Phase 2 study examining magnesium-dependent tinnitus.

BACKGROUND: Recent studies in noise-induced and idiopathic sensorineural hearing loss have suggested that magnesium supplementation may lessen both hearing loss and the severity of tinnitus in patients. Further epidemiological evidence indicates that all age groups of Americans fall short of the recommended daily allowance for magnesium by 100 mg daily. PURPOSE: The purpose of this study was to examine any potential benefit in lessening the severity of tinnitus in patients taking supplemental magnesium. RESEARCH DESIGN: The study was a single-arm, open-label, before-and-after study of oral magnesium (532 mg per day) in 26 patients for 3 months. Tinnitus severity was evaluated and recorded daily by the patient using the Tinnitus Distress Rating (TDR) scale of 0 (no tinnitus) to 10 (worst possible tinnitus). The Tinnitus Handicap Inventory (THI) was administered before and at the end of the study, and scores were converted to the grades of the 5-item Tinnitus Severity Scale (TSS). The purpose of this phase 2 study was to investigate whether the treatment was effective at all, and, as such, a placebo control was not performed. All data were collected at Mayo Clinic in Scottsdale, Arizona, between March 6 and December 10, 2008. STUDY SAMPLE: Patients with moderate to very severe tinnitus (TDR score of 3 through 8). INTERVENTION: Daily magnesium supplementation, 532 mg; patient completion of the THI; and daily self-report of TDR. DATA COLLECTION AND ANALYSIS: The main outcome measures were mean TDR scale scores and THI scores as converted to TSS grades. The primary analysis was done on the basis of intention to treat. RESULTS: Twenty-six patients were enrolled; 19 completed the study. The extent of handicap, as measured by THI/TSS, for subjects with slight or greater impairment was significantly decreased (P=.03). Patients who ranked slight or greater on the THI/TSS before intervention showed a significant decrease in the severity of their tinnitus at post-testing (P=.008). CONCLUSION: The results suggest that magnesium may have a beneficial effect on perception of tinnitus-related handicap when scored with the THI.

Medicare Reimbursement Trends for Facility Performed Otolaryngology Procedures: 2000-2019.

OBJECTIVE: There is a paucity of data regarding financial trends for procedural reimbursements in otolaryngology. The purpose of this study was to evaluate monetary trends in Medicare reimbursement rates for the 20 most commonly billed otolaryngology procedures from 2000 to 2019. STUDY DESIGN: Analysis of physician reimbursement. METHODS: The American Academy of Otolaryngology-Head and Neck Surgery database was queried to determine the 20 most performed otolaryngology procedures. Next, the Physician Fee Schedule Look-Up Tool from the Centers for Medicare and Medicaid Services was utilized to assess each of the top 20 most utilized Current Procedural Terminology (CPT) codes in otolaryngology, and reimbursement data was extracted. All monetary data was adjusted for inflation to 2019 U.S. dollars using changes to consumer price index. Average annual and total percentage change in reimbursement were calculated based on adjusted values for all included procedures. RESULTS: After adjusting for inflation, the average reimbursement for the total 20 procedures decreased by 37.63% from 2000 to 2019. The greatest single mean decrease was seen in CPT code 61782 for stereotaxis procedures on the skull, meninges, and brain (-59.96%), whereas the smallest mean decrease was in CPT code 30520 for septoplasty (-1.50%). From 2000 to 2019, the adjusted reimbursement rate for the combined procedures decreased by an average of 2.33% each year. CONCLUSION: Medicare reimbursement for included procedures has decreased from 2000 to 2019. Increased awareness and consideration of these trends will be important for policy makers, hospitals, and surgeons in order to assure continued access to meaningful otolaryngology care in the United States. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:496-501, 2021.

Cochlear implant patients with superficial siderosis.

BACKGROUND: Considered a rare disorder, superficial siderosis of the central nervous system (SSCN) has become more frequently diagnosed in recent years. As it is characterized by progressive sensorineural hearing loss, patients' needs may surpass the capability of hearing aid technology. Despite the retrocochlear nature of the disorder, patients have undergone cochlear implantation (CI) with varying success. PURPOSE: To summarize the issues surrounding cochlear implant candidates with SSCN as well as highlight trends in performance postimplantation. RESEARCH DESIGN: Retrospective case reports of seven cochlear implant candidates detail the symptoms, typical audiologic presentation, and array of clinical issues for patients with this progressive and potentially fatal disease. RESULTS: Despite the retrocochlear component of a hearing loss caused by SSCN, cochlear implantation may be a viable option. CONCLUSIONS: It is essential that the CI audiologist not only be aware of the disorder but also be well versed in the resulting implications for the cochlear implant process. A more thorough case history, an expanded candidacy test battery, and knowledge of the typical presentation of SSCN are critical. The diagnosis of SSCN will impact expectations for success with the cochlear implant, and counseling should be adjusted accordingly.

