The Size of Internal Auditory Canal Diverticula Is Unrelated to Degree of Hearing Loss.

OBJECTIVES: To explore the relationship between hearing loss and the internal auditory canal (IAC) diverticula. To determine whether diverticula exist within or medial to the otic capsule and the prevalence in a control population. METHODS: Retrospective review of adult patients with radiologic evidence of an IAC diverticulum, no evidence of otosclerosis, and audiometric testing. Analyzed degree of hearing loss and width, length, height, and volume of diverticulum. Hounsfield unit (HU) measurements lateral and medial to the diverticulum. RESULTS: Pure tone average (PTA), air-bone gap, and WRS (word recognition score) did not correlate with length, width, height, and volume of the diverticula. In patients with a unilateral diverticulum, there was no difference in mean PTA or WRS when comparing the diverticulum and nondiverticulum sides. Mean HU lateral to the diverticulum (2104 HU) was found to be significantly higher than medial to the diverticulum (1818 HU). There is a 5.6% prevalence of IAC diverticula in patients who underwent high-resolution computed tomography (CT) scans for chronic sinusitis (control group). CONCLUSION: These data support the notion that hearing loss in this population is a product of sampling bias. The size of IAC diverticula does not correlate with the degree of hearing loss, and there is no statistically significant association between sensorineural hearing loss (SNHL) and the presence of an IAC diverticulum. IAC diverticula may exist medial to, rather than within, the otic capsule given the significant difference in mean HUs medial and lateral to the diverticula. LEVEL OF EVIDENCE: 4 Laryngoscope, 130:1011-1015, 2020.

Implementing Contrast Reaction Management Training for Residents Through High-Fidelity Simulation.

RATIONALE AND OBJECTIVES: Adverse reactions to intravenous contrast for radiologic examinations can result in significant patient morbidity and mortality. It is critical that radiologists be proficient at recognizing and treating reactions in a timely and appropriate manner. Therefore, we developed a hands-on simulation curriculum to improve residents' ability and comfort in recognizing and responding to contrast reactions. MATERIALS AND METHODS: Contrast reaction management simulations were performed in 2016 and 2017 with 25 and 26 resident participants, respectively. Participants completed pre- and postsimulation surveys both years to assess knowledge and comfort in managing contrast reactions. RESULTS: In 2016, 25 participants answered 12 questions assessing knowledge of contrast reaction management. Percentage of correct answers increased from pre- to postsurvey in 83% of questions (10/12). Participants indicated their comfort level in managing contrast reactions increased on all six questions from pre- to postsurvey. In 2017, 26 participants answered 14 questions assessing knowledge of contrast reaction management. Similarly, percentage of correct answers increased from pre- to postsurvey in 86% of questions (12/14). Participant comfort levels also increased on all six questions from pre- to postsurvey. Subgroup analysis performed on 19 participants who completed the curriculum both years demonstrated further improvement in knowledge and comfort after completing the second year, showing added benefit of repeated simulation. CONCLUSION: These results suggest that incorporating high-fidelity contrast reaction management simulation into resident education improves both residents' knowledge and comfort in managing reactions. We have therefore incorporated annual contrast reaction simulation as a standard component of our residency curriculum.

Outcomes of type II endoleaks after endovascular abdominal aortic aneurysm (AAA) repair: a single-center, retrospective study.

PURPOSE: This study aims to determine incidence and outcomes of type II endoleaks (T2E) after endovascular abdominal aortic aneurysm repair (EVAR). METHODS: A retrospective review of procedural angiograms, computed tomography angiography, and medical records of 202 patients who underwent EVAR with the Gore Excluder stent graft was performed to determine presence and outcomes of T2E. RESULTS: Median follow-up time for 163 patients meeting inclusion criteria [136 males (83%)] was 24.7 months (range=0.5-85.2 months). T2E occurred in 66/163 patients (40.5%). Aneurysm sac size was unchanged in 32/66 patients (48.5%), decreased in 22/66 (33.3%), and increased in 12/66 (18.2%). No aneurysm ruptures, conversion to open repair, or aneurysm-related deaths occurred. CONCLUSION: T2E are a common occurrence after EVAR, often with benign outcome. However, routine surveillance should be performed, particularly in patients with persistent endoleak or sac growth.