Twelve-Month Outcomes of Simultaneous Translabyrinthine Resection and Cochlear Implantation.

OBJECTIVE: Audiometric outcomes at 12 months following simultaneous translabyrinthine (TL) resection of vestibular schwannoma (VS) and cochlear implantation (CI). STUDY DESIGN: Prospective cohort study. SETTING: Tertiary referral center. METHODS: Adult patients undergoing TL resection of sporadic, unilateral VS ≤ 2 cm were prospectively enrolled. Preoperative testing included binaural AZBio in noise and quiet and unilateral Consonant-Nucleus-Consonant (CNC). Tinnitus Handicap Index (THI) and Speech, Spatial, and Qualities of Hearing (SSQ) questionnaires were also completed. Patients underwent TL resection with simultaneous CI. The preoperative test battery was repeated at 1, 3, 6, and 12 months after activation. Statistical analysis was performed to characterize short-term outcomes (preoperative to 3 months), longer-term outcomes (3-12 months), and overall changes during the preoperative to 12-month period. RESULTS: AZBio, CNC, and THI improved at 3 months with no significant changes thereafter and showed durable improvement at 12 months compared to preoperative testing. While SSQ did not improve at 12 months, a subset of patients showed either recovery or improvement of SSQ-spatial subscores. Patients with cerebellopontine angle tumors had poorer performance, although the impact of tumor size and location could not be deduced based on the small sample size. CONCLUSION: Patients undergoing simultaneous CI and TL resection of VS had durable improvements in speech perception and tinnitus severity 12 months following surgery. Subjective improvements in localization were not observed. Additional studies are needed to determine which VS patients are optimal candidates for CI.

Preoperative Evaluation of Otosclerosis: A National Survey of Otologists.

OBJECTIVE: Describe practice patterns in preoperative assessment for stapedectomy. STUDY DESIGN: Survey. SETTING: Tertiary referral center. SUBJECTS: Active members of the American Neurotologic Society and American Otologic Society. INTERVENTION: Survey. MAIN OUTCOME MEASURES: Percent of respondents performing preoperative testing with acoustic reflexes (ARs), electrocochleography, vestibular evoked myogenic potentials, and computed tomography (CT). Further analysis of those not ordering routine CT to determine whether imaging would be ordered for previous ear surgery, vestibular complaints, childhood hearing loss, AR inconsistent with otosclerosis, possible advanced otosclerosis, or atypical complaints, including autophony. Further subgroup analysis based on years in practice and practice setting (private versus academic). RESULTS: Most respondents (56.5%) had practiced more than 15 years and worked in academic settings (69.4%). Rates of routine use of preoperative AR, vestibular evoked myogenic potential, and electrocochleography were 80, 4.7, and 0%, respectively. There were no significant differences based on time in practice or practice settings. For CT, 35.3% reported routine use with a statistically significant difference between academic and private practice respondents (42.4% versus 19.2%, p = 0.040). For CT contingent on specific clinical factors, only AR inconsistent with otosclerosis showed a statistically significant difference between academic and private practice providers (85.3% versus 57.1%, p = 0.020). CONCLUSION: Most otologists routinely obtain AR before stapedectomy. Academic providers more commonly order CT routinely and for AR inconsistent with otosclerosis. Most respondents not ordering routine CT ordered imaging in specific clinical scenarios. Overall, there is a high level of consistency in preoperative testing regardless of practice setting or time in practice.

Patient Sentiments Influencing Management Strategy for Single-sided Deafness.

OBJECTIVE: Assess opinions that influence treatment choice for single sided deafness (SSD). STUDY DESIGN: Retrospective chart review. SETTING: Tertiary neurotology referral center. PATIENTS: Patients with SSD were recruited between December 2020 and February 2021. Included patients were self-selected by voluntary completion of the study questionnaire. MAIN OUTCOME MEASURES: Tinnitus Handicap Inventory (THI), Hearing Handicap Inventory for Adults (HHIA), and a questionnaire containing 25 areas of inquiry relevant to management strategy decision making. RESULTS: In comparison to the surgical management group, patients opting for nonsurgical amplification were significantly more concerned about device visibility (p = 0.005, 1.32 ±â€Š0.22 versus 2.67 ±â€Š0.37), undergoing surgery (p = 0.017, 1.64 ±â€Š0.23 versus 2.89 ±â€Š0.51), and the thought of harboring an implanted device (p = 0.003, 1.46 ±â€Š0.22 versus 2.82 ±â€Š0.35). Patients with a major hearing handicap (grade 2-4) placed significantly less emphasis on out-of-pocket costs (p = 0.049, 2.38 ±â€Š0.17 versus 2.94 ±â€Š0.21) and were less concerned about experiencing discomfort from the device (p = 0.033, 3.13 ±â€Š0.11 versus 3.56 ±â€Š0.16) or ease of device use (p = 0.040, 3.20 ±â€Š0.13 versus 3.63 ±â€Š0.13) when compared with the minor handicap group. CONCLUSIONS: Lingering concerns about device visibility, undergoing surgery, and harboring an implanted device underscore the need for thorough patient counseling during SSD device selection consultations. These efforts should aim to address esthetic and surgical risk concerns while emphasizing the potential for improvements in quality of life.

