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.

Analysis of Prognostic Factors For External Auditory Canal Carcinoma: A 22-Year Experience.

OBJECTIVE: This study aimed to investigate the prognostic factors and treatment outcomes in patients with the external auditory canal (EAC) squamous cell carcinoma (SCC). METHODS: All patients diagnosed with EAC SCC and treated with curative intent at a single tertiary institution were retrospectively reviewed over a 22-year period. Treatment modalities included surgery with adjuvant treatment or definitive radiotherapy. The primary endpoints were overall survival (OS) and disease-specific survival (DSS). RESULTS: There were 51 patients in our cohort. The 5-year OS and DSS were 64.0% ± 7.0% and 72.0% ± 7.0% respectively. Patients in the surgical arm and RT arm showed no significant difference in OS, DSS, and LRFS (p = 0.075, 0.062, 0.058 respectively). Compared to other routes of spread within the temporal bone, pattern of posterior disease invasion (involving mastoid/sigmoid sinus) showed poorer OS and DSS on multivariate analysis (hazard ratio, HR4.34 and 5.88; p = 0.006 and 0.009). On multivariate analysis, the following factors were independently prognostic of poorer OS and DSS: Previous radiotherapy (HR 3.29 and 4.81, p = 0.021 and p = 0.029); Presence of facial nerve palsy (HR 3.80 and 7.63, p = 0.013 and p = 0.003); Posterior pattern of invasion (HR4.05 and 3.59, p = 0.013 and p = 0.043). Advanced modified Pittsburgh stage was not predictive of poor OS and DSS (HR1.17 and 1.17 E+5, p = 0.786 and p = 0.961). CONCLUSION: Presence of previous radiotherapy, facial nerve palsy and posterior pattern of disease invasion were independent prognostic factors of poorer survival in patients with EAC SCC. LEVEL OF EVIDENCE: 4 Laryngoscope, 133:2203-2210, 2023.

A novel treatment for CI extrusion with vacuum-assisted closure device.

OBJECTIVE: To assess if a vacuum-assisted closure device initially utilised as a temporising measure to dress a wound defect over a cochlear implant prior to definitive surgical intervention could instead be used to close the soft tissue and avoid surgery. METHOD: This is a case report describing the novel use of VAC (Vacuum-Assisted Closure Device) in the successful closure of a wound defect with cochlear implant hardware exposure post soft tissue infection during the Covid-19 pandemic. RESULTS: While the VAC system was initiated for temporary wound coverage, it was observed at each dressing change to be successfully decreasing the soft tissue defect for our patient. This resulted in complete epithelisation of the soft tissue defect at Day 35 and avoidance of a surgical procedure. The patient was able to restart wearing her device on Day 50 and Cochlear MAPping performed on Day 58 showed minimal changes in patient's current requirements compared to her settings pre-infection. CONCLUSION: The use of V.A.C dressing for a small soft tissue defect over an extruded cochlear implant seems promising as exemplified by our case study. However, due to the lack of literature, more studies should be done to prove its usefulness in such an application.

Pediatric Auditory Brainstem Implantation: Impact on Audiological Rehabilitation and Tonal Language Development.

OBJECTIVE: This is a retrospective review of the impact of an Auditory Brainstem Implant (ABI) on the audiological rehabilitation and tonal language development of pediatric patients with prelingual profound deafness in Hong Kong. RESULTS: From January 2009 to February 2015, 11 pediatric patients with profound prelingual deafness received an ABI in Hong Kong (age range 1.67-3.75 years). Etiologies included Cochlear Nerve Deficiency in 7, Severe Cochlear Malformations in 2, and Retrocochlear Deafness in 2. All of them were rehabilitated in Cantonese, a dialect of Chinese. Standard pediatric cochlear implant outcome measurements were used in this study that comprised of the 7-Sound Detection, Syllable Identification, Vowel Identification, Consonant Identification, Tone Imitation, Tone Production and Speech Perception Category. Audiological rehabilitation and speech development outcomes were reviewed. Age-matched outcomes of pediatric cochlear implant users were used for comparisons. CONCLUSION: Encouraging results of speech development were found, especially with continued use of the ABI. There was considerable variation in outcomes. Children with coexisting developmental and nonauditory cognitive disabilities did not perform as well. Auditory brainstem implantation is a safe and beneficial treatment for profound prelingual deafness in Cantonese-speaking pediatric patients.

