Intraindividual Comparison of Image Artifacts of Two Generations of Rotatable Cochlear Implant Magnets.

In cochlear implant recipients, the diagnostic value of magnetic resonance imaging (MRI) scans is reduced by image artifacts. The static magnetic field of a 3.0T scanner is associated with the risk of implant demagnetization. The development of rotatable implant magnets aimed to support the advancement of 3.0T MRI scanners and eliminate the risk of demagnetization of cochlear implant magnets. This study aimed to compare the image artifacts caused by first-t and second-generation rotatable cochlear implant magnets in 3.0T MRI. Three Tesla MRI T2W TSE sequences were performed on 3 subjects with first- and second-generation rotatable cochlear implant magnets. The cochlear implant was fixed to the head at the implantation position by a swim cap. The size of the image artifact was determined in the transverse plane. Intraindividual comparative analyses showed that within the margin of combined uncertainty of 5 mm at a resolution of 2 mm, the cochlear implant-induced image artifacts in all subjects showed for both (first- and second-generation rotatable cochlear implant magnets), the same maximum image artifact dimension of 125 mm. We could show that no difference in image artifact size was detected within the margin of error determined by resolution, localized induced shift of the scan, and reproducibility of the tilt angle of the head relative to the chest in a living subject. Assumed improved magnet attachment can be reached without compromising of the magnet artifact size.

Human papillomavirus-associated head and neck squamous cell carcinoma cells lose viability during triggered myocyte lineage differentiation.

Head and neck squamous cell carcinoma (HNSCC) is a highly malignant disease, and death rates have remained at approximately 50% for decades. New tumor-targeting strategies are desperately needed, and a previous report indicated the triggered differentiation of HPV-negative HNSCC cells to confer therapeutic benefits. Using patient-derived tumor cells, we created a similar HNSCC differentiation model of HPV+ tumor cells from two patients. We observed a loss of malignant characteristics in differentiating cell culture conditions, including irregularly enlarged cell morphology, cell cycle arrest with downregulation of Ki67, and reduced cell viability. RNA-Seq showed myocyte-like differentiation with upregulation of markers of myofibril assembly. Immunofluorescence staining of differentiated and undifferentiated primary HPV+ HNSCC cells confirmed an upregulation of these markers and the formation of parallel actin fibers reminiscent of myoblast-lineage cells. Moreover, immunofluorescence of HPV+ tumor tissue revealed areas of cells co-expressing the identified markers of myofibril assembly, HPV surrogate marker p16, and stress-associated basal keratinocyte marker KRT17, indicating that the observed myocyte-like in vitro differentiation occurs in human tissue. We are the first to report that carcinoma cells can undergo a triggered myocyte-like differentiation, and our study suggests that the targeted differentiation of HPV+ HNSCCs might be therapeutically valuable.

MRI-Based Inner Ear Assessment and Cochlin Tomoprotein-Based Evaluation of Perilymphatic Fistula in Patients with Sudden Hearing Loss.

OBJECTIVES: To study the correlation between positive cochlin tomoprotein testing (CTP), magnetic resonance (MR) imaging, and the auditory and vestibular function amongst patients with sudden hearing loss. STUDY DESIGN: Prospective case series. METHODS: We prospectively examined eight patients who presented with sudden hearing loss (>60 dB) with or without vertigo or tinnitus. We performed an ELISA-based CTP detection test using middle ear lavage samples. In addition to the CTP examination, a magnetic resonance imaging (MRI) examination was performed using different sequences (T1 and a T1 sequence with a contrast medium (CM), a T2 sequence, 4 h delayed intravenous gadolinium-enhanced three-dimensional fluid-attenuated inversion recovery (3D FLAIR)). RESULTS: All patients with sudden hearing loss (>60 dB) presented a non-specific contrast enhancement in the cochlea and vestibulum on the affected side on delayed 3D-FLAIR MRI. Four patients had a positive CTP test, suggesting a perilymphatic fistula (PLF). However, no specific MRI signal for a PLF was observed. CONCLUSIONS: Using multimodal diagnostic measures, such as CTP testing and different MRI sequences, no correlation could be found in patients with a PLF.

