Revision stapes surgery for lysis of the long process of the incus: comparing hydroxyapatite bone cement versus malleovestibulopexy and total ossicular replacement prosthesis.

The objective of the study was to report audiological results in revision stapes surgery, comparing hydroxyapatite (HAP) bone cement, malleovestibular (MV) prosthesis, and total ossicular replacement prosthesis (TORP). The study is a retrospective case review conducted in a tertiary referral center. Patients treated for revision stapes surgery from 2010 to 2014, where a lysis of the long process of the incus (LPI) was observed with the use of HAP bone cement, MV prosthesis, or a TORP were included in the study. The main outcomes measured were pre- and postoperative bone conduction (BC) and air conduction (AC) pure-tone averages (PTA) (0.5, 1, 2, 3 kHz), including high frequencies BC (HFBC) (1, 2, 3, 4 kHz) and air-bone gap (ABG). 107 revision stapes surgery were performed in 96 ears. Main cause of failure was LPI lysis in 38 cases (39.6 %). 31 patients were analyzed: HAP bone cement was used in 11 patients (Group I), MV prosthesis in ten patients (Group II), and TORP in ten patients (Group III). The mean post-operative ABG was 10.7 dB (±7.4) (p = 0.003), 10.7 dB (±8.8) (p = 0.001), and 16.9 dB (±9.8) (p = 0.001), respectively. There were no significant differences between groups. In Group I, the mean change in HFBC revealed an improvement of 5.6 dB (±7.9) (p = 0.03), while in Group III there was a significant deterioration of the thresholds of 5.8 dB (±7.6) (p = 0.04). There were no cases of post-operative anacusis. In revision stapes surgery when LPI is eroded, we recommend to perform a cement ossiculoplasty for stabilizing a standard Teflon piston when LPI is still usable, the LPI lengthening with cement being not recommended. When LPI is too eroded, we prefer performing a malleovestibulopexy, and reserve TORP for cases with a bad anatomical presentation.

Effect of corticosteroids on facial function after cerebellopontine angle tumor removal: a double-blind study versus placebo.

The aim of this study was to assess the effect of corticosteroids administered intra- and postoperatively on the occurrence of facial palsy after a cerebellopontine angle (CPA) tumor resection, and to investigate pre- and intraoperative prognostic factors. A multicenter, prospective, randomized, double-blind and versus-placebo study was conducted between 2006 and 2010. Three hundred and ten patients operated on for a CPA tumor (96% vestibular schwannomas, 4% miscellaneous) were included by five participating centers. The population was stratified into patients with small (≤15 mm CPA on axial MRI views) and large tumors. In each group, patients were randomized to receive corticosteroid (1 mg/kg/day i.v. methylprednisolone intraoperatively and at postoperative days 1-5) or placebo. Steroids did not affect the facial function at postoperative days 1, 8 and 30 in patients with small or large tumors as evaluated by House and Brackmann grading.

Experience of multidisciplinary team meetings in vestibular schwannoma: a preliminary report.

To assess the contribution of multidisciplinary team meetings (MTM) on vestibular schwannoma management as well as to (1) compare professional compliance to national guidelines and (2) study the percentage of loss to follow-up in cases of conservative management by radiologic observation. A retrospective descriptive study of MTMs held between January 2011 and May 2013 in a tertiary referral center. Patients were classified in three groups according to the MTM decision (observation, surgery or radiotherapy). A total of 363 cases were discussed during the study period (29 months). One hundred and ninety-four decisions (53.4%) were for conservative management with radiologic observation, 130 (35.8%) for surgery, and 39 (10.7%) for radiation therapy. The sex ratio was 0.94, and the patients had a median age of 59 years (range 18-86 years). Most of the vestibular schwannomas (74.2%) were small (stages I and II). Global concordance between the MTM decision and International Radiosurgery Association guidelines was 88.7%. Twenty-three percent of the 104 files that were discussed in MTMs between January 2011 and July 2012, for which conservative management was decided, were lost to follow-up by 18 months. Management of vestibular schwannoma remains controversial, but it usually depends on the evolutive status. MTMs improve practice and facilitate the creation and maintenance of local registries. Future studies in MTMs are warranted to evaluate the benefit and evaluated if MTM could optimize long-term follow-up, limiting loss to follow-up in the observation of vestibular schwannomas that may be evolutive.

Hearing preservation after translabyrinthine approach performed to remove a large vestibular schwannoma.

