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STUDY DESIGN: Review of database. SETTING: Tertiary care neurotology center. PATIENTS: Patients undergoing adverse events. INTERVENTION: MAUDE database evaluation of Eustachian tube balloon dilation (ETBD) for the treatment of Eustachian tube dysfunction. MAIN OUTCOME MEASURES: Medical device reports (MDRs) from the MAUDE database were analyzed for adverse patient events (AE) and device malfunctions (DM) among different devices for ETBD. The objective of this analysis is to assess AE rates and compare them across different devices. Sales data was also used to calculate AE rates. RESULTS: There were 18 MDRs noted in the MAUDE database for patients undergoing ETBD out of an initial 23 results. When separated into devices, the Aera had 9 total MDRs (50 %), Xpress had 8 (44.4 %) and Audion had 1 (5.6 %). There were 10 AE and 8 DM. When separated by device, Aera had 4 AEs and 5 DMs, Xpress had 5 AEs and 3 DMs, and Audion had 1 AE. The most common AE was subcutaneous emphysema (n = 4), in the head and neck region with one report of mediastinal involvement. Using this sales data, the Aera balloon has an MDR rate of 0.0128 % is established, with a rate of AE at 0.0058 %. The Audion balloon had an MDR and AE rate of 0.0164 %. CONCLUSIONS: ETBD is a safe procedure with minimal complications, with subcutaneous emphysema being the most commonly reported adverse event, consistent with literature findings. A comprehensive analysis of AE, coupled with sales data, indicates a commendably low MDR rate of 0.0128 % for the Aera balloon while the Audion balloon had an MDR rate of 0.0164 %. These findings offer valuable insights on post-procedure expectations and engaging in informed consent discussions with patients, highlighting the overall safety of ETBD as an intervention.
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PURPOSE: Determine whether adult cochlear implant users with radiographic superior semicircular canal dehiscence experience clinically significant differences in audiological outcomes when compared to cochlear implant users with normal temporal bone anatomy. MATERIALS AND METHODS: Retrospective, single institution review. Adult, post-lingual deaf patients implanted between 2010 and 2020. Inclusion criteria included age 18 years or older, available preoperative computed tomography imaging, and preoperative and postoperative AzBio audiological data for at least 6 months of cochlear implant use. Preoperative and postoperative AzBio Sentence Test scores were compared between patients with normal temporal bone anatomy and those with radiographic superior semicircular canal dehiscence or near dehiscence. RESULTS: 110 patients met inclusion criteria. Mean AzBio score for normal temporal bone anatomy group improved from 35.2 % (SD 28.2) preoperatively to 70.3 % (SD 25.7) postoperatively, an improvement of 35.1 % (SD 28.6). Mean AzBio score for near dehiscent temporal bone anatomy group improved from 26.6 % (SD 28.9) preoperatively to 64.5 % (SD 30.6) postoperatively, an improvement of 37.9 % (SD 27.9). Mean AzBio score for dehiscent temporal bone anatomy group improved from 26.3 % (SD 20.4) preoperatively to 65.1 % (SD 27.6) postoperatively, an improvement of 38.7 % (SD 26.9). Utilizing the one-way analysis of variance test, there was no significant difference in audiologic outcomes between the three groups. CONCLUSIONS: Patients with complete or near complete radiographic superior canal dehiscence at the time of cochlear implantation achieve similar improvements in speech perception scores compared to normal anatomy adult cochlear implant users.
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Implantación Coclear , Implantes Cocleares , Dehiscencia del Canal Semicircular , Hueso Temporal , Tomografía Computarizada por Rayos X , Humanos , Masculino , Femenino , Estudios Retrospectivos , Persona de Mediana Edad , Implantación Coclear/métodos , Adulto , Anciano , Dehiscencia del Canal Semicircular/cirugía , Resultado del Tratamiento , Hueso Temporal/diagnóstico por imagen , Hueso Temporal/cirugía , Canales Semicirculares/cirugía , Canales Semicirculares/diagnóstico por imagen , Sordera/cirugía , Sordera/diagnóstico por imagenRESUMEN
OBJECTIVE: Identify if pre-incident aspirin influences severity and outcome of idiopathic sudden sensorineural hearing loss (SSNHL). STUDY DESIGN: Retrospective review. SETTING: Tertiary care center. METHODS: Patients with idiopathic SSNHL were identified and separated into aspirin and non-aspirin groups. Variables, including demographics, comorbid conditions, audiologic outcomes were identified and compared between groups. RESULTS: One hundred forty-eight patients were included that met inclusion criteria. There were 38 patients who were on pre-incident aspirin therapy and 110 patients not on aspirin prior to the onset of SSNHL. Pre- and post-treatment audiologic status was worsened in the aspirin group. Other comorbid conditions, including hyperlipidemia, coronary artery disease (CAD), cerebrovascular accident (CVA), and vertigo symptoms had an effect as well. With multivariate analysis, CAD, CVA, and vertigo symptoms appeared to have an effect more than aspirin. CONCLUSIONS: Patients on aspirin have a worsened pre- and post-treatment audiologic status. This appears to be more due to the underlying CAD or history of CVA rather than aspirin use itself.