Analysis of MRI Volumetric Changes After Hypofractionated Stereotactic Radiation Therapy for Benign Intracranial Neoplasms.

PURPOSE: To quantitatively assess volumetric changes after hypofractionated stereotactic radiation therapy (HFSRT) in patients treated for vestibular schwannomas and meningiomas. METHODS AND MATERIALS: We retrospectively reviewed records of patients treated with HFSRT at our institution from 2002 to 2014. Patients received a median dose of 25 Gy in 5 fractions. After treatment, they underwent clinical and radiologic follow-up with magnetic resonance imaging (MRI) at 3- to 12-month intervals. Gross tumor volume was outlined on each thin slice of contrast-enhanced T1 series before and on each scan after HFSRT. Volumetric changes were calculated and compared with neuroradiologist interpretations. RESULTS: Forty-three patients underwent 182 MRI scans. Tumor types included vestibular schwannoma (n = 34) and meningioma (n = 9). Median follow-up time was 29 months. Median gross tumor volume was 3.1 cm3. Local control was 81.4% for the entire cohort at the time of last follow-up. Transient volume expansion was noted in 17 patients (50%) with vestibular schwannoma and 2 (22%) with meningioma. For all patients, transient volume expansion and subsequent regression occurred at a median time of 5.5 and 12 months, respectively. Neuroradiologist agreement with regard to tumor regression, progression, or stability occurred in 155 of 182 total reports (85%). The largest discordance identified was a stable finding on the MRI interpretation when the measured volumetric change exceeded 20% (n = 24 [13%]). CONCLUSIONS: HFSRT is associated with excellent local control and a low incidence of toxicity. With volumetric MRI measurement, transient volume expansion was a common finding and was associated with temporary adverse effects. Although the neuroradiologist's interpretation generally agreed with the volumetric MRI measurement, the overall 15% discordance rate emphasizes the potential benefit of considering volumetric measurements, which may help clinicians correlate posttreatment symptoms with MRI findings.

Establishing a diagnosis of benign paroxysmal positional vertigo through the dix-hallpike and side-lying maneuvers: a critically appraised topic.

BACKGROUND: Many patients consult neurologists because of vertigo. Benign paroxysmal positional vertigo (BBPV) is one of the most common types of vertigo. Although the clinical presentation of this common condition is straightforward, the diagnosis and diagnostic maneuvers can be challenging. OBJECTIVES: How useful is the Dix-Hallpike test in establishing the diagnosis of BPPV? How useful is an alternative positional test, such as the side-lying maneuver, in the diagnosis of BPPV? METHODS: We addressed the question through development of a structured critically appraised topic. Participants included consultant and resident neurologists, clinical epidemiologists, medical librarian, and clinical content expert in the field of otolaryngology. Participants started with a clinical scenario and structured questions, devised search strategies, located and compiled the best evidence, performed critical appraisals, synthesized the results, summarized the evidence, provided commentary, and declared bottom-line conclusions. RESULTS: A single study comparing the Dix-Hallpike and side-lying tests was identified. For the Dix-Hallpike test, the estimated sensitivity was 79% [95% confidence interval (CI) 65-94], specificity was 75% (33-100), positive likelihood ratio (LR) was 3.17 (95% CI 0.58-17.50), negative LR was 0.28 (95% CI 0.11-0.69). For the side-lying test, the estimated sensitivity was 90% (95% CI 79-100), specificity was 75% (33-100), positive LR was 3.59 (95% CI 0.65-19.67), negative LR was 0.14 (95% CI 0.04-0.46). The study employed very weak methodology, and therefore the results had limited validity. CONCLUSIONS: The Dix-Hallpike test is the standard from which the diagnosis of posterior semicircular canal BPPV is made. Hence evaluations of its diagnostic test properties and utility are challenging. For patients unable to move into the Dix-Hallpike test positions, alternative tests such as the side-lying test can be attempted. These modifications, however, are rarely necessary.

Postural orthostatic tachycardia syndrome for the otolaryngologist.

