Decompression of the tympanic and labyrinthine segments of the facial nerve by middle cranial fossa approach: an anatomic study.

BACKGROUND: Peripheral facial palsy is characterized by the permanent or temporary interruption of facial muscle function. The middle cranial fossa (MCF) approach has been used to decompress the facial nerve (FN) when hearing needs to be preserved. In this work, we describe a technique for decompressing the FN through the MCF approach, which allows the direct exposure of the labyrinthine and entire tympanic segment of the FN, with preservation of inner ear function. METHODS: Twenty cadavers heads were used in this study. The reference landmarks used were the middle meningeal artery, greater superficial petrosal nerve, arcuate eminence, inferior petrosal sinus and meatal plane following the petrous apex from its most anterior and medial portion. RESULTS: The tympanic segment of the FN presented, on average, a total length of 11 ± 0.67 mm to the right and 11.5 ± 0.60 mm to the left. The longitudinal lengths of the bone window in the tegmen tympani were 16.8 ± 1.67 mm to the right and 16.8 ± 1.20 mm to the left. The cross-sectional lengths of the bone window in the tegmen tympani were 5.5 ± 1.20 mm and 5.0 ± 1.75 mm to the right and left sides, respectively. The average value of the elliptical area formed by the longitudinal and transversal lengths of the bone window made in the tegmen tympani was 72.5 ± 22.5 mm(2) to the right and 65.9 ± 30.3 mm(2) to the left. CONCLUSION: The proposed technique can be used for the surgical decompression of the tympanic, labyrinthine and meatal segments of the FN through the MCF in addition to reducing the surgical time and the risk to patients.

Programming peculiarities in two cochlear implant users with superficial siderosis of the central nervous system.

OBJECTIVE: To report the audiological outcomes of cochlear implantation in two patients with severe to profound sensorineural hearing loss secondary to superficial siderosis of the CNS and discuss some programming peculiarities that were found in these cases. METHOD: Retrospective review. Data concerning clinical presentation, diagnosis and audiological assessment pre- and post-implantation were collected of two patients with superficial siderosis of the CNS. RESULTS: Both patients showed good hearing thresholds but variable speech perception outcomes. One patient did not achieve open-set speech recognition, but the other achieved 70% speech recognition in quiet. Electrical compound action potentials could not be elicited in either patient. Map parameters showed the need for increased charge. Electrode impedances showed high longitudinal variability. CONCLUSION: The implants were fairly beneficial in restoring hearing and improving communication abilities although many reprogramming sessions have been required. The hurdle in programming was the need of frequent adjustments due to the physiologic variations in electrical discharges and neural conduction, besides the changes in the impedances. Patients diagnosed with superficial siderosis may achieve limited results in speech perception scores due to both cochlear and retrocochlear reasons. Careful counseling about the results must be given to the patients and their families before the cochlear implantation indication.

Efeitos da terapia renal substitutiva no sistema auditivo: uma revisão de escopo / Effects of renal replacement therapy on the auditory system: a scoping review / Efectos del tratamiento renal sustitutivo sobre el sistema auditivo: una revisión general

Objetivo: responder as seguintes questões: A) Quais os efeitos no sistema auditivo da terapia renal substitutiva em pacientes dialíticos? B) Quais os principais métodos utilizados para avaliar o sistema auditivo de pacientes dialíticos? Método: Revisão de escopo realizada no mês de janeiro de 2023, utilizando as bases PubMed, Scielo e Medline. Foram utilizados descritores a partir dos seguintes eixos temáticos: terapia renal substitutiva e alterações no sistema auditivo. Resultados: Foram encontrados 358 artigos. Após critérios de elegibilidade, 15 foram incluídos neste estudo. A maioria dos estudos (66,6%) apresentou alteração auditiva para indivíduos que estavam em terapia renal substitutiva, destes (20,0%) descreveram alteração coclear. A perda do tipo neurossensorial nas altas frequências foi a mais frequente com respostas ausentes para as emissões otoacústicas. Foram identificados oito diferentes métodos para avaliação auditiva desta população, sendo o mais utilizado para acompanhamento auditivo a audiometria tonal (73,3%) e a imitânciometria (33,3%). O teste de emissões otoacústicas é o mais citado para diagnóstico precoce. Conclusão: Pacientes em TRS apresentam perda auditiva do tipo neurossensorial nas frequências altas, com grau variando de acordo com o número de terapia renal duração da insuficiência renal. Curvas timpanométricas do tipo A e ausência de respostas nas EOA. O teste mais utilizado para acompanhamento auditivo desta população é a Audiometria Tonal, porém as EOA são os testes mais citados para diagnóstico precoce.