First Clinical Experience with a New Device for the Removal of Cochlear Schwannomas.

Background: In most cases, intralabyrinthine schwannoma (ILS) occurs in patients with unilateral hearing deterioration or neurofibromatosis type II (NF II). The pattern of localization of these tumors varies but mostly affects the cochlea. Extirpation of the cochlear schwannoma, if hidden by the cochlea modiolus, is difficult under the aspect of complete removal. Therefore, a tissue removal device (TRD) was designed and tested in temporal bones. The principle of handling the new device is a pushing and pipe cleaner handling inside the cochlea. This present study aimed to describe the first in vivo experience with the newly developed TRD for removing cochlear intralabyrinthine schwannomas. Methods: In three patients, the TRD was used for the tumor removal of cochlear schwannomas. In two patients with a cochlear schwannoma in combination with a cochlea implantation and one patient suffering from NF II, a cochlear schwannoma was removed with the TRD. The access was performed with a posterior tympanotomy, an enlarged round window approach and an additional second turn access. The device was inserted and extracted gradually from the second turn access until the rings were visible in the second turn access. By pushing and pipe cleaner handling, the tumors were removed. An MRI control was performed on the day postoperatively with a T1 GAD sequence. Results: Tumor removal with the TRD was performed in a 15-min procedure without any complications. An MRI control confirmed complete removal on the postoperative day in all cases. Conclusions: In vivo handling of the device confirmed straightforward handling for the tumor removal. MRI scanning showed complete removal of the tumor by the TRD.

Case Report: A rare case of bilateral middle ear tophaceous gout.

Introduction: Hypacusia can be caused by various etiologies; however, hearing loss attributed to gouty tophi remains a rare occurrence. This case report presents, for the first time, a bilateral gouty tophi causing hearing impairment. Case presentation: This report describes a case study involving an 83-year-old Caucasian female patient who presented symptoms of hypacusia, pruritus, and a sensation of pressure in her right ear. A computed tomography scan revealed the presence of non-homogeneous calcified structures in both ears. Following a comprehensive assessment that included pure-tone audiometry and a thorough evaluation of the patient's clinical complaints, a tympanoplasty procedure was initially performed on the right ear. Pathological analysis revealed the presence of gouty tophi. After surgical removal of the tophus, a notable improvement in the patient's hearing threshold was observed. Four months later, a similar surgical intervention was performed on the contralateral ear, achieving a similar positive outcome. The substantial postoperative decrease of bone conduction indicates an inner ear affection by the gout tophi. Conclusion: Gout tophus in both ears is a very rare but possible cause of hypacusia, even in the absence of a pre-existing diagnosis of systemic gout disease. We report a case of gout tophi in both ears as a rare cause of hearing loss.

Case Report: Inflamed Jacobson nerve: an uncommon cause of persisting otalgia after an acute otitis media.

Introduction: Otalgia can have multiple causes. Mostly otalgia is caused by a tubal dysfunction or an acute middle ear infection. This case describes a patient with an inflammation of the Jacobson's nerve causing severe persistent otalgia after an acute otitis media. The patients complaints completely disappeared after neurolysis of the Jacobson's nerve. Case presentation: We describe a case of a 21-year-old female caucasian patient with acute otitis media and persistent intractable otalgia. Infection was first successfully controlled by antibiotics. But the patient reported a persistent otalgia not responding to analgetics. We performed a CT scan, which exhibited a regular aerated middle ear finding, and a diagnostic tympanoscopy to examine the middle ear structures particularly the tympanic Jacobson's nerve as a possible cause for persistent pain. The following neurolysis of Jacobson's nerve under general anaesthesia led to a resolution of otalgia. Conclusion: An inflamed tympanic Jacobson's nerve is a rare observation and a persisting otalgia after an acute otitis media not responding to conservative treatment can be treated by a neurolysis.

