Revision stapes surgery for lysis of the long process of the incus: comparing hydroxyapatite bone cement versus malleovestibulopexy and total ossicular replacement prosthesis.

The objective of the study was to report audiological results in revision stapes surgery, comparing hydroxyapatite (HAP) bone cement, malleovestibular (MV) prosthesis, and total ossicular replacement prosthesis (TORP). The study is a retrospective case review conducted in a tertiary referral center. Patients treated for revision stapes surgery from 2010 to 2014, where a lysis of the long process of the incus (LPI) was observed with the use of HAP bone cement, MV prosthesis, or a TORP were included in the study. The main outcomes measured were pre- and postoperative bone conduction (BC) and air conduction (AC) pure-tone averages (PTA) (0.5, 1, 2, 3 kHz), including high frequencies BC (HFBC) (1, 2, 3, 4 kHz) and air-bone gap (ABG). 107 revision stapes surgery were performed in 96 ears. Main cause of failure was LPI lysis in 38 cases (39.6 %). 31 patients were analyzed: HAP bone cement was used in 11 patients (Group I), MV prosthesis in ten patients (Group II), and TORP in ten patients (Group III). The mean post-operative ABG was 10.7 dB (±7.4) (p = 0.003), 10.7 dB (±8.8) (p = 0.001), and 16.9 dB (±9.8) (p = 0.001), respectively. There were no significant differences between groups. In Group I, the mean change in HFBC revealed an improvement of 5.6 dB (±7.9) (p = 0.03), while in Group III there was a significant deterioration of the thresholds of 5.8 dB (±7.6) (p = 0.04). There were no cases of post-operative anacusis. In revision stapes surgery when LPI is eroded, we recommend to perform a cement ossiculoplasty for stabilizing a standard Teflon piston when LPI is still usable, the LPI lengthening with cement being not recommended. When LPI is too eroded, we prefer performing a malleovestibulopexy, and reserve TORP for cases with a bad anatomical presentation.

Effect of corticosteroids on facial function after cerebellopontine angle tumor removal: a double-blind study versus placebo.

The aim of this study was to assess the effect of corticosteroids administered intra- and postoperatively on the occurrence of facial palsy after a cerebellopontine angle (CPA) tumor resection, and to investigate pre- and intraoperative prognostic factors. A multicenter, prospective, randomized, double-blind and versus-placebo study was conducted between 2006 and 2010. Three hundred and ten patients operated on for a CPA tumor (96% vestibular schwannomas, 4% miscellaneous) were included by five participating centers. The population was stratified into patients with small (≤15 mm CPA on axial MRI views) and large tumors. In each group, patients were randomized to receive corticosteroid (1 mg/kg/day i.v. methylprednisolone intraoperatively and at postoperative days 1-5) or placebo. Steroids did not affect the facial function at postoperative days 1, 8 and 30 in patients with small or large tumors as evaluated by House and Brackmann grading.

Experience of multidisciplinary team meetings in vestibular schwannoma: a preliminary report.

To assess the contribution of multidisciplinary team meetings (MTM) on vestibular schwannoma management as well as to (1) compare professional compliance to national guidelines and (2) study the percentage of loss to follow-up in cases of conservative management by radiologic observation. A retrospective descriptive study of MTMs held between January 2011 and May 2013 in a tertiary referral center. Patients were classified in three groups according to the MTM decision (observation, surgery or radiotherapy). A total of 363 cases were discussed during the study period (29 months). One hundred and ninety-four decisions (53.4%) were for conservative management with radiologic observation, 130 (35.8%) for surgery, and 39 (10.7%) for radiation therapy. The sex ratio was 0.94, and the patients had a median age of 59 years (range 18-86 years). Most of the vestibular schwannomas (74.2%) were small (stages I and II). Global concordance between the MTM decision and International Radiosurgery Association guidelines was 88.7%. Twenty-three percent of the 104 files that were discussed in MTMs between January 2011 and July 2012, for which conservative management was decided, were lost to follow-up by 18 months. Management of vestibular schwannoma remains controversial, but it usually depends on the evolutive status. MTMs improve practice and facilitate the creation and maintenance of local registries. Future studies in MTMs are warranted to evaluate the benefit and evaluated if MTM could optimize long-term follow-up, limiting loss to follow-up in the observation of vestibular schwannomas that may be evolutive.

