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1.
Otol Neurotol ; 41(9): e1118-e1121, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32925847

RESUMO

OBJECTIVE: We sought to examine the intra- and interobserver variability in measuring the cochlear duct length (CDL) from magnetic resonance imaging (MRI) images versus computed tomography (CT) images using an otological surgical planning software that uses measurements of the basal turn diameter and cochlear width to estimate the CDL. PATIENTS: Twenty-one adult cochlear implant patients with preoperative MRI and CT images. INTERVENTION: Three fellowship-trained neurotologists served as the raters in the study. One rater measured the CDL using preoperative CT scans to serve as the benchmark. Two of the raters measured the CDL on preoperative MRI scans. One rater also remeasured the scans using MRI images after a period of 1 week to assess intraobserver variability. MAIN OUTCOME MEASURE: Intraclass correlational coefficients were calculated to assess for intra- and interobserver agreement. RESULTS: The mean CDL measured from the CT scans was 32.7 ±â€Š2.0 mm (range 29.4 - 37.6 mm). The mean difference between the raters when measuring the CDL using MRI scans was -0.15 ±â€Š2.1 mm (range -3.2 to 4.3 mm). The intraclass correlational coefficients for inter-rater reliability of CDL determination using MRI scans was judged as fair to excellent (0.68; 95% CI 0.41-0.84). The intrarater reliability of CDL determination using MRI scans was judged at fair to excellent (0.73; 95% CI 0.491-0.866). CONCLUSION: We demonstrate that a validated otological surgical planning software for estimating the CDL preoperatively had comparable performance using MRI scans versus the gold-standard CT scans.

2.
Otolaryngol Head Neck Surg ; : 194599820954144, 2020 Sep 22.
Artigo em Inglês | MEDLINE | ID: mdl-32957864

RESUMO

OBJECTIVE: The aim of this study is to investigate facial nerve outcomes after microsurgical resection in neurofibromatosis type 2 (NF2) compared to sporadic tumors. STUDY DESIGN: Single institutional retrospective chart review. SETTING: Tertiary referral center. METHODS: All adult patients with NF2 vestibular schwannoma (VS) or sporadic VS who underwent microsurgical resection from 2008 to 2019 with preoperative magnetic resonance imaging (MRI) and 1 year of postsurgical follow-up were included. The primary outcome measure was postoperative House-Brackmann (HB) facial nerve score measured at first postoperative visit and after at least 10 months. RESULTS: In total, 161 sporadic VSs and 14 NF2 VSs met inclusion criteria. Both median tumor diameter (NF2, 33.5 mm vs sporadic, 24 mm, P = .0011) and median tumor volume (NF2, 12.4 cm3 vs sporadic, 2.9 cm3, P = .0005) were significantly greater in patients with NF2. The median follow-up was 24.9 months (range, 12-130.1). Median facial nerve function after 1 year for patients with NF2 was HB 3 (range, 1-6) compared to HB 1 (range, 1-6) for sporadic VS (P = .001). With multivariate logistic regression, NF2 tumors (odds ratio [OR] = 13.9, P = .001) and tumor volume ≥3 cm3 (OR = 3.6, P = .025) were significantly associated with HB ≥3 when controlling for age, sex, extent of tumor resection, translabyrinthine approach, and prior radiation. CONCLUSION: Tumor volume >3 cm3 and NF2 tumors are associated with poorer facial nerve outcomes 1 year following microsurgical resection.

3.
Artigo em Inglês | MEDLINE | ID: mdl-32876726

RESUMO

PURPOSE: Otolaryngologists have had to postpone the majority of surgical procedures in the current COVID-19 pandemic. Airborne transmission, beyond the projection of droplets from upper airways, expose healthcare workers to a risk of viral infection. Aerosol generating procedures (AGP) increase the risk of viral transmission to staff within the operating room. METHODS: Surgery of middle ear and mastoid is also considered an AGP, particularly mastoidectomy performed using a high-speed drill. The authors report their experience in endoscopic ear surgery as an alternative technique to reduce AGP in otologic procedures. RESULTS: Transcanal endoscopic ear surgery is a reliable technique used to manage many otologic conditions. CONCLUSION: The endoscopic approach may reduce the risk of viral transmission to operating room staff by reducing the need for mastoidectomy.

