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Objective: The aim of this study was to investigate brain reorganization following cochlear implantation using electroencephalography, an implant-compatible technique to record electrical brain activity., Methods: We investigated cortical plasticity in cochlear implant (CI) users using visual evoked potentials in response to visual motion changes. We estimated visual and auditory neural sources in CI users (n = 20) and normal hearing (NH) matched control participants (n = 22)., Results: Results showed intra-modal plasticity in the visual cortex of CI users, revealed by higher P1 and visual mismatch negativity amplitude, and greater contribution of the visual cortex during visual motion changes compared to NH controls., Conclusions: Our results suggest more efficient processing of visual information in CI users that may reflect enhanced multimodal compensatory strategies during speech processing., Significance: This study showcases an objective, implant-compatible method that could be used in a clinical setting to measure and longitudinally track cortical plastic changes, enabling a better understanding of the link between individual patterns of cortical plasticity and CI outcomes., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.)

Oropharyngeal cancer (opc) has become the leading site for human papillomavirus (hpv)-associated cancers in humans. It is an epidemic that remains relatively unfamiliar to most physicians, potentially delaying diagnosis and treatment. Traditionally, cancers involving the head and neck have occurred in smokers and in those with a significant alcohol history. Typically, hpv-positive opc presents in a younger, healthier population with a different set of risk factors and good prognosis for survival. However, many head-and-neck cancer patients, including those with hpv-positive disease, develop lifelong disabilities because of the morbid nature of their treatments, and those patients have the highest level of unmet needs in studies spanning cancer sites. Knowledge of this epidemic, a high index of suspicion, and an understanding of how the tumours present in clinical practice can help physicians to make an early diagnosis, thus sparing the patient significant morbidity from treatments associated with more advanced disease stages. Furthermore, recognizing that these patients have distinct psychosocial needs and implementing a collaborative team approach is critical to providing optimal care and improving quality of life in the survivorship period., Competing Interests: CONFLICT OF INTEREST DISCLOSURES We have read and understood Current Oncology’s policy on disclosing conflicts of interest, and we declare that we have none.

Objective To systematically review and quantify current evidence regarding the association of GJB2 mutation status with outcomes of pediatric cochlear implantation. Data Sources PubMed, Embase, and the Cochrane Library were searched for "GJB2,""pediatric hearing loss," and "cochlear implantation" and their synonyms, with no language restrictions, until December 2, 2015. Review Methods Studies were included that investigated the status of GJB2 mutation and its predictive value for outcomes of pediatric cochlear implantation. Speech recognition scores, Infant-Toddler Meaningful Auditory Integration Scale, Speech Intelligibility Rating, and Categorized Auditory Performance were pooled using weighted mean differences, and a 95% confidence interval. Results Eighteen studies met the inclusion criteria. The differences between GJB2-related deafness and non- GJB2-related deafness due to unidentified causes and other types of genetic deafness without additional disabilities were not statistically significant ( P = .15 and P = .30, respectively); however, the difference between GJB2-related deafness and acquired hearing loss due to environmental etiologies was statistically significant and favored GJB2-related deafness ( P = .03). Conclusion GJB2-related deafness leads to significantly better cochlear implantation outcomes when compared with acquired deafness caused by environmental etiologies. However, GJB2 mutation is not associated with a significantly better prognosis when compared with those whose deafness results from either nonsyndromic hearing loss of unknown origin or other types of genetic mutations in the absence of other neurologic deficits.

Objectives: To compare the hearing outcomes of stapedotomy vs cochlear implantation in patients with advanced otosclerosis., Data Sources: PubMed, EMBASE, and The Cochrane Library were searched for the terms otosclerosis, stapedotomy, and cochlear implantation and their synonyms with no language restrictions up to March 10, 2015., Methods: Studies comparing the hearing outcomes of stapedotomy with cochlear implantation and studies comparing the hearing outcomes of primary cochlear implantation with salvage cochlear implantation after an unsuccessful stapedotomy in patients with advanced otosclerosis were included. Postoperative speech recognition scores were compared using the weighted mean difference and a 95% confidence interval., Results: Only 4 studies met our inclusion criteria. Cochlear implantation leads to significantly better speech recognition scores than stapedotomy (P < .0001). However, this appears to be due to the variability in outcomes after stapedotomy. Cochlear implantation does not lead to superior speech recognition scores compared with the subgroup of successful cases of stapedotomy plus hearing aid (P = .47). There is also no significant difference with respect to speech recognition between primary cochlear implantation and those secondary to a failed stapedotomy (P = .22)., Conclusions: Cochlear implantation leads to a statistically greater and consistent improvement in speech recognition scores. Stapedotomy is not universally effective; however, it yields good results comparable to cochlear implantations in at least half of patients. For cases of unsuccessful stapedotomy, the option of cochlear implantation is still open, and the results obtained through salvage cochlear implantation are as good as those of primary cochlear implantation., (© American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.)

