Daniel H. Coelho

Partial and double-array implantation of the ossified cochlea.

Objective: To review our experience with partial standard and double-array cochlear implantation in the ossified cochlea. Study Design: Retrospective case review. Setting: Tertiary referral center. Patients: Twenty cochleae in 19 adult and pediatric patients with ossified cochleae. Intervention(s): Patients underwent either partial insertion of a standard electrode array or double-array electrode insertion for their cochlear implantation. Main Outcome Measure(s): Number of electrodes inserted, number of active electrodes at follow-up, and open-set speech performance. Results: Twelve patients (four children and eight adults) had partial insertion of standard array electrode. The mean number of electrodes inserted and active at follow-up was 14.8 and 11.3, respectively. Eight patients (four children and four adults) had a double-array electrode implanted. The mean number of electrodes inserted and active at follow-up was 18.1 and 16.3, respectively. Open-set speech recognition was better in children regardless of duration of deafness. There were no complications. Conclusion: These findings suggest that the double array allows for more usable electrodes than in partially inserted cochlear implant. Compared with adults, children with ossified cochlea do well both in partial standard and double-array insertion. Both insertion techniques are safe, with no complications occurring in our patients. Straight and double arrays should be available in the operating suite for any patient in whom suspected cochlear ossification is confronted.

Implanting common cavity malformations using intraoperative fluoroscopy.

To describe a safe and effective technique for the implantation of common cavity cochleae. Study Design: Retrospective case review. Setting: Tertiary referral center. Patients: Fifteen cochleae in 9 adults and children with common cavity deformities implanted with and without the use of intraoperative fluoroscopy. Intervention(s): Fluoroscopically assisted cochlear implantation. Main Outcome Measure(s): Rates of extracochlear placement, bending, kinking, intrameatal placement, and complications were analyzed. Numbers of electrodes inserted, number of active electrodes, and speech performance were compared between the 2 groups. Results: Half of the nonfluoroscopy group had suboptimal placement of their electrode arrays. This group also had a higher rate of complications, lower numbers of electrodes implanted, and lower number of active electrodes at follow-up. Results of speech perception testing suggest that fluoroscopically assisted implantation of the common cavity results in improved performance. Conclusion: Intraoperative fluoroscopy is an easy, safe, and effective technique that results in improved outcomes for cochlear implant patients with common cavity deformities.

Comprehensive Management of Presbycusis Central and Peripheral

The prevailing otolaryngologic approach to treatment of age-related hearing loss (ARHL), presbycusis, emphasizes compensation of peripheral functional deficits (ie, hearing aids and cochlear implants). This approach does not address adequately the needs of the geriatric population, 1 in 5 of whom is expected to consist of the “old old” in the coming decades. Aging affects both the peripheral and central auditory systems, and disorders of executive function become more prevalent with advancing age. Growing evidence supports an association between age-related hearing loss and cognitive decline. Thus, to facilitate optimal functional capacity in our geriatric patients, a more comprehensive management strategy of ARHL is needed. Diagnostic evaluation should go beyond standard audiometric testing and include measures of central auditory function, including dichotic tasks and speech-in-noise testing. Treatment should include not only appropriate means of peripheral compensation but also auditory rehabilitative training and counseling.

A century of citation classics in otolaryngology–head and neck surgery journals revisited

Citation classics have traditionally been defined in the smaller medical specialties as any article published in a peer‐reviewed journal that has received 100 or more citations from other articles also published in peer‐reviewed journals. This study aimed to determine patterns of citation classics changes in the medical field otorhinolaryngology and head and neck surgery (OHNS) over the past decade and serves as a follow‐up to an original study published in 2002, “A Century of Citation Classics in Otolaryngology–Head & Neck Surgery.”

Minimally Invasive Surgery for Osseointegrated Auditory Implants A Comparison of Linear versus Punch Techniques

Objectives (1) To describe the benefits of the minimally invasive punch technique without soft tissue reduction (PT) for the placement of percutaneous osseointegrated auditory implants. (2) To compare and contrast techniques and outcomes from PT with the linear technique with soft tissue reduction (LT). Study Design Case series with chart review Setting Performed at a tertiary otology practice at an academic medical center. Subjects and Methods LT was used until 2012 when a switch was made for all patients to PT. Preoperative variables recorded included age, sex, BMI, smoking status, indication, device selected, and abutment length. Outcomes measures included surgical time, skin reaction grading by Holgers score at 1 week and at most recent follow-up, and any other complications. Two-sample t test and χ2 was used to compare. Results A total of 51 patients (34 LT, 17 PT) were identified. Surgical time was found to be significantly shorter for the PT group (LT, 49.2 min; PT, 13.4 min; P < .001). There were no statistically significant differences between LT and PT for mean Holgers at first (LT, 0.24; PT, 0.47; P = .87) or final follow-up (LT, 0.62; PT, 0.41; P = .22). Conclusions The punch technique offers several potential surgical and cosmetic advantages over the linear technique without compromising skin-reactivity outcomes. This study supports a growing trend toward minimally invasive percutaneous auditory implant surgery.