4.
Otol Neurotol ; 2020 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-32740547

RESUMO

OBJECTIVE: We sought to examine the intra- and interobserver variability in measuring the cochlear duct length (CDL) from magnetic resonance imaging (MRI) images versus computed tomography (CT) images using an otological surgical planning software that uses measurements of the basal turn diameter and cochlear width to estimate the CDL. PATIENTS: Twenty-one adult cochlear implant patients with preoperative MRI and CT images. INTERVENTION: Three fellowship-trained neurotologists served as the raters in the study. One rater measured the CDL using preoperative CT scans to serve as the benchmark. Two of the raters measured the CDL on preoperative MRI scans. One rater also remeasured the scans using MRI images after a period of 1 week to assess intraobserver variability. MAIN OUTCOME MEASURE: Intraclass correlational coefficients were calculated to assess for intra- and interobserver agreement. RESULTS: The mean CDL measured from the CT scans was 32.7 ±â€Š2.0 mm (range 29.4 - 37.6 mm). The mean difference between the raters when measuring the CDL using MRI scans was -0.15 ±â€Š2.1 mm (range -3.2 to 4.3 mm). The intraclass correlational coefficients for inter-rater reliability of CDL determination using MRI scans was judged as fair to excellent (0.68; 95% CI 0.41-0.84). The intrarater reliability of CDL determination using MRI scans was judged at fair to excellent (0.73; 95% CI 0.491-0.866). CONCLUSION: We demonstrate that a validated otological surgical planning software for estimating the CDL preoperatively had comparable performance using MRI scans versus the gold-standard CT scans.

5.
Cochlear Implants Int ; : 1-5, 2020 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-32657236

RESUMO

Objective: To identify the rate of cochlear implantation (CI) re-implantation and assess audiologic outcomes. Methods: Demographic, audiometric, radiographic, and clinical data were collected from the medical records of the first 834 pediatric patients (age < 18) who underwent CI at a tertiary-care center. Results: Reviewing the first 834 pediatric patients who underwent CI between 1986 and 2013, 33 (4%) children have required re-implantation. Seven (0.8%) of these required a second re-implantation, for a total of 40 total revision surgeries (4.8%) and 21.1% of patients who underwent revision required multiple re-implantations. The mean age at initial CI was 3.5 years old, with identification of the failure an average of 2.7 years later (range, 0.1-10.1 years). The most common indications for re-implantation CI were unknown etiology (58%), vendor recall (18%), and trauma (9%). Twenty-three (88.5%) of the 26 patients who underwent only one re-implantation surgery achieved a complete insertion with both procedures. Eleven (91.7%) of 12 patients who had open set speech after their initial procedure maintained this after re-implantation surgery. Eight (38.1%) of 21 patients who did not have open-set speech after their initial implantation achieved open set speech with CI re-implantation. Conclusion: CI re-implantation is not common in the pediatric population. However, given the time-sensitive nature of speech/language development in children, with the right indications, CI re-implantation can be performed safely without compromising audiologic outcomes. However, re-implanted patients have an increased risk they will require re-implantation again in the future.

6.
Otol Neurotol ; 2020 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-32558754

RESUMO

OBJECTIVE: To elucidate the impact of hearing loss on patient health literacy. STUDY DESIGN: Prospective, cross-sectional study. SETTING: Academic otology practice at a university hospital. PATIENTS: Consecutive, adult, English-speaking patients. MAIN OUTCOME MEASURES: Inadequate health literacy, defined as a composite score of less than or equal to nine on the brief health literacy screen (BHLS), was compared with patient hearing data utilizing the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) hearing classification. Secondary outcome measures included comparisons of inadequate BHLS scores according to patient demographic and clinical information. RESULTS: There were 300 consecutive adult (>18 years old) patients evaluated with the BHLS at a university otology practice between February and March 2019. The median patient age was 60-years (range, 18-91 yr), a slight majority (160, 53.3%) were women, and most patients were White (241, 86.7%) and non-Hispanic (260, 91.6%). Overall, 9.7% of patients were found to have inadequate health literacy. Men had higher rates of inadequate health literacy as compared with women (13.6% versus 6.3%, odds ratio [OR] = 2.35, 95% confidence interval [CI] 1.06-5.25). Audiometric data was available for 284 (95%) patients, of which 235 (82.7%) had class A or B hearing and 49 (17.3%) had class C or D hearing. Patients with Class C or D hearing had a lower median composite BHLS score compared with patients with Class A or B hearing (11.6 versus 13.6, p < 0.0001) and an increased rate of inadequate health literacy (28.6% versus 4.7%, OR = 8.15, 95% CI 3.42-19.37). Increased age, female sex, and better hearing were independent predictors of higher BHLS scores on multivariable analysis. CONCLUSIONS: Hearing loss is an independent risk factor for inadequate health literacy. Providers should be aware of this risk and consider implementing strategies to improve counseling for this at-risk group of patients.