We report the case of a 27-year-old woman from whom a left vestibular schwannoma (grade IV) was removed by a translabyrinthine approach. The initial period was uneventful except for a few days of vertigo. This patient had no facial paresis (House-Brackman grade I). She was seen 1, 3, 6 and 12 months after operation and reported a sensation of hearing in the left ear. The audiological studies showed a left medium hearing loss. At the 1-year follow-up visit, her hearing status was unchanged. A hearing aid was fitted and functioned satisfactory. At the 5-year follow-up visit, audiometry studies were unchanged. Our case demonstrated that some hearing preservation could be obtained even if the vestibular schwannoma was large and excised by a translabyrinthine approach. Hearing with the help of a good hearing aid allowed a satisfactory function in this case. We believe that it is possible to preserve some hearing after translabyrinthine approach even if no care was taken to preserve the membraneous labyrinth and the loss of endolymph and even if the vestibular schwannoma was large. However, further experimental studies are needed to determine and understand the mechanisms of hearing preservation in this case.

Are stage IV vestibular schwannomas preoperatively different from other stages?

OBJECTIVE: The aim of this study was to focus on the clinical and paraclinical symptoms of patients suffering from Stage IV vestibular schwannomas (VSs). PATIENTS: In this prospective study, we included 734 patients who have VS and candidates for operation. MAIN OUTCOME MEASURES: Patients were classified as having Stage I, II, III, or IV tumors according to Tos criteria as evaluated by magnetic resonance imaging. PREOPERATIVE CLINICAL EVALUATION: We recorded the occurrence of complaints (%) and duration (yr) of hearing loss, tinnitus, and balance disorder. Preoperative paraclinical evaluation included pure-tone (PTA) and speech audiometry, auditory brainstem response (ABR) patterns, and vestibular deficit at videonystamography (VNG). Continuous variables were compared between Stage IV and other stages using analysis of variance. Qualitative variables expressed as a percentage of presence were compared between Stage IV and other stages using percentage comparison. RESULTS: Quantitative Parameters. Patients with Stage IV VS were significantly younger as compared with patients with other stages. Stage IV hearing loss was greater compared with other stages at 250 and 500 Hz but smaller at 2,000 and 8,000 Hz. We found no difference in the loss of PTA between Stage IV and the other stages. Speech discriminancy score was smaller in Stage IV. The durations of hearing loss, tinnitus, and balance disorders were similar whatever the tumor stage. Auditory brainstem response patterns showed no difference in Wave III latency between Stage IV VS and other stages, whereas Wave V latency and V-I interval were higher in Stage IV. Both ABR threshold and VNG caloric deficit were higher in Stage IV VS compared with other stages. Qualitative Parameters. The percentage of patients with Stage IV was lower than that with Stages II and III. The percentage of men and women was similar in all stages. The occurrence of hearing loss was similar in all stages, whereas that of tinnitus was lower in Stage IV compared with Stages I and II. In contrast, the occurrence of balance disorder was higher in Stage IV compared with all other stages. CONCLUSION: In clinical and paraclinical manifestation, Stage IV VS is different from the other stages. The PTA differences may be attributed to the younger age. Occurrence of clinical symptoms, ABR, and VNG pattern can be explained by the fact that Stage IV develops rapidly in the vestibular, rather than the cochlear nerve and by the fact that larger tumors can be cerebellar compression. This has been confirmed by the higher occurrence of balance disorders in Stage IV and the lower occurrence of tinnitus with similar hearing loss in all stages.

Fully implantable hearing device as a new treatment of conductive hearing loss in Franceschetti syndrome.

The objective is to investigate a new therapeutic option for treatment of conductive hearing loss in children with Franceschetti syndrome. A Carina fully implantable device with the MET V transducer for conductive applications was implanted in a 14-year-old male suffering from bilateral conductive hearing loss (mean PTA loss: 70 dB on the right ear and 64 dB on the left ear) secondary to Franceschetti (a.k.a Treacher Collins) syndrome with bilateral agenesis of external ear canal and ossicular malformation. Postoperative unaided PTA was unchanged by the surgical procedure. When the implant was activated, mean PTA was 29 dB improved on the implanted ear. The capacity of the Carina MET ossicular stimulator to provide appropriate gain relative to the degree of hearing loss indicates that the device may be a viable treatment for children with agenesis of external auditory canal and severe malformation of the middle ear. However, these initial results need to be furthered by: (1) additional studies including a greater number of patients to confirm these preliminary results and (2) a long-term follow-up must be carried out to detect possible long-term cochlear adverse effects, in particular on the basilar membrane.

A survey of satisfaction and use among patients fitted with a BAHA.