Aim: to answer the following questions: A) What are the effects on the auditory system of renal replacement therapy in dialysis patients? B) What are the main methods used to evaluate the auditory system in dialysis patients? Method: Scoping review conducted in January 2023 using PubMed, Scielo and Medline. Descriptors were used from the following thematic axes: renal replacement therapy and auditory system changes. Results: 358 articles were found. After eligibility criteria, 15 were included in this study. Most studies (66.6%) presented hearing loss in individuals who were on renal replacement therapy, and of these (20.0%) described cochlear alteration. The sensorineural type loss in the high frequencies was the most frequent with absent responses for otoacoustic emissions. Eight different methods were identified for hearing assessment in this population, with tonal audiometry (73.3%) and immittance audiometry (33.3%) being the most used for hearing monitoring. The otoacoustic emissions test is the most cited for early diagnosis. Conclusion: Patients on SRT have sensorineural hearing loss in the high frequencies, with the degree varying according to the number of renal therapy duration of renal failure. Type A tympanometric curves and absence of OAE responses. The most commonly used test for auditory monitoring in this population is Tonal Audiometry, but OAE is the most cited test for early diagnosis.

Objetivo: responder a las siguientes preguntas: A) ¿Cuáles son los efectos sobre el sistema auditivo del tratamiento renal sustitutivo en pacientes en diálisis? B) ¿Cuáles son los principales métodos utilizados para evaluar el sistema auditivo en pacientes en diálisis? Método: Revisión exploratoria realizada en enero de 2023, utilizando las bases de datos PubMed, Scielo y Medline. Se utilizaron descriptores de los siguientes ejes temáticos: terapia renal sustitutiva y alteraciones del sistema auditivo. Resultados: Se encontraron 358 artículos. Tras los criterios de elegibilidad, se incluyeron 15 en este estudio. La mayoría de los estudios (66,6%) presentaban hipoacusia en individuos en tratamiento renal sustitutivo, de éstos (20,0%) describían alteración coclear. La hipoacusia neurosensorial en altas frecuencias fue el tipo más frecuente, con ausencia de respuestas para las otoemisiones acústicas. Se identificaron ocho métodos diferentes para la evaluación auditiva en esta población, siendo la audiometría tonal (73,3%) y la audiometría de inmitancia (33,3%) los más utilizados para el control auditivo. La prueba de otoemisiones acústicas es la más citada para el diagnóstico precoz. Conclusión: Los pacientes en TRS presentan hipoacusia neurosensorial en las frecuencias agudas, variando el grado según el número de tratamientos renales y la duración de la insuficiencia renal. Curvas timpanométricas de tipo A y ausencia de respuestas OAE. La audiometría tonal es la prueba más utilizada para el control auditivo en esta población, pero la OAE es la prueba más mencionada para el diagnóstico precoz.

Treatment and Prognosis of Facial Palsy on Ramsay Hunt Syndrome: Results Based on a Review of the Literature.

Introduction Ramsay Hunt syndrome is the second most common cause of facial palsy. Early and correct treatment should be performed to avoid complications, such as permanent facial nerve dysfunction. Objective The objective of this study is to review the prognosis of the facial palsy on Ramsay Hunt syndrome, considering the different treatments proposed in the literature. Data Synthesis We read the abstract of 78 studies; we selected 31 studies and read them in full. We selected 19 studies for appraisal. Among the 882 selected patients, 621 (70.4%) achieved a House-Brackmann score of I or II; 68% of the patients treated only with steroids achieved HB I or II, versus 70.5% when treated with steroids plus antiviral agents. Among patients with complete facial palsy (grades V or VI), 51.4% recovered to grades I or II. The rate of complete recovery varied considering the steroid associated with acyclovir: 81.3% for methylprednisolone, 69.2% for prednisone; 61.4% for prednisolone; and 76.3% for hydrocortisone. Conclusions Patients with Ramsay-hunt syndrome, when early diagnosed and treated, achieve high rates of complete recovery. The association of steroids and acyclovir is better than steroids used in monotherapy.