7.
Laryngoscope ; 2020 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-32022283

RESUMO

OBJECTIVE: Rigid endoscopes can improve visualization of the tympanic space compared to traditional microscopic techniques. This study investigates whether use of transcanal endoscopic ossiculoplasty influences audiologic outcomes compared to microscopic ossiculoplasty following chronic ear surgery in children. STUDY DESIGN: Comparative cohort study at two tertiary care centers. METHODS: Retrospective review of pediatric chronic ear cases where ossiculoplasty was performed from February 2009 to March 2018. RESULTS: We identified 100 ears that underwent endoscopic ossiculoplasty and 100 ears that underwent microscopic ossiculoplasty. The mean age was 11 years (range, 4-18 years) with 63% males. There were no significant differences in these parameters between the two groups. Subjects underwent either primary ossiculoplasty or ossiculoplasty during second-look procedures. There was no significant difference in air conduction pure tone average (PTA) after microscopic cases compared to endoscopic cases (-12.5 dB vs. -10.5 dB, P = .40). These results were independent of prosthesis type. Microscopic ossiculoplasty was significantly more likely to use a post-auricular approach (P = .0001). There was no difference in complication rate between the two groups. The malleus was more likely to be absent or removed prior to endoscopic ossiculoplasty (P = .0004) with no significant difference in the change in PTA between groups. CONCLUSIONS: Transcanal endoscopic ossiculoplasty was found to have equivalent audiometric outcomes with significantly fewer post-auricular approaches and no increase in complications compared to microscopic ossiculoplasty. While the malleus was more likely to be absent in endoscopic cases, this did not appear to influence the change in PTA. LEVEL OF EVIDENCE: 4 Laryngoscope, 2020.

8.
Am J Otolaryngol ; 41(3): 102431, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32107056

RESUMO

OBJECTIVE: Describe the effect of hearing aid type used during cochlear implantation evaluation on qualification rates. METHODS: Consecutive adult patients at an academic cochlear implant program undergoing cochlear implantation evaluation were identified to determine cochlear implantation qualification rate according to history of hearing aid use and type of hearing aid used during evaluation. RESULTS: 609 patients met criteria. 90.1% of patients reported prior use of a hearing aid, and 77.4% reported current use of a hearing aid. Patients were most likely to undergo cochlear implantation evaluation utilizing their own personal hearing aids exclusively (61.6%) followed by loaner hearing aids fitted at the time of the evaluation (28.2%). White patients were more likely to be tested using personal hearing aids (OR = 2.60, 95% CI 1.43 to 4.71). Married patients were more likely to be current hearing aid users (OR 1.62, 95% CI 1.04 to 2.51) and were more likely to be tested using personal hearing aids (OR = 1.68, 95% CI 1.10 to 2.56). Patients with a history of any hearing aid use (OR = 2.50, 95% CI 1.42 to 4.40) and current hearing aid use (OR = 1.62, 95% CI 1.06 to 2.49) were more likely to qualify for cochlear implantation. Patients tested using personal hearing aids were 1.5 times more likely to qualify for cochlear implantation (95% CI 0.99 to 2.27). CONCLUSION: History of hearing amplification and current amplification predict cochlear implant qualification. Hearing aids fitted at the time of cochlear implantation evaluation may result in lower qualification rates.