Hearing preservation in retrosigmoid approach of small vestibular schwannomas: prognostic value of the degree of internal auditory canal filling.

OBJECTIVES: To assess the contribution of preoperative radiologic appearance of vestibular schwannoma (VS) on the magnetic resonance imaging in constructive interference in steady-state sequences and demonstrate if the degree of the internal auditory canal (IAC) filling is correlated with hearing and facial preservation. PATIENTS: A group of 278 patients who underwent VS surgery in a tertiary referral center. INTERVENTION: Retrosigmoid approach surgery. MAIN OUTCOME MEASURES: Patients were classified in 4 groups according to the percentage of IAC filling on the preoperative magnetic resonance imaging as Group IAC 1(IAC empty or filled <25% and with free fundus), Group IAC 2 (IAC filled from 25% to 50% with free fundus), Group IAC 3 (IAC filled from 50% to 75% with free fundus), and Group IAC 4 (complete filling of the IAC without fundus obliteration). RESULTS: A good correlation was observed between the IAC classification and the rate of hearing and facial preservation. The global rate of postoperative facial palsy was 10.4%. The global rate of hearing preservation in 213 patients with preoperative hearing class A and B was 40.8%. Regression analysis showed that the degree of lateral extension of the VS in the IAC was a strong predictor of hearing preservation ( p < 0.04). CONCLUSION: The retrosigmoid approach yields good facial outcomes in selected patients with possible hearing preservation. In case of patient with small tumor and IAC empty or filled less than 75% and with free fundus, surgery is the treatment of choice for patients with serviceable hearing and the desire to retain it.

Hearing rehabilitation in congenital aural atresia using the bone-anchored hearing aid: audiological and satisfaction results.

CONCLUSION: The BAHA (bone-anchored hearing aid) remains the most reliable method of auditory rehabilitation for patients with congenital aural atresia and improves hearing outcome and quality of life in these patients who are otherwise unable to benefit from traditional hearing aids. New techniques are being developed, such as fully implantable hearing devices, and will have to prove their efficacy and safety in this indication. OBJECTIVE: To evaluate the audiological results and patient satisfaction after rehabilitation of congenital aural atresia using the BAHA. METHODS: Sixteen patients suffering from bilateral congenital aural atresia were implanted with unilateral BAHA. Preoperative air- and bone-conduction thresholds and air-bone gap (ABG), preoperative sound reception threshold (SRT), postoperative aided thresholds, implantation complications, patient satisfaction, and the APHAB questionnaire were collected. RESULTS: After a mean follow-up period of 6.5 years, 15 patients were still using their device. Each patient had an average improvement of 33 ± 7 dB. Closure of the ABG within 15 dB of the preoperative bone-conduction thresholds occurred in 10 patients. Adverse skin reactions appeared in 50% of patients over 6.5 years of follow-up. Eleven of the 12 patients used their BAHA for more than 8 h per day.

Perioperative complications after translabyrinthine removal of large or giant vestibular schwannoma: Outcomes for 123 patients.

CONCLUSION: Large vestibular schwannomas are benign but dangerous tumors. The translabyrinthine approach allows the surgeon to limit vital and functional complications due to the disease itself or to its surgical removal. OBJECTIVE: Morbi-mortality study focused on large vestibular schwannoma surgically treated by translabyrinthine removal. METHODS: This was a retrospective review of prospectively collected data in a series of 123 patients who underwent translabyrinthine removal of a large vestibular schwannoma (>4 cm in the cerebellopontine angle, stage IV). All surgical and medical complications and facial function were reviewed, with a 1-year follow-up. RESULTS: Mortality during the first year was 0.8% (one case of infarct of the anterior inferior cerebellar artery, fatal after 8 months). In all, 4.9% of patients underwent a second surgery (for delayed hemorrhage or cerebrospinal fluid leak) during the first months after removal of a large vestibular schwannoma; 3.2% of patients experienced definitive neurologic complications (one death, one cerebellar disturbance, and two cases of 10th cranial nerve palsy).

