Christopher A. Schutt

The correlation between obesity, obstructive sleep apnea, and superior semicircular canal dehiscence: a new explanation for an increasingly common problem.

Objective To investigate rates of obesity and obstructive sleep apnea (OSA) in patients with a diagnosis of superior semicircular canal dehiscence (SSCD). Study Design Retrospective cohort study. Setting Two tertiary referral centers. Patients Thirty-one patients with SSCD were identified from patient records at Yale between January 1, 2003 and August 1, 2013 and from the University of Cincinnati between November 1, 2008 and November 1, 2013. The control cohort consisted of 100 consecutive adult patients who obtained high-resolution CT imaging of their temporal bones at Yale University for any reason. Interventions CT images were reviewed by two authors in double blind fashion and patient data was analyzed statistically. Main Outcome Measures Rates of OSA, body mass index (BMI), and presence of tegmental defects in patients with SSCD were compared to the control cohort. Results The 31 patients with SSCD demonstrated higher BMIs [SSCD avg. 31.62, standard deviation (SD) 8.6 vs. no SSCD 28.01, SD 6.3, P = 0.036], rates of OSA (SSCD 29.03% vs. no SSCD 7.00, P = 0.001), and rates of tegmental defects (SSCD avg. 64.5% vs. no SSCD 16%, P = 1.24 × 10−7), in comparison to the control cohort. SSCD was found in 6 of 100 consecutively reviewed adult CT scans and in 0 of 41 scans obtained in those under 17 years of age. Conclusions Patients with SSCD demonstrated higher BMIs, higher rates of OSA, and were more likely to have accompanying tegmental defects. These results may support a possible causality between increased intracranial pressure and the formation of superior semicircular canal dehiscence.

Cochlear implantation after resection of an intralabyrinthine schwannoma

Intralabyrinthine schwannomas are rare tumors of the distal ends of the cochlear and vestibular nerve. Their presence can be debilitating secondary to symptoms of hearing loss, vertigo, tinnitus, and imbalance. Currently, treatment to restore hearing in those who have become profoundly deaf is not attempted. Additionally, resection in patients with functioning hearing is rare, as the surgery assures deafness. We report the first case demonstrating the feasibility of resection of an intralabyrinthine schwannoma with immediate cochlear implantation. This technique addresses the patients hearing status by taking into account advancing technology, allowing for an improved quality of life.

The correlation between the vestibulo-ocular reflex and multi-focal ocular correction: implications for vestibular compensation.

PURPOSE An accurate vestibulo-ocular reflex is important for gaze stability, and is adaptable through modification, based on stable and repeated vestibular and visual feedback. The optical power of eye glasses changes the ocular rotation needed to view an object due to the prismatic effect. Depending on the diopter of a lens, eyes have to rotate through fewer or more degrees to correct for refractive change. We aim to determine how multifocal lenses, such as progressives, affect needed ocular rotation and ocular gain based on location of the lens in which an object is viewed. Differing ocular gains within the same field of vision will create non-stable visual feedback possibly delaying vestibular recovery. METHODS AND MATERIALS Needed ocular rotation, and ocular gain to view an object 30° lateral to midline were calculated across different points in the vertical axis of a representative progressive lens. RESULTS In a progressive lens with superior correction of +1 D and inferior correction of +5.5 D, needed ocular rotation to view an object 30° lateral to midline would differ by 4.015°, with difference in ocular gain of 0.1336, indicating a 13.027% change in ocular gain, based on superior verse inferior viewing. CONCLUSIONS Progressive lenses have variable areas of VOR gain. This lack of consistent vestibulo-visual feedback may lead to prolonged compensation time in patients with vestibular injury.

Immunological treatment options for locoregionally advanced head and neck squamous cell carcinoma.

Patients with squamous cell carcinoma of the head and neck (HNSCC) are usually treated by a multimodal approach with surgery and/or radiochemotherapy as the mainstay of local–regional treatment in cases with advanced disease. Both chemotherapy and radiation therapy have the disadvantage of causing severe side effects, while the clinical outcome of patients diagnosed with HNSCC has remained essentially unchanged over the last decade. The potential of immunotherapy is still largely unexplored. Here the authors review the current status of the art and discuss the future challenges in HNSCC treatment and prevention.

Temporoparietal fascia flap "sandwich" technique for repair of near-total traumatic auricle avulsion.

NA Laryngoscope, 126:826–828, 2016

Bilateral osteomas and exostoses of the internal auditory canal

Osteomas and exostoses are benign tumors of the bone that occur in the head and neck region but are rarely found within the internal auditory canal (IAC). In this report, we review the literature on bony lesions of the IAC and present two cases: one case of bilateral compressive osteomas and one case of bilateral compressive exostoses of the IAC.

Thirty-day morbidity and mortality following otologic/neurotologic surgery: Analysis of the national surgical quality improvement program

To determine the rate and timing of, as well as risk factors for, postoperative morbidity and mortality following otologic and neurotologic surgery.

The Impact of Dairy Consumption on Salivary Inoculum

Quantitative levels of harmful oral microbes present following complex surgical excisions of head and neck cancer are important since wounds are often contaminated through direct connection to the oral cavity and its flora. This possibility is especially important in irradiated patients who have decreased protective salivary function. In addition, high oral microbial levels increase and intensify oral mucositis leading to significant morbidity in patients treated with radiation therapy. One previously untested surgical teaching to decrease the bacterial inoculum present in the oral cavity is to counsel patients against consuming otherwise nutritious dairy products, as they are thought to coat the oral cavity with rate-limiting nutrients vital for bacterial growth. This risk may extend to individuals with chronic laryngeal penetration or aspiration, since salivary bacterial load might represent a lethal threat in the presence of marginal pulmonary reserve. A crossover study using six healthy adult volunteers and six patients who had previously undergone radiation therapy to an oropharyngeal primary site was performed. Saliva samples were quantitatively cultured in both groups with and without the consumption of dairy products at 1-h and 5-h intervals. Analysis of quantitative cultures demonstrated that the consumption of dairy products had no influence on bacterial levels present in previously radiated subjects and nonirradiated controls. Additionally, the consumption of dairy did not affect the composition of microbes present. Due to the lack of changes in both quantity and composition of oral bacteria seen in this study, patients would not benefit from the avoidance of dairy products.

Semicircular canal dehiscence among idiopathic intracranial hypertension patients

The cause of superior semicircular canal dehiscence (SSCD) is unknown. Because of a demonstrated association with tegmental defects and obesity, some have suggested idiopathic intracranial hypertension (IIH) could contribute by eroding the bone over the canal and resulting in SSCD. However, an association between IIH and SSCD has not previously been evaluated. Our objective was to evaluate an association between IIH and SSCD.

Posterior semicircular canal dehiscence secondary to jugular enlargement

Semicircular canal dehiscence is an important entity often presenting with symptoms of noise or pressure induced vertigo, autophony, aural fullness and conductive hearing loss. Due to its varied presentation and mimic of other otologic conditions its consideration is of increased importance. Within we report a case of right sided posterior semicircular canal dehiscence secondary to an enlarged and high jugular bulb. The results of this observation indicate a need for patients with auditory symptoms and high riding jugular bulbs to be evaluated for possible posterior semicircular canal dehiscence.