10.
World Neurosurg ; 136: e440-e446, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31931234

RESUMO

OBJECTIVE: To explore patient demographics as to predicting vestibular schwannoma (VS) size and treatment plan within a single institution. METHODS: Using a large tertiary referral skull base center database, all patients with sporadic VS who presented to the center between 2009 and 2018 were reviewed. RESULTS: A total of 816 patients with VS over 18 years of age were included. The median age was 56.8 years (range: 18.6-90.9 years). The median tumor diameter at diagnosis was 11.9 mm (range: 0.6-51.1 mm). With multivariate analysis, older age was associated with decreased tumor size (0.23 mm, 95% confidence interval [CI]: 0.17-0.29), whereas married patients had larger tumors (2.5 mm, 95% CI: 0.92-4.09). When comparing observation, radiation, or surgery, older patients are more likely to pursue observation as compared with surgery and radiation (odds ratio [OR]: 1.08, 95% CI: 1.06-1.10 and OR: 1.20, 95% CI: 1.08-1.33), respectively. Married patients were less likely to pursue observation as compared with surgery (OR: 0.49, 95% CI: 0.29-0.82). Each additional mile a patient lives farther from the center increases his or her odds of pursuing treatment (OR: 1.002, 95% CI: 1.001-1.003). CONCLUSIONS: Older age is associated with smaller tumors, whereas married patients have larger tumors at diagnosis as compared with nonmarried patients. Furthermore, married patients are more likely to pursue treatment, specifically surgery, as compared with nonmarried patients, whereas patients who live farther from the center are more likely to pursue treatment.


Assuntos
Neuroma Acústico/patologia , Carga Tumoral , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Cobertura do Seguro/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Masculino , Estado Civil , Pessoa de Meia-Idade , Neuroma Acústico/terapia , Planejamento de Assistência ao Paciente , Características de Residência/estatística & dados numéricos , Fatores de Risco , Adulto Jovem
11.
Ann Otol Rhinol Laryngol ; 129(4): 347-354, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31735055

RESUMO

OBJECTIVE: To identify demographic predictors of patients undergoing cochlear implantation evaluation and surgery. METHODS: Consecutive adult patients between 2009 and 2018 who underwent cochlear implantation evaluation at a university cochlear implantation program were retrospectively identified to determine (1) cochlear implantation qualification rate and (2) pursuit of surgery rate with respect to age, gender, race, primary spoken language, marital status, insurance type, and distance to the cochlear implantation center. RESULTS: A total of 823 cochlear implantation evaluations were analyzed. Overall, 76.3% of patients qualified for cochlear implantation and 61.5% of these patients pursued surgery. Age was the only independent predictor for cochlear implantation qualification, such that, for each year younger, the odds of qualifying for cochlear implantation increased by 2.5% (OR 0.98; 95% CI: 0.96-0.99). Age, race, marital status, and insurance type were each independent predictors of the decision to pursue surgery. The odds of pursuing surgery increased by 2.8% for each year younger (OR 1.03; 95% CI: 1.01-1.05). Compared to White patients, non-Whites were half as likely to pursue surgery (OR 0.47; 95% CI: 0.25-0.88). Single (OR 0.49; 95% CI: 0.26-0.94) and widowed patients (OR 0.46; 95% CI: 0.23-0.95) were about half as likely to pursue surgery as compared to married patients. Patients with military insurance were 13 times more likely to pursue surgery as compared to patients with Medicare (OR 13.0; 95% CI: 1.67-101.4). CONCLUSION: Younger age is an independent predictor for a higher cochlear implantation qualification rate, suggesting the possibility for delayed candidacy referral. Rate of surgical pursuit in qualified cochlear implantation candidates is lower for racial minorities, single and widowed patients, and older patients.


Assuntos
Implante Coclear , Demografia , Disparidades em Assistência à Saúde/estatística & dados numéricos , Perda Auditiva Neurossensorial , Fatores Etários , Implante Coclear/métodos , Implante Coclear/normas , Definição da Elegibilidade/métodos , Definição da Elegibilidade/normas , Estudos de Avaliação como Assunto , Feminino , Perda Auditiva Neurossensorial/epidemiologia , Perda Auditiva Neurossensorial/cirurgia , Humanos , Revisão da Utilização de Seguros , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Encaminhamento e Consulta/estatística & dados numéricos , Estados Unidos/epidemiologia
12.
Otol Neurotol ; 40(10): 1313-1321, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31634277

