Darius Kohan

Reconstruction of congenital microtia-atresia: outcomes with the Medpor/bone-anchored hearing aid-approach.

Ideal surgery for congenital microtia-atresia would offer excellent cosmetic and hearing rehabilitation, with minimal morbidity. Classic approaches require multiple procedures, including rib cartilage harvest and aural atresia repair. Our facial plastic and otologic team approach incorporates a high-density porous polyethylene (Medpor, Porex Surgical, Newnan, GA) auricular framework, followed by single-stage bone-anchored hearing aid (BAHA) implantation. We evaluated the efficacy, safety, and morbidity of this 2-stage dual system approach. A prospective database of microtia patients was used to identify patients undergoing combined Medpor/BAHA auricular reconstruction and hearing rehabilitation between