Intraoperative assessment of cochlear nerve functionality in various vestibular schwannoma scenarios: Lessons learned.

The use of cochlear implants (CIs) is on the rise for patients with vestibular schwannoma (VS). Besides CI following tumor resection, new scenarios such as implantation in observed and/or irradiated tumors are becoming increasingly common. A significant emerging trend is the need of intraoperative evaluation of the functionality of the cochlear nerve in order to decide if a CI would be placed. The purpose of this paper is to explore the experience of a tertiary center with the application of the Auditory Nerve Test System (ANTS) in various scenarios regarding VS patients. The results are compared to that of the studies that have previously used the ANTS in this condition. Patients with unilateral or bilateral VS (NF2) who were evaluated with the ANTS prior to considering CI in a tertiary center between 2021 and 2023 were analyzed. The presence of a robust wave V was chosen to define a positive electrical auditory brainstem response (EABR). Two patients underwent promontory stimulation (PromStim) EABR previous to ANTS evaluation. Seven patients, 2 NF-2 and 5 with sporadic VS were included. The initial scenario was simultaneous translabyrinthine (TL) tumor resection and CI in 3 cases while a CI placement without tumor resection was planned in 4 cases. The ANTS was positive in 4 cases, negative in 2 cases, and uncertain in one case. Two patients underwent simultaneous TL and CI, 1 patient simultaneous TL and auditory brainstem implant, 3 patients posterior tympanotomy with CI, and 1 patient had no implant placement. In the 5 patients undergoing CI, sound detection was present. There was a good correlation between the PromStim and ANTS EABR. The literature research yielded 35 patients with complete information about EABR response. There was one false negative and one false positive case; that is, the 28 implanted cases with a present wave V following tumor resection had some degree of auditory perception in all but one case. The ANTS is a useful intraoperative tool to asses CI candidacy in VS patients undergoing observation, irradiation or surgery. A positive strongly predicts at least sound detection with the CI.

Has Coranavirus Disease 2019 Changed the Incidence and Outcome of Bell's Palsy?

BACKGROUND: Objectives: (1) To determine whether the incidence of Bell's Palsy (BP) increased during the pandemic. (2) To investigate whether the outcomes of patients with BP and COVID-19 infection or vaccination differ from those in the pre-pandemic era. METHODS: Patients with BP were studied in 2 periods retrospectively (March 2021-March 2022 and August 2018-August 2019). A prospective study from March 2021 to March 2022 was also performed. Primary outcome was grade ≤Ⅱ in the House-Brackmann (HB) and/or >70 in the Sunnybrook facial grading system (SFGS) scales at the 12-week visit. Reverse transcriptase polymerase chain reaction (PCR) for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and enzyme-linked immunosorbent assay-based SARS-CoV-2 immuonoglobulin G (IgG) test (blood) were measured. RESULTS: About 162 and 196 patients with BP were identified between March 2021 and March 2022 and August 2018 and August 2019, respectively. Forty-seven patients (29%) entered the prospective study; 85% had HB grades I or II, while 92% had an SFGS score of 71-100 at the last visit. Only 3 patients (6.5%) had a positive PCR during the initial episode, whereas 35 patients (77%) had positive IgG SARS-CoV-2. There was no association between positive PCR and facial function outcomes. Of the 162 patients, 105 (67%) had received COVID-19 vaccine. In 23 of them (22%), the paralysis appeared within the first 30 days after a vaccine dose. CONCLUSION: Coronavirus disease 2019 did not increase the incidence of BP. A direct association between the coronavirus and BP outcome cannot be established. The considerable number of patients developing BP within the first month suggests a possible association between COVID-19 vaccines and BP.

Is Age a Limiting Factor for Audiological Results in Active Middle Ear Implants?

Active middle ear implants (AMEI) are implantable options for patients with sensorineural, conductive, or mixed hearing loss who are not good candidates for hearing aids. The aim of this study was to compare audiological, surgical, quality of life, and sound quality outcomes in adults <60 and ≥60 years receiving an AMEI. Twenty adult patients who underwent AMEI implantation were divided into two groups, <60 and ≥60 y. Preoperative tests included pure-tone average and speech discrimination score (SDS) at 65 dB for disyllabic words in quiet. Postoperative measures included AMEI-aided bone conduction threshold, free-field warble-tone threshold, and SDS at 65 dB for disyllabic words in quiet 12 months after the AMEI fitting. Subjective benefit was evaluated using the Nijmegen Cochlear Implant Questionnaire (NCIQ), Glasgow Benefit Inventory (GBI), and Hearing Implant Sound Quality Index (HISQUI19). Mean functional gain was 32 and 30 dB, and SDS at 65 dB improved from 19 to 95% and from 31 to 84% in the <60 and ≥60 y groups, respectively. All NCIQ domains improved following surgery, and all patients had a positive overall GBI score. The mean HISQUI19 score was 97 in both age groups. AMEIs are an effective hearing restoration method for older adults suffering from conductive or mixed hearing loss.