Occlusion of the Lateral Semicircular Canal, Endolymphatic Sac Surgery, and Cochlear Implantation: A Low Destructive Treatment for Unilateral Ménière's Disease and Deafness.

INTRODUCTION: Surgical treatment of Ménière's disease (MD) and deafness aims to treat vertigo and hearing disabilities. Current treatment options like labyrinthectomy and cochlear implantation (CI) have shown acceptable results but are destructive. Less destructive procedures, like the occlusion of the lateral semicircular canal and endolymphatic sac surgery, have been shown to be successful in vertigo control. The combination of both procedures with CI has not been investigated; therefore the objective of this study was to investigate the outcome of this combination in patients with single-sided MD and moderately severe to complete sensorineural hearing loss. METHODS: In this retrospective study, 10 patients with single-sided MD and moderately severe to complete sensorineural hearing loss were included. In all of them, a single-staged surgery, which consisted of CI, endolymphatic sac surgery, and occlusion of the lateral semicircular canal, was performed. The surgery was performed after a failed conservative therapy trial. The clinical outcome was evaluated by the Dizziness Handicap Inventory (DHI) and audiological tests. These were assessed preoperatively, 3 and 6 months after surgery. An MRI with a hydrops sequence was performed to support the clinical diagnosis. RESULTS: After the combined surgery, the mean DHI testing improved significantly from 71 to 30. Mean audiological monosyllabic speech testing outcome with the cochlea implant was 65% at 65 dB. The residual hearing of 2 patients could be preserved after the surgical procedure. CONCLUSION: The combination of occlusion of the lateral semicircular canal, endolymphatic sac surgery, and CI is an efficient low traumatic treatment for patients with a single-sided MD and moderately severe to complete sensorineural hearing loss.

[Increase in the natural hearing threshold after treatment with cochlear implants]. / Anstieg der natürlichen Hörschwelle nach Cochleaimplantatversorgung.

More than 5% of the world's population suffers from disabling hearing loss. If the cause of hearing loss is unclear, it is referred to as idiopathic sudden sensorineural hearing loss (ISSNHL). After failure of standard treatment, the use of hearing aids or a cochlear implant is generally recommended. In this case, a 55-year-old patient was treated with cochlear implantation (CI) after ISSNHL and unsuccessful conservative therapy. Approximately 1 year after implantation and 7 years after the sudden hearing loss, subjective measurements revealed restoration of the hearing threshold.

Objective Assessment of Perilymphatic Fistula in Cases of Postoperative Vertigo after Cochlear Implantation by Cochlin Tomoprotein (CTP).

OBJECTIVE: Vertigo is a quite frequent complication after cochlear implantation. Perilymphatic fistula (PLF) is assumed to be one cause of this problem. Cochlin tomoprotein (CTP) is a newly introduced marker for PLF. The present aim was to evaluate the rate of positive CTP testing in cases of newly occurring vertigo after cochlear implantation. MATERIALS AND METHODS: Twelve patients with vertigo after cochlear implantation and a revisional electrode-sealing procedure underwent intraoperative rinsing of their middle ear. The sample was evaluated for CTP with monoclonal antibody testing. Sixteen controls from six CI patients were taken. RESULTS: 4 out of 12 (33%) cases showed positive CTP testing, indicating that a PLF could be evaluated. In all of the positive CTP cases, surgery decreased the vertigo symptoms. A relation between the subjective visual assessment of a fistula and a positive CTP value was not observed. Controls confirmed the value of the testing. DISCUSSION: CTP detection objectively shows that PLF can occur in patients with vertigo after CI.

Endolymphatic Hydrops Magnet Resonance Imaging in Ménière's Disease Patients after Cochlea Implantation.