Otologics middle ear transducer with contralateral conventional hearing aid in severe sensorineural hearing loss: evolution during the first 24 months.

OBJECTIVES: To report the audiometric outcomes of patients with severe sensorineural hearing loss and who have been fitted with a Middle Ear Transducer (MET) on one side and fitted with an optimized conventional hearing aid on the other side. STUDY DESIGN: The MET fitting results were measured and compared with contralateral conventional hearing aids in a prospective study. SETTING: Tertiary referral center. PATIENTS: Seven patients (ages, 53-77 yr) with severe sensorineural hearing loss (pure-tone average, 71-90 dB HL) were implanted between December 2004 and March 2006. METHOD: Audiometric testing was performed the day of activation (2 mo postoperative) and after 8 days and 1, 3, 6, 9, 12, and 24 months. For each follow-up, MET and conventional hearing aid were optimized according to the patient's hearing loss. RESULTS: Mean functional gains were 29 dB for conventional hearing aid and 35 dB the first day of the study with the MET and 39 dB after 6 months. DISCUSSION: The performance of the MET and the absence of occlusion of the external auditory canal could explain the improved benefit. For maximum gain, the MET requires a regular follow-up during the first 6 months. CONCLUSION: MET seems to be a suitable and successful treatment option resulting in significant improvement in speech comprehension, especially after 6 months, in patients with severe sensorineural hearing loss. During the 24-month follow-up of this study, the MET has been a safe and effective treatment for severe hearing loss.

Characteristics of 629 vestibular schwannomas according to preoperative caloric responses.

OBJECTIVES: To assess the contribution of preoperative caloric responses in patients with vestibular schwannoma on the following: preoperative parameters and postoperative results (facial function and hearing preservation). STUDY DESIGN: Retrospective review of prospectively collected data. SETTING: Tertiary referral center. PATIENTS: A group of 629 patients who underwent vestibular schwannoma surgery. MAIN OUTCOME MEASURES: Caloric responses are quantified in terms of slow-phase nystagmus velocities generated during warm and cool irrigations of each ear, with asymmetry between the two horizontal semicircular canals was quantified by the Jongkees formula. When unilateral weakness (UW) was less than 20%, caloric response was regarded as normal (group N). When UW was greater than 70%, caloric response was classified as severe caloric weakness (group S), and when the UW was comprised between 70 and 20%, caloric response was classified as moderate (group M) caloric weakness (CW). RESULTS: 47.8% of the studied patients were included in group S, 38.2% in group M, and 14% in group N. Preoperative mean hearing loss was higher in group S compared with that in groups M and N. The auditory brainstem response threshold was higher in group S compared with that in group N and also higher in group M compared with that in group N. A good correlation was observed between CW and tumor size. Postoperative facial palsy was more frequent in group S compared with groups N and M. Postoperative hearing preservation was more frequently observed in group N compared with groups S and M. CONCLUSION: Our results suggest that caloric responses are well correlated with the studied preoperative and intraoperative factors and provide predictive factors with regard to postoperative facial palsy and hearing outcome.

European results with totally implantable carina placed on the round window: 2-year follow-up.