Carina® and Esteem®: a systematic review of fully implantable hearing devices.

OBJECTIVE: To review the outcomes of the fully implantable middle ear devices Carina and Esteem regarding the treatment of hearing loss. DATA SOURCES: PubMed, Embase, Scielo, and Cochrane Library databases were searched. STUDY SELECTION: Abstracts of 77 citations were screened, and 43 articles were selected for full review. From those, 22 studies and two literature reviews in English directly demonstrating the results of Carina and Esteem were included. DATA EXTRACTION: There were a total of 244 patients ranging from 18 to 88 years. One hundred and 10 patients were implanted with Carina and with 134 Esteem. There were registered 92 males and 67 females. Five studies provided no information about patients' age or gender. From the data available, the follow-up ranged from 2 to 29.4 months. DATA SYNTHESIS: The comparison of the results about word recognition is difficult as there was no standardization of measurement. The results were obtained from various sound intensities and different frequencies. The outcomes comparing to conventional HAs were conflicting. Nevertheless, all results comparing to unaided condition showed improvement and showed a subjective improvement of quality of life. CONCLUSION: There are still some problems to be solved, mainly related to device functioning and price. Due to the relatively few publications available and small sample sizes, we must be careful in extrapolating these results to a broader population. Additionally, none of all these studies represented level high levels of evidence (i.e. randomized controlled trials).

Remote programming of cochlear implants.

PURPOSE: To verify the effectiveness of remote programming of cochlear implants by stimulation levels and results in the perception of speech and free-field audiometry tests. METHODS: Twelve patients from both genders, aged between 18 and 59 years, users of internal cochlear implant and speech processor of the same model for at least 12 months, were selected. Both the remote programming (RP) and the live programming (LP) were performed on the same day, measuring the minimum (T) and maximum (C) stimulation levels of five electrodes with the interpolation of the remaining ones. Speech perception tests were applied using 65 dBSPL (recorded open context sentences and monosyllables). The patients were submitted to free-field audiometry at 250-8,000 Hz frequencies. The results for the RP and LP were compared. RESULTS: Differences in mean of the T levels for three electrodes and the C levels for one electrode were found. No difference between the results was obtained in the speech perception tests and audiometric thresholds in the RP and LP. CONCLUSION: The RP is a simple and effective procedure for programming cochlear implant devices and, although there were differences in the stimulation levels of some electrodes, it did not interfere in the speech perception outcomes.

Implantable and semi-implantable hearing AIDS: a review of history, indications, and surgery.

Introduction The complaints associated with the use of conventional amplifying hearing aids prompted research at several centers worldwide that ultimately led to the development of implantable devices for aural rehabilitation. Objectives To review the history, indications, and surgical aspects of the implantable middle ear hearing devices. Data Synthesis Implantable hearing aids, such as the Vibrant Soundbridge system (Med-El Corporation, Innsbruck, Austria), the Maxum system (Ototronix LLC, Houston, Texas, United States), the fourth-generation of Carina prosthesis (Otologics LLC, Boulder, Colorado, United States), and the Esteem device (Envoy Medical Corporation - Minnesota, United States), have their own peculiarities on candidacy and surgical procedure. Conclusion Implantable hearing aids, which are currently in the early stages of development, will unquestionably be the major drivers of advancement in otologic practice in the 21st century, improving the quality of life of an increasingly aged population, which will consequently require increased levels of hearing support.

Intracochlear schwannoma: diagnosis and management.