OBJECTIVE: To describe the postural orthostatic tachycardia syndrome (POTS), including clinical presentation, pathophysiology, diagnostic methods, and current management models. DATA SOURCES: PubMed, Cochrane Library were searched for articles available prior to October 30, 2015. METHODS: Review of the available English-language literature. RESULTS: Postural orthostatic tachycardia syndrome presentation is discussed, along with underlying associated physiology for POTS and recommended nonpharmacologic and pharmacologic management strategies. CONCLUSION: Postural orthostatic tachycardia syndrome patients commonly present with complaints of postural lightheadedness, or dizziness, which can be associated with various other conditions. Nonpharmacologic and pharmacologic treatment methods are available to improve the underlying pathophysiology of the disorder. Laryngoscope, 127:1195-1198, 2017.

Pantopaque contrast mimicking intracanalicular vestibular schwannoma.

Pantopaque (iophendylate) is an oily contrast medium historically used during spine imaging. Due to its persistence in the subarachnoid space and the potential to lead to severe arachnoiditis, it is no longer used today. We present a 40-year-old male with new-onset headaches, imbalance, and vertigo. Brain magnetic resonance imaging revealed a 2-mm T1 -hyperintense intracanalicular lesion. Numerous hyperdense foci were scattered throughout the subarachnoid space on computed tomography. Further history revealed the patient received Pantopaque 30 years prior, after sustaining spinal trauma. Remnant Pantopaque contrast is an important differential when evaluating a patient with a suspected intracranial tumor in order to avoid unwarranted surgical intervention. Laryngoscope, 127:1916-1919, 2017.

Measurement of cochlear length using the 'A' value for cochlea basal diameter: A feasibility study.

OBJECTIVES: To determine whether the cochlea basal diameter (A value) measurement can be consistently and precisely obtained from high-resolution temporal bone imaging for use in cochlear length estimation. METHODS: A feasibility study at a tertiary referral center was performed using the temporal bone CTs of 40 consecutive patients. The distance from the round window to the lateral wall was measured for each cochlea by two independent reviewers, a neuroradiologist and an otolaryngologist. The interrater reliability was calculated using the intraclass correlation coefficient (ICC) and the Bland-Altman plot. RESULTS: Forty patients (19 males, 21 females) for a total of 80 cochleae were included. Interrater reliability on the same ear had a high level of agreement by both the ICC and the Bland-Altman plot. ICCs were 0.90 (95% CI: 0.82, 0.94) for the left ear and 0.96 (95% CI: 0.92, 0.98) for the right ear. Bland-Altman plot confirmed interrater reliability with all 96% of measurements falling within the 95% limits of agreement. CONCLUSIONS: Measurement between the round window and lateral cochlear wall can be consistently and reliably obtained from high-resolution temporal bone CT scans. Thus, it is feasible to utilize this method to estimate the cochlear length of patients undergoing cochlear implantation.

Diagnosing Large Vestibular Aqueduct: Radiological Review of High-Resolution CT Versus High-Resolution Volumetric MRI.

OBJECTIVES: To compare the diagnostic yield of high-resolution volumetric T2-weighted MRI (HRT2-MRI) with high-resolution computed tomography (HRCT) for diagnosis of large vestibular aqueduct (LVA). STUDY DESIGN: Three board-certified neuroradiologists performed an independent, blinded radiological review for diagnosing LVA with 2:1 age-matched controls on patients with both HRCT and HRT2-MRI imaging. SETTING: Tertiary referral center. PATIENTS: All patients between 2002 and 2016 with hearing loss who underwent both HRCT and HRT2-MRI and were diagnosed with LVA on either modality. MAIN OUTCOME MEASURES: Concordance rate for LVA between HRCT and HRT2-MRI. RESULTS: Concordance rate for HRCT and HRT2-MRI for diagnosing LVA was 88% (124/141) when assessing both the midpoint and external aperture diameters. Fifteen ears had LVA on computed tomography (CT), but not on magnetic resonance imaging (MRI); in comparison, two ears had LVA on MRI, but not on CT (p = 0.002). Excellent inter-rater reliability among the three radiologists was demonstrated. CONCLUSION: Historically, HRCT has been the imaging modality of choice for diagnosing LVA. Although a higher concordance rate of HRT2-MRI was found compared with previous studies utilizing earlier MRI technology, HRCT still detected a larger number of patients with clinically significant hearing loss compared with MRI. Given the high concordance rate and efficacy of both modalities in diagnosing LVA, the ultimate decision of which modality to choose may depend on other patient-specific and clinical factors.