Background: The purpose of this study was to investigate the prognostic value of the pretreatment inflammatory markers platelet-to-lymphocyte ratio (PLR) and the neutrophil-to-lymphocyte ratio (NLR) in patients with head and neck squamous cell carcinoma (HNSCC)., Methods: We conducted a retrospective analysis of patients diagnosed with HNSCC at McGill University Health Center from 2000 to 2011 (273 patients were retained). Hematologic parameters were recorded within 4 weeks of diagnosis. Mortality and recurrence rates were compared according to various PLR and NLR thresholds., Results: Of the total patients, 20.5% died and 11.0% had disease recurrence. PLR >170 was associated with higher mortality (p = .008). The subgroup with a combination of PLR >170 and NLR ≤3.0 was associated with higher T classification and highest mortality (43%). NLR above 4.2 predicted higher rates of recurrence (p < .0001). The NLR/PLR combination was at least as good as TNM staging in predicting survival., Conclusion: PLR is an independent predictor of mortality; NLR is an independent predictor of recurrence in HNSCC. These parameters might be used to identify advanced stages rapidly and economically., (© 2014 Wiley Periodicals, Inc.)

Objectives: The reported prevalence of vestibular dysfunction after cochlear implantation (CI) is varies between different scientific papers. The aim of this study is to determine the reported post-implantation outcome in terms of dizziness, and to measure its impact on quality of life using the Dizziness handicap inventory (DHI)., Methods: This was a prospective questionnaire based study of postoperative cochlear implant patients. The questionnaire assessed the type and onset of dizziness in addition to the DHI., Results: 122 patients were recruited in this study, which is the largest sample size in the literature reported so far. Dizziness was evident in 45.9% of the population post-CI and in 27% pre-CI. The commonest subtype of the dizziness was unsteadiness followed by lightheadedness. The dizziness was mild in most of the patients., Conclusion: Although mild, dizziness is a common complaint post-cochlear implantation. An understanding of symptoms helps counsel patients preoperatively.

Ectomesenchymal chondromyxoid tumor (ECMT) is a rare benign neoplasm arising in the tongue. With only 45 cases reported in the literature, there are several unique features defining this lesion. Firstly, almost all patients present with an asymptomatic slow growing mass on the anterior dorsum of the tongue. At the microscopic level, it is recognizable as a well-circumscribed unencapsulated proliferation of uniform round to fusiform cells embedded in a chondromyxoid matrix. Lastly, the immunohistochemistry profile is characterised by positivity for glial fibrillary acidic protein and frequent positivity for S-100 and cytokeratins. We report a case of a mass located on the posterior dorsum of the tongue and meeting the aforementioned morphological and immunohistochemical criteria of ECMT.

Somatosensation plays an important role in the motor control of vocal functions, yet its neural correlate and relation to vocal learning is not well understood. We used fMRI in 17 trained singers and 12 nonsingers to study the effects of vocal-fold anesthesia on the vocal-motor singing network as a function of singing expertise. Tasks required participants to sing musical target intervals under normal conditions and after anesthesia. At the behavioral level, anesthesia altered pitch accuracy in both groups, but singers were less affected than nonsingers, indicating an experience-dependent effect of the intervention. At the neural level, this difference was accompanied by distinct patterns of decreased activation in singers (cortical and subcortical sensory and motor areas) and nonsingers (subcortical motor areas only) respectively, suggesting that anesthesia affected the higher-level voluntary (explicit) motor and sensorimotor integration network more in experienced singers, and the lower-level (implicit) subcortical motor loops in nonsingers. The right anterior insular cortex (AIC) was identified as the principal area dissociating the effect of expertise as a function of anesthesia by three separate sources of evidence. First, it responded differently to anesthesia in singers (decreased activation) and nonsingers (increased activation). Second, functional connectivity between AIC and bilateral A1, M1, and S1 was reduced in singers but augmented in nonsingers. Third, increased BOLD activity in right AIC in singers was correlated with larger pitch deviation under anesthesia. We conclude that the right AIC and sensory-motor areas play a role in experience-dependent modulation of feedback integration for vocal motor control during singing.