RESUMO

OBJECTIVE: To investigate the recidivism rate of cholesteatoma treated via endoscopic ear surgery (EES), either via transcanal endoscopic ear surgery or endoscopic assisted tympanomastoidectomy compared with a microscopic postauricular approach. STUDY DESIGN: Retrospective chart review. SETTING: Academic otology practice. PATIENTS: Adult patients (18 years and older) with at least 11 months of surgical follow-up who were treated for cholesteatoma via endoscopic techniques or microscopic postauricular approach. INTERVENTION: Use of the endoscope for cholesteatoma dissection. MAIN OUTCOME MEASURE: Residual or recurrent cholesteatoma identified at second look surgery or postoperative diffusion-weighted magnetic resonance imaging. RESULTS: Fifty-nine patients treated for cholesteatoma via endoscopic techniques and 35 patients treated via microscopic postauricular approach were analyzed. The endoscopic group required significantly fewer mastoid procedures (28% versus 80%, p-value 0.001). Postoperative changes in median ABG (5 dB versus 3.75 dB, p = 0.9519), median PTA (6.875 dB versus 1.25 dB, p = 0.3864), and median word recognition score (0% versus 0%, p = 0.3302) were not significantly different between the EES and microscopic surgery groups. Median operative times were not significantly different between the two groups (182 min endoscopic versus 174 min microscopic, p-value 0.66). The rate of residual disease (17% EES versus 17% microscopic, p = 0.959) or disease recurrence (18% endoscopic versus 20% microscopic, p = 0.816) were not significantly different between the two groups. CONCLUSIONS: EES is an effective option for cholesteatoma management with similar rates of recurrent or residual disease as compared with the more traditional microscopic postauricular approach in these samples.

13.
Otol Neurotol ; 40(9): e901-e908, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31436633

RESUMO

OBJECTIVE: Identify features on computed tomography (CT) that predict mastoidectomy conversion (MC) during transcanal endoscopic ear surgery (TEES). STUDY DESIGN: Retrospective case-control. SETTING: University otology practice. PATIENTS: Consecutive patients with cholesteatoma. INTERVENTION: TEES cholesteatoma dissection versus those requiring MC. MAIN OUTCOME MEASURES: Antrum opacification, depth of scutum involvement, and erosion of the mastoid trabeculae, ossicular chain, and tegmen were evaluated. Univariable and multivariable regression analysis was performed. The Antrum-Malleus-Tegmen (AMT) score was created using receiver operating characteristic curves to assess feasibility of performing TEES for cholesteatoma dissection. RESULTS: There were 39 TEES and 19 MC cases. Groups had similar age (median 28.5 yr), gender, laterality, and revision surgery status. Median surgical time for MC cases was longer than TEES (231 min vs. 171 min, p < 0.001). Radiographic predictors of MC by multivariable regression included antrum opacification (p = 0.036), malleus erosion (p = 0.044), and tegmen erosion (p = 0.023). The AMT score predicted the feasibility of TEES without MC with a sensitivity of 90% and specificity of 75% when ≥2 of the following conditions were met on preoperative CT: intact tegmen, intact malleus, and absence of antrum opacification. CONCLUSIONS: An aerated antrum, intact malleus, and intact tegmen suggest that TEES cholesteatoma dissection without the need for mastoidectomy is highly likely. A score of ≥2 on the AMT score predicts this with a positive predictive value of 88% and negative predictive value of 78%.

14.
Otol Neurotol ; 40(5S Suppl 1): S23-S28, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31225819

RESUMO

OBJECTIVE: To describe histologic and radiographic findings associated with insertion of a new lateral wall electrode in human temporal bones, as well as quantify the ease of insertion as characterized by multiple cochlear implant surgeons. SETTING: Multi-institutional cadaveric study. METHODS: The Slim J electrode was inserted in cadaveric temporal bones via a standard mastoidectomy and facial recess approach. Insertion was performed by five cochlear implant surgeons with no previous experience with the Slim J electrode array. Electrode array insertion was performed via a round window, an extended round window, or a cochleostomy approach. Intracochlear trauma, and angular insertion depth was assessed histologically and radiologically, respectively, after placement of the Slim J electrode array. RESULTS: Scala tympani insertion was accomplished in all 40 specimens. Thirty-eight specimens (95%) showed minimal trauma (Esrhaghi grade 0 or 1). One patient had rupture of basilar membrane (grade 2 trauma) at 380 degrees. One patient had grade 4 trauma with scalar translocation beginning at 210 degrees. The mean angular insertion depth was 416.4 degrees (range: 338.7-509.2 degrees, SD 44 degrees). Surgical handling was described as easy in 38 cases (95%). CONCLUSION: In a human cadaveric model the lateral wall Slim J electrode produced minimal intracochlear trauma that was positioned completely within the scala tympani in 97.5% of cases.