Hearing aids: a review of what's new.

OBJECTIVE: To review the recent innovations in hearing aid technology. STUDY DESIGN: Review of the literature. SETTING: Private tertiary referral otology/neurotology practice. RESULTS: Recent innovations including digital signal processing (DSP), directional microphone technology, and open mold hearing aid fitting have resulted in improved satisfaction with current hearing aids. CONCLUSION: Current hearing aid technology with its innovations better meet needs of individuals who are hard of hearing. SIGNIFICANCE: The image commonly held of hearing aids by the general public is a negative one that can be improved with greater education.

Reconstruction of Lateral Skull Base Defects: A Comparison of the Submental Flap to Free and Regional Flaps.

OBJECTIVES: To compare reconstructive techniques, operative times, duration of hospitalization, and need for subsequent flap revisions between reconstructive approaches to lateral skull base defects. STUDY DESIGN: Case series with chart review. SETTING: Tertiary academic referral center. SUBJECTS: Patients (n = 31) undergoing reconstruction of composite lateral skull base defects from 2002 to 2014. METHODS: Data were analyzed for demographics, tumor characteristics, reconstructive technique, operative time, duration of hospitalization, complications, and outcomes. RESULTS: Thirty-one patients were identified for inclusion. Lateral temporal bone defects resulted from resection of malignant lesions, including squamous cell carcinoma (n = 25), basal cell carcinoma (n = 2), and other carcinoma (n = 4). Defects were reconstructed with submental flaps (n = 16), pedicled latissimus dorsi flaps (n = 6), and free anterolateral thigh flaps (n = 9). All cases involved neurosurgery, neurotology, and head and neck surgery services. Although time of surgical resection was similar, time saving was noticed with submental reconstruction. Compared with free flaps, submental flap reconstruction was associated with significantly reduced total operative time (mean, 544 vs 683 min; P = .00817) and duration of hospitalization (4.9 vs 9.8 days; P = .02067). Submental flaps were significantly less likely to require revision debulking procedures (mean = 0.6) compared with latissimus dorsi flaps (mean, 1.3; P < .00001) and free flaps (mean, 1.6; P < .00001). There was 100% flap survival. CONCLUSION: The musculocutaneous submental flap provides an excellent option for reconstruction of lateral skull base defects given its proximity, reliability, ease of harvest, and exceptional color match. Submental flap reconstruction was associated with reduced operative time, hospitalization duration, and flap revisions.

Craniocervical Pneumatization: Estimation of Prevalence and Imaging of Treatment Response.

OBJECTIVE: Estimate the prevalence of craniocervical pneumatization (CCP) and describe successful treatment of this condition with clinical and radiologic correlation. PATIENTS: Individuals with documented CCP on computed tomography (CT). INTERVENTION(S): CT scans of the head, temporal bone, face, neck, and cervical spine. Cessation of habitual Valsalva maneuver (VM) and insertion of pressure-equalization (PE) tubes. MAIN OUTCOME MEASURE: The prevalence of CCP on CT examinations performed during two decades in a large academic healthcare system. Documentation of symptomatic and imaging improvement following treatment of CCP. RESULTS: Radiology database review identified two cases of CCP out of a total of 636,854 head and neck CT scans (0.00031%) or 43,553 temporal bone CT scans (0.0046%). Both CCP patients were symptomatic (aural fullness, hearing loss, vertigo) and practiced habitual VM. One patient showed decreased CCP 4 months following cessation of VM, whereas the other patient improved symptomatically and demonstrated reversion of CCP to normal bone on magnetic resonance imaging (MRI) within 3 years following PE tube placement. CONCLUSIONS: Acquired CCP is exceedingly rare and, when successfully treated, reversion to normal bone may accompany symptom resolution.

Magnetic Resonance Imaging Assessment of Vascular Contact of the Facial Nerve in the Asymptomatic Patient.