INTRODUCTION: Cochlear implantation in patients with Ménière's disease (MD) is the treatment of choice in cases of functional deafness. Additional vertigo control is of central importance in this group of patients. Endolymphatic hydrops (ELH) is the pathophysiological correlate of MD and can be evaluated by magnet resonance imaging (MRI). Bilateral MD occurs in 10-33% and can be the reason for a postoperative persisting or newly occurring vertigo in this group. Recent developments in the field of implant magnets and experience in MRI sequences allow the diagnostic performance of MRI in cochlear implantees to be evaluated. The aim of the present study was to evaluate the possibility of MRI as a visual diagnostic tool for endolymphatic hydrops in cochlear implantees. MATERIAL AND METHODS: This was a retrospective study including three cochlear implantees (age: 61-76 years, one female, two male) suffering from MD who, postoperatively, had a recurrence of vertigo with Ménière's-like symptoms. An MRI was performed for the evaluation of ELH (ELH-MRI). MRI observation was performed by a 4 h iv. delayed Gad 3 D Flair sequence. RESULTS: In all cases, the ipsilateral implant magnet artifact covered the vestibulum, the semicircular canals and the cochlea. The contralateral vestibulum, the semicircular canal and the cochlea were fully observable, and a classification of the ELH-MRI could be performed. CONCLUSION: ELH-MRI scanning allows for the detection of contralateral labyrinthine endolymphatic hydrops and is a tool for the postoperative evaluation of vertigo in cochlear implantees.

Corrigendum: A new device for the removal of cochlear schwannoma: A temporal bone study.

[This corrects the article DOI: 10.3389/fsurg.2023.1077407.].

Prospective Evaluation of 3 T MRI Effect on Residual Hearing Function of Cochlea Implantees.

INTRODUCTION: The approval process for MRI safety of implants includes physical observations and an experimental evaluation in artificial settings to simulate the in vivo effect. This contains the observation of temperature changes and artificial current generation by the magnetic field. From these findings, the safety of an implant and its effect on the patient can be estimated. MRI safety is based on an in vivo evaluation of adverse events after the approval process, but an actual analysis of the effect on different tissues is not followed. The effect of MRI scanning in cochlea implantees on their residual hearing as the correlate of the hair cell function is so far unknown, therefore the aim of the present study was to observe the effect of 3 T MRI on the residual hearing of cochlea implantees. MATERIAL AND METHODS: In this prospective study, we performed a 3 T MRI T2 2D MS Drive sequence in eight cochlea-implanted ears. Before and after the MRI scan, a bone conduction pure tone audiogram (BC PTA) was performed. All cochlea implantees had a pre-scanning threshold of low frequency residual hearing between 20 dB and 65 dB. RESULTS: Low frequency mean residual hearing was not affected by the 3 T T2 2D MS Drive sequence. We observed a pre-scanning threshold at 250 Hz of 42.9 (SD 3.9) dB and for 500 Hz 57.1 (SD 6.4) dB. Post-scanning BC PTA was for 250 Hz 42.1 (SD 3.9) dB and for 500 Hz 57.1 (SD 5.7) dB. CONCLUSION: 3 T MRI scanning has no significant functional effect on the hair cells in cochlea implantees in low frequencies with a T2 2D MS Drive sequence.

Algorithm-Based Hearing and Speech Therapy Rehabilitation after Cochlear Implantation.

INTRODUCTION: Due to the changes in the indication range for cochlear implants and the demographic development towards an aging society, more and more people are in receipt of cochlear implants. An implantation requires a close-meshed audiological and logopedic aftercare. Hearing therapy rehabilitation currently requires great personnel effort and is time consuming. Hearing and speech therapy rehabilitation can be supported by digital hearing training programs. However, the apps currently on the market are to a limited degree personalized and structured. Increasing digitalization makes it possible, especially in times of pandemics, to decouple hearing therapy treatment from everyday clinical practice. MATERIAL AND METHODS: For this purpose, an app is in development that provides hearing therapy tailored to the patient. The individual factors that influence hearing outcome are considered. Using intelligent algorithms, the app determines the selection of exercises, the level of difficulty and the speed at which the difficulty is increased. RESULTS: The app works autonomously without being connected to local speech therapists. In addition, the app is able to analyze patient difficulties within the exercises and provides conclusions about the need for technical adjustments. CONCLUSIONS: The presented newly developed app represents a possibility to support, replace, expand and improve the classic outpatient hearing and speech therapy after CI implantation. The way the application works allows it to reach more people and provide a time- and cost-saving alternative to traditional therapy.