Correlación clínico-radiológica de las fracturas de hueso temporal / Clinical-radiological correlation in temporal bone fractures

Introducción: El diagnóstico de las fracturas del hueso temporal (FHT) se basa en la imagen radiológica. La clasificación más utilizada divide las fracturas en longitudinales, transversales y mixtas. En los últimos años han surgido otras clasificaciones con el objeto de predecir mejor las manifestaciones clínicas.ObjetivosRevisar las imágenes de tomografía computarizada (TC) del hueso temporal, definir su patrón radiológico según la clasificación tradicional y estudiar la concordancia interobservador de los hallazgos encontrados con los descritos en el informe radiológico. Analizar la asociación entre los tipos de fractura y los hallazgos clínicos. Estudiar el impacto de la neumatización mastoidea en las características de la fractura.Materiales y métodosEstudio retrospectivo de 110 FHT diagnosticadas mediante TC entre enero de 2016 y mayo 2019.ResultadosSe identificaron 52 fracturas transversales (47%), 34 longitudinales (30%) y 19 mixtas (17%) con buena concordancia interobservador (k = 0,637). Las fracturas longitudinales se asociaron con hipoacusia de transmisión (p < 0,001) y las transversales con hipoacusia neurosensorial (p = 0,005). El 8,2% de las fracturas presentaron afectación de cápsula ótica y se asociaron con hipoacusia neurosensorial (p < 0,001), parálisis facial (p = 0,019) y vértigo (p = 0,035). Las fracturas fueron más frecuentes en los casos de mayor neumatización, y la afectación de cápsula ótica en casos de muy buena neumatización (p = 0,024). (AU)

Introduction: The diagnosis of temporal bone fractures (TBF) is based on radiological imaging. The most widely used classification divides fractures into longitudinal, transverse, and mixed. In recent years, other classifications have emerged to better predict clinical manifestations.ObjectivesTo review computed tomography (CT) images of TBF, define their radiological pattern, and study the concordance of the observed findings with those described in the radiological report. To analyse the association between fracture types and clinical findings. To study the impact of mastoid pneumatization on fracture characteristics.MethodsRetrospective study of 110 TBF diagnosed with CT between January 2016 and May 2019.ResultsFifty-two transverse (47%), 34 longitudinal (30%), and 19 mixed fractures (17%) were identified with good interobserver agreement (k = .637). Longitudinal fractures were associated with conductive hearing loss (p < .001) and transverse fractures with sensorineural hearing loss (p = .005). Of the fractures, 8.2% showed involvement of the otic capsule, and were associated with sensorineural hearing loss (p < .001), facial paralysis (p = .019) and vertigo (p = .035). Fractures were more frequent in cases of greater pneumatization, and the involvement of the otic capsule in cases of very good pneumatization (p = .024). (AU)

Guía clínica sobre implantes de conducción de vía ósea / Clinical guideline on bone conduction implants

Introducción y objetivos: En la última década se han producido numerosos y relevantes avances en el tratamiento de la hipoacusia transmisiva y mixta que han desembocado en una ampliación de las indicaciones de los implantes de conducción de vía ósea y la aparición de nuevos dispositivos. La Comisión Científica de Audiología de la Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (SEORL-CCC), junto con las comisiones de Otología y Otoneurología, ha llevado a cabo una revisión del estado actual de los implantes de vía ósea con la finalidad de ofrecer a los especialistas de Otorrinolaringología, a los profesionales de la sanidad, a las autoridades sanitarias y a la sociedad en general una guía clínica sobre implantes de conducción de vía ósea. Métodos: Esta guía clínica sobre implantes de conducción ósea contiene información sobre los siguientes temas: 1) definición y descripción de los implantes auditivos de vía ósea; 2) indicaciones actuales y emergentes de los implantes de vía ósea; compatibilidad y resonancia magnética, y 3) requisitos organizativos para un programa de implantes de vía ósea. Resultado y conclusiones: La finalidad de esta guía es describir los diferentes sistemas de conducción ósea, sus particularidades e indicaciones, con el objeto de aportar unas coordenadas que ayuden a todos estos agentes en las tomas de decisiones que deban asumir en los diferentes ámbitos de responsabilidad en los que están enmarcados en sus áreas de trabajo