Objective The objective of this study was to determine the prevalence of facial nerve vascular contact on magnetic resonance imaging (MRI) in patients without hemifacial spasm (HFS). Study Design Our radiology database was queried to identify consecutive adult patients without a history of HFS, intracranial tumor, brain radiation therapy, intracranial surgery, traumatic brain injury, or trigeminal nerve vascular compression. One hundred high-resolution MRIs of the posterior fossa were independently reviewed by two neuroradiologists for facial nerve vascular contact (200 sides). Main Outcome Measures The prevalence of vascular nerve contact in the non-HFS patient, the location of contact along the facial nerve, the culprit vessel, and severity of compression was recorded. Results The presence of vascular contact in the non-HFS patient may be as high as 53%. It is typically mild to moderate in severity, most commonly involves the cisternal portion, and usually caused by the anterior inferior cerebellar artery. Conclusion Vascular contact of the facial nerve is frequently identified in asymptomatic individuals but tends to be more peripheral and mild compared with previous descriptions of neurovascular contact in HFS patients. These results should be considered in assessing the candidacy of HFS patients for microvascular decompression.

Infected cochlear implant after large-volume nasal irrigation.

OBJECTIVE: A patient with a well-healed, functional cochlear implant (CI) experienced a CI and mastoid infection shortly after initiating large-volume nasal irrigations after sinus surgery. The goal of this report is to bring attention to a rare complication and to question if large-volume nasal irrigation is safe in CI recipients. PATIENTS: Single patient at a tertiary care hospital. INTERVENTIONS: A CI recipient began using large-volume nasal irrigations with saline and budesonide after undergoing sinus surgery. MAIN OUTCOME MEASURES: CI infection and mastoiditis. RESULTS: Two weeks after starting nasal irrigations, the patient presented with mastoiditis and CI infection. Mastoid and intranasal middle meatal cultures both grew Group A streptococcus. CONCLUSION: Large-volume nasal irrigations may be related to our patient's CI infection, ultimately leading to explantation. Though a causal relationship cannot be definitively proven, awareness of this potential safety issue should be disseminated.

Analysis of Intraoperative Radiographic Electrode Placement During Cochlear Implantation.

OBJECTIVE: To investigate the clinical value of intraoperative plain radiographs in determining correct placement of cochlear implants. PATIENTS: All cochlear implant insertions over a 10-year period by a single surgeon. INTERVENTIONS: Cochlear implantation with intraoperative imaging. MAIN OUTCOME MEASURE: Whether intraoperative imaging affects clinical/surgical management. RESULTS: A consecutive retrospective review of 207 cochlear implantations performed in 187 patients was performed. All implants performed had intraoperative plain film imaging. Etiology of hearing loss, surgical variations, gender, age, and implant type did not affect intraoperative imaging. Four cases were identified where variations in intraoperative imaging interpreted by the surgeon warranted further discussion. In one patient, the intraoperative x-ray interpretation missed an incorrectly placed electrode. Postoperative CT scan confirmed implant electrode within the superior semicircular canal. In three patients, intraoperative x-ray results aided management by confirming surgical findings; however, no subsequent clinical or surgical alterations were made based on imaging. One of these three patients experienced a noticeable function decline postoperatively that correlated with altered positioning of the cochlear implant on intraoperative radiographs. In all surgeries, no changes were made to the electrode placement based on the intraoperative radiographs. CONCLUSION: Intraoperative plain film imaging during cochlear implantation, although commonly employed, does not typically affect clinical management. For select cases, imaging may continue to be useful based on the surgeon's discretion and intraoperative findings for confirmatory purposes.

Cost Effectiveness of Childhood Cochlear Implantation and Deaf Education in Nicaragua: A Disability Adjusted Life Year Model.

INTRODUCTION: Cochlear implantation (CI) is a common intervention for severe-to-profound hearing loss in high-income countries, but is not commonly available to children in low resource environments. Owing in part to the device costs, CI has been assumed to be less economical than deaf education for low resource countries. The purpose of this study is to compare the cost effectiveness of the two interventions for children with severe-to-profound sensorineural hearing loss (SNHL) in a model using disability adjusted life years (DALYs). METHODS: Cost estimates were derived from published data, expert opinion, and known costs of services in Nicaragua. Individual costs and lifetime DALY estimates with a 3% discounting rate were applied to both two interventions. Sensitivity analysis was implemented to evaluate the effect on the discounted cost of five key components: implant cost, audiology salary, speech therapy salary, number of children implanted per year, and device failure probability. RESULTS: The costs per DALY averted are $5,898 and $5,529 for CI and deaf education, respectively. Using standards set by the WHO, both interventions are cost effective. Sensitivity analysis shows that when all costs set to maximum estimates, CI is still cost effective. CONCLUSION: Using a conservative DALY analysis, both CI and deaf education are cost-effective treatment alternatives for severe-to-profound SNHL. CI intervention costs are not only influenced by the initial surgery and device costs but also by rehabilitation costs and the lifetime maintenance, device replacement, and battery costs. The major CI cost differences in this low resource setting were increased initial training and infrastructure costs, but lower medical personnel and surgery costs.