We report the first case of hepatoid adenocarcinoma of the skull base, as well as the first reported case in the head and neck region. Hepatoid adenocarcinoma is a rare, aggressive, extrahepatic malignancy with a distinct morphological similarity to hepatocellular carcinoma, in the absence of primary hepatic disease. A 45-year-old man presented with sinus headaches and retro-orbital pain and was found to have a nasopharyngeal mass on endoscopy and a large, destructive sinonasal mass extending intracranially on imaging. Histo- and cytopathological features were similar to hepatocellular carcinoma, and the cells were immunoreactive for α-fetoprotein, epithelial membrane antigen, periodic acid-Schiff, cytokeratin (CK)8/18, CK19, and S100.

Objective: To evaluate vestibular evoked myogenic potentials (VEMPs) in Meniere disease and vestibular schwannoma. Given that the saccule and inferior vestibular nerve may be damaged in Meniere disease and vestibular schwannoma, respectively, VEMP latency may be prolonged in the patient's affected ear., Design: Prospective study., Setting: Urban otolaryngology practice., Methods: Ten Meniere disease and 12 vestibular schwannoma patients. Subjects were tested with the VEMP head rotation protocol., Main Outcome Measure: VEMP latency., Results: In Meniere disease patients, the pI latencies (mean +/- SEM, milliseconds) were 12.26 +/- 0.75 (healthy ear) and 14.20 +/- 0.73 (affected ear) (p = .041). The nI latencies were 20.29 +/- 1.06 (healthy ear) and 25.06 +/- 1.64 (affected ear) (p = .013). In vestibular schwannoma patients, the pI latencies were 12.02 +/- 0.93 (healthy ear) and 15.88 +/- 1.35 (affected ear) (p = .016). The nI latencies were 20.98 +/- 1.59 (healthy ear) and 24.84 +/- 1.08 (affected ear) (p = .031)., Conclusion: VEMP pI and nI latencies were prolonged in the affected ear of Meniere disease and vestibular schwannoma patients. We propose classifying VEMP as abnormal if both the pI latency is > 1 ms longer and the nI latency is > 2 ms longer (sensitivity 66.7%, specificity 86.4%) compared with the other ear. This study suggests a role for VEMP in the clinical testing of these patients.

Objective: To evaluate the methodology for vestibular evoked myogenic potential (VEMP) testing, with a focus on the usefulness of the head rotation as a means to tense the sternocleidomastoid (SCM) muscles. Our goal was to obtain normative data for our site and methodology., Design: Prospective study., Setting: Outpatient otolaryngology clinic., Methods: P rospective study. Volunteers without an otologic history were selected. While sitting, the volunteer rotated his or her head away from the tested ear so as to tense the ipsilateral SCM. While the SCM was tensed, the volunteer was presented with loud clicks. Responses were averaged., Main Outcome Measures: VEMP positive (pI) wave latency and amplitude, VEMP negative (nI) wave latency and amplitude, and volunteer ability to perform the head rotation method., Results: In healthy controls, average P1 latencies (milliseconds) were 12.58 +/- 0.39 and N1 latencies were 21.88 +/- 0.40. Average P1 amplitudes (microvolts) were 20.48 +/- 1.94 and N1 amplitudes were -25.56 +/- 2.21. VEMP amplitudes were less consistent in patients with limited neck strength., Conclusions: VEMPs can be elicited from the majority of volunteers. The test is easy to perform, and it is only mildly uncomfortable for most patients using the head rotation method.

