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Objectives: Profound SNHL responds well to a standard cochlear implant (CI) with rewarding results. However, if the individual has residual hearing in the low frequencies there is a reasonable chance that the pure tones will be lost. Hybrid cochlear implants have been suggested as a solution for this problem. Unfortunately, there continues to be a loss of the low frequency pure tones in a large number of these patients. Methods: One solution would be to use a middle ear implant instead of a hybrid CI. The Maxum middle ear implant has the advantage of being a minimally invasive surgical procedure that can be performed under local anesthesia. A small magnet is attached to the stapes through a transcanal approach. Results: After 3 weeks an integrated processor coil (IPC) is inserted into the external auditory canal. The IPC has an electromagnet driver. By driving the stapes directly it is possible to obtain as much as 60 dB of functional gain in the high frequencies without distortion, acoustic feedback, or the sensation of occlusion. Conclusions: For these reasons the author believes a Maxum should be considered in these patients before a Hybrid Cochlear Implant. If the SNHL progresses, then a CI can still be performed at a later date. This sequence of events delays the invasion of the cochlea and in some cases prevents the need for a CI altogether. [ABSTRACT FROM AUTHOR]

Objective: To report the results of patients with the Maxum middle ear implant (MEI) and compare word recognition scores (WRS) and speech perception gap (SP Gap) of Maxum versus optimally fit hearing aids (HA)., Study Design: Case series with chart review., Setting: Single, private otology clinic., Patients: Eleven ears, in nine adult patients (two women; average age 62.7 yr)., Interventions: Twelve consecutive ears with moderate to severe sensorineural hearing loss (SNHL) underwent implantation of the Maxum system. One patient was not included due to inadequate preoperative testing., Main Outcome Measures: Primary outcome measures included word recognition score (WRS) and SP Gap (maximum word understanding [PB max] - WRSaided) improvement compared with HAs., Results: The average Maxum WRS was 64.7% (range, 28-94%), a 41.6% improvement (range, 10-66%) over HAs (p < 0.001). The average Maxum SP Gap was 6.6% (range, -8 to 24%), a 41.6% improvement (range, 10-66%) over HAs (p < 0.001)., Conclusion: These data demonstrate that the Maxum provides superior WRS than HAs for patients with significant aided SP Gaps. There is a significant, very strong correlation between Maxum WRS and PB max (r = 0.85, p = 0.001). This implies that PB max may reasonably predict WRS outcomes with Maxum before implantation, and the SP Gap can reasonably predict the degree of additional potential benefit with Maxum. In advising patients who may be candidates for both a CI and MEI, PB max and SP Gap measurements will provide useful predictive information to help clinicians counsel patients on their choice of hearing technology., Level of Evidence: 4.

Objectives/hypothesis: To report the preliminary results of the Ototronix MAXUM middle ear implant for treatment of severe high-frequency sensorineural hearing loss., Study Design: Case series with chart review., Methods: Six consecutive ears with severe high-frequency sensorineural hearing loss (≥75 dB HL at 2, 3, and 4 kHz) and poor aided word recognition performance (≤60% single words) underwent implantation of the MAXUM system at a single, private otologic referral center. Primary outcome measures included frequency-specific functional gain and word recognition score improvement compared to optimally fitted hearing aids., Results: Six ears, in four adult patients (two female; median age 67.5 years) were included. The median unaided preoperative high-frequency pure-tone average (HFPTA) (2, 3, and 4 kHz) was 80.0 dB (range, 75.0-85.0 dB), and the median best-aided word recognition score was 48.0% (range, 24%-60%). The median HFPTA functional gain with the MAXUM system was 47.2 dB, a 25.0 dB improvement (range, 16.7-33.3 dB) (P = .03) over optimally fit hearing aids, and the median word recognition score with MAXUM was 81.5%, a 42.0% improvement (range, 20%-48%) (P = .03) with the MAXUM middle ear implant over optimally fitted hearing aids., Conclusions: These preliminary data demonstrate that the MAXUM middle ear implant provides superior functional gain and word recognition scores in quiet for patients with severe high-frequency sensorineural hearing loss compared to optimally fitted hearing aids. Future studies with greater patient numbers and patient reported outcome measures are needed to confirm these promising but preliminary results., Level of Evidence: 4 Laryngoscope, 126:2124-2127, 2016., (© 2016 The American Laryngological, Rhinological and Otological Society, Inc.)

Objective: To characterize the clinical presentation, surgical management, and outcomes of a large consecutive cohort of patients with glomus tympanicum (GT) tumors managed at a single tertiary referral group over 4 decades., Study Design: Retrospective review., Setting: Tertiary neurotological referral center., Subjects and Methods: All patients underwent surgical treatment of histopathologically confirmed GT between January 1973 and March 2014. Audiometric outcomes were reported according to AAO-HNS guidelines, and tumor stage was described using the Glasscock-Jackson classification system., Results: There were 115 patients (90.4% women; mean age, 55.2 years) who met the inclusion criteria; 38 (33.0%) cases of GT were stage I, 51 (44.3%) stage II, 10 (8.7%) stage III, and 16 (13.9%) stage IV. There were 108 (93.9%) patients who underwent gross total removal, while 7 (6.1%) received less than complete resection for advanced disease that was adherent to the petrous carotid artery, facial nerve, stapes footplate, or round window. Two patients who underwent gross total resection experienced transient facial paresis, and 1 had internal carotid injury with stroke. No patients had been diagnosed with recurrent disease at a mean follow-up of 30.4 months., Conclusion: Surgery remains the treatment of choice for GT, providing a high rate of tumor control and resolution of aural symptoms with a low risk of complications. The surgical approach and extent of resection should be tailored to the patient. Gross total resection can be performed in over 90% of patients; however, leaving a limited adherent tumor remnant on the facial nerve or carotid artery should be considered with advanced infiltrative disease to prevent unnecessary morbidity., (© American Academy of Otolaryngology—Head and Neck Surgery Foundation 2014.)