OBJECTIVES: First, to assess for the performance of the Carina placed on the round window at various European centers; second, to study the follow-up after 2 years and discuss limitations and technical issues; and finally, to further develop our understanding of the principles of acoustic transfer through the round window. MATERIALS AND METHODS: Eleven patients were included in this retrospective study (7 women and 4 men) from 7 European tertiary referral hospitals (4 centers in France, 2 in Belgium, 1 in Spain). The mean age was 50.8 years (35-71 yr). All patients have multiple previous surgeries (>3 surgical procedures) for otosclerosis (3 patients) or chronic otitis media (8 patients), and in all cases, the stapes was not accessible due to obliteration by sclerotic tissue. Preoperative and postoperative air conduction, bone conduction, as well as aided and unaided thresholds and speech scores were measured. RESULTS: No significant differences were observed between preoperative and postoperative air-conduction and bone-conduction pure-tone averages. The average free field functional gain obtained with the implant ranged from 22 to 42 dB at each individual frequency, with a mean of 29 +/- 5 dB across all audiometric frequencies. Word recognition scores demonstrated significant differences between unaided and implant-aided conditions. Complications included 2 cases of postoperative infection (including 1 anacusis) that required explantation, and 1 case reduced initial benefit, followed by a nonfunctioning device. In 10 patients, postoperative hearing was unchanged. The 8 other patients are using their implant daily. CONCLUSION: These results show that this option is valid for patients with a fixed footplate and unsuccessful previous surgeries or patients who cannot benefit from a stapedotomy for anatomic reasons. In some cases, access to the round window membrane could represent a limitation. However, these promising initial results establish the need for further works with regard to 3 issues: 1) clinical data studies are needed, including a greater number of patients to confirm these preliminary results; 2) a long-term follow-up must be performed to detect any possible cochlear adverse effects, in particular, on the basilar membrane; 3) the effect of fascia interposition and tip size has to be evaluated in experimental studies.

Fully implantable hearing device with transducer on the round window as a treatment of mixed hearing loss.

OBJECTIVE: To demonstrate the safety and efficacy of the Otologics Carina Middle Ear Transducer for treatment of mixed hearing loss through a case report. METHODS: A Carina fully implantable device with the MET transducer for conductive applications was implanted in a 48-year-old woman suffering from right mixed hearing loss (mean PTA loss: 80 dB). A facial recess approach was used to access the middle ear. Sclerotic tissue obliterated the stapes footplate so the approach selected was to place the transducer directly on the round window. The mounting bracket was placed on the mastoid and the prosthesis was advanced toward the round window until the Otologics surgical software indicated contact. Effective stimulation of the cochlea was confirmed intraoperatively by ABR monitoring. RESULTS: Postoperative unaided PTA thresholds were unchanged after surgery. When the implant was activated, the mean PTA functional gain was 39 dB. DISCUSSION-CONCLUSION: The capability of the Carina MET Ossicular stimulator to provide appropriate gain relative to the degree of hearing loss indicates that the device offers a viable treatment option for mixed hearing loss. However, these promising initial results establish the need for future work on two fronts: (1) further studies are needed including a greater number of patients to confirm these preliminary results; (2) a long term follow-up must be carried out to detect any possible cochlear adverse effects on the cochlea, in particular on the basilar membrane.

Hearing preservation after translabyrinthine approach performed to remove a large vestibular schwannoma.

We report the case of a 27-year-old woman from whom a left vestibular schwannoma (grade IV) was removed by a translabyrinthine approach. The initial period was uneventful except for a few days of vertigo. This patient had no facial paresis (House-Brackman grade I). She was seen 1, 3, 6 and 12 months after operation and reported a sensation of hearing in the left ear. The audiological studies showed a left medium hearing loss. At the 1-year follow-up visit, her hearing status was unchanged. A hearing aid was fitted and functioned satisfactory. At the 5-year follow-up visit, audiometry studies were unchanged. Our case demonstrated that some hearing preservation could be obtained even if the vestibular schwannoma was large and excised by a translabyrinthine approach. Hearing with the help of a good hearing aid allowed a satisfactory function in this case. We believe that it is possible to preserve some hearing after translabyrinthine approach even if no care was taken to preserve the membraneous labyrinth and the loss of endolymph and even if the vestibular schwannoma was large. However, further experimental studies are needed to determine and understand the mechanisms of hearing preservation in this case.

