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Objectives/hypothesis: To describe the histopathology of the invasion patterns of advanced-stage external auditory canal (EAC) squamous cell carcinoma (SCC). Study Design Retrospective cohort study.Methods: Retrospective analysis of medical records of patients diagnosed with EAC SCC available at the Massachusetts Eye and Ear temporal bone (TB) collection. TBs underwent processing for histologic examination. Hematoxylin and eosin-stained slides were examined. Histologic findings were compared to premortem clinical data.Results: Nine TBs were identified. Male:female ratio was 6:3. The average age of diagnosis and duration of survival was 64 (46-80 years) and 2.3 years (1-50 months), respectively. All presented with T4 disease, most commonly due to petrous apex (PA) invasion and facial nerve (FN) weakness. The mastoid air cells system served as a tumor conduit to the tegmen mastoideum and overlying dura in four patients, posterior fossa dura in one patient, vertical segment of FN in four patients, and middle ear (ME) and lateral semicircular canal in five patients. The tumor did not penetrate the tympanic membrane, oval window membrane (fenestra vestibule), or round window (RW) membrane. Supra- and infralabyrinthine pneumatization patterns allowed direct routes to the PA. Translabyrinthine PA invasion was seen in two patients. The most common locus of otic capsule invasion was the cochlea. One patient had FN paralysis due to compression rather than invasion.Conclusions: SCC does not tend to extend from the ME to the inner ear through the RW and vestibule-stapedial ligament. Tumors tend to spread along the preexisting TB air-tract routes. Well-aerated TB, may facilitate extension to the PA.Level Of Evidence: 4 Laryngoscope, 131:E590-E597, 2021. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effects of conductive hearing loss and occlusion on bone-conducted cervical vestibular evoked myogenic potentials (cVEMPs). Study Design: Prospective cohort study conducted in the year 2018. The right ear of each volunteer was evaluated under 3 conditions by using bone-conducted cVEMPs: normal (open external auditory canal), occluded (conductive hearing loss with occlusion effect), and closed (conductive hearing loss without the occlusion effect). Setting: Single academic center. Subjects and Methods: The study comprised 30 healthy volunteers aged 20 to 35 years (16 women, 14 men). All had normal hearing and no vestibular or auditory pathologies. The thresholds and amplitudes of cVEMP responses were recorded for the 3 conditions. The results of each condition for a particular participant were compared. Results: As compared with the open condition, the conductive condition increased thresholds by 2.8 dB (P =.01), and the occluded condition decreased thresholds by 3.8 dB (P =.008). The amplitude in the occluded condition was larger than the normal condition and the conductive condition (mean difference: 20.64 [ P =.009] and 31.76 [ P <.001], respectively) Conclusion: The occlusion effect is present in cVEMP responses. The mechanism is not due to the conductive hearing loss induced. Clinical implications include potentially altering vestibular function with sealed hearing aids and in the surgically modified ears (ie, obliterated ears and open cavity mastoidectomy). [ABSTRACT FROM AUTHOR]

Objective: To describe the histopathologic findings and clinical presentation of intra‐temporal facial nerve invasion in primary and metastatic malignancies of the human temporal bone (TB). Materials and Methods: Retrospective analysis of all medical records of patients diagnosed with peripheral facial nerve palsy (PFnP) of a malignant origin was performed. Temporal bones underwent standard processing for histologic examination. Hematoxylin and eosin (H&E)–stained slides were examined by light microscopy. The histologic findings were compared to premortem clinical data. Results: Eighteen TBs were identified in 16 patients. The male to female ratio was 9:7. The median (range) age of death was 56.5 years (27 months to 75 years). The median time interval from facial nerve injury to death was 5.5 months. There were 11 carcinomas and seven sarcomas identified. Primary TB malignancies were identified in seven TBs (39%), and the rest (11 TBs, 61%) were of metastatic origin. Complete facial nerve paralysis (House‐Brackmann [HB] grade VI), was the most common clinical presentation affecting nine patients (10 TBs, 56%). Neural involvement was multifocal in nature (16 of 18 TBs, 89%). The most commonly involved cranial nerve (CN) VII segment was the meatal segment (13 TBs, 72%), followed by the labyrinthine, tympanic, and vertical segments (nine, eight, and six TBs, respectively). Conclusion: PFnP can be the result of local, regional, or distant malignancy, and is associated with poor survival. The facial nerve can serve as a route of tumor progression intracranially. Whereas every segment of CNV II can be violated by tumors, not all PFnP are related to direct tumor invasion. Level of Evidence: 4 Laryngoscope, 130:E358–E367, 2020 [ABSTRACT FROM AUTHOR]