We compared the indices of satisfaction and use among patients wearing an osseo-integrated prosthesis BAHA (bone anchored hearing aid) according to the indications: conductive or mixed hearing loss (CHL) and patients with single side deafness (SSD). The study was carried out among patients wearing a BAHA fitted in one of three French departments between November 2001 and November 2005. Each patient received a postal questionnaire relating to the ease of use and the daily utilization period of the prosthesis, as well as a satisfaction rating (from 1 to 10) evaluating improvement in quality of life, overall satisfaction, improvement in sound localization and satisfaction from the aesthetic point of view. In total, 170 out of 231 patients responded to the questionnaire (response rate of 73.5%). The average age at the time of fitting of the BAHA was 56 years (18-79 years). The SSD group was composed of 118 patients (69.4%): 92 following surgery for vestibular schwannoma, 2 following surgery for meningioma and 24 with "other" causes (e.g. idiopathic sudden deafness, sensori neural hearing loss complicating surgery of the middle ear). The CHL group was composed of 52 patients (30.5%): 44 patients with a chronic otitis and 8 with a malformation of the middle ear. The average duration of use of the prosthesis was 22 months (3-72 months). The average utilization period was higher than 8 h per day in 48.5% of cases. There was a significant difference between the two groups concerning the quality of life (p < 0.0001), general satisfaction (p < 0.0001) and sound localization (p < 0.01). There was no significant difference concerning aesthetics. Among the patients of the CHL group, the levels of satisfaction and quality of life are comparable with recent data in the literature with scores of good or very good. The BAHA thus remains one of the methods of choice for hearing rehabilitation in this group of patients. Among the patients of the SSD group, the levels of satisfaction and quality of life are significantly poorer than in the CHL group, but remain generally good with the exception of sound localization. The treatment of SSD patients with a BAHA is interesting. A study comparing the BAHA with the WIFI CROS system is justified in order to ascertain the respective advantages of these two treatment options.

Bone-anchored hearing aid in unilateral inner ear deafness: electrophysiological results in patients following vestibular schwannoma removal.

CONCLUSIONS: The results show that the healthy cochlea perceives one auditory stimulus from two auditory signals: the first through normal air conduction and the second provided by the bone-anchored hearing aid (BAHA). This artificial acoustic difference could partly explain 'pseudo' binaural hearing. Functional cerebral imaging using the same experimental procedure is now necessary. OBJECTIVES: The aim of this study was to evaluate electrophysiological phenomena induced by BAHA on brainstem and long-latency auditory evoked potentials (AEPs) to understand how patients recover a 'pseudo' binaural sensation with only one functional cochlea. PATIENTS AND METHODS: This prospective study included 10 patients operated via the translabyrinthine approach and who received implants on the deaf side. Electrophysiological recordings were performed at least 2 months after BAHA use. Brainstem and long-latency (N1, P2, N2, P300) AEPs were studied in free field according to four conditions: 1, without BAHA; 2, with BAHA; 3, with BAHA and normal ear occluded; 4, without BAHA and normal ear occluded. RESULTS: For brainstem AEPs, we found significantly longer latencies of waves III and V in condition 3 compared with condition 1. For long-latency AEPs, comparison between conditions showed no significant differences.

Intralabyrinthine schwannomas: symptoms and managements.

OBJECTIVE: To describe the characteristic presentations, radiologic findings and managements of the intralabyrinthine schwannomas. METHOD: Retrospective review of patient records, their managements, and review of the literature. RESULT: Four patients with a variety of otologic symptoms including hearing loss, vertigo, and tinnitus were found to have a schwannomas involving the labyrinth. In all cases, the inner ear lesions were preoperatively identified on magnetic resonance imaging, and the surgical removals were performed in all patients without serviceable hearing. The patients experienced improvement in their vertigo and tinnitus after surgery. Two patients were implanted the Bone-Anchored Hearing Aid (BAHA) to reconstruct the pseudo-stereophonic hearing. CONCLUSION: Intralabyrinthine schwannomas are the rare tumours in the otology. The tumour can be removed by surgical approach, but we do not propose surgical excision for the patients with serviceable hearing. BAHA can give patients a post-operative monaural pseudo-stereophonic hearing.

Value of temporal bone density measurements in otosclerosis patients with normal-appearing computed tomographic scan.

OBJECTIVES: Previous studies demonstrated that otosclerosis diagnosis benefits from temporal bone density measurements. We sought to assess bone density measurements of the fissula ante fenestram (FAF) in normal patients, in patients with otosclerosis, and in patients with cholesteatoma. We discuss the value of temporal bone density measurements in patients with otosclerosis who have a normal-appearing computed tomographic (CT) scan. METHODS: This was a prospective case-control study in which 219 temporal bones (123 adults, 18 to 84 years of age) were included between November 1, 2002, and April 30, 2004. All patients underwent a CT scan of the temporal bones. Axial views were obtained with density measurement of the FAF. RESULTS: The FAF density was significantly different (p < .0001) in the otosclerosis group (n = 119) compared to the control group (n = 100). There was no significant difference between the otosclerosis group with a normal-appearing CT scan and the control group (p = .64). CONCLUSIONS: From our results, it may be suggested that 1) temporal bone density measurements seem not to be strictly comparable between CT scan devices; and 2) temporal bone density measurements of the FAF did not allow the diagnosis of otosclerosis when the CT scan appeared normal.