The objective of the present study was to examine the association between human papillomavirus (HPV) infection and risk of developing oral cancer. The investigation followed a hospital-based case-control design. Cases consisted of newly diagnosed patients with squamous cell carcinoma of the oral cavity and oropharynx. Controls were frequency matched to cases on gender, age, and hospital. Subjects were interviewed to elicit information on putative risk factors. Oral exfoliated cells were tested for detection of HPV DNA by the PGMY09/11 polymerase chain reaction protocol. Serum antibodies against HPV 16, 18, and 31 viral capsids were detected using an immunoassay technique. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CI) of oral cancer according to HPV exposure variables. HPV DNA was detected in 19% of cases (14 out of 72), and 5% of controls (six out of 129). Among tonsil-related cancers (palatine tonsil and base of tongue) viral DNA was detected in 43% of cases (nine out of 21). The OR for tonsil-related cancers for high-risk HPV types was 19.32 (95%CI: 2.3-159.5), after adjustment for socio-demographic characteristics, tobacco, and alcohol consumption. The equivalent OR for HPV 16 seropositivity was 31.51 (95%CI: 4.5-219.7). The ORs of non-tonsillar oral cancers for high risk HPV DNA in oral cells and for seropositivity were 2.14 (95%CI: 0.4-13.0) and 3.16 (95%CI: 0.8-13.0), respectively. These results provide evidence supporting a strong causal association between HPV infection and tonsil-related cancers. The evidence for an etiologic link is less clear for non-tonsillar oral cancers.

Objective: To describe genetic susceptibility in the first familial clustering of parotid gland lymphoepithelioma reported in North America., Design: Retrospective study., Setting: Tertiary care institution with outreach to northern Quebec., Methods: Chart, family history, literature review, and c-kit assay., Main Outcome Measure: C-kit assay., Results: Four family members of both sexes over two generations had lymphoepithelioma of the parotid gland, without involvement of the nasopharynx. Two c-kit assays were positive of the three cases that could be done. Association with Epstein-Barr virus has been demonstrated in the oncogenesis of lymphoepithelioma., Conclusion: Genetic susceptibility and common familial environmental factors play a role in the development of parotid gland lymphoepithelioma. A complete family history should be obtained in all cases of lymphoepithelioma of the parotid gland.

Introduction: Loss of vestibular information from one labyrinth produces marked asymmetries of postural and ocular motor control, which resolve over time. Recent developments in mouse genetic engineering, which allow the generation of transgenic and knockout mutant mice, provide a unique opportunity to bridge the gap between the molecular mechanisms that underlie compensation and behaviour., Method: We compared compensation following unilateral labyrinthectomy in wild-type mice and a cerebellar-dysfunctional mouse (the Lurcher mutant). The Lurcher mutant is characterized by a point mutation in the ionotropic glutamate receptor delta 2 subunit gene that results in loss of all Purkinje cells. To further investigate this question, we characterized vestibular compensation in a strain of mutant mice that completely lack cerebellar Purkinje cells., Results: Static signs resolved within 24 hours in wild-type mice but did not fully resolve in Lurcher mice. Dynamic signs were evaluated by the quantitative analysis of vestibulo-ocular (VOR) and vestibulocollic (VCR) reflexes. The VOR assessed at 0.5 Hz exhibited increasing gain from day 1 to day 5, reaching control levels by day 20 for the wild-type mice. In contrast, Lurcher mutant mice showed significantly less compensation over this same period. VOR compensation in the mutant mice was slightly more robust in response to high acceleration thrusts but again never reached control levels. Similarly, VCR gains showed limited compensation and remained subnormal in mutant mice., Conclusion: Compensation for dynamic signs starts at day 5 after unilateral labyrinthectomy in normal mice. Cerebellar dysfunctional mutant mice do not compensate for static signs and show limited vestibular compensation for dynamic signs only. We conclude that other noncerebellar pathways for vestibular compensation exist, and our findings emphasize the need for these to be further explored.