Introduction Schwannomas of the eighth cranial nerve are benign tumors that usually occur in the internal auditory canal or the cerebellopontine angle cistern. Rarely, these tumors may originate from the neural elements within the vestibule, cochlea, or semicircular canals and are called intralabyrinthine schwannomas. Intracochlear schwannomas (ICSs) represent a small percentage of these tumors, and their diagnosis is based on high-resolution magnetic resonance imaging (MRI). Objectives To report the clinical and radiologic features and audiometric testing results of an ICS in a 48-year-old man after a 22-month follow-up period. Resumed Report A patient with an 8-year history of persistent tinnitus in his right ear, combined with ipsilateral progressive hearing loss and aural fullness. Audiometry revealed normal hearing in the left ear and a moderate to severe sensorineural hearing loss in the right ear, with decreased speech reception threshold and word recognition score, compared with the exam performed 5 years previously. MRI showed a small intracochlear nodular lesion in the modiolus, isointense on T1 with a high contrast enhancement on T1 postgadolinium images. During the follow-up period, there were no radiologic changes on imaging studies. Thus, a wait-and-scan policy was chosen as the lesion remained stable with no considerable growth and the patient still presents with residual hearing. Conclusions Once diagnosed, not all ICS patients require surgery. Treatment options for ICS include stereotactic radiotherapy and rescanning policy, depending on the tumor's size, evidence of the tumor's growth, degree of hearing loss, intractable vestibular symptoms, concern about the pathologic diagnosis, and the patient's other medical conditions.

Cochlear implantation through the middle fossa: an anatomic study for a novel technique.

CONCLUSION: The technique proposed is simple, reliable, and provides sufficient exposure of the basal portion of the cochlea while avoiding disabling complications. It enables visualization of the cochlear basal turn and the osseous spiral lamina, facilitating the insertion of the cochlear implant array through the scala tympani. OBJECTIVES: To describe a novel approach for exposing the cochlear basal turn for cochlear implantation through the middle cranial fossa. METHODS: Fifty temporal bones were dissected and a cochleostomy was performed via a middle fossa approach on the most superficial part of the cochlear basal turn, using the superior petrosal sinus, the skeletonized petrous apex, the lateral surface of the meatal plane trailed on the petrous apex from its most proximal portion, and the great superficial petrosal nerve as landmarks. The distance between the landmarks and the distance between the cochleostomy and the round window were measured. RESULTS: In all temporal bones, only the top portion of the cochlear basal turn was uncovered. The cochleostomy allowed both the scala tympani and the vestibule to be exposed. A computed tomography scan of the temporal bones was performed to document the electrode insertion from the cochlear basal turn until its apex. The mean ± SD minor and major distances between the cochleostomy and the meatal plane were estimated to be 2.48 ± 0.88 mm and 3.11 ± 0.86 mm, respectively. The mean distance from the cochleostomy to the round window was 8.38 ± 1.96 mm, and that to the superior petrosal sinus was 9.19 ± 1.59 mm. The mean minor and major distances between the cochleostomy and the long axis of the meatal plane from its most proximal portion were estimated to be 6.63 ± 1.38 mm and 8.29 ± 1.43 mm, respectively.

Cochlear implantation through the middle cranial fossa: a novel approach to access the basal turn of the cochlea.

UNLABELLED: The classic approach for cochlear implant surgery includes mastoidectomy and posterior tympanotomy. The middle cranial fossa approach is a proven alternative, but it has been used only sporadically and inconsistently in cochlear implantation. OBJECTIVE: To describe a new approach to expose the basal turn of the cochlea in cochlear implant surgery through the middle cranial fossa. METHOD: Fifty temporal bones were dissected in this anatomic study of the temporal bone. Cochleostomies were performed through the middle cranial fossa approach in the most superficial portion of the basal turn of the cochlea, using the meatal plane and the superior petrous sinus as landmarks. The lateral wall of the internal acoustic canal was dissected after the petrous apex had been drilled and stripped. The dissected wall of the inner acoustic canal was followed longitudinally to the cochleostomy. RESULTS: Only the superficial portion of the basal turn of the cochlea was opened in the fifty temporal bones included in this study. The exposure of the basal turn of the cochlea allowed the visualization of the scala tympani and the scala vestibuli, which enabled the array to be easily inserted through the scala tympani. CONCLUSION: The proposed approach is simple to use and provides sufficient exposure of the basal turn of the cochlea.