Absent pyramidal eminence and stapedial tendon associated with congenital stapes footplate fixation: Intraoperative and radiographic findings.

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.

Development of in-house genetic screening for pediatric hearing loss.

OBJECTIVES: To evaluate the efficiency of in-house genetic testing for mutations causing the most common types of inherited, nonsyndromic, sensorineural hearing loss (SNHL). METHODS: Retrospective cohort study of 200 patients at a single, pediatric medical center with suspected or confirmed hearing loss who underwent either send out vs in-house genetic testing for mutations in GJB2/GJB6, SLC26A4, and MTRNR1. Primary outcome measure was the difference in mean turnaround time for send-out vs in-house genetic testing. Additional outcomes included associations between audiometric findings and genetic test results. RESULTS: One hundred four send-out tests were performed between October 2010 and June 2014, and 100 in-house tests were performed between November 2014 and November 2016. The mean turnaround time for send-out testing was 53.7 days. The mean turnaround time for in-house testing was 18.9 days. This difference was statistically significant (P < .001). The largest component of turnaround time was the amount of time elapsed between receipt of specimen in the lab and final test result. These intervals were 47.0 and 18.3 days for send-out and in-house tests, respectively. Notably, the longest turnaround time for in-house testing (43 days) was less than the average turnaround time for send-out testing. In addition, we identified two simple audiometric parameters (ie, bilateral newborn hearing screen referral and audiometry showing symmetric SNHL) that may increase diagnostic yield of genetic testing. CONCLUSIONS: The development of in-house genetic testing programs for inherited SNHL can significantly reduce testing turnaround times. Newborn hearing screening and audiometry results can help clinicians identify patients most likely to benefit from genetic testing. LEVEL OF EVIDENCE: IV.

Outcomes Following Modified Tympanomastoidectomy With Soft-wall Reconstruction.

OBJECTIVE: To report outcomes following modified tympanomastoidectomy with soft-wall reconstruction (MTMSWR). STUDY DESIGN: Retrospective cohort. SETTING: Tertiary referral center. PATIENTS: Forty-seven patients (48 ears) with aggressive cholesteatoma undergoing MTMSWR. INTERVENTIONS: Canal wall down (CWD) tympanomastoidectomy with temporalis fascia reconstruction of the posterior external auditory canal (EAC). MAIN OUTCOME MEASURES: Cholesteatoma recidivism; hearing outcomes; degree of soft-wall retraction; time to epithelialization; otorrhea. RESULTS: All ears had some form of ossicular compromise. There were 41 ears with completed surveillance of which 39% demonstrated recidivism for cholesteatoma. Of these, 68.8% had a small cholesteatoma foci averaging 3.7 mm. Air pure-tone average remained stable or improved for 60.0% and declined ≤ 20 dB for 85.7%. Excluding ears unable to undergo ossicular chain reconstruction, final air-bone gap was ≤ 30 dB for 66.7%. Retraction of the reconstructed wall was absent-to-mild in 34.7% and moderate-to-full in 52.1%. Thirteen percent had soft-wall breakdown. Average time to full epithelialization of the wall was 58.5 days. CONCLUSIONS: MTMSWR is an option for restoring the posterior EAC wall following CWD surgery. Recidivism is comparable to canal wall up surgery, and hearing outcomes are generally better than CWD. Other advantages include rapid epithelialization, low rates of otorrhea, and restoration of a self-cleaning EAC regardless of retraction into the mastoid cavity.

Trends in Pediatric Otolaryngology Disparities Research.

Objectives To describe trends in disparities research within pediatric otolaryngology as evidenced by major meeting presentations and to compare observed trends with those in the realm of patient safety and quality improvement (PSQI). Study Design Retrospective review of presentations at national otolaryngology meetings. Setting Online review of meeting programs. Subjects and Methods Meeting programs from the American Society of Pediatric Otolaryngology, Triological Society, American Academy of Otolaryngology-Head and Neck Surgery Foundation, and Society for Ear, Nose and Throat Advances in Children from 2003 to 2016 were manually searched for pediatric oral and poster presentations addressing disparities and socioeconomic determinants of health, as well as PSQI. Presentation frequency was compared between categories and within each category over time. Results Of 11,311 total presentations, 3078 were related to the pediatric population, and 1945 (63.2%) of those were oral presentations. Disparities-related presentations increased from 0 in 2003 to 17 in 2016. From 2003 to 2009, 9 of 656 (1.4%) presentations involved disparities, as opposed to 70 of 2422 (2.9%) from 2010 to 2016 ( P = .03). The proportion of presentations regarding PSQI also increased: from 42 of 656 (6.4%) in 2003-2009 to 221 of 2422 (9.1%) in 2010-2016 ( P = .01). PSQI presentations remain more common than disparities presentations (9.1% vs 2.9%, P < .001). Conclusion Health care disparities are increasingly addressed in pediatric otolaryngology meeting presentations. Compared with the well-established realm of PSQI, disparities research remains nascent but is gaining attention. Health care reform and quality improvement efforts should recognize the role of socioeconomic factors and include strategies for addressing disparities.