The Feasibility of Magnetic Resonance Imaging for the Differentiation of Cerebrospinal Fluid Leak From Middle Ear Effusion: A Quantitative Analysis.

OBJECTIVE: Assess quantitatively whether magnetic resonance imaging (MRI) signal intensity can be used to distinguish cerebrospinal fluid (CSF) leaks in the temporal bone from middle ear effusions. STUDY DESIGN: Retrospective case review. SETTING: Tertiary referral center. PATIENTS: Forty-nine patients, 18 with middle ear effusions (MEE), 30 with CSF leaks, and 1 with an MEE on one side and a CSF leak on the other, were evaluated in the study. Primary inclusion criteria for CSF leak patients were operative management of CSF leak with confirmatory diagnosis in follow-up. Primary inclusion criteria for MEE patients were electronic medical record documentation of an effusion with subsequent resolution on follow-up. For all patients, inclusion criteria included MRI imaging with 3D-T2 weighted sequences (3DT2) and fluid-attenuated inversion recovery (FLAIR) sequences performed within 1 year of diagnosis code entry. INTERVENTION: Computational analysis of signal intensity of fluid collections in MRI imaging. MAIN OUTCOME MEASURES: Sensitivity and specificity of 3DT2 and FLAIR signal intensity in the detection of CSF leak. RESULTS: For 3DT2 sequences with a chosen normalized signal intensity threshold (CSF leak if ≥ 0.5), sensitivity was 100% (95% CI: 86.3-100) and specificity was 83.3% (95% CI: 51.6-97.9). For FLAIR sequences with a threshold of 1.0 (CSF leak if < 1.0), sensitivity was 77.4% (95% CI: 58.9-90.4) and specificity was 85.7% (95% CI: 63.6-97.0). For a combined test in which a fluid collection was considered CSF if both 3DT2 ≥ 0.5 and FLAIR < 1.0, sensitivity was 76% (95% CI: 54.9-90.6) and specificity was 100% (95% CI: 73.5-100).

Middle Cranial Fossa Approach to Vestibular Schwannoma Resection in the Older Patient Population.

OBJECTIVE: Compare outcomes of middle cranial fossa approach (MCF) to vestibular schwannoma (VS) resection in patients 60 years of age and older to patients under 60. STUDY DESIGN: Retrospective case series. SETTING: Tertiary referral center. PATIENTS: Charts of 216 consecutive VS patients over 18 years of age were reviewed to identify 67 patients who underwent MCF approach to VS resection between 2006 and 2017. INTERVENTION(S): Age at time of surgery. MAIN OUTCOME MEASURE(S): Measured outcomes included postoperative hearing results, facial nerve function, length of hospital stay, wound complications, cerebrospinal fluid leak, myocardial infarction, cerebrovascular accident, seizure, deep vein thrombosis, 30-day readmission, and return to operating room. RESULTS: Sixty-seven patients underwent VS resection via MCF approach including 16 patients > = 60 years (mean 64.4 SD 3.3) and 51 patients < 60 years (mean 45.7 SD 10.2). Between these two groups, there were no differences in sex, tumor laterality, tumor size (10.4 mm versus 9.8 mm, p = 0.6), or other demographic characteristics. Postoperatively, there were no differences between groups in complication rates. Rates of HB 1 or 2 facial nerve function were similar (93.8% versus 88.2%, p = 0.7) as were rates of maintenance of class A or B hearing (58.3% versus 44.4%, p = 0.7). CONCLUSIONS: Patients over 60 undergoing MCF for VS resection experienced similar rates of postoperative complications, facial nerve outcomes, and hearing preservation compared with younger patients. MCF for VS may be considered in the older population. Further research is warranted to evaluate appropriate limitations for this approach based on age.

Visual Speech Recognition: Improving Speech Perception in Noise through Artificial Intelligence.

OBJECTIVES: To compare speech perception (SP) in noise for normal-hearing (NH) individuals and individuals with hearing loss (IWHL) and to demonstrate improvements in SP with use of a visual speech recognition program (VSRP). STUDY DESIGN: Single-institution prospective study. SETTING: Tertiary referral center. SUBJECTS AND METHODS: Eleven NH and 9 IWHL participants in a sound-isolated booth facing a speaker through a window. In non-VSRP conditions, SP was evaluated on 40 Bamford-Kowal-Bench speech-in-noise test (BKB-SIN) sentences presented by the speaker at 50 A-weighted decibels (dBA) with multiperson babble noise presented from 50 to 75 dBA. SP was defined as the percentage of words correctly identified. In VSRP conditions, an infrared camera was used to track 35 points around the speaker's lips during speech in real time. Lip movement data were translated into speech-text via an in-house developed neural network-based VSRP. SP was evaluated similarly in the non-VSRP condition on 42 BKB-SIN sentences, with the addition of the VSRP output presented on a screen to the listener. RESULTS: In high-noise conditions (70-75 dBA) without VSRP, NH listeners achieved significantly higher speech perception than IWHL listeners (38.7% vs 25.0%, P = .02). NH listeners were significantly more accurate with VSRP than without VSRP (75.5% vs 38.7%, P < .0001), as were IWHL listeners (70.4% vs 25.0% P < .0001). With VSRP, no significant difference in SP was observed between NH and IWHL listeners (75.5% vs 70.4%, P = .15). CONCLUSIONS: The VSRP significantly increased speech perception in high-noise conditions for NH and IWHL participants and eliminated the difference in SP accuracy between NH and IWHL listeners.

Is Longer Surgery More Dangerous? Operative Duration Not Associated With Complications After Vestibular Schwannoma Resection.

OBJECTIVE: To examine the association between operative duration and complications after vestibular schwannoma (VS) surgery. STUDY DESIGN: Retrospective chart review. SETTING: Tertiary referral center. PATIENTS: One hundred forty-eight patients undergoing vestibular schwannoma resection in a single institution. INTERVENTION: Vestibular schwannoma resection. MAIN OUTCOME MEASURES: Operative duration, surgical approach, tumor size, and postoperative complications. RESULTS: Forty-one patients underwent middle cranial fossa (MCF) approach, 46 underwent translabyrinthine (TL) approach, and 61 underwent retrosigmoid (RS) approach. The mean operative duration overall was 407 minutes (MCF-339 min, TL-450 min, RS 420 min). When controlling for tumor size, there was no difference in procedure duration by approach (OR 0.92, CI 0.82-1.02, p=0.11).When controlling for approach, there was a significant increase in procedure duration by tumor size (OR 1.36, CI 1.23-1.50, p < 0.0001). Increased procedure duration was not associated with 30-day readmission (p = 0.82), cerebrospinal fluid leak (CSF) (p = 0.84), return to the operating room (p = 0.75), postoperative deep vein thrombosis (p = 1.0), postoperative stroke (p = 0.23), or postoperative wound complications (p = 0.70). Longer operative time was associated with increased hospital length of stay (p = 0.04). However, when controlling for tumor size and surgical approach, hospital length of stay was no longer associated with increased procedure duration (OR 1.15, CI 0.98-1.33, p = 0.3). CONCLUSION: Increased operative duration was associated with larger tumor size; however contrary to previous reports, increased operative duration was not associated with postoperative complications.