Assuntos
Cóclea/cirurgia , Implante Coclear/métodos , Implantes Cocleares , Cadáver , Humanos , Osso Temporal/cirurgia
15.
Ann Otol Rhinol Laryngol ; 128(9): 862-868, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31067979

RESUMO

OBJECTIVE: Compare experts' ability to differentiate malignant and benign causes of facial nerve paralysis (FNP) using the initial presenting magnetic resonance image (MRI) for each patient. METHODS: This retrospective case-controlled study compared MRIs for 9 patients with a malignant cause for FNP, 8 patients with Bell's palsy, and 9 cochlear implant patients serving as controls. The initial presenting MRI for each condition was used such that raters were evaluating real-world rather than optimal studies. Three blinded expert raters independently evaluated each segment of the facial nerve for abnormalities, provided a diagnosis, and graded MRI quality. Cohen's and Light's kappa were used to calculate interrater reliability and overall index of agreement, respectively. RESULTS: MRI protocols for the malignancy group were universally suboptimal. There was poor agreement among raters for abnormalities of the facial nerve along the brainstem (0.13), geniculate (0.10), tympanic segment (0.12), and mastoid segment (0.13); moderate agreement along the cisternal segment (0.58) and internal auditory canal (0.55); and fair agreement along the labyrinthine segment (0.26) and extratemporal segment (0.36). Agreement regarding final diagnosis was fair (0.37) when compared to the true diagnosis. There were 2 false negative interpretations (failure to correctly identify malignancy) and 1 false positive interpretation. CONCLUSION: MRI for FNP is often initially performed with an incorrect protocol and thus may fail to reliably differentiate neoplastic from inflammatory FNP even when interpreted by experienced clinicians. Nevertheless, expert readers correctly diagnosed 87.5% of malignant causes of FNP despite these limitations.


Assuntos
Paralisia de Bell/diagnóstico , Nervo Facial , Paralisia Facial/diagnóstico , Imagem por Ressonância Magnética/métodos , Neoplasias/diagnóstico , Adulto , Paralisia de Bell/etiologia , Diagnóstico Diferencial , Nervo Facial/diagnóstico por imagem , Nervo Facial/patologia , Paralisia Facial/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/complicações , Reprodutibilidade dos Testes
16.
J Neurol Surg B Skull Base ; 80(Suppl 3): S274-S275, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31143587

RESUMO

Objectives To describe a retrosigmoid craniectomy, hearing-preservation approach for resection of vestibular schwannoma. Design/Setting/Participants A video of a single patient undergoing the above approach at a tertiary care skull base surgery program. Results This video demonstrates a retrosigmoid craniectomy approach for resection of an enlarging intracanalicular vestibular schwannoma in a patient with normal hearing. The video highlights the pertinent surgical anatomy and outlines in a step-by-step fashion the surgical steps. The patient obtained a gross total resection with preservation of hearing. Conclusion A retrosigmoid craniectomy approach for vestibular schwannoma offers a potentially hearing preservation approach for selected tumors. The link to the video can be found at: https://youtu.be/VM663XztRZw .

17.
J Neurol Surg B Skull Base ; 80(Suppl 3): S279-S280, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31143589

RESUMO

Objectives This video demonstrates the transcanal transpromontorial approach for resection of vestibular schwannoma. Design/Setting/Participants Present study is based on a video of a single patient undergoing the above approach at a tertiary care skull base surgery program. Results This video demonstrates a transcanal microscopic transpromontorial approach for resection of an enlarging intracanalicular vestibular schwannoma in a young patient with nonserviceable hearing. The video highlights the pertinent surgical anatomy and outlines, in a step-by-step fashion, the approach to the internal auditory canal via this minimally invasive approach. The surgical indications and reconstructive techniques are also discussed ( Fig. 1 ). Conclusions A transcanal microscopic transpromontorial approach for vestibular schwannoma is feasible and offers a minimally invasive option for patients electing for microsurgical resection. The link to the video can be found at: https://youtu.be/-oKkRooytws .