Introduction and goals: During the last decade there have been multiple and relevant advances in conduction and mixed hearing loss treatment. These advances and the appearance of new devices have extended the indications for bone-conduction implants. The Scientific Committee of Audiology of the Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello SEORL-CCC (Spanish Society of Otolaryngology and Head and Neck Surgery), together with the Otology and Otoneurology Committees, have undertaken a review of the current state of bone-conduction devices with updated information, to provide a clinical guideline on bone-conduction implants for otorhinolaryngology specialists, health professionals, health authorities and society in general. Methods: This clinical guideline on bone-conduction implants contains information on the following: 1) Definition and description of bone-conduction devices; 2) Current and upcoming indications for bone conduction devices: Magnetic resonance compatibility; 3) Organization requirements for a bone-conduction implant programme. Results and conclusions: The purpose of this guideline is to describe the different bone-conduction implants, their characteristics and their indications, and to provide coordinated instructions for all the above-mentioned agents for decision making within their specific work areas

Implantes activos de oído medio / Active middle ear implants

Los implantes activos de oído medio son prótesis implantadas quirúrgicamente, que estimulan la cadena osicular o los fluidos del oído interno a través de la ventana oval o redonda. Estos implantes pueden ser útiles para el tratamiento de determinados pacientes con pérdida auditiva neurosensorial, así como para pérdida auditiva conductiva o mixta. Esta guía clínica pretende resumir los conocimientos actuales sobre las características básicas y las indicaciones de los implantes de oído medio más utilizados, como Vibrant Soundbrige (Med-el, Innsbruck), Carina (Cochlear, Australia) y CodacsTM. (Cochlear, Australia)

Active middle ear implants are surgically implanted prosthesis, which intend to stimulate the ossicular chain or the inner ear fluids through the oval or round windows. These implants may be useful for the treatment of certain patients with sensorineural hearing loss as well as for conductive or mixed hearing loss. This clinical guide attempts to summarize the current knowledge concerning the basic characteristics and indications of the most commonly used middle ear implants, including Vibrant Soundbrige (Med-el, Innsbruck), Carina (Cochlear, Australia), and CodacsTM. (Cochlear, Australia)

Guía clínica sobre implantes cocleares / Guideline on cochlear implants

Introducción: En la última década son numerosos los hospitales que han iniciado su actividad en pacientes candidatos a un implante coclear (IC), y se han producido numerosos y relevantes avances para el tratamiento de la hipoacusia neurosensorial que han desembocado en una ampliación de las indicaciones de los IC. Objetivos: Ofrecer a los especialistas de otorrinolaringología, de otras especialidades médicas, autoridades sanitarias y a la sociedad en general una guía clínica sobre implantes cocleares. Métodos: Las comisiones científicas de otología, otoneurología y audiología de la Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (SEORL-CCC), de manera coordinada y consensuada, han llevado a cabo una revisión del estado actual de los IC basándose en las reglamentaciones existentes y en las publicaciones científicas que se referencian en la bibliografía del documento elaborado. Resultados: La guía clínica sobre implantes cocleares aporta información sobre: a) definición y descripción sobre IC; b) indicaciones de los IC; y c) requisitos organizativos para un programa de IC. Conclusiones: Se ha elaborado por un comité de expertos de la SEORL-CCC una Guía clínica sobre implantes cocleares que aporta coordenadas de actuación para todos aquellos agentes de la sanidad en la toma de decisiones en el ámbito de los IC como forma de tratamiento de la discapacidad auditiva

Introduction: In the last decade numerous hospitals have started to work with patients who are candidates for a cochlear implant (CI) and there have been numerous and relevant advances in the treatment of sensorineural hearing loss that extended the indications for cochlear implants. Objectives: To provide a guideline on cochlear implants to specialists in otorhinolaryngology, other medical specialities, health authorities and society in general. Methods: The Scientific Committees of Otology, Otoneurology and Audiology from the Spanish Society of Otolaryngology and Head and Neck Surgery (SEORL-CCC), in a coordinated and agreed way, performed a review of the current state of CI based on the existing regulations and in the scientific publications referenced in the bibliography of the document drafted. Results: The clinical guideline on cochlear implants provides information on: a) Definition and description of Cochlear Implant; b) Indications for cochlear implants; c) Organizational requirements for a cochlear implant programme. Conclusions: A clinical guideline on cochlear implants has been developed by a Committee of Experts of the SEORL-CCC, to help and guide all the health professionals involved in this field of CI in decision-making to treathearing impairment