Viral and Clinical Oncology of Head and Neck Cancers.

PURPOSE OF REVIEW: This study assesses the current state of knowledge of head and neck squamous cell carcinomas (HNSCC), which are malignancies arising from the orifices and adjacent mucosae of the aerodigestive tracts. These contiguous anatomical areas are unique in that 2 important human oncoviruses, Epstein-Barr virus (EBV) and human papillomavirus (HPV), are causally associated with nasopharyngeal and oropharyngeal cancers, respectively. Mortality rates have remained high over the last 4 decades, and insufficient attention paid to the unique viral and clinical oncology of the different subgroups of HNSCC. RECENT FINDINGS: We have compared and contrasted the 2 double-stranded DNA viruses and the relevant molecular oncogenesis of their respective cancers against other head and neck cancers. Tobacco and alcohol ingestion are also reviewed, as regard the genetic progression/mutation accumulation model of carcinogenesis. The importance of stringent stratification when searching for cancer mutations and biomarkers is discussed. Evidence is presented for a dysplastic/pre-invasive cancerous phase for HPV+ oropharyngeal cancers, and analogous with other HPV+ cancers. This raises the possibility of strategies for cancer screening as early diagnosis will undoubtedly save lives. Staging and prognostication have changed to take into account the distinct biological and prognostic pathways for viral+ and viral- cancers. Diagnosis of pre-cancers and early stage cancers will reduce mortality rates. Multi-modal treatment options for HNSCC are reviewed, especially recent developments with immunotherapies and precision medicine strategies. Knowledge integration of the viral and molecular oncogenic pathways with sound planning, hypothesis generation, and clinical trials will continue to provide therapeutic options in the future.

Influence of Intracochlear Air on Experimental Pressure Measurements.

INTRODUCTION: Intracochlear pressure changes have been assumed to play a central role in hearing preservation during cochlear implantation. The pressure in different settings has been evaluated (temporal bones vs. cochlea models) and was found to have advantages and disadvantages. Experimentally, problems have been discussed to influence the results substantially. OBJECTIVE: The aim of the present study was to evaluate the effect of intracochlear air on the measurements in a cochlea model by using a fiber optic pressure sensor. MATERIALS AND METHODS: The experiments were performed in an uncurled 3D printed full cochlea model. A microfiber-optic pressure sensor was inserted, and intracochlear pressures were evaluated under 3 conditions: (1) cochlea model filled to 100% with fluid, (2) cochlea model filled with air, and (3) cochlea model filled to approximately 50% with fluid. Since the cochlea model is transparent, a direct visualization of air under the microscope was possible when performing the insertions. RESULTS: In the first condition, the mean intracochlear pressure at the end of the insertion was 0.044 psi (SD 0.012, 95% CI). In the second setting, the results were similar. In the last scenario, with 50% filling, the mean intracochlear pressure was statistically significantly different with a mean value of 0.074 psi (SD 0.013, 95% CI) (p < 0.0044, ANOVA). Besides this, in the last condition with 50% fluid, a plateau was formed when the fiber optic reached the air portion. CONCLUSION: The results obtained in a 3D printed full cochlea model show the importance of a direct evaluation of air inside the experimental setting. The exclusion of intracochlear air should be an important factor for the choice of the model for intracochlear pressure measurement (temporal bone vs. cochlea model).

Quality Control after Intracochlear Intralabyrinthine Schwannoma Resection and Cochlear Implantation.