Auditory Brainstem Implantation in Chinese Patients With Neurofibromatosis Type II: The Hong Kong Experience.

OBJECTIVE: To describe our experience and outcomes of auditory brainstem implantation (ABI) in Chinese patients with Neurofibromatosis Type II (NF2). STUDY DESIGN: Retrospective case review. SETTING: Tertiary referral center. PATIENTS: Patients with NF2 who received ABIs. RESULTS: Between 1997 and 2014, eight patients with NF2 received 9 ABIs after translabyrinthine removal of their vestibular schwannomas. One patient did not have auditory response using the ABI after activation. Environmental sounds could be differentiated by six (75%) patients after 6 months of ABI use (mean score 46% [range 28-60%]), and by five (63%) patients after 1 year (mean score 57% [range 36-76%]) and 2 years of ABI use (mean score 48% [range 24-76%]). Closed-set word identification was possible in four (50%) patients after 6 months (mean score 39% [range 12-72%]), 1 year (mean score 68% [range 48-92%]), and 2 years of ABI use (mean score 62% [range 28-100%]). No patient demonstrated open-set sentence recognition in quiet in the ABI-only condition. However, the use of ABI together with lip-reading conferred an improvement over lip-reading alone in open-set sentence recognition scores in two (25%) patients after 6 months of ABI use (mean improvement 46%), and five (63%) patients after 1 year (mean improvement 25%) and 2 years of ABI use (mean improvement 28%). At 2 years postoperatively, three (38%) patients remained ABI users. CONCLUSION: This is the only published study to date examining ABI outcomes in Cantonese-speaking Chinese NF2 patients and the data seems to show poorer outcomes compared with English-speaking and other nontonal language-speaking NF2 patients. Environmental sound awareness and lip-reading enhancement are the main benefits observed in our patients. More work is needed to improve auditory implant speech-processing strategies for tonal languages and these advancements may yield better speech perception outcomes in the future.

Evaluation of the utricular and saccular function using oVEMPs and cVEMPs in BPPV patients.

BACKGROUND: It is well-known that ocular vestibular evoked myogenic potentials (oVEMPs) predominantly reflect utricular function whilst cervical vestibular evoked myogenic potentials (cVEMPs) reflect saccular function. To date, there are no published reports on the systemic evaluation of utricular and saccular function in benign paroxysmal positional vertigo (BPPV), nor are there any reports on the differences in VEMPs between patients with recurrent and non-recurrent BPPV. The aim of this study was to evaluate the difference in cervical and ocular (c/o)VEMPs between patients with BPPV and normal controls, as well as between patients with recurrent and non-recurrent BPPV. METHODS: Thirty patients with posterior canal BPPV and 30 healthy subjects (as normal controls) were prospectively enrolled. cVEMP and oVEMP testing using 500 Hz tone-burst stimuli were performed on all. VEMP tests were repeated 3 times on each subject to ensure reliability and reproducibility of responses. VEMPs were defined as present or absent. Abnormal VEMP was defined by lack of VEMP response. RESULTS: In the control group, abnormal cVEMPs responses were detected in 6.67% and abnormal oVEMPs responses were detected in 3.34%. In BPPV patients (10 with recurrent BPPV, 20 with non-recurrent BPPV), abnormal cVEMPs responses were detected in 30% and abnormal oVEMPs responses were detected in 56.7%. More patients with BPPV showed abnormal responses in c/oVEMPs as compared to the control group (p < 0.05). oVEMPs was more often abnormal as compared to cVEMPs in BPPV patients (p < 0.05). There was no statistical difference between abnormal cVEMP responses in non-recurrent BPPV patients (25%) and recurrent BPPV patients (40%) (p > 0.05). Differences in abnormal oVEMP responses (non-recurrent BPPV, 40%; recurrent BPPV, 90%) were significant (p < 0.05). CONCLUSION: An increased occurrence of abnormal c/oVEMP recordings appeared in BPPV patients, possibly as a result of degeneration of the otolith macula. oVEMPs were more often abnormal in BPPV patients as compared to cVEMPs, suggesting that utricular dysfunction may be more common than saccular dysfunction. Furthermore, oVEMP abnormalities in the recurrent BPPV group were significantly higher than those in the non-recurrent BPPV group. Assessment of c/oVEMPs in BPPV patients may therefore be of prognostic value in predicting likelihood of BPPV recurrence.