Objectives: The surgical management of pituitary tumours is being impacted by the development of two key technologies: image guidance and endoscopy. This study sought to assess their impact., Methods: Retrospective review of all patients referred to the Skull Base Clinic of the McGill University Health Centre since 2000. Patients were operated on in a multidisciplinary context using a multimodal approach combining endoscopy and microscopy. Imaging during the surgery was initially supported by both three-dimensional neuronavigation and traditional C-arm fluoroscopy., Results: Seventy-five patients were referred to the multidisciplinary clinic, for a total of 41 surgeries. Neuronavigation was used in all cases. C-arm fluoroscopy was not found to improve our surgeries and was removed from our protocol. Endoscopy was found to be advantageous as it allowed improved visualization. It also permitted identifying surrounding structures in the lateral wall of the sphenoid sinus, next to the tumour, and "around corners." Moreover, it encouraged multidisciplinary co-operation as it allowed neurosurgeons and otolaryngologists to follow progress during the case. Nevertheless, the microscope continued to play a role as it facilitated a bimanual technique, stable magnification, and a three-dimensional view. Morbidities in our case series appeared to be minimal., Conclusion: Both endoscopy and the microscope were found to have a role in our surgeries. We consider these technologies to be complementary. C-arm fluoroscopy was rendered obsolete by the neuronavigation unit. A multidisciplinary, multimodal approach maximizes the benefits of these new technologies and permits the best surgical result.

Objectives: To evaluate the relationships between laryngeal inflammation assessed using the Reflux Finding Score (RFS), laryngeal sensory function, and apnea severity in patients with obstructive sleep apnea (OSA)., Methods: Endoscopic sensory testing (EST) was performed with subsequent blinded scoring from video of RFS. An RFS>7 was indicative of increased inflammatory change., Results: Of 34 patients evaluated, 29 had OSA (apnea-hypopnea index [AHI]>or=15 events/h) at polysomnography. Increased inflammation was present in 26/29 (90%), with changes suggestive of laryngopharyngeal reflux. There were significant correlations between: inflammation and OSA severity (eg, RFS vs AHI, r=0.57, P<0.001); inflammation and laryngeal sensory impairment (EST detection threshold and pressure required to elicit the laryngeal adductor reflex, LAR); and the degree of sensory impairment and OSA severity., Conclusions: Laryngeal inflammation is prevalent among OSA patients and correlates with laryngeal sensory dysfunction, attenuation of the LAR, and apnea severity., Ebm Rating: C-4.

Objectives: To determine the prevalence of obstructive sleep apnea (OSA) in patients with cancer of the oral cavity and oropharynx scheduled for primary surgical resection. To correlate the presence of OSA and the occurrence of postoperative morbidities in this patient population., Methods: This was a prospective study involving 17 patients with malignancies of the oral cavity and oropharynx scheduled for primary surgical resection. Consecutive patients were approached to undergo overnight polysomnography to determine the apnea-hypopnea index (AHI). OSA was defined by an AHI value > or = 20 events per hour. Postoperative morbidities were evaluated in a blinded fashion for the patients completing surgery., Results: OSA was present in 13 of 17 patients, yielding a striking prevalence of 76% in this patient group. The mean AHI for patients with OSA was 44.7 +/- 3.5 (standard error) events per hour, with a mean nadir oxygen saturation of 88.2 +/- 1.8%, consistent with moderate to severe sleep-disordered breathing. The OSA and non-OSA patients were similar with respect to age and body mass index. The mean size of the primary tumour was 3.3 cm in patients with an AHI < 20 and 3.5 cm in those with an AHI > or = 20 (p = not significant). Overall, postoperative complications, defined as prolonged intensive care unit stay (> 24 hours), need for mechanical ventilation, and cardiopulmonary morbidities, were observed in 67% of OSA and 25% of non-OSA patients., Conclusions: These findings point to a strong association between OSA and malignancies of the oral cavity and oropharynx. This relationship was independent of the size of the primary malignancy in this patient population with tumours ranging from 1 to 7 cm (p = not significant). When comparing the two groups (AHI < 20 and AHI > or = 20), there was a tendency for the group with OSA to have an increase in postoperative morbidities. Further research is warranted to further evaluate the postoperative morbidities and mortalities associated with OSA in this patient population and to determine the potential roles for preoperative treatment with continuous positive airway pressure and tracheotomy.

Objectives: The mechanical behaviour of the footplate and its annular ligament depends critically on their shape and orientation in the oval window, but accurate measurements have been difficult to make owing to their small size. Our aims are to visualize the footplate at high resolution and understand its dynamics., Methods: The human cadaver stapes footplate was dissected, and very high-resolution x-ray computed tomographic (CT) scans, with voxel sizes from 4 to 8 pm, were performed. Locally developed software was used to reconstruct the images., Results: The data permit us to explore minor details of shape and orientation. The footplate looks like a footprint, and the annular ligament has variable thickness, with a cleft (groove) in its anterior attachment to the oval window. The CT data also permit us to create a three-dimensional finite-element model that can simulate footplate motion., Conclusions: The results obtained lead to further understanding of the mechanical behaviour of the footplate and the annular ligament.