Benefit of the Vibrant Soundbridge device in patients implanted for 5 to 8 years.

OBJECTIVES: To assess audiological performance, satisfaction rate, and side effects of 100 patients who have been using the middle ear implant Vibrant Soundbridge (VSB) for 5 to 8 yr when compared with data collected from 3 to 18 mo postsurgery. DESIGN: Audiological testing and subjective evaluation using self-assessment scales were performed in 77 out of the 100 patients using the VSB for 5 to 8 years. The results were compared to data collected 3 months (audiological testing) and 18 months (self-assessment scales) after surgery. Twenty-three patients have not been evaluated for different reported reasons. RESULTS: Pure-tone hearing thresholds decreased similarly in both implanted and contralateral ears. The satisfaction ratings and the functional gain provided by the VSB remained stable. Speech comprehension in quiet conditions without the VSB decreased from 56 to 37% in 5 to 8 yr, but an 81% score was achieved with the VSB. CONCLUSIONS: This study demonstrates that the performance of the VSB does not deteriorate for more than 5 yr, without adverse effect. These results confirm the safety and the effectiveness of the VSB with a long-term follow-up.

[Meningiomas of the posterior petrous bone: diagnostic and therapeutic aspects]. / Méningiomes de la face postérieure du rocher: aspects diagnostiques et therapeutiques.

OBJECTIVE: To compare the clinical and paraclinical picture and the postoperative results of meningiomas of the posterior petrous bone and to compare them with those of vestibular schwannomas (VSs) operated on by the same surgical team. MATERIAL AND METHOD: A retrospective study of 27 patients (23 females) operated on for meningioma of the posterior petrous bone between 1994 and 2004. These were compared with 424 patients with VS operated on between October 1994 and January 2001. All patients had a full audiovestibular workup before and after surgery. Tumours were classified according to the Desgeorges classification for meningiomas and Koss for the VS. RESULTS-DISCUSSION: For smaller tumours, facial function is better for the VS, whereas other cranial nerves are more frequently affected in the meningiomas. For larger tumours, facial function results are better for meningiomas, but other cranial nerve complications are more frequent, with a 33.3% cranial nerve V complication rate and a mortality rate of 6.6%. CONCLUSION: Meningiomas of the posterior temporal bone may present clinically and radiologically like a VS, especially for intracanalar tumour and stage IV tumours. For smaller meningiomas, hearing preservation is similar to VS and could be proposed even for stage III meningiomas. On the other hand, trigeminal nerve, facial nerve, and other cranial nerve complications are more common after excision of stage I and II meningiomas.

A survey of satisfaction and use among patients fitted with a BAHA.

We compared the indices of satisfaction and use among patients wearing an osseo-integrated prosthesis BAHA (bone anchored hearing aid) according to the indications: conductive or mixed hearing loss (CHL) and patients with single side deafness (SSD). The study was carried out among patients wearing a BAHA fitted in one of three French departments between November 2001 and November 2005. Each patient received a postal questionnaire relating to the ease of use and the daily utilization period of the prosthesis, as well as a satisfaction rating (from 1 to 10) evaluating improvement in quality of life, overall satisfaction, improvement in sound localization and satisfaction from the aesthetic point of view. In total, 170 out of 231 patients responded to the questionnaire (response rate of 73.5%). The average age at the time of fitting of the BAHA was 56 years (18-79 years). The SSD group was composed of 118 patients (69.4%): 92 following surgery for vestibular schwannoma, 2 following surgery for meningioma and 24 with "other" causes (e.g. idiopathic sudden deafness, sensori neural hearing loss complicating surgery of the middle ear). The CHL group was composed of 52 patients (30.5%): 44 patients with a chronic otitis and 8 with a malformation of the middle ear. The average duration of use of the prosthesis was 22 months (3-72 months). The average utilization period was higher than 8 h per day in 48.5% of cases. There was a significant difference between the two groups concerning the quality of life (p < 0.0001), general satisfaction (p < 0.0001) and sound localization (p < 0.01). There was no significant difference concerning aesthetics. Among the patients of the CHL group, the levels of satisfaction and quality of life are comparable with recent data in the literature with scores of good or very good. The BAHA thus remains one of the methods of choice for hearing rehabilitation in this group of patients. Among the patients of the SSD group, the levels of satisfaction and quality of life are significantly poorer than in the CHL group, but remain generally good with the exception of sound localization. The treatment of SSD patients with a BAHA is interesting. A study comparing the BAHA with the WIFI CROS system is justified in order to ascertain the respective advantages of these two treatment options.

