measurements taken of their shaft and tip; a measurement was also taken 5 mm in front of the endoscope tip.Results:Temperature changes took place rapidly. The amount of heat produced by the endoscopes was maximal at the tip, with larger diameter endoscopes attaining a higher temperature. Temperatures on the shaft and in front of the tip reached relatively constant temperatures independent of the type of endoscope. The maximum temperature achieved was 104.6°C for the 4 mm, 0° endoscope. Cooling occurred rapidly after the light source was switched off.Conclusion:The heat produced by some endoscopes is sufficiently great to cause thermal injury to tissues. Awareness of the temperatures produced by these endoscopes should prompt clinicians to actively cool their endoscopes during a procedure, before any thermal injury is caused.

Previous studies of computed tomography (CT) and magnetic resonance imaging (MRI) before cochlear implantation have been of limited sample size, lacked statistical analysis, and been inconsistent in their conclusions. We aim to quantify the utility of CT, MRI, and their combination in order to rationalize their selection.Clinical records and radiological findings were correlated retrospectively in 158 adults and children. All underwent both CT and MRI.A total of 27.9% (95% confidence interval (CI): 21.0-35.5) of patients had a significant radiological abnormality, but these were considered critical to subsequent management in only 12.7% (7.9-18.9). All these were detected by MRI. They were missed by CT in 6.3% (3.1-11.3). In all, 6.3% also had non-critical abnormalities that were reported only on CT. Cochlear dysmorphisms were more common in children but the overall frequency of abnormalities and their detection rates did not depend on age. Omitting CT and using MRI alone are estimated to miss no critical abnormalities (95% CI: 0-2.3 %).While CT may be better at defining some abnormalities, MRI appears to be able to detect all abnormalities that are critical to patient management. Most candidates for cochlear implantation can therefore be assessed by MRI initially. CT is most likely to be helpful in those with a history of severe middle ear disease, meningitis, or dysmorphic syndromes, who should undergo both CT and MRI.

Objective: Previous studies of CT and MRI before cochlear implantation have been of limited sample size, lacked statistical analysis, and been inconsistent in their conclusions. We aim to quantify the utility of CT, MRI, and their combination in order to rationalize their selection.Method: Clinical records and radiological findings were correlated retrospectively in 158 adults and children. All underwent both CT and MRI.Results: A total of 27.9% (95% CI: 21.0 - 35.5) of patients had a significant radiological abnormality, but these were considered critical to subsequent management in only 12.7% (7.9 - 18.9). All of these were detected by MRI. They were missed by CT in 6.3% (3.1 - 11.3). A total of 6.3% also had noncritical abnormalities that were reported only on CT. Cochlear dysmorphisms were more common in children, but the overall frequency of abnormalities and their detection rates did not depend on age. Omitting CT and using MRI alone is estimated to miss no critical abnormalities (95% CI: 0 - 2.3%)....

Objective: Oncological surgical technological innovation has produced alternative hemostatic dissection techniques. Collateral tissue destruction and impact upon assessment of tumor resection margins from Harmonic and Coblation dissectors remains unknown. This study uses an ex-vivo animal model to quantify the collateral tissue destruction caused by the harmonic scalpel vs coblator wand dissection.Method: Incisions through cow tongue were made between defined parallel lines with each dissection technique. The residual tissue width was measured with vernier calipers and subtracted from the width of original tissue. A scalpel blade was used as a control.Results: The mean width of collateral tissue destruction for each modality was as follows: harmonic cutting 3.0 mm, harmonic coagulating 4.1 mm, coblation cutting 3.5 mm, harmonic cutting under tissue tension 1.2 mm.Conclusion: This study demonstrates that tissue destruction produced when using the harmonic scalpel and coblation is significant when compared ...

Epistaxis is a common problem. Most patients presenting to hospital will stop bleeding with simple first-aid measures or with nasal packing. Those who do not stop will usually require surgical management. For persistent posterior epistaxis, the sphenopalatine artery may be ligated as the artery leaves the sphenopalatine foramen to enter the nasal mucosa of the lateral wall of the nose. This may be performed endoscopically. We describe the anatomy of the area and the surgical technique. We also present a brief review of the literature on this technique.

Postlaryngectomy tracheostomal stenosis is a common complication. Stomal narrowing can be severe, requiring urgent management with dilatation of the stoma. There are numerous ways to achieve this, ranging from forcibly inserting a larger tracheostomy tube, using a graduated dilator, to surgical intervention in the form of a stomaplasty. We describe an alternative technique using a readily available cuffed tracheostomy tube.