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(1) Background: Incomplete excision of vestibular schwannomas (VSs) is sometimes preferable for facial nerve preservation. On the other hand, subtotal resection may be associated with higher tumor recurrence. We evaluated the correlation between intra-operative assessment of residual tumor and early and follow-up imaging. (2) Methods: The charts of all patients undergoing primary surgery for sporadic vestibular schwannoma during the study period were retrospectively reviewed. Data regarding surgeons' assessments of the extent of resection, and the residual size of the tumor on post-operative day (POD) one and follow-up MRI were extracted. (3) Results: Of 109 vestibular schwannomas meeting inclusion criteria, gross-total resection (GTR) was achieved in eighty-four, near-total (NTR) and sub-total resection (STR) in twenty-two and three patients, respectively. On follow up imaging, volumetric analysis revealed that of twenty-two NTRs, eight were radiographic GTR and nine were radiographic STR (mean volume ratio 11.9%), while five remained NTR (mean volume ratio 1.8%). Of the three STRs, two were radiographic GTR while one remained STR. Therefore, of eighteen patients with available later follow up MRIs, radiographic classification of the degree of resection changed in six. (4) Conclusions: An early MRI (POD#1) establishes a baseline for the residual tumor that may be more accurate than the surgeon's intraoperative assessment and may provide a beneficial point of comparison for long-term surveillance. [ABSTRACT FROM AUTHOR]

Objectives: To demonstrate the feasibility and efficacy for next-day loading of a percutaneous bone-anchored hearing device.Study Design: Multicenter prospective cohort study.Setting: Tertiary neurotologic referral centers.Subject and Methods: In this multicenter prospective study, a 4.5-mm laser-etched bone-anchored hearing device was implanted in adult subjects who had conductive/mixed hearing loss or single-sided deafness. One day following implantation, the surgical site was assessed for soft tissue reaction per the Holgers Scale, and implant stability was evaluated by manual palpation and resonance frequency analysis. On the same day, subjects were fitted with the processor. Follow-up evaluations were at 1 week, 4 weeks, 3 months, 6 months, and 12 months. The Glasgow Benefit Inventory and Abbreviated Profile of Hearing Aid Benefit questionnaires were completed postoperatively.Results: Fourteen devices were implanted in 12 subjects. Two subjects underwent bilateral implantation. Implant stability was rated as firm at every interval for all ears, and the Implant Stability Quotient values at 3 months were stable or increased as compared with day 1 measurements. Skin irritation was limited to Holgers grade 0 and 1, with the majority having no skin irritation. The mean Glasgow Benefit Inventory global score was +43.8, and the mean Abbreviated Profile of Hearing Aid Benefit global benefit score was 60.2%. All 14 implants have remained firmly anchored.Conclusions: Next-day loading of this 4.5-mm-diameter percutaneous bone-anchored hearing device appears to be a feasible alternative to the original 3-month delayed loading. Although this is a preliminary study, the results support continued investigation of a next-day loading strategy. [ABSTRACT FROM AUTHOR]

Objective: To determine the incidence of abnormal otospongiotic or otosclerotic findings on high-resolution computed tomography (HRCT) as read by local radiologists in patients with surgically-confirmed otosclerosis. Study design: Retrospective chart review. Setting: Tertiary-referral private otology-neurotology practice. Patients: Adults (>18 years old) with surgically-confirmed otosclerosis between 2012 and 2017 with a HRCT performed preoperatively. Intervention: Preoperative HRCT then stapedotomy. Main outcome measures: Positive identification and location of radiographic otosclerosis as reported by the local radiologist. We then correlated the CT with surgical location as documented at time of surgery. Audiometry, demographic data, intraoperative findings, and surgical technique were secondarily reviewed. Results: Of the 708 stapes surgeries were performed during the study time frame. Preoperative HRCT scans were available for 68 primary stapedotomy surgeries performed in 54 patients. Otosclerosis was reported in 20/68 (29.4%). Following a negative report by the local radiologist, a re-review by the surgeon and/or collaborating neuroradiologist confirmed otosclerosis in 12/48 additional cases (25.0%). There was an overall sensitivity of 47.1%. Intraoperatively, cases with negative reads tended to have more limited localization at the ligament (8.7%) or anterior crus (39.1%), compared with positive reads, which demonstrated more extensive involvement, with bipolar foci (30.0%) or diffuse footplate manifestations (20.0%) more common. Acoustic reflexes were characteristically absent. Conclusions: While HRCT may aid in the diagnosis of otosclerosis and rule out concomitant pathology in certain cases of clinical uncertainty or unexplained symptoms, its sensitivity for otosclerosis remains low. HRCT should not be relied upon to diagnose routine fenestral otosclerosis. [ABSTRACT FROM AUTHOR]