ABR in the diagnosis of vestibular schwannomas: a meta-analysis.

PURPOSE The aim of this study is to rigorously evaluate the role of auditory brainstem response (ABR) testing in the diagnosis of vestibular schwannomas (VS). MATERIALS AND METHODS Searches were conducted in multiple online databases, supplemented by hand searches. From the studies chosen for final inclusion, relevant data were extracted and meta-analysis of pooled data was performed. RESULTS 623 studies were identified from which 43 met inclusion criteria for analysis (1978 to 2009) including 3314 patients. Pooled sensitivity for ABR detection of vestibular schwannomas was 93.4% (95% CI 92.6-94.3, P=0.0000). For tumors less than 1cm (8 studies, 176 patients) sensitivity was 85.8% (95% CI 80.6-90.1, P=0.0116). For tumors greater than 1cm (6 studies, 251 patients) pooled sensitivity was 95.6% (95% CI 93.1-98.2, P=0.0660). Sensitivity of ABR to detect extracanalicular tumors was higher than for intracanalicular tumors, though pooled data were not statistically valid. Pooled specificity (8 studies, 2432 patients) was 82.0% (95% CI 80.5-83.6, P=0.0000). CONCLUSIONS Although MRI remains the gold standard, emerging trends towards more conservative management coupled with limited financial resources may prompt many clinicians to review the role of ABR testing in screening for retrocochlear pathology. In light of the high sensitivity and specificity of ABR testing for VS, we strongly urge its reconsideration as a useful diagnostic tool for patients with clinically suspected VS.

Implanting Obstructed and Malformed Cochleae

Implantation of the ossified and dysplastic cochlea presents many unique challenges to both the surgeon and programming team. Altered embryology and physiology of these labyrinthine dysplasias may result in forms and functions unfamiliar to those casually involved with cochlear implants. Remarkable developments in diagnosis, surgical technique, electrode design, processing strategies, and programming have all contributed to the ability to successfully implant patient populations previously excluded from this life-changing intervention.

Small Vestibular Schwannomas With No Hearing: Comparison of Functional Outcomes in Stereotactic Radiosurgery and Microsurgery

Objectives: To date, numerous studies have compared functional outcomes between stereotactic radiosurgery (SRS) and microsurgery (MS) in the treatment of vestibular schwannomas (VS). However, most of them involve tumors of difference sizes, radiation dosages, and surgical approaches. Few have systematically compared issues of dysequilibrium. By studying only patients with small tumors and no hearing, we sought to minimize confounding variables.

Variability in the Management of Idiopathic Sudden Sensorineural Hearing Loss

Objectives. To evaluate current trends in the management of idiopathic sudden sensorineural hearing loss (ISSNHL), determine if variance in diagnostic and treatment protocols exists, and compare diagnostic and treatment strategies of ISSNHL between nonotologists/neurotologists (NONs) and otologists/neurotologists (ONs). Study Design. Cross-sectional survey of practicing otolaryngologists. Setting. Otolaryngology practices within the United States. Subjects and Methods. In January 2010, a survey was mailed to 500 NONs and 500 ONs. Data were collected and analyzed using χ2, standard deviations, and variance. Results. A variety and distribution of responses were seen in the definition of ISSNHL, including dB loss necessary for diagnosis, number of consecutive frequencies involved, and maximum duration of hearing loss. Differences in diagnostic tools were also seen, with 50.4% of respondents (NON 34.2%, ON 66.7%; P = .0001) always using magnetic resonance imaging in their workup. Of the total respondents, 26.7% (NON 35.0%, ON 18.3%; P < .0001) preferred oral steroids alone; 22.1% (NON 11.7%, ON 32.5%; P < .0001) preferred a combination of oral and intratympanic steroids. Of the respondents, 68.6% (NON 57.5%, ON 80.0%; P = .0003) would continue with additional treatment after partial response; 20.8% (NON 33.3%, ON 8.3%; P < .005) would retreat with oral steroids alone and 46.6% (NON 35.8%, ON 57.3%; P < .05) with intratympanic injections. Overall, 69.2% (NON 45.8%, ON 92.5%; P = .0001) were very comfortable managing ISSNHL. Conclusion. Significant differences exist in the diagnosis and treatment of ISSNHL. Such lack of uniformity highlights the need for strong evidence-based research—ultimately leading to formalized practice guidelines and educational outreach.

Posttraumatic olfactory dysfunction

Impairment of smell may occur following injury to any portion of the olfactory tract, from nasal cavity to brain. A thorough understanding of the anatomy and pathophysiology combined with comprehensively obtained history, physical exam, olfactory testing, and neuroimaging may help to identify the mechanism of dysfunction and suggest possible treatments. Although most olfactory deficits are neuronal mediated and therefore currently unable to be corrected, promising technology may provide novel treatment options for those most affected. Until that day, patient counseling with compensatory strategies and reassurance is essential for the maintenance of safety and QoL in this unique and challenging patient population.