Reply to Theodorou et al. Comment on "Umemoto et al. Management of Migraine-Associated Vestibulocochlear Disorders. Audiol. Res. 2023, 13, 528-545".

We thank the authors for their insightful and thoughtful commentary on our recent publication [...].

A Novel Technique of Reduction Meatoplasty for Correction of Very Large Meatus from a Previous Canal Wall-Down Mastoidectomy.

OBJECTIVE: To evaluate the efficacy of reduction meatoplasty, a novel technique aiming to improve the usage of molded hearing aids and ear plugs in patients undergoing mastoid obliteration of a previous canal wall-down (CWD) mastoidectomy, complicated with a very large meatus. PATIENTS: Twenty-six patients from a tertiary care neurotology clinic with a very large meatus from a previous CWD mastoidectomy, who were unable to use molded hearing aids or ear plugs for water protection. INTERVENTION: Reduction meatoplasty after mastoid obliteration (cartilage strips and bone pate) of the CWD mastoidectomy. The procedure involves removing a wedge of skin and underlying soft tissue superiorly in the meatus. MAIN OUTCOME MEASURES: Reduction in meatus size, enabling usage of hearing aids and ear plugs. RESULTS: Twenty-six patients underwent mastoid obliteration and reduction meatoplasty to reduce meatus size. Patients were followed up for an average of 22 months postoperation. After operation, the meatus size was significantly reduced in all patients, enabling usage of over-the-counter ear plugs. In addition, all six patients with hearing aids could use standard occlusive hearing aid domes without requiring molded hearing aids. No patients showed symptoms of chronic infection in the mastoid cavity during the follow-up period. CONCLUSIONS: Results of reduction meatoplasty showed significant improvements in functionality of the external auditory meatus, indicating that this technique is effective in reducing meatus size and improving the normal meatal anatomy after mastoid obliteration.

Management of Migraine-Associated Vestibulocochlear Disorders.

Migraine is a chronic neurological disorder that frequently coexists with different vestibular and cochlear symptoms (sudden hearing loss, tinnitus, otalgia, aural fullness, hyperacusis, dizziness, imbalance, and vertigo) and disorders (recurrent benign positional vertigo, persistent postural perceptual dizziness, mal de debarquement, and Menière's disease). Despite evidence of an epidemiological association and similar pathophysiology between migraine and these vestibulocochlear disorders, patients suffering from migraine-related symptoms are usually underdiagnosed and undertreated. Current migraine treatment options have shown success in treating vestibulocochlear symptoms. Lifestyle and dietary modifications (reducing stress, restful sleep, avoiding migraine dietary triggers, and avoiding starvation and dehydration) and supplements (vitamin B2 and magnesium) offer effective first-line treatments. Treatment with migraine prophylactic medications such as tricyclic antidepressants (e.g., nortriptyline), anticonvulsants (e.g., topiramate), and calcium channel blockers (e.g., verapamil) is implemented when lifestyle and dietary modifications are not sufficient in improving a patient's symptoms. We have included an algorithm that outlines a suggested approach for addressing these symptoms, taking into account our clinical observations. Greater recognition and understanding of migraine and its related vestibular and cochlear symptoms are needed to ensure the appropriate diagnosis and treatment of affected patients.