Purpose: Recent evidence has suggested that amplitude modulated tones might have some advantages over broadband noise. Method: Fifty-six subjects listened to S-Tones at a carrier frequency matched at the tinnitus pitch (amplitude modulation rate of 40 Hz) and to broadband noise. Subjects rated their tinnitus loudness before, during, and after a 120-s duration masker. Results: The results suggested that S-Tones were generally more effective at reducing tinnitus loudness than noise. In about one third (21/56) of the subjects, there was no significant effect from any masker. In other subjects, 54.3% (19/35) showed a greater reduction for the S-Tones, 20% (7/35) showed a greater reduction with the noise, and 25.7% (9/35) showed similar performance between the 2 stimuli. The S-Tones showed a statistically significant benefit (p < .01) versus noise at reducing the patient’s tinnitus perception. Using low-level stimuli that were rated much softer than the subjects’ baseline tinnitus, the S-Tones reduced the tinnitus loudness by 1.9 times the amount that noise did (about 28% on average, whereas the noise reduced the tinnitus by about 15%). Conclusion: S-Tones at the tinnitus pitch-match frequency are more likely to be effective than broadband noise at reducing tinnitus loudness. [ABSTRACT FROM AUTHOR]

Objective: Recently, the association of meningitis with cochlear implants has raised concern over the safety of these devices. We examined the incidence of all postoperative infections in patients undergoing cochlear implant surgery.Study design and settings: A retrospective chart review of all patients undergoing cochlear implants at a private tertiary referral center from 1993 to 2002 was performed. Cochlear implant surgeries in 462 adults and 271 children were reviewed. Patients with evidence of a postoperative infection or infectious complication related to cochlear implantation were identified, and data on patient characteristics, surgery, and treatment outcome were obtained.Results: The overall incidence of postoperative infection in our cochlear implant series was 4.1%. Major infectious complications occurred in 3.0% of cases, and the majority of infections required surgical intervention. A history of chronic ear disease may increase the risk of infectious complications. There were no cases of meningitis.Conclusions: Cochlear implants remain a safe procedure with a low complication rate. The majority of infections can be managed without removing the implant device. Advances in surgical technique and flap design have decreased the occurrence of wound-related complications. However, identification of risk factors for infection and optimization of treatment regimens will further reduce the complications associated with postoperative infection. [Copyright &y& Elsevier]

The patulous eustachian tube (pET) presents a challenging management problem. Patients with the pET disorder are disturbed to the point of mental illness by their symptoms of aural fullness and autophony, especially the echo of their own voice. Thus far, described treatment methods are often temporary or ineffective. Here, we describe a minimally invasive method for the treatment of pET that involves cauterization with autologous fat graft plugging of the ET at its nasopharyngeal orifice, in conjunction with myringotomy and ventilation tube placement. This procedure has been successful for the treatment of refractory pET in 2 patients at the House Ear Clinic with at least 1-year follow-up and we propose that it may accomplish relief of symptoms by permanent stenosis of the ET. (Otolaryngol Head Neck Surg 2003;128:88-91.) [Copyright &y& Elsevier]

The purpose of this study was to determine the association of intraoperative auditory brain-stem responses (ABRs) and near-field cochlear nerve action potentials (CNAPs) with postoperative hearing preservation in acoustic tumor surgery. Thirty-three consecutive patients undergoing middle fossa surgery had intraoperative surface ABR and direct CNAP assessments. Postoperatively, hearing was assessed. Hearing preservation was defined as any measurable hearing at any frequency and also by the American Academy of Otolaryngology--Head and Neck Surgery (AAO-HNS) hearing preservation classification system. The presence of an ABR or CNAP was associated with hearing preservation and the absence of an ABR, and CNAP was associated with no hearing preservation in 75.6 percent of the cases. The presence of either the ABR or CNAP was not related to AAO-HNS class outcome. ABR and CNAP had a useful rate of prediction of hearing preservation surgery outcome. However, in nearly one-quarter of the cases, no association between ABR or CNAP responses and hearing preservation was found. This finding must be taken into account when determining the clinical usefulness of these techniques. [ABSTRACT FROM AUTHOR]