Solitary plexiform neurofibromas of the intraparotid facial nerve are extremely rare tumours that can present a diagnostic challenge. Knowledge of their existence is key to its proper management. Only two cases have been reported in the English literature. We describe the first paediatric case of an intraparotid facial nerve solitary plexiform neurofibroma.

In previous studies, electromyographic potentials, recorded in response to auditory clicks, have been attributed to stimulation of the otolith (saccule) and have been termed vestibular evoked myogenic potentials (VEMPs). In this study, we assessed the VEMPs in subjects with normal auditory brainstem evoked responses, with no history of vestibular symptoms or neck and other skeletal muscle abnormalities. To this effect, 32 subjects (64 ears), after ethics committee approval, were exposed to 75, 150, and 300 clicks at 100 dB, and the responses were averaged. Electromyographic activity was recorded by applying surface electrodes over the sternocleiodomastoid muscle under the following three conditions: no muscle contraction/no clicks, muscle contraction/no clicks, and muscle contraction/clicks. Our findings suggest that electromyographic responses have to be obtained, during muscle contraction, first without and then with clicks. Our data also suggest that comparison of these two recordings is necessary for meaningful results.

Computer-generated models are increasingly being used in otolaryngology for teaching purposes, preoperative planning, and clinical simulations, especially when dealing with small, complex areas such as the middle ear. One technique used to analyze the mechanics of complex models is the finite-element method, whereby the system of interest is divided into a large number of small, simple elements. The mechanical properties and applied forces are represented by functions defined over each element, and the mechanical response of the whole system can then be computed. We present a unique three-dimensional finite-element model of the human eardrum and middle ear. Our model takes advantage of phase-shift moiré shape measurements to precisely define the shape of the eardrum. The middle ear geometry is derived from histologic serial sections and from high-resolution magnetic resonance microscopy of the human ear. We discuss the importance of this model in terms of understanding and teaching the mechanics of the human middle ear, simulating various pathologic conditions, and designing ossicular prostheses.

Objective: The perceived visual vertical (PVV) has been shown to be abnormal in patients with acute vestibular lesions but reverts to normal in compensated patients. The objectives of this study are to ascertain whether the PVV can be modulated by caloric stimulation and whether this modulation diminishes in compensated patients with unilateral vestibular lesions., Design: Prospective., Setting: Tertiary care facility., Method: Sixty-eight patients referred for vestibular testing had an electronystagmography and a PVV., Main Outcome Measures: Tilt in PVV, in degrees after caloric stimulation., Results: Cold caloric stimulation resulted in a mean tilt in the PVV toward the irrigated ear and warm irrigation had the reverse effect. The mean modulation (amplitude of the angular distance in degrees between cold and warm tilts) was 4.3 degrees. In a subgroup of patients with severe unilateral vestibular dysfunction, this modulation of the PVV with caloric stimulation was diminished on the side of the lesion (p = .0001)., Conclusion: Further study is required to assess the potential of the caloric PVV as a test of otolith function.

Meningiomas are the second most common tumor to involve the cerebellopontine angle (CPA), but controversy exists as to whether they can arise within the internal auditory canal (IAC) or whether involvement of the IAC occurs secondarily by extension from the CPA. This paper reports on a patient with an enhancing IAC meningioma that then grew and on subsequent scans was found to involve the CPA. This case demonstrates that these tumors can arise within the IAC and can grow out to involve the CPA. These findings are discussed within the context of meningioma tumor genetics and the histologic evidence for precursor cells in the IAC. The radiologic findings useful in distinguishing an acoustic neuroma from a meningioma are reviewed in the light of this case. While an enhancing mass projecting into the IAC is most often an acoustic neuroma, this radiologic findings is not pathognomonic.