Submental nodular fasciitis: report of an unusual case.

A 30-year-old woman presented for evaluation of a hard, enlarging, submental mass that was fixed to the underlying mandible. Fine-needle aspiration cytology initially led to a diagnosis of pleomorphic adenoma, which was unusual given the superficial location of the lesion on computed tomography. The lesion was a well-defined rim-enhancing mass, and it had displaced adjacent structures medially. Intraoperatively, the mass was found to abut against and erode the mandibular cortex. A diagnosis of nodular fasciitis was established by histologic analysis. Such a location for this tumor is unusual. The prognosis for patients with this benign condition is excellent following complete surgical excision. We discuss the clinical presentation and the cytologic, histologic, and radiologic features of this uncommon entity.

Endoscopic modified Lothrop approach for the excision of bilateral frontal sinus tumors.

We describe the use of an endoscopic modified Lothrop approach for clearance of an extensive sinonasal-type hemangiopericytoma of the nasal cavity and paranasal sinuses with bilateral frontal sinus involvement in a 44-year-old woman. The modified Lothrop approach is conventionally used to treat sinusitis, but with some slight modifications to the technique, it can also be used for tumor excision.

Habituation following tinnitus retraining therapy in tinnitus sufferers.

INTRODUCTION: This study evaluated the efficacy of tinnitus retraining therapy (TRT) in habituating patients with tinnitus. MATERIALS AND METHODS: This is a retrospective review of patients who underwent TRT in a tertiary referral Otorhinolaryngology unit. Patients were followed up with structured interviews with the aid of questionnaire forms. Habituation following TRT was evaluated. RESULTS: A total of 702 patients were included (55% male, 45% female). Habituation of reaction to tinnitus and habituation of perception were analysed. Average duration of follow up was 33 months. In total, 68% of patients described improvement in annoyance following TRT. Of these patients, 80% of them described habituation of perception as well. There was no statistical difference in gender and age between patients who did and did not respond to TRT. However, duration of treatment was significantly longer in patients who habituated (P <0.05). Patients who adopted treatment strategies recommended based on Jastreboff's TRT categories were also found to have higher success rates compared to those who refused. CONCLUSION: The goal of TRT is to achieve habituation of reaction to tinnitus. Habituation of perception is often a secondary result of sufficiently habituated response. From our study, more than two thirds of patients with tinnitus achieved habituation of reaction and of these, the majority also habituated to awareness of the tinnitus.

Clinical parameters in obstructive sleep apnea: are there any correlations?

OBJECTIVE: To assess the correlation between clinical symptoms and examination findings with severity of obstructive sleep apnea (OSA). DESIGN: Prospective observational study. SETTING: Otorhinolaryngology sleep clinic in a tertiary referral centre. PARTICIPANTS: Consecutive patients referred to the sleep clinic with a suspected diagnosis of OSA. MAIN OUTCOMES MEASURES: Body mass index (BMI), Epworth Sleepiness Scale (ESS) score, tonsil size, modified Mallampati index (MMP), Müller manoeuvre, reflux finding score (RFS), apnea-hypopnea index (AHI), lowest oxygen saturation, and percentage of rapid eye movement sleep. RESULTS: Eighty patients (14 female, 66 male), with a mean age of 42.9 years (range 22-66), were included in the study. The mean BMI was 27.6 (range 20-39). A correlation was found between ESS score and anteroposterior pharyngeal wall collapse at the level of the soft palate during Müller manoeuvre (r=.3, p=.02). BMI was significantly associated with a history of hypertension (r=.3, p=.01), MMP (r=.3, p=.001), and lateral wall collapse at the level of the soft palate during Müller manoeuvre (r=.4, p=.0001). OSA severity correlated significantly with male gender (p=.02), history of hypertension (r=.5, p<.0001), BMI (r=.2, p=.03), MMP (r=.3, p=.003), and upper airway collapse during Müller manoeuvre. CONCLUSIONS: Clinical findings in patients with OSA do correlate with the severity of OSA and polysomnographic findings. The degree of upper airway collapse during Müller manoeuvre does correlate with AHI severity. Accuracy in predicting the presence and severity of OSA allows for greater cost-effectiveness in screening patients prior to polysomnography.