Hearing loss commonly occurs after radiation therapy for an acoustic neuroma, and it is highly unusual for hearing to return after a prolonged period of time. We report the case of a 12-year-old boy with neurofibromatosis 2 who underwent fractionated stereotactic radiotherapy for the treatment of a left-sided vestibular schwannoma. Following treatment, he demonstrated an elevation of pure-tone audiometric thresholds and a sudden decrease in speech discrimination score (SDS) to 0%. However, 20 months postoperatively, his SDS suddenly and spontaneously rose to 92%, although there was no improvement in his speech reception threshold. We discuss the possible reasons for the unusual outcome in this patient. [ABSTRACT FROM AUTHOR]

We investigated the feasibility of using laser tissue welding techniques to perform transcanal underlay tympanoplasty. We used 10 temporal bones obtained from human cadavers. After creating a subtotal tympanic membrane perforation, we introduced harvested periosteum through the perforation and used laser tissue welding to secure the periosteum graft in place in an underlay fashion. The procedure was performed via a transcanal approach and did not require middle ear packing. Immediately after the graft had been placed, we qualitatively tested its integrity with a blunt probe. The graft was as strong as the native cadaver tympanic membrane in all 10 cases. We conclude that laser transcanal underlay tympanoplasty is a feasible and effective method of repairing a tympanic membrane. The ultimate goal is to develop a technique that will allow physicians to routinely perform underlay tympanoplasty on moderately sized perforations in an office setting. [ABSTRACT FROM AUTHOR]

The management of facial nerve paralysis is a topic that stimulates considerable debate. Depending on the features of a given case, practitioners may advocate treatment options ranging from no intervention to urgent surgery. There is some validity to all treatment options; the key is understanding when features of a given case dictate a particular therapeutic approach. This miniseminar will address several topics related to management of facial paralysis including: (1) pitfalls in diagnosis of Bell’s palsy; (2) acute facial paralysis in pregnancy; (3) use of antiviral medications; (4) indications for and interpretation of electroneuronography (ENoG) and electromyography (EMG); (5) role of imaging studies; (6) indications, timing, and outcomes of decompression surgery; (7) techniques to aid recovery from acute facial paralysis; (8) botulinum toxin for rehabilitation; and (9) medical legal aspects of chronic facial paralysis. The format will include short presentations, panel discussion of interesting cases, and audience participation. [Copyright &y& Elsevier]

Objectives: To determine the safety and efficacy of an intratympanic round window catheter (DURECT Corp.) treatment for sudden sensorineural hearing loss after oral steroid treatment.Methods: Nine subjects with idiopathic sudden hearing loss who did not benefit from a 14-day course of 60 mg/day of prednisone were enrolled. In a prospective single arm design, subjects were implanted with a round window catheter and received 14 days of methylprednisolone (62.5 mg/mL) at 10 mL/hour. Safety data, including dizziness, tinnitus, and other potential adverse events, were monitored closely. Audiometric data were collected prior to treatment, at removal of the catheter, 1 month, and 3 months post-catheter removal.Results: There were no serious adverse events. However, 8 of 9 subjects experienced tympanic membrane perforation post-catheter removal. All perforations responded to in-office treatment. No subject improved in 4-frequency pure-tone average (PTA) from pretreatment (average, 83 dB) to 1 month posttreatment (average, 96 dB). The difference in PTA was not significant.Conclusions: While a safe treatment method, the intratympanic round window catheter did not result in improvements in hearing after 14 days of treatment. Further work is necessary to test additional medications and to develop better methods of round window catheter implantation and other round window drug delivery methods. [Copyright &y& Elsevier]

