Search

Despite the spread of novel-generation cochlear-implant (CI) magnetic systems, access to magnetic resonance imaging (MRI) for CI recipients is still limited due to safety concerns. The aim of this study is to assess and record the experiences of Hires Ultra 3D (Advanced Bionics) recipients who underwent an MRI examination. A multicentric European survey about this topic was conducted focusing on safety issues, and the results were compared with the current literature. We collected a total of 65 MRI scans performed in 9 otologic referral centers for a total of 47 Hires Ultra 3D recipients, including, for the first time, 2 children and 3 teenagers. Preventive measures were represented by scanning time and sedation for children. Head wrapping was used in eight cases, and six of the eight cases received local anesthesia, even if both measures were not needed. Only three patients complained of pain (3/65 examinations, 4.6%) due to the tight head bandage, and one of the three cases required MRI scan interruption. No other adverse events were reported. We believe that these results should encourage MRI execution in accordance with manufacturer recommendations for Ultra 3D recipients. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to evaluate the safety and surgical outcome of superior petrosal vein (SPV, Dandy's vein) sacrifice in translabyrinthine approach (TLA) for resection of vestibule schwannoma (VS) as compared with SPV preservation, with further investigation of preoperational factors associated with the implement of SPV sacrifice. Methods: The authors prospectively collected data from patients surgically treated for VS through TLA between June 2021 and April 2022 at the Gruppo Otologico. Results: There were 30 and 49 patients in SPV sacrifice and preservation groups, respectively. SPV sacrifice group had significantly larger tumor size (2.46 vs. 1.40 cm), less percentage of solid tumor (26.7% vs. 83.7%), higher incidence of brainstem compression (80% vs. 26.5%), and higher percentage of facial numbness (20.0% vs. 4.1%) than SPV preservation group. Gross total resection (GTR) rates were 73.3% after SPV sacrifice and 87.8% after SPV preservation. Facial nerve preservation rates were similar. No complication related with SPV sacrifice was observed. Logistic regression analysis showed tumor size and complete solid consistency as significant risk factors associated with SPV sacrifice. ROC curve further demonstrated tumor size as a fair predictor (AUC = 0.833), with optimum cutoff value of 1.68 cm. Conclusion: SPV sacrifice via TLA as needed is a safe and effective maneuver for removal of relatively large VS. Tumor size and consistency can be used as a guidance in preoperational decision-making, with cutoff value of 1.68 cm and cystic formation as predictive indicators. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To assess the effect of the position of the SS on CI regarding the ability to perform posterior tympanotomy, round window visibility, and mastoid pneumatization. MATERIALS and METHODS: This is a prospective study, including 65 adult patients with CI performed at our center during 2017. We used 3 methods to assess SS position using a computed tomography (CT) scan. Lee's line passing through the tympanic segment of the facial nerve. Park's line passing through the facial nerve and round window membrane. Our proposed method using a parallel line from the external auditory canal and passing through the facial nerve. Relation to mastoid pneumatization on CT and to intraoperative round window visibility were assessed in relation to intraoperative position of the SS. RESULTS: The method by Park et al. was statistically significant (p<0.001); however, a cutoff point could not be set. Lee's method was statistically insignificant (p=0.091). Our proposed method was statistically significant with a cutoff point at =2.46 mm (p=0.001). SS position did not affect pneumatization nor round window visibility. CONCLUSION: The position of SS preoperatively using a CT might suggest the inability to perform posterior tympanotomy and the need to change side or approach. However, it does not affect neither mastoid pneumatization nor visibility of the round window niche through the facial recess. [ABSTRACT FROM AUTHOR]

Background: The primary treatment of vagal paraganglioma (VP) includes 'wait and scan', surgery and radiotherapy., Objectives: To present the clinical findings, surgical treatment including application of internal carotid artery (ICA) stenting to facilitate surgery, and complications, as well as to review the literature and to discuss the decision-making process in the management of VP cases based on our experience and the literature., Design: A retrospective case review of 22 cases with VP., Setting: Quaternary neurotologic and skull base referral center., Material and Methods: The retrospective chart review identified 22 patients presenting with VP. Our indication for surgery was VP in younger patients, irrespective of the existence of vocal cord paralysis. Preoperative endovascular management of the ICA included permanent balloon occlusion (PBO) and stenting. The transcervical approach and the infratemporal fossa approach type A (ITFA) were used., Results: Fifteen cases had multicentric paragangliomas, 5 cases bilateral tumors, 3 cases a genetic mutation, and 2 cases a positive family history. The most common symptoms were hoarseness, tinnitus and hearing loss. The surgical approaches commonly employed for excision were the transcervical approach (9 cases) and the ITFA (12 cases), whereas 1 case did not have surgery. Three cases had PBO and 7 had intracarotid stent insertion. Gross total removal was achieved in 19 cases, and 1 case had a recurrence. Eighteen cases had no dysphagia or were well compensated after surgery. There were no significant complications noted in our series., Conclusions: In younger patients with VP, surgery should be recommended. The proper preoperative endovascular intervention and surgical approach facilitates gross total tumor removal. In the management of bilateral or familial paragangliomas, careful and appropriate decision making is essential., (Copyright © 2011 S. Karger AG, Basel.)

Objective: To evaluate the short- (6 mo) and long-term (5 yr) outcomes of modified Bondy technique, with particular reference to hearing results., Study Design: Retrospective study., Setting: Quaternary referral otology and cranial base center., Patients: Two hundred thirty ears of 222 patients were operated on, using a modified Bondy technique between 1983 and 2005. All patients had primary acquired epitympanic cholesteatomas with intact pars tensa and intact ossicular chain in normal or good-hearing ear. Preoperative audiometric results revealed a mean air conduction pure-tone average of 27.7 +/- 9.6 dB (range, 10-65 dB) and a mean bone conduction pure-tone average of 14.2 +/- 6.4 dB (range, 5-50 dB). The mean preoperative air-bone gap was 13.5 +/- 6.7 dB (range, 0-25 dB). The average length of follow-up was 7.8 years (range, 5-16 yr)., Results: There was no recurrent cholesteatoma in the present series. A pearl-like residual cholesteatoma was found in the cavity in 7.4% of ears. Two patients (0.8%) developed stenosis of meatoplasty. Three ears (1.3%) exhibited retraction pockets extending to the attic. Postoperative discharging ear was observed in 3% of cases and was successfully treated with topical drops. At the long-term follow-up, the air-bone gap was unchanged or improved from the preoperative level in 88% of cases. The mean postoperative short- and long-term air-bone gaps were 14.6 +/- 8.5 dB (range, 0-55 dB) and 14.1 +/- 8.2 dB (range, 0-50 dB), respectively. Postoperative high-frequency sensorineural hearing loss with bone conduction worsening between 20 and 30 dB at 4 kHz was observed in 4 cases (1.7%). No dead ears were encountered postoperatively., Conclusion: A modified Bondy operation is recommended in selected cases of epitympanic cholesteatoma in normal or good-hearing ear with an intact pars tensa and ossicular chain. Modified Bondy technique ensures complete eradication of disease while preserving a good preoperative hearing in 1-stage operation.