For many hearing-impaired individuals, the benefits of conventional amplification may be limited by acoustic feedback, occlusion effect, and/or ear discomfort. The MAXUM system and other implantable hearing devices have been developed as an option for patients who derive inadequate assistance from traditional HAs, but who are not yet candidates for cochlear implants. The MAXUM system is based on the SOUNDTEC Direct System technology, which has been shown to provide improved functional gain as well as reduced feedback and occlusion effect compared to hearing aids. This and other implantable hearing devices may have increasing importance as future aural rehabilitation options., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Objective: To systematically review the safety and efficacy of the 3 Food and Drug Administration-approved middle ear implant (MEI) systems currently in use for the rehabilitation of sensorineural hearing loss., Data Sources: MEDLINE and Cochrane Library databases were systematically searched by 2 independent reviewers., Study Selection: An initial search yielded 3,020 articles that were screened based on title and abstract. A full manuscript review of the remaining 80 articles was performed, of which 17 unique studies satisfied inclusion criteria and were evaluated., Data Extraction: Variables including functional gain, speech recognition score improvement, audiometric threshold shift following surgery, adverse events, and patient reported outcome measures were recorded. Study quality was appraised according to author conflict of interest, prospective or retrospective study design, inclusion criteria, number of patients, proper use of study controls, outcome measures reported, length of follow-up, and level of evidence., Data Synthesis: Heterogeneous outcome reporting precluded meta-analysis; instead a structured review was performed using best available data., Conclusion: The majority of studies evaluating the safety and efficacy of MEIs are retrospective in nature with limited follow-up. To date, no prospective randomized controlled trial exists comparing contemporary air conduction hearing aid performance and MEI outcomes. Based on available data for patients with sensorineural hearing loss, functional gain and word recognition improvement seems similar between conventional hearing aids and MEIs, whereas patient-perceived outcome measures suggest that MEIs provide enhanced sound quality and eliminate occlusion effect.

Objective: To describe a contemporary, pragmatic approach to managing cholesteatoma in the only hearing ear., Study Design: Retrospective case series., Setting: Single tertiary referral center., Patients: All patients that underwent cholesteatoma surgery, having profound hearing loss in the contralateral ear., Intervention(s): Cholesteatoma surgery., Main Outcome Measure(s): Surgical strategy, preoperative and postoperative audiometric outcomes, short- and long-term complications, recidivism., Results: Twenty-eight patients met criteria, representing 0.25% of all chronic ear surgeries performed between 1970 and 2012. Patients undergoing surgery in the latter half of the study underwent intact canal wall procedures and ossicular chain reconstruction more frequently despite having similar severities of disease. All patients with inner ear fistula underwent an open-cavity operation. In the early postoperative period, 86% of ears had stable or improved hearing levels, and all patients maintained preoperative bone conduction thresholds. At a mean follow-up of 48 months, 79% of patients maintained stable or improved pure tone thresholds, whereas 2 subjects experienced delayed sensorineural hearing loss and 2 experienced isolated declining speech discrimination. Notably, 3 of the latter 4 patients were diagnosed with labyrinthine fistula and had undergone radical mastoidectomy. None of the patients who received an intact canal wall tympanomastoidectomy experienced worsening bone conduction thresholds, whereas 1 subject demonstrated a delayed decline in speech discrimination and another recurred., Conclusion: It is commonly held that the radical or classic modified radical mastoidectomy is the procedure of choice when managing cholesteatoma in the only hearing ear while intact canal wall techniques are contraindicated. Over the last 20 years, we have adopted a less-rigid, functional approach favoring intact canal wall procedures in the absence of inner ear fistula rather than unequivocally committing to an open cavity. This strategy has been influenced by advancements in preoperative evaluation, increasing familiarity and refinement of closed-cavity techniques, postoperative imaging surveillance options, and the potential for cochlear implant "salvage" in the rare case of profound hearing loss. Based on the current series, this approach appears safe when performed by an experienced surgeon, and reliable long-term patient follow-up is maintained.

Objective: To better understand the characteristics and outcomes of facial nerve schwannomas (FNSs) over a 30-year period., Study Design: Retrospective study., Setting: Subspecialty practice at a tertiary hospital., Patients: Fifty-six patients diagnosed with FNS over a 30-year period., Methods: Preoperative data (audiologic data, facial nerve [FN] function, and patient symptoms), intraoperative data (tumor location, total versus subtotal resection, and FN status), and postoperative data (audiologic data, FN function, and recurrence) were collected. Mann-Whitney and χ2 analyses were done to determine which factors correlated with poor FN outcomes (defined as House-Brackmann ≥ 4)., Results: Of the 56 patients in this study, 53 (94.6%) underwent surgical resection of their FNS. Of those patients, 45 (84.9%) underwent total resection, and 8 (15.1%) underwent subtotal resection. Subtotal resection was associated with a statistically significant decreased risk of having postoperative HB grade ≥ 4 (odds ratio, 0.09; 95% confidence interval, 0.01-0.77; p = 0.028). Of those undergoing a subtotal resection, no patient had further tumor growth seen on postoperative magnetic resonance imaging (average time of last magnetic resonance imaging since operation, 44.9 mo). Tumor location was not statistically associated with poor FN outcome (all p > 0.05). Preoperative FN paralysis was the only preoperative clinical finding statistically associated with poor FN outcomes (p = 0.004)., Conclusion: We have identified multiple characteristics of FNS as well as multiple factors associated with increased statistical risk of poor FN outcomes.