Objectives: To determine whether clinically obtained auditory brainstem response (ABR) shows significant changes over time associated with the growth of vestibular schwannomas related to neurofibromatosis 2 (NF2) and to evaluate the clinical use of derived band ABR in NF2 patients.Methods: Subjects meeting the NIH NF2 diagnostic criteria were enrolled (n = 103) across 9 domestic and international investigational sites. ABR and MRI exams were conducted annually. Each site was instructed to follow a comprehensive protocol for acquiring the MRI. The sites were instructed to assess the ABR either with the usual clinical parameters or using derived band methodology.Results: Wave 5 latency data were available for 35 subjects at both baseline and year 1. Average latency values were found to be clinically normal at both evaluations (average = 6.4 ms). Subjects experienced an average change in Wave 5 from baseline to year 1 of 0.06 ms. A strong association was found between Wave 5 latency at baseline and the greatest diameter measurement of the tumor (Pearson’s correlation = 0.62, P < 0.05), where larger tumors have longer latencies. The subjects with derived band ABR were further evaluated for change over time.Conclusions: ABR wave 5 latency shows a strong association with size, the longer the latency, the larger the vestibular schwannoma, regardless of how the ABR was obtained. Across evaluations, there was a nonsignificant change in wave latencies. Clinically obtained ABR provides information regarding size but provides less information about the change in vestibular schwannomas over time. Derived band ABR offers greater measurement specificity for observing NF2 patients over time. [Copyright &y& Elsevier]

The symposium will consist of a panel discussion about management of chronic ear disease in children. There will be no formal presentation. The symposium will consist of lively interaction among panelists. Two cases will be presented: The cases will evolve during the discussion as initial treatment fails. Case 1. A case of posttympanostomy tube otorrhea. The following questions will be addressed to the panel: (1) What is the natural history of the disease? Is treatment always indicated? If not, what circumstances should define when treatment is necessary? What is your initial management? (2) How long do you wait to see if initial treatment proceeds and if it fails, what do you do next? What is the role of tube removal, adenoidectomy, culture and C&S, immune workup and surgery? (3) If fungal organisms are identified on culture, what is their significance? Are they pathogens, saprophytes or contaminants? How often are they the result of previous antibacterial therapy? How should fungal organisms be managed? Case 2. Established CSOM with an aural polyp. The following questions will be addressed to the panel: (1) What puts children at risk for CSOM? Can the risk be reduced? (2) What is the differential diagnosis of an aural polyp? How is it managed? (3) How important is aural toilet and how is it best achieved? (4) What are the roles of topical and systemic antibiotic therapy? What antibiotics are most useful? Can oral quinolones be used in children? (5) How important is granulation tissue and how is it best managed? (6) What is the role of imaging? What imaging modalities are most useful? What are the key points of interpretation? (7) When is surgery indicated? What operations are most useful? What are the key features of successful operations? For each case, as opportunity arises, panelists will be asked about the significance of biofilms and about new or investigational interventions. The last 15–20 minutes will be set aside for questions for the audience. [Copyright &y& Elsevier]

Context.--Lipochoristomas (lipomatous choristomas) are rare tumors of the acoustic nerve (cranial nerve VIII/vestibulocochlear nerve) within the internal acoustic canal and sometimes the cerebellopontine angle, and are histogenetically believed to be congenital malformations. Their clinically indolent behavior has recently prompted a more conservative management protocol in a quest for maximal nerve/hearing preservation. This approach contrasts sharply with that for the common internal acoustic canal/cerebellopontine angle tumors, the neuroepithelial neoplasms (acoustic schwannomas and meningiomas), which behave more aggressively and have more prominent clinical manifestations. Owing to their rarity, the clinicopathologic features of cranial nerve VIII lipochoristomas have been obtained mainly through case reports. Objective.--We present the clinicopathologic features of 11 cases of lipochoristomas of cranial nerve VIII. Design.--The 11 cases were documented between 1992 and 2003. We performed complete clinical reviews with histologic, histochemical, and immunohistochemical analyses of formalin-fixed, paraffin-embedded tumor samples. Results.--The patients were 8 men and 3 women with hearing loss of the right ear (5 patients) or the left ear (6 patients). No patient had bilateral tumors. All lipochoristomas histologically possessed mature adipose tissue admixed with varied amounts of mature fibrous tissue, tortuous thick-walled vessels, smooth muscle bundles, and skeletal muscle fibers, the latter verified with immunohistochemistry. Conclusions.--The histomorphologic and immunophenotypic evidence showed that these tumors are better characterized as choristomas than as simple "lipomas," as they have been labeled in the past. Their overall nonaggressive clinical nature in addition to the characteristic radiologic and histomorphologic findings are important clinicopathologic features for the pathologist to recognize and differentiate, especially during frozen... [ABSTRACT FROM AUTHOR]