Objective: Understanding communication difficulties related to tinnitus, by identifying tinnitus-related differences in the perception of spoken emotions, focussing on the roles of semantics (words), prosody (tone of speech) and their interaction. Study sample and design: Twenty-two people-with-tinnitus (PwT) and 24 people-without-tinnitus (PnT) listened to spoken sentences made of different combinations of four discrete emotions (anger, happiness, sadness, neutral) presented in the prosody and semantics (Test for Rating Emotions in Speech). In separate blocks, listeners were asked to attend to the sentence as a whole, integrating both speech channels (gauging integration), or to focus on one channel only (gauging identification and selective attention). Their task was to rate how much they agree the sentence conveys each of the predefined emotions. Results: Both groups identified emotions similarly, and performed with similar failures of selective attention. Group differences were found in the integration of channels. PnT showed a bias towards prosody, whereas PwT weighed both channels equally. Conclusions: Tinnitus appears to impact the integration of the prosodic and semantic channels. Three possible sources are suggested: (a) sensory: tinnitus may reduce prosodic cues. (b) Cognitive: tinnitus-related reduction in cognitive processing. (c) Affective: group differences were related to the existence of tinnitus, but not to the extent of tinnitus complaints and/or affective symptoms. [ABSTRACT FROM AUTHOR]

Background: Balance is a complex process involving the coordinated activities of multiple sensory, motor and biomechanical components. Balance function may be disturbed in subjects suffering from hearing loss but the impairment has been attributed to the pathology underlying the hearing loss. Aim: The purpose of the study was to investigate the possible interference of simulated conductive hearing loss with the ability to maintain postural balance. Methods: Twenty normal‐hearing subjects, 20‐30 years old, underwent the computerised dynamic posturography test battery before and after plugging their external ear canals with earplugs, thus simulating a 40dB conductive hearing loss. Results: Eighteen females and two males were tested before and after plugging their ear canals. Average CHL was 40 ± 4.9dB. The composite equilibrium score was significantly diminished after plugging the ears with an average sway score of 73.5% (P <.05, T = 2.27). The fourth test condition was specifically affected with an average sway score of 72.85% with earplugs (P <.05, T = 2.37). Conclusions: Conductive hearing loss has a negative effect on balance. This can be theoretically explained by the association between hearing loss and saccular dysfunction. [ABSTRACT FROM AUTHOR]

Introduction: Sudden sensorineural hearing loss (SSNHL) can be the presenting symptom of vestibular schwannoma (VS). Usually, steroidal treatment is given before magnetic resonance imaging (MRI) is performed.Objectives: The aim of this study was to investigate whether there is a different pattern of steroidal treatment response after SSNHL in patients with and without a VS, in order to determine whether rapid hearing improvement can serve as a predictor of the presence of VS.Methods: Charts of patients with SSNHLs were reviewed. Analysis of the presenting symptoms of patients with an SSNHL with and without a coexisting VS and comparison of the response to steroids of the two groups of patients was performed.Results: A total of 420 patients were treated for SSNHLs during the study period. Treatment consisted of intraoral prednisone 1 mg/kg/day. The male-to-female ratio was 1.00:1.17, and the median age at diagnosis was 38 years (range 18-82); neither parameter correlated with the presence of VS. MRI scans demonstrated a VS in 20 patients (4.76%). Audiometric testing 7 days after steroidal treatment initiation revealed that the pure-tone average of 240 patients (60%) without VS improved, and that of the 16 (80%) patients with VS improved by the same audiometric criteria (p = 0.0007).Conclusions: Improvement of hearing within 1 week after steroidal treatment initiation in patients with SSNHLs may suggest the presence of a VS. [ABSTRACT FROM AUTHOR]