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PURPOSE: To determine whether patients have improved quality of life outcomes with percutaneous bone conduction implant (p-BCI) versus transcutaneous bone conduction implant (t-BCI). MATERIALS & METHODS: Retrospective chart review of patients who have undergone placement of a BCI in the Ascension St John Providence Health System from 2013 to 2018. Patient satisfaction of t-BCI and p-BCI was measured using a questionnaire that incorporated the Glasgow Benefit Inventory (GBI) and BAHA, aesthetic, hygiene & use (BAHU) survey. Key outcome variables were separated into 2 categories: (1) evaluation of wound healing and implant-associated complications, and (2) quality of life improvements. RESULTS: Comparative analysis of the 27 p-BCI patients and 10 t-BCI patients showed overall positive benefit with no statistically significant difference on quality of life improvement between the two groups. Total complication rates for p-BCI (48.1 %) vs t-BCI (10 %) was marginally significant (p = 0.056). Rate of revision for p-BCI versus t-BCI was 14.8 % vs 0 %, respectively. CONCLUSION: This study provides a much-needed comparative insight in patient's experience with these two devices. Understanding which device is preferable in the patient's view will offer helpful information for guiding proper implant selection.
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Audífonos , Humanos , Estudios Retrospectivos , Calidad de Vida , Conducción Ósea , Anclas para Sutura , Pérdida Auditiva Conductiva , Resultado del TratamientoRESUMEN
OBJECTIVE: To evaluate if endolymphatic sac decompression (ESD) significantly improves secondary symptoms of Meniere's disease including tinnitus and aural fullness. STUDY DESIGN: Survey study with retrospective chart review. SETTING: Tertiary care center. METHODS: Survey of adult patients with Meniere's disease that underwent primary ESD surgery from 2015 to 2020. Subjective reporting of pre- and postoperative aural fullness and tinnitus based on postoperative survey. Survey results and audiologic data of the patients that reported were compared pre- and postoperatively. RESULTS: Statistical analysis was performed using weighted kappa statistics to examine the level of agreement. There was a value of 0.12 for pre- and postoperative aural fullness, indicating a difference in the two groups with 77 % having improvement and only 4 % having worsening. There was a value of 0.21 for pre- and postoperative tinnitus, demonstrating a lack of agreement with 58 % having improvement and 4 % having worsening. Overall, there was significant improvement in both tinnitus and aural fullness postoperatively. There was no significant difference in word recognition score, speech reception threshold, or pure tone average between the pre- and postoperative group based on paired t-test. CONCLUSIONS: There is a significant improvement in both aural fullness and tinnitus for patients undergoing ESD with no negative effect on audiologic status. ESD is a viable option for treatment of Meniere's disease with vertigo, aural fullness, and tinnitus relief. Future prospective studies are needed to further improve the evidence of ESD's effect on secondary symptoms of Meniere's disease.
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Saco Endolinfático , Enfermedad de Meniere , Acúfeno , Adulto , Humanos , Enfermedad de Meniere/diagnóstico , Saco Endolinfático/cirugía , Acúfeno/cirugía , Acúfeno/complicaciones , Estudios Retrospectivos , DescompresiónRESUMEN
OBJECTIVE: To quantify contralateral hearing outcomes after labyrinthectomy for unilateral Ménière's disease (MD). STUDY DESIGN: Retrospective case series. SETTING: Tertiary neurotology referral center. PATIENTS: Labyrinth removal for the management of MD or translabyrinthine (TLAB) acoustic neuroma resection between 2008 and 2012. MAIN OUTCOME MEASURE: Long-term hearing changes via pure tone averages (PTA). RESULTS: Upon comparison of low-frequency PTA (250, 500, 1000 Hz), MD patients experienced a greater degree of hearing loss during the follow-up period when compared to the TLAB lab group (7.54 ± 2.11 dB vs 2.39 ± 1.10 dB, p = 0.035). This difference as attributable to 12 (28.6 %) MD patients experiencing a ≥30 dB increase in low-frequency PTA, whereas none (0.0 %) of the TLAB surpassed this threshold. CONCLUSIONS: At 10 years post-labyrinthectomy there is a heightened risk for MD patients to develop low-frequency sensorineural hearing loss. Clinicians should monitor for audiometric changes through regular testing in the decade following labyrinth removal.