Intracanalicular meningioma mimicking vestibular schwannoma.

SUMMARY: Three cases of intracanalicular meningioma mimicking vestibular schwannoma are presented. In each case, a contrast-enhancing mass filling the internal auditory canal was identified on MR images and was originally diagnosed as a vestibular schwannoma. Although it is difficult to differentiate definitively between these lesions preoperatively, imaging findings inconsistent with a diagnosis of vestibular schwannoma can be identified. Preoperative identification of intracanalicular meningiomas permits alterations in surgical planning that allow for the more complete resection of these rare tumors.

Hearing preservation in acoustic neuroma surgery: importance of adhesion between the cochlear nerve and the tumor.

OBJECT: To evaluate the possible prognostic factors for hearing preservation, the authors retrospectively reviewed the results of 30 consecutive acoustic neuroma operations in which hearing preservation was attempted, in a total series of 63 acoustic neuromas. METHODS: Intracanalicular tumors or those that extended less than 3 mm outside the porus acusticus (10 cases) were resected via the middle fossa approach. The retrosigmoid approach was used for tumors exceeding the limits for the middle fossa approach (20 cases). Overall, hearing was preserved (pure tone average < or = 50 dB and speech discrimination score > or = 50%) in 21 patients (70%). There were 11 patients with severe adhesion between the cochlear nerve and tumor capsule, and 19 without. Hearing was preserved postoperatively in only two (18.2%) of 11 patients with severe adhesion, whereas all 19 without severe adhesion had hearing preservation. CONCLUSIONS: The presence or absence of severe adhesion in the interface between the cochlear nerve and the tumor might be the most significant prognostic factor for hearing preservation postsurgery.

Intratympanic injections of dexamethasone for long-term control of vertigo.

OBJECTIVE: To examine whether intratympanic injection of dexamethasone is effective in long-term control of vertigo for patients with Ménière disease whose dietary and diuretic therapy has proved unsuccessful. STUDY DESIGN: Retrospective chart review performed at Carolina Ear and Hearing Clinic, Raleigh, North Carolina. METHODS: Thirty-four patients with intractable Meniere disease were given intratympanic injections of corticosteroids using dexamethasone 10 mg/mL for 4 weeks. The control of vertigo was documented in the 2-year period after completion of the course of injections. All patients were continued on a diet and a diuretic during the study period. RESULTS: Only 24% (8 of 34) of patients had control of vertigo with a single course of injections. Three patients had control of vertigo for 12 months and responded to a repeat series of injections with good control. Five patients who had recurrent vertigo at 6 months or earlier responded to repeat injections, for a total of 16 patients (47%) whose vertigo was controlled with a single course or multiple courses of intratympanic injections of corticosteroids. CONCLUSIONS: Approximately one-half of patients (47%) with intractable Ménière disease achieved control of vertigo with one or more courses of intratympanic injections of corticosteroids. A single course of treatment alone can be expected to produce long-term control of vertigo in only one-fourth (24%) of patients. This study indicates that intratympanic injections of corticosteroids should not be expected to give long-term control of vertigo in patients with Ménière disease. Multiple courses of intratympanic injections of corticosteroids, in conjunction with other treatments, are necessary in most patients with Ménière disease who have intractable vertigo.

Preliminary ossiculoplasty results using the Kurz titanium prostheses.

OBJECTIVE: Limitations in biocompatibility and hearing improvement with ossicular chain reconstruction prostheses are addressed with new, lightweight titanium prostheses designed to maximize visualization of the capitulum and footplate regions. The effectiveness of these new prostheses is being tested in a prospective multicenter study. STUDY DESIGN: Prospective case series. SETTING: Multicenter (8 sites), primarily tertiary private practice or academic otologic clinics. PATIENTS: A convenience sample of 31 patients undergoing ossiculoplasty, with 16 partial ossicular chain reconstructions using the Bell prosthesis and 15 total reconstructions using the Aerial prosthesis. INTERVENTION: Ossiculoplasty using new Kurz titanium prostheses. Cartilage was interposed between the tympanic membrane and the prosthesis. MAIN OUTCOME MEASURES: Air-bone gap for pure tone average and 3,000 and 4,000 Hz, assessed preoperatively and 3 months, 6 months, and 12 months postoperatively; percent of patients obtaining an air-bone gap of