Fully implantable hearing device as a new treatment of conductive hearing loss in Franceschetti syndrome.

The objective is to investigate a new therapeutic option for treatment of conductive hearing loss in children with Franceschetti syndrome. A Carina fully implantable device with the MET V transducer for conductive applications was implanted in a 14-year-old male suffering from bilateral conductive hearing loss (mean PTA loss: 70 dB on the right ear and 64 dB on the left ear) secondary to Franceschetti (a.k.a Treacher Collins) syndrome with bilateral agenesis of external ear canal and ossicular malformation. Postoperative unaided PTA was unchanged by the surgical procedure. When the implant was activated, mean PTA was 29 dB improved on the implanted ear. The capacity of the Carina MET ossicular stimulator to provide appropriate gain relative to the degree of hearing loss indicates that the device may be a viable treatment for children with agenesis of external auditory canal and severe malformation of the middle ear. However, these initial results need to be furthered by: (1) additional studies including a greater number of patients to confirm these preliminary results and (2) a long-term follow-up must be carried out to detect possible long-term cochlear adverse effects, in particular on the basilar membrane.

Bone-anchored hearing aid in unilateral inner ear deafness: electrophysiological results in patients following vestibular schwannoma removal.

CONCLUSIONS: The results show that the healthy cochlea perceives one auditory stimulus from two auditory signals: the first through normal air conduction and the second provided by the bone-anchored hearing aid (BAHA). This artificial acoustic difference could partly explain 'pseudo' binaural hearing. Functional cerebral imaging using the same experimental procedure is now necessary. OBJECTIVES: The aim of this study was to evaluate electrophysiological phenomena induced by BAHA on brainstem and long-latency auditory evoked potentials (AEPs) to understand how patients recover a 'pseudo' binaural sensation with only one functional cochlea. PATIENTS AND METHODS: This prospective study included 10 patients operated via the translabyrinthine approach and who received implants on the deaf side. Electrophysiological recordings were performed at least 2 months after BAHA use. Brainstem and long-latency (N1, P2, N2, P300) AEPs were studied in free field according to four conditions: 1, without BAHA; 2, with BAHA; 3, with BAHA and normal ear occluded; 4, without BAHA and normal ear occluded. RESULTS: For brainstem AEPs, we found significantly longer latencies of waves III and V in condition 3 compared with condition 1. For long-latency AEPs, comparison between conditions showed no significant differences.

Are stage IV vestibular schwannomas preoperatively different from other stages?

