Managing cholesteatomas with labyrinthine fistula.

Introduction: A retrospective study (2011 to 2018) was conducted to evaluate the management of cholesteatomas with labyrinthine fistulae (LFs), clinical characteristics and postoperative hearing outcomes in a hospital. Methods: Demographic data of patients with primary middle ear mastoidectomies for cholesteatoma were extracted. Preoperative high-resolution computed tomography (HRCT) temporal bone and intraoperative findings, and hearing levels preoperatively and postoperatively were evaluated. Results: Of the middle ear cholesteatomas, 15.6% (n = 14) of ears were complicated by LF. HRCT scans showed 92.9% sensitivity and 94.7% specificity in the identification of LFs. Intraoperative findings of LFs include stapes erosion (78.6%), malleus erosion (78.6%), incus erosion (92.9%), dehiscence of tegmen tympani (28.6%) and tympanic facial canal (64.3%). Compared to the non-LF group, the LF group showed significantly higher incidence of stapes erosion (P < 0.001), tegmen tympani dehiscence (P = 0.016) and semicircular canal dehiscence (P < 0.001). Matrix was removed completely in 85.7% (n = 12) and was left behind in 14.3% (n = 2) of ears. Also, 21.5% (n = 3) had preoperative dead ears. Postoperative hearing results had a mean follow-up time of 2.1 (standard deviation 1.5, range 0.14-4.84) years. In the matrix removal group (n = 9), 77.9% had unchanged hearing levels, 11.1% showed improvement and 11.1% showed decrease in hearing levels. The matrix preservation group (n = 2) had deteriorated hearing levels. Conclusion: Preservation of hearing in LFs is possible with cautious matrix removal. Despite matrix preservation to preserve hearing in large LFs, our patients' hearing deteriorated postoperatively. Longer follow-up of hearing with matrix preservation may show poorer hearing outcomes.

Mobile and landline telephone performance outcomes among telephone-using cochlear implant recipients.

OBJECTIVE: To objectively study mobile and standard landline telephone speech perception performance using cochlear implant recipients. STUDY DESIGN: Nonrandomized trial. SETTING: Tertiary referral center. SUBJECTS AND METHODS: Twenty-five subjects enrolled in this study from a pool of 50 cochlear implant recipients who had participated in an earlier questionnaire study from which demographic data were gathered. Preoperative speech perception scores were collated from preoperative audiological data. Postoperative speech perception scores were calculated with subjects listening to the Australian Version of the Bamford-Kowal-Bench Sentence Test read aloud in a soundproof booth via live voice, played back on a speaker, on a standard landline and mobile phone. Telephone speech perception scores were analyzed and banded into 3 performance categories: very good (90%-100%), good (80%-89%), and fair (<80%). RESULTS: The mean speech perception scores were 88.6% (SD, 14.3%) for postoperative recorded speech and 92.3% (SD, 10.7%) for live voice listening, which were significantly better than the mean score of 37.2% (SD, 29.1%) listening to recorded voice preoperatively. The mean speech perception score was 84.3% (SD, 20.7%) using a mobile telephone and 57% (SD, 29.4%) using the standard landline. Further analysis showed better performance with mobile phones over standard landlines. Seventy-six percent of subjects attained at least good telephone speech performance (score >80%). Older patients had poorer telephone speech perception than younger patients did. CONCLUSIONS: Many cochlear implant recipients achieve good objective telephone speech perception performance, indicating that they should be effective telephone users, especially when using mobile telephones and among younger implant recipients.

Uvulopalatopharyngoplasty outcome assessment with quantitative computer-assisted videoendoscopic airway analysis.

CONCLUSION: Quantitative digital imaging upper airway analysis enables surgeons to assess the pre- and postoperative upper airway morphology quantitatively, objectively and accurately, and to correlate these changes in surgical parameters with improvement of obstructive sleep apnea. OBJECTIVE: This was a prospective study using a new method of quantitative computer-assisted digital-imaging videoendoscopic upper airway analysis to quantify objectively and correlate the changes in surgical parameters with improvement of obstructive sleep apnea following uvulopalatopharyngoplasty. PATIENTS AND METHODS: Nineteen male patients underwent uvulopalatopharyngoplasty for obstructive sleep apnea after continuous positive airway pressure trial. All had undergone pre- and postoperative digital imaging upper airway examination, Epworth scores, and polysomnographic studies. Postoperative static and dynamic changes in upper airway parameters were compared, analyzed and correlated with improvement of the apnea-hypopnea index (AHI) by statistical regression. RESULTS: There were 65.12% and 64.37% improvements in the AHI and Epworth scales, respectively, after uvulopalatopharyngoplasty. Retropalatal areas measured were significantly correlated with improvement of the AHI. A 1 cm2 increase in retropalatal area during Mueller's maneuver in the supine position resulted in an improvement of 32.65 in the AHI; a 1 cm increase in the transverse diameter of the retropalatal area in the erect position resulted in an improvement of 31.83 in the AHI.

Clinical predictors in obstructive sleep apnea patients with computer-assisted quantitative videoendoscopic upper airway analysis.

AIM: To identify the clinical predictors and assist surgeons in their clinical management of obstructive sleep apnea (OSA). A prospective study with a new approach to analyze the static and dynamic upper airway morphology between patients with OSA and normal subjects. METHOD: Quantitative computer-assisted videoendoscopy (validated with upper airway magnetic resonance imaging) was performed in 49 (43 males, 6 females) patients with OSA and compared with 39 (22 males, 17 females) controls (apnea-hypopnea index [AHI] < 5). Absolute cross-sectional areas and transverse and longitudinal diameters at the retropalatal and retrolingual levels were measured during end of quiet respiration and during Mueller's maneuver in the erect and supine positions, allowing us to study static and dynamic morphology (collapsibility) of the upper airway. Three thousand seven hundred forty-four (3,744) parameters were analyzed. RESULTS: In males, retropalatal and retrolingual areas during Mueller's maneuver in the supine position of 0.7981 cm (relative operating characteristics [ROC] = 0.9284, positive pressure ventilation [PPV] = 86.05%, negative pressure ventilation [NPV] = 84.62%) and 2.0648 cm (ROC = 0.8183, PPV = 76%, NPV = 83.33%), respectively, were found to be good predictors/cut-off values for OSA. The retropalatal area measured in the supine position (AS1 mol/L) and collapsibility of the retropalatal area in the supine position (CAS1) were found to have significant correlations with severity of OSA. In females, the areas measured during Mueller's maneuver in the supine position of 0.522 cm at the retropalatal level (ROC = 1, 100% PPV and NPV) and the transverse diameter at the retrolingual level during erect Mueller's maneuver of 1.1843 cm (ROC = 0.9056, PPV = 100%, NPV = 83.33%) were found to be predictive. All measurements at the retropalatal level and in the supine position had higher predictability. Area measurements obtained during Muller's maneuver were more predictive (ROC > 0.9910) than resting measurements (ROC >0.8371). Several sex and anatomic-site specific formulas with excellent predictability (ROC close or equal to 1) were also devised. CONCLUSION: Upper airway Mueller's studies are predictive and useful (independent samples t test/Mann-Whitney U test, ROC) in identifying patients with OSA. With these sex and anatomic-site specific OSA predictors/formulas and this innovative clinical method, we hope to assist other surgeons with quantitative clinical diagnosis, assessment, surgical planning, and outcome assessment tools for OSA patients.