BACKGROUND: The combination of intralabyrinthine schwannoma (ILS) removal and cochlear implantation is the standard of care after surgical resection for audiological rehabilitation. Intracochlear ILS is not only the most frequent tumor in this group of schwannomas, but it is also, to some degree, surgically the most challenging because of its position behind the modiolus. Recent developments in the knowledge of implant position, implant magnet choice, and magnetic resonance imaging (MRI) sequences make an MRI follow-up after surgical removal possible. Thus far, no results are known about the surgical success and residual rate of these kind of tumors. The aim of the present study was to perform an early MRI follow-up for the evaluation of residual or recurrent intracochlear ILS after surgical removal and cochlear implantation. METHODS: In a retrospective study, we evaluated seven patients after an intracochlear ILS removal and single-stage cochlear implantation with a mean period of 13.4 months post surgery with a 3T T1 GAD 2 mm sequence for a residual ILS. Patients were operated on using an individualized technique concept. RESULTS: In six out of seven cases, 3 T T1 GAD 2 mm MRI follow-up showed no residual or recurrent tumor. In one case, a T1 signal indicated a tumor of the upper inner auditory canal (IAC) at the MRI follow up. CONCLUSION: MRI follow-up as a quality control tool after ILS removal and cochlear implantation is highly important to exclude residual tumors. Long-term MRI evaluation results are needed and can be obtained under consideration of implant position, implant magnet, and MRI sequence choice. A preoperative MRI slice thickness less than 2 mm can be recommended to visualize possible modiolar and IAC expansion.

Nasopharyngeal Coil Dislocation of an Embolized Internal Carotid Artery Pseudoaneurysm.

OBJECTIVE: Severe epistaxis caused by ruptured intracranial pseudoaneurysms can be effectively treated by coil embolization. This is generally an efficient and safe procedure and provides sufficient protection recurrent epistaxis. However, complications such as aneurysm rupture, arterial dissection, bleeding, and emboli can occur. A dislocation of a nasopharyngeal coil is an extremely rare event. Patient. We present a case of a 61-year-old patient with a recurrent undifferentiated nasopharyngeal carcinoma (NPC) treated with severe epistaxis. Initially, epistaxis was successfully controlled by a nasal packing. Recurrent bleeding despite packing required a neuroradiological intervention. An intracranially ruptured pseudoaneurysm was detected by magnetic resonance imaging (MRI) and computed tomography (CT), originating from the internal carotid artery at the junction of the petrous part to the cavernous part. Coiling and endovascular plug embolization was performed for the treatment of aneurysm. Ten months later, the patient removed a foreign body out of his left nose. It was dislocated coil material due to radionecrosis. MRI confirmed sufficient embolization of the internal carotid artery. CONCLUSIONS: This case report highlights the possibility of a nasopharyngeal coil dislocation of an embolized internal carotid artery aneurysm emerging as a nasal foreign body.

Intraluminal Monitoring of Micro Vessels. A Surgical Feasibility Study.

Objective: Monitoring of vessel perfusion is of high clinical importance in vascular anastomosis of free flaps. Current sensor systems are based on different principles and show limitations in validity and accuracy. Fiber optic pressure sensors exhibit high accuracy and are small in size. The aim of the present study was to evaluate the surgical feasibility of intraluminal pressure (ILP) measurements with a fiber optic pressure sensor in an animal model. Methods: In a microsurgical setting we sedated 10 Wistar rats with weight adapted phenobarbital, xylazine, and fentanyl. We performed a surgical approach to A. carotis communis and V. jugularis and introduced a 600 µm fiber optic pressure sensor into the vessels followed by measuring the ILP. The sensor was stabilized by the surrounding tissue, and the vessels were closed. Results: In all cases, surgical placement was uneventful. Measurement of intra-venous and intra-arterial pressure was possible and stable over the whole measurement period of an hour. Conclusion: Fiber optic pressure measurement in microvessels is possible and surgically feasible. An application to monitor the perfusion of free flaps seems possible.