OBJECTIVE: The aim of this study was to focus on the clinical and paraclinical symptoms of patients suffering from Stage IV vestibular schwannomas (VSs). PATIENTS: In this prospective study, we included 734 patients who have VS and candidates for operation. MAIN OUTCOME MEASURES: Patients were classified as having Stage I, II, III, or IV tumors according to Tos criteria as evaluated by magnetic resonance imaging. PREOPERATIVE CLINICAL EVALUATION: We recorded the occurrence of complaints (%) and duration (yr) of hearing loss, tinnitus, and balance disorder. Preoperative paraclinical evaluation included pure-tone (PTA) and speech audiometry, auditory brainstem response (ABR) patterns, and vestibular deficit at videonystamography (VNG). Continuous variables were compared between Stage IV and other stages using analysis of variance. Qualitative variables expressed as a percentage of presence were compared between Stage IV and other stages using percentage comparison. RESULTS: Quantitative Parameters. Patients with Stage IV VS were significantly younger as compared with patients with other stages. Stage IV hearing loss was greater compared with other stages at 250 and 500 Hz but smaller at 2,000 and 8,000 Hz. We found no difference in the loss of PTA between Stage IV and the other stages. Speech discriminancy score was smaller in Stage IV. The durations of hearing loss, tinnitus, and balance disorders were similar whatever the tumor stage. Auditory brainstem response patterns showed no difference in Wave III latency between Stage IV VS and other stages, whereas Wave V latency and V-I interval were higher in Stage IV. Both ABR threshold and VNG caloric deficit were higher in Stage IV VS compared with other stages. Qualitative Parameters. The percentage of patients with Stage IV was lower than that with Stages II and III. The percentage of men and women was similar in all stages. The occurrence of hearing loss was similar in all stages, whereas that of tinnitus was lower in Stage IV compared with Stages I and II. In contrast, the occurrence of balance disorder was higher in Stage IV compared with all other stages. CONCLUSION: In clinical and paraclinical manifestation, Stage IV VS is different from the other stages. The PTA differences may be attributed to the younger age. Occurrence of clinical symptoms, ABR, and VNG pattern can be explained by the fact that Stage IV develops rapidly in the vestibular, rather than the cochlear nerve and by the fact that larger tumors can be cerebellar compression. This has been confirmed by the higher occurrence of balance disorders in Stage IV and the lower occurrence of tinnitus with similar hearing loss in all stages.

Intralabyrinthine schwannomas: symptoms and managements.

OBJECTIVE: To describe the characteristic presentations, radiologic findings and managements of the intralabyrinthine schwannomas. METHOD: Retrospective review of patient records, their managements, and review of the literature. RESULT: Four patients with a variety of otologic symptoms including hearing loss, vertigo, and tinnitus were found to have a schwannomas involving the labyrinth. In all cases, the inner ear lesions were preoperatively identified on magnetic resonance imaging, and the surgical removals were performed in all patients without serviceable hearing. The patients experienced improvement in their vertigo and tinnitus after surgery. Two patients were implanted the Bone-Anchored Hearing Aid (BAHA) to reconstruct the pseudo-stereophonic hearing. CONCLUSION: Intralabyrinthine schwannomas are the rare tumours in the otology. The tumour can be removed by surgical approach, but we do not propose surgical excision for the patients with serviceable hearing. BAHA can give patients a post-operative monaural pseudo-stereophonic hearing.

Value of temporal bone density measurements in otosclerosis patients with normal-appearing computed tomographic scan.

OBJECTIVES: Previous studies demonstrated that otosclerosis diagnosis benefits from temporal bone density measurements. We sought to assess bone density measurements of the fissula ante fenestram (FAF) in normal patients, in patients with otosclerosis, and in patients with cholesteatoma. We discuss the value of temporal bone density measurements in patients with otosclerosis who have a normal-appearing computed tomographic (CT) scan. METHODS: This was a prospective case-control study in which 219 temporal bones (123 adults, 18 to 84 years of age) were included between November 1, 2002, and April 30, 2004. All patients underwent a CT scan of the temporal bones. Axial views were obtained with density measurement of the FAF. RESULTS: The FAF density was significantly different (p < .0001) in the otosclerosis group (n = 119) compared to the control group (n = 100). There was no significant difference between the otosclerosis group with a normal-appearing CT scan and the control group (p = .64). CONCLUSIONS: From our results, it may be suggested that 1) temporal bone density measurements seem not to be strictly comparable between CT scan devices; and 2) temporal bone density measurements of the FAF did not allow the diagnosis of otosclerosis when the CT scan appeared normal.