Objective: Intraoperative facial nerve monitoring has reduced the incidence of facial nerve paralysis associated with acoustic neuroma surgery, but poor facial nerve outcomes continue to occur. Intraoperative prediction of facial nerve outcome would be advantageous in patient management and counseling. This study seeks to evaluate intraoperative facial nerve stimulus thresholds as a tool for predicting postoperative facial nerve outcome., Study Design: This study is a prospective clinical study of the prognostic value of intraoperative stimulus thresholds., Setting: The study was performed at a tertiary referral center., Patients: There were 109 patients undergoing excision of acoustic neuromas included in this study., Interventions: The minimum current required to stimulate the facial nerve at the brain stem was prospectively recorded after excision of the acoustic neuroma., Main Outcome Measures: Facial nerve outcome was evaluated by the House-Brackmann grade., Results: A statistically significant relationship was found between poor initial facial nerve outcome and higher stimulus thresholds. Long-term impaired facial function was also more common in the higher stimulus group compared to that of the lower stimulus groups., Conclusions: Although these findings suggest that intraoperative stimulus thresholds have prognostic potential, other prognostic factors should also be considered and additional research is needed.

The management of congenital and acquired subglottic stenosis has been considerably facilitated with the introduction of the anterior cricoid split operation and, more recently, the single-stage laryngotracheoplasty. These procedures are followed by a 1- to 2-week period of sedation, during which the patient is paralyzed and completely dependent on mechanical ventilation. Although these procedures have proven very successful at achieving decannulation, the postoperative period can be the source of significant complications. This is illustrated with 4 cases of severe postoperative complications. The possible pathophysiologic causes are discussed, and the literature concerning the postoperative complications of these procedures is reviewed. The avoidance of neuromuscular blockade must be weighed against the possible increased need for narcotics and increased risk of self-extubation. An intensive care unit setting proficient in the care of these patients is necessary for a successful outcome.

Endoscopic repair of cerebrospinal fluid (CSF) fistulas has been proposed as an alternative to the traditional intracranial and extracranial approaches. This study reports on four consecutive adult cases of anterior skull base CSF fistulas. The technique used for endoscopic repair, which was designed to maximize postoperative nasal function, is described in detail. The results and complications recorded, using this technique, are reported. Endoscopic repair appears to be a safe and successful approach in the surgical treatment of CSF fistulas while preserving nasal function.

Positron emission tomography (PET) is an imaging modality that generates in vivo maps of tissue radioactivity originating from a labelled substrate of glucose metabolism: 18-fluorine labelled deoxy-glucose (FDG). This study was undertaken to evaluate PET in the detection of head and neck malignancies, and to determine its effectiveness in diagnosing recurrent cancer in operated or irradiated fields. PET revealed that each biopsy-proven tumour is an area of increased radioactivity. Tumour radioactivity ranged from 130% to 300% above that of the cerebellum, and up to 650% above the contralateral, normal side. By basing the maps on tissue metabolic function, PET proved capable of distinguishing tumour (increased radioactivity) from scar tissue (reduced radioactivity). Its application may facilitate the diagnosis of recurrent tumours amid the fibrosis and distortion of normal architecture in operated, irradiated fields.

Although tracheostomy is an ancient technique, disagreement continues concerning the complication rate associated with the procedure. A retrospective review of 281 consecutive tracheostomies was undertaken to evaluate the current risks of tracheostomy in tertiary care teaching hospitals. In addition, we sought to identify factors associated with increased morbidity. The intraoperative and postoperative complications were analyzed regarding indication and comorbidity factors. The majority of cases (56%) were performed on ICU patients. The total complication rate was 24%. A statistically significant increased risk of complications was found both in emergency situations and in ICU patients. Delaying tracheostomy was associated with prolongation of ICU stay. Despite the relatively large number of patients studied, there were no deaths.

Although first characterized over 45 years ago Cogan's syndrome still remains a rare disease, with a high incidence of poor outcome. Experience with a case of Cogan's syndrome over a 10-year period is presented. The fluctuating clinical evolution and laboratory findings over this period are depicted, starting from presentation at age 10. The response to treatment, as revealed by audiograms, is traced. The literature is reviewed with regard to treatments that have been proposed. In those cases where a sustained follow-up is available, the success of the therapy on the vestibuloauditory system is evaluated. Although some patients have a positive response to steroids, the prognosis for hearing remains poor. The ability of steroids to change the prognosis for hearing loss is not yet established, but warrants further clinical trial.