18.
Otolaryngol Head Neck Surg ; 161(1): 150-156, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30857467

RESUMO

OBJECTIVE: To compare endoscopic and microscopic pediatric stapes surgery. STUDY DESIGN: Case series with chart review. SETTING: Two academic otology practices. SUBJECTS AND METHODS: Surgical and hearing outcomes were compared for consecutive children (<18 years) undergoing microscopic and endoscopic stapes surgery. The main outcome measure was closure of the air-bone gap (ABG) to ≤20 dB. RESULTS: Twenty-two endoscopic surgeries (17 stapedectomies, 4 stapedotomies, and 1 stapes mobilization) and 52 microscopic surgeries (30 stapedectomies, 19 stapedotomies, and 3 stapes mobilizations) were performed. Patient demographics, history of ipsilateral middle ear surgery, and revision stapes surgery status were similar. The most common diagnosis for the endoscopic group and microscopic group were congenital stapes footplate fixation (45.5%) and juvenile otosclerosis (46.2%), respectively. Preoperative ABGs in the endoscopic (37.7 dB) and microscopic (32.8 dB) groups (P = .170) were similar. There were no major complications, including facial nerve injury or anacusis, in the endoscopic group. Postoperative sensorineural hearing loss (>15 dB) did not occur in any patients in the endoscopic group but was present in 2 patients in the microscopic group (P = .546). Improvement in pure-tone average (25.9 dB vs 18.5 dB, P = .382) and ABG (21.7 dB vs 14.7 dB, P = .181) was similar, and postoperatively, the median ABG was 11.3 dB and 15.0 dB for endoscopic and microscopic cases (P = .703), respectively. ABG closure to ≤20 dB (72.7% vs 65.2%, P = .591) was also similar. CONCLUSION: Pediatric endoscopic stapes surgery is safe and hearing outcomes are similar to the microscopic approach when performed by experienced endoscopic ear surgeons.


Assuntos
Endoscopia/métodos , Microcirurgia/métodos , Otosclerose/cirurgia , Cirurgia do Estribo/métodos , Adolescente , Criança , Feminino , Testes Auditivos , Humanos , Masculino , Estribo/anormalidades
19.
Plast Reconstr Surg ; 143(5): 1498-1512, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30807496

RESUMO

The field of facial paralysis requires the reconstructive surgeon to apply a wide spectrum of reconstructive and aesthetic principles, using a comprehensive array of surgical tools, including microsurgery, peripheral nerve surgery, and aesthetic facial surgery on the road to optimize patient outcomes. The distinct deficits created by different anatomical levels of facial nerve injury require a fundamental understanding of facial nerve anatomy. Palsy duration, followed by location and mechanism, will determine mimetic muscle salvageability, by means of either direct repair, grafting, or nerve transfers, whereas longer palsy durations will necessitate introducing a new neuromuscular unit, whether by muscle transfer or free functional muscle transplant. A thorough history, physical examination, and basic understanding of ancillary studies, emphasizing palsy duration, location, and mechanism of injury, are critical in evaluation, prognostication, and treatment strategies in traumatic facial palsy patients. The importance of ancillary and aesthetic procedures cannot be overstated. Although these do not provide motion, they constitute essential tools in the treatment of facial paralysis, providing both protective and improved aesthetic outcomes, yielding the highest impact in final surgeon and patient satisfaction, bringing our patients to smile not only on the outside, but also on the inside.


Assuntos
Músculos Faciais/transplante , Traumatismos do Nervo Facial/cirurgia , Nervo Facial/transplante , Paralisia Facial/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Doença Aguda/epidemiologia , Doença Aguda/terapia , Adulto , Doença Crônica/epidemiologia , Doença Crônica/terapia , Músculos Faciais/inervação , Traumatismos do Nervo Facial/complicações , Traumatismos do Nervo Facial/epidemiologia , Paralisia Facial/diagnóstico , Paralisia Facial/epidemiologia , Paralisia Facial/etiologia , Retalhos de Tecido Biológico/transplante , Humanos , Incidência , Masculino , Sorriso , Fatores de Tempo , Resultado do Tratamento
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