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Oído Interno , Enfermedad de Meniere , Humanos , Enfermedad de Meniere/cirugía , Estudios de Seguimiento , Estudios Retrospectivos , Oído Interno/cirugía , AudiciónRESUMEN
OBJECTIVES: To analyze audiometric outcomes of surgery for pediatric onset stapedial pathology (POSP). STUDY DESIGN: Retrospective cohort study. SETTING: Single-institution database. METHODS: Retrospective analysis of 809 stapes procedures performed at a single high-volume tertiary referral otology practice, 75 of which were POSP cases. RESULTS: Oval window drillout for thick footplate and aborting the procedure were more common in POSP cases compared to the rest of the cohort (28.0% versus 9.8% [p < .001] and 5.3% versus 1.2% [p = .007], respectively). Postoperative complications were rare. Postoperative Air-Bone Gap (pABG) closure to ≤20 dB was significantly lower in the POSP group (80.0% versus 89.0%, p = .021). Rates of sensorineural hearing loss (SNHL) were not different between the two groups. Poor audiometric outcomes in the POSP group were largely driven by revision cases; pABG≤10 dB was 60.3% in primary cases but only 11.8% in revisions (p < .001), and postoperative SNHL was significantly higher in revisions (29.4% versus 0.0%, p < .001). In multivariate analysis, POSP was not a predictor of successful closure of the pABG at either level, nor did it predict significant postoperative SNHL. CONCLUSIONS: Surgery for pediatric onset stapedial pathology had significantly worse audiometric outcomes, particularly in revision cases, as compared to the rest of the cohort.
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Otosclerosis , Cirugía del Estribo , Conducción Ósea , Niño , Humanos , Otosclerosis/cirugía , Reoperación , Estudios Retrospectivos , Estribo , Cirugía del Estribo/métodos , Resultado del TratamientoRESUMEN
OBJECTIVE: To identify which patients with advanced otosclerosis may have the greatest audiologic improvement with stapedotomy based on different classifications of advanced otosclerosis. STUDY DESIGN: Retrospective chart review. SETTING: Single tertiary neurotology center. METHODS: Patients were divided into different classifications of advanced otosclerosis based on either a bone conduction threshold of greater than 60 dB HL (Bone Conduction (BC) Group), a word recognition score of less than 70% (Word Recognition (WRS) Group), or pure tone average of greater than 85 dB HL (Pure Tone Average (PTA) Group). Audiologic outcomes and complication profiles were compared between these groups. RESULTS: Nineteen patients met criteria for one or more group. There were 18 patients in the PTA group, 11 in the BC group, and 12 in the WRS group. There was no significant difference in the pre- or postoperative audiologic status between the different groups. CONCLUSIONS: Patients with advanced otosclerosis have significant improvements in pure tone averages and air-bone gaps following stapedotomy regardless of the classification criteria used. Stapedotomy remains a reasonable primary intervention for the majority of patients with advanced otosclerosis.
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Otosclerosis , Cirugía del Estribo , Audiometría de Tonos Puros , Conducción Ósea , Humanos , Otosclerosis/complicaciones , Otosclerosis/cirugía , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
PURPOSE: To determine the utility and value of pre-operative imaging among the elderly population ≥70 y.o. with bilateral progressive sensorineural hearing loss undergoing cochlear implantation. MATERIALS AND METHODS: A retrospective, cross-sectional review was performed at a tertiary referral center between 2010 and 2018 including patients ≥70 y.o. with bilateral presbycusis who underwent preoperative imaging and cochlear implantation. Primary outcome was whether pre-operative imaging changed the surgeon's surgical plan such as side of implant or abort procedure entirely. Patient characteristics including age, sex, side of implant, imaging modality, whether imaging changed surgical plan, and surgical complications were reviewed. One-way analysis of variance with post-hoc tests using the Bonferroni and Fisher's exact test were used to examine differences between groups. Secondary outcome was cost of preoperative imaging. RESULTS: One hundred thirty-three patients (mean age 79.38 [5.51 SD]) who underwent a total of 142 surgical cases and 147 total scans. There were 92, 27, and 14 patients who underwent CT, MRI, or both, respectfully (n=133). Of the 142 implants that were placed, preoperative imaging did not reveal a contraindication to placing implant on one side over another. Total cost of imaging was $29,694. Estimated cost if 20% of cochlear implant eligible patients ≥70 y.o. underwent imaging is $7,763,490. CONCLUSION: Decreasing unnecessary preoperative imaging can potentially decrease cost in cochlear implantation. In this sample, preoperative imaging did not affect the surgeon's choice of which side to operate on. However, imaging may provide an anatomic roadmap and contribute to either surgical confidence or caution. With the increasing amount of cochlear implant eligible elderly adults, preoperative imaging needs to be more clearly defined in this unique population.
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Cóclea/diagnóstico por imagen , Cóclea/cirugía , Implantación Coclear/métodos , Pérdida Auditiva Sensorineural/diagnóstico por imagen , Pérdida Auditiva Sensorineural/cirugía , Imagen por Resonancia Magnética/métodos , Tomografía Computarizada por Rayos X/métodos , Factores de Edad , Anciano , Anciano de 80 o más Años , Implantación Coclear/economía , Estudios Transversales , Progresión de la Enfermedad , Femenino , Costos de la Atención en Salud , Humanos , Imagen por Resonancia Magnética/economía , Masculino , Periodo Preoperatorio , Estudios Retrospectivos , Tomografía Computarizada por Rayos X/economíaRESUMEN
OBJECTIVE: Report an association between congenital stapes footplate fixation (CSFF) and radiological absence of the pyramidal eminence and stapedial tendon. PATIENTS: Children and adults with intraoperatively confirmed CSFF and an absent stapedial tendon. INTERVENTIONS: Computed tomography (CT); exploratory tympanotomy with stapedotomy. MAIN OUTCOME MEASURES: Absence of a pyramidal eminence and stapedial tendon aperture identified on preoperative CT that was confirmed intraoperatively. RESULTS: Eight patients with intraoperative confirmation of CSFF and absent stapedial tendon were retrospectively identified. The average preoperative bone conduction and air conduction pure tone averages were 19.6 dB (SD 15.6 dB) and 55.9 dB (SD 23.6 dB), respectively. The average air-bone gap was 36.3 dB (SD 17.9 dB) preoperatively. In the seven patients who underwent preoperative CT, all were consistently identified to have an absent or hypoplastic pyramidal eminence and absent stapedial tendon aperture at the pyramidal eminence. In six cases, the stapedial footplate appeared normal, while in one case the footplate appeared abnormal which correlated with severe facial nerve prolapse observed intraoperatively. All eight cases underwent exploratory tympanotomy and demonstrated intraoperative stapes footplate fixation, absent stapedial tendon and either absent or hypoplastic pyramidal eminence, which correlated with preoperative CT findings. CONCLUSIONS: This study identifies a clinically pragmatic association between an absent pyramidal eminence identified on high-resolution CT and the diagnosis of CSFF. In a condition that otherwise generally lacks distinctive radiological features, the absence of a pyramidal eminence on CT in a patient with nonprogressive, congenital conductive hearing loss may strengthen clinical suspicion for CSFF.
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Pérdida Auditiva Conductiva/etiología , Pérdida Auditiva Conductiva/cirugía , Estapedio/anomalías , Estapedio/cirugía , Cirugía del Estribo/métodos , Tendones/anomalías , Tendones/cirugía , Adolescente , Adulto , Conducción Ósea , Niño , Enfermedades del Nervio Facial/complicaciones , Femenino , Pérdida Auditiva Conductiva/congénito , Pérdida Auditiva Conductiva/diagnóstico por imagen , Humanos , Periodo Intraoperatorio , Masculino , Prolapso , Estudios Retrospectivos , Estapedio/diagnóstico por imagen , Estapedio/fisiopatología , Tendones/diagnóstico por imagen , Tendones/fisiopatología , Tomografía Computarizada por Rayos X , Adulto JovenRESUMEN
INTRODUCTION: To evaluate perioperative costs of canal wall-down (CWD) mastoidectomy as an initial surgery compared to revision surgery following initial canal wall-up (CWU) mastoidectomy. METHODS: This study is a retrospective chart review of adult patients who underwent CWD mastoidectomy for chronic otitis media with or without cholesteatoma at a tertiary referral center. Patients were divided into groups that had previous CWU surgery and were undergoing revision CWD and those that were having an initial CWD mastoidectomy. Cost variables including previous surgeries, imaging costs, audiometric testing, and post-operative visits were compared between the two groups using t-test analysis. RESULTS: There was no significant difference with regards to the cost of post-operative visits, peri-operative imaging, or revision surgeries between the two groups. Hearing outcomes based on mean speech reception threshold (SRT) were not statistically different between the two groups (p = 0.087). There was a significant difference in total cost with the revision group having a higher mean cost by $6967.84, most of which was accounted for by the difference in the cost of the previous surgeries of $6488.53. CONCLUSIONS: The revision CWD surgery group had increased total cost that could be attributed to the cost of previous surgery. Increased peri-operative cost was not noted with the initial CWD surgery group for any individual variables examined. Initial CWD mastoidectomy should be considered in the proper patient population to help decrease healthcare costs.
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Costos y Análisis de Costo , Mastoidectomía/economía , Mastoidectomía/métodos , Otitis Media/economía , Otitis Media/cirugía , Periodo Perioperatorio , Reoperación/economía , Adolescente , Adulto , Anciano , Audiometría/economía , Colesteatoma/complicaciones , Enfermedad Crónica , Ahorro de Costo/economía , Diagnóstico por Imagen/economía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Visita a Consultorio Médico/economía , Otitis Media/complicaciones , Cuidados Posoperatorios/economía , Estudios Retrospectivos , Adulto JovenRESUMEN
PURPOSE: To review surgical outcomes of stapes surgery for otosclerosis with persistence of the stapedial artery. MATERIALS AND METHODS: A retrospective case review of a tertiary neurotology referral center of patient with otosclerosis undergoing primary stapes surgery between 2010 and 2017 found to have a persistent stapedial artery. Stapedectomy was performed with or without cauterization of the stapedial artery. The primary outcome measures include pre- and postoperative hearing as well complications. Hearing was measured by air conduction (AC) and bone conduction (BC) pure-tone averages (PTA), air-bone gap (ABG), and word recognition scores (WRS). Neurologic complications, including facial nerve function, were assessed. RESULTS: Four patients out of 853 with otosclerosis undergoing stapedectomy were found to have a persistence of the stapedial artery. Mean AC PTA was 55 dB preoperatively, and 24 dB postoperatively (p = .0041), while the ABG improved on average from 31 dB to 6 dB (p = .0014). Mean follow-up time was 32 months, and there were no significant complications. Facial nerve function was preserved in all patients (House-Brackmann grade I/VI). CONCLUSIONS: In the case of a persistent stapedial artery, excellent hearing outcomes are achievable for otosclerosis via stapedectomy without an apparent increased risk of neurologic complication.
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Arterias/cirugía , Otosclerosis/cirugía , Cirugía del Estribo/métodos , Estribo/irrigación sanguínea , Anciano , Nervio Facial/fisiopatología , Femenino , Audición , Humanos , Masculino , Persona de Mediana Edad , Otosclerosis/fisiopatología , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
PURPOSE: In the largest reported United States (U.S.) cohort of benign paroxysmal positional vertigo (BPPV), does the presence or absence of migraine correlate with increased associations of other factors? MATERIALS & METHODS: A retrospective chart review from a single U.S. neurotology center. Adult patients with BPPV from 2003 to 2017 classified into two groups: 1) with migraine; 2) without migraine. RESULTS: The prevalence of self-reported migraine history in a BPPV-positive population (n = 1481) was 25.8% (n = 382). Among those with BPPV and migraine, 88.5% were female, 8.1% had diabetes, 22.5% had prior history of BPPV, 8.9% had Meniere's disease and recurrence rate was 38.3%. No statistically significant differences between recurrence or resolution rates between the two groups were demonstrated (p > 0.05). Adjusted logistic regression model found that women and those with a prior history of BPPV had significantly higher odds of having both BPPV and migraine conditions compared to their counterparts. In contrast, older age and diabetes were associated with significantly lower odds of concomitant BPPV and migraine. CONCLUSIONS: The prevalence of migraine among the study sample was 25.8%. Female gender, prior history of BPPV, younger age, and lack of diabetes were independently associated with the concurrent comorbidity of BPPV and migraine. These data further substantiate previously reported rates (from smaller studies); and, demonstrate that recurrence and resolution rates are not worse in those with BPPV and migraine compared to the general BPPV population. Findings support an association between migraine and BPPV and enhances one's ability to accurately counsel patients regarding these diseases.
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Vértigo Posicional Paroxístico Benigno/epidemiología , Trastornos Migrañosos/epidemiología , Factores de Edad , Estudios de Cohortes , Comorbilidad , Consejo , Diabetes Mellitus/epidemiología , Femenino , Humanos , Masculino , Enfermedad de Meniere/epidemiología , Prevalencia , Recurrencia , Estudios Retrospectivos , Factores Sexuales , Estados Unidos/epidemiologíaRESUMEN
OBJECTIVES: To assess the accuracy of pre-operative diagnosis of masses of the cerebellopontine angle (CPA) when compared to surgical pathology. DESIGN: Retrospective chart review. PARTICIPANTS: Patients who underwent surgery for CPA masses at two tertiary care institutions from 2007 to 2017. MAIN OUTCOME MEASURES: Percent concordance between pre-operative and surgical pathologic diagnosis; sensitivity, specificity, positive predictive value, and negative predictive value for predicted diagnoses. RESULTS: Concordance between pre-operative diagnosis and surgical pathology was 93.2% in 411 sampled patients. Concordance was 57.9% for masses other than vestibular schwannoma. Prediction of vestibular schwannoma and meningioma had high positive (0.95 and 0.97, respectively) and negative (0.76 and 0.99, respectively) predictive values. Prediction of facial neuroma had sensitivity of 0.13 and positive predictive value of 0.25. Headache (pâ¯=â¯0.001) and facial weakness (pâ¯=â¯0.003) were significantly associated with different pathologic profiles. Hearing loss was associated with differences in diagnostic prediction (pâ¯=â¯0.02) but not with differences in surgical pathology (pâ¯>â¯0.05). CONCLUSIONS: Comparison between pre-operative predicted diagnosis and surgical pathology for cerebellopontine angle masses is presented. Vestibular schwannoma and meningioma were effectively identified while rarer CPA masses including facial neuroma were rarely identified correctly. Clinicians caring for patients with CPA masses should be mindful of diagnostic uncertainty which may lead to changes in treatment plan or prognosis.
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Neoplasias Cerebelosas/diagnóstico , Neoplasias Cerebelosas/patología , Ángulo Pontocerebeloso , Neuroma Acústico/diagnóstico , Neuroma Acústico/patología , Adulto , Anciano , Neoplasias Cerebelosas/cirugía , Ángulo Pontocerebeloso/patología , Diagnóstico Diferencial , Neoplasias Faciales , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Neoplasias Meníngeas , Meningioma , Persona de Mediana Edad , Estudios Multicéntricos como Asunto , Neuroma , Neuroma Acústico/cirugía , Valor Predictivo de las Pruebas , Periodo Preoperatorio , Estudios Retrospectivos , Sensibilidad y Especificidad , Centros de Atención TerciariaRESUMEN
PURPOSE: To evaluate the effect of intratympanic steroid injection frequency on hearing outcomes for patients with idiopathic sudden sensorineural hearing loss. MATERIALS AND METHODS: A retrospective chart review was performed from 2007 to 2015 at a neurotology tertiary referral center. Adults who met academy criteria for idiopathic sudden sensorineural hearing loss within two months of onset and negative imaging were grouped based on injection frequency. Injection schedules were every 1-4 (group 1), 5-10 (group 2), or 11-30 (group 3) days. All patients had at least two injections with Dexamethasone 10â¯mg/ml. All patients had pre- and post-injection audiograms. RESULTS: Seventy patients met inclusion criteria (group 1, nâ¯=â¯21; group 2, nâ¯=â¯29; group 3, nâ¯=â¯20). There was no significant difference between group demographics or baseline audiometric data. Mean gains were significant and similar between groups for pure tone average (group 1â¯=â¯-23.6⯱â¯22.0â¯dB; group 2â¯=â¯-19.7⯱â¯18.4â¯dB; group 3â¯=â¯-24.9⯱â¯24.7â¯dB; pâ¯=â¯0.67) and word recognition score (group 1â¯=â¯+26.3⯱â¯34.8%; group 2â¯=â¯+23.3⯱â¯29.9%; group 3â¯=â¯+33.4⯱â¯28.9%; pâ¯=â¯0.53). CONCLUSIONS: Frequency of intratympanic steroid injections does not significantly affect hearing outcomes. Following injection therapy, hearing outcomes improved regardless of prior or concomitant oral steroid regimen. Earlier time to initiating injections yielded a higher rate of hearing improvement. Long term hearing outcomes >6â¯months did not show significant additional improvement.
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Dexametasona/administración & dosificación , Glucocorticoides/administración & dosificación , Pérdida Auditiva Sensorineural/tratamiento farmacológico , Pérdida Auditiva Súbita/tratamiento farmacológico , Adulto , Anciano , Audiometría de Tonos Puros , Esquema de Medicación , Femenino , Humanos , Inyección Intratimpánica , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
OBJECTIVES: Quantify number of MRI scans obtained in a tertiary neurotology practice and identify likelihood of pathologic findings. STUDY DESIGN: Retrospective cohort study. SETTING: Tertiary neurotology center. SUBJECTS AND METHODS: A retrospective analysis of all adult patients over 20â¯months (3/2012-10/2013) where MRI was deemed necessary for evaluation of neurotologic complaints. Demographics, clinical history, physical examination, and audiometric findings were used to categorize new patients into 7 groups: definite Meniere's disease (MD), probable MD, possible MD, vague dizziness, tinnitus only, asymmetric hearing loss (HL), and other symptoms to stratify risk for retrocochlear tumor and other relevant pathology. RESULTS: 1537 MRI scans were performed, 932 of these were for a new diagnosis. Discovering retrocochlear tumors was rare (1.4%). Patients with HL had a 0.3% (1/314) chance of retrocochlear tumor and 3.2% (10/314) chance of relevant pathology. Patients with only unilateral tinnitus had no evidence of retrocochlear tumors, and 3.8% chance of finding relevant pathology. Patients with "definite" or "probable" MD had no evidence of retrocochlear tumor or other relevant findings. All discovered acoustic neuromas were in the "possible MD" category, which had a 9.3% chance of finding all relevant pathology. CONCLUSIONS: In a tertiary neurotology center, the likelihood of finding a retrocochlear tumor on MRI is rare. In the current study, unilateral tinnitus exclusively, "definite MD," and "probable MD" failed to yield a single example of retrocochlear tumor. Patients with "possible MD" had the highest probability of finding retrocochlear tumors and other relevant pathology.
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Encéfalo/diagnóstico por imagen , Oído Interno/diagnóstico por imagen , Imagen por Resonancia Magnética , Enfermedad de Meniere/diagnóstico por imagen , Enfermedades Retrococleares/diagnóstico por imagen , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Mareo/diagnóstico por imagen , Mareo/etiología , Femenino , Pérdida Auditiva/diagnóstico por imagen , Pérdida Auditiva/etiología , Humanos , Masculino , Enfermedad de Meniere/etiología , Persona de Mediana Edad , Enfermedades Retrococleares/complicaciones , Estudios Retrospectivos , Evaluación de Síntomas , Acúfeno/diagnóstico por imagen , Acúfeno/etiología , Adulto JovenRESUMEN
PURPOSE: Benign paroxysmal positional vertigo (BPPV) involving the horizontal and superior semicircular canals is difficult to study due to variability in diagnosis. We aim to compare disease, treatment, and outcome characteristics between patients with BPPV of non-posterior semicircular canals (NP-BPPV) and BPPV involving the posterior canal only (P-BPPV) using the particle repositioning chair as a diagnostic and therapeutic tool. METHODS: Retrospective review of patients diagnosed with and treated for BPPV at a high volume otology institution using the particle repositioning chair. RESULTS: A total of 610 patients with BPPV were identified, 19.0% of whom had NP-BPPV. Patients with NP-BPPV were more likely to have bilateral BPPV (52.6% vs. 27.6%, pâ¯<â¯0.0005) and Meniere's disease (12.1% vs. 5.9%, pâ¯=â¯0.02) and were more likely to have caloric weakness (40.3% vs. 24.3%, pâ¯=â¯0.01). Patients with NP-BPPV required more treatments for BPPV (average 3.4 vs. 2.4, pâ¯=â¯0.01) but did not have a significantly different rate of resolution, rate of recurrence, or time to resolution or recurrence than patients with posterior canal BPPV. CONCLUSIONS: Comparison of NP-BPPV and P-BPPV is presented with reliable diagnosis by the particle repositioning chair. NP-BPPV affects 19% of patients with BPPV, and these patients are more likely to have bilateral BPPV and to require more treatment visits but have similar outcomes to those with P-BPPV. NP-BPPV is common and should be part of the differential diagnosis for patients presenting with positional vertigo.
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Vértigo Posicional Paroxístico Benigno/diagnóstico , Vértigo Posicional Paroxístico Benigno/terapia , Posicionamiento del Paciente/instrumentación , Posicionamiento del Paciente/métodos , Canales Semicirculares/fisiopatología , Centros Médicos Académicos , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Distribución de Chi-Cuadrado , Estudios de Cohortes , Bases de Datos Factuales , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Medición de Riesgo , Índice de Severidad de la Enfermedad , Factores Sexuales , Resultado del TratamientoRESUMEN
PURPOSE: The purpose of this study is to assess implant stability, implant loss, adverse skin reactions and quality of life benefit following surgical implantation and early processor loading (3-weeks post-implantation) of the Oticon Ponto 4.5 mm osseointegrated auditory implant. This study also investigates the relationship between the type of post-operative skin reactions and the gender, BMI and medical co-morbidities of participants. MATERIALS/METHODS: Using a prospective, multicenter design, thirty adult patients 18 years or older who met medical and audiological candidacy for an osseointegrated auditory bone-anchored hearing device were evaluated. They underwent simultaneous implantation of the Oticon 4.5mm wide implant and a 3.75 mm sleeper implant. Sound processor loading occurred at three weeks post-implantation. Implant stability was measured using Radio Frequency Analysis (RFA) at surgery, 1, 3, 6, 12, 26 and 52 weeks. The Glasgow Benefit Inventory was used to assess quality of life benefit at 12 and 52 weeks following implantation. RESULTS: The results show a positive linear trend in implant stability measures in all subjects over time. There have been no implant losses with early 3-week loading. Skin reactions were limited to grade 0 and 1 of the modified Holger's grading scale. Due to the limited incidence of complications, no conclusion can be made regarding the relationship between patient demographic data and soft tissue reaction. CONCLUSION: Our findings confirm the safety and efficacy of early loading of the Oticon 4.5 mm wide implant. Participants showed satisfaction with the earlier use of their processor with no added complications after one year post-implantation.
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Conducción Ósea/fisiología , Audífonos , Pérdida Auditiva/cirugía , Audición/fisiología , Calidad de Vida , Anclas para Sutura , Titanio , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Pérdida Auditiva/diagnóstico , Pérdida Auditiva/fisiopatología , Pruebas Auditivas , Humanos , Masculino , Persona de Mediana Edad , Oseointegración , Estudios Prospectivos , Diseño de Prótesis , Factores de Tiempo , Resultado del Tratamiento , Adulto JovenRESUMEN
PURPOSE: To evaluate the outcome of round window (RW) tissue reinforcement in the management of superior semicircular canal dehiscence (SSCD). MATERIALS AND METHODS: Twenty-two patients with confirmed diagnosis of SSCD by clinical presentation, imaging, and/or testing were included in the study. Six surgeons at four institutions conducted a multicenter chart review of patients treated for symptomatic superior canal dehiscence using RW tissue reinforcement or complete RW occlusion. A transcanal approach was used to reinforce the RW with various types of tissue. Patients completed a novel postoperative survey, grading preoperative and postoperative symptom severity. RESULTS: Analysis revealed statistically significant improvement in all symptoms with the exception of hearing loss in 19 patients who underwent RW reinforcement. In contrast, 2 of 3 participants who underwent the alternate treatment of RW niche occlusion experienced worsened symptoms requiring revision surgery. CONCLUSION: RW tissue reinforcement may reduce the symptoms associated with SSCD. The reinforcement technique may benefit SSCD patients by reducing the "third window" effect created by a dehiscent semicircular canal. Given its low risks compared to middle cranial fossa or transmastoid canal occlusion, RW reinforcement may prove to be a suitable initial procedure for intractable SSCD. In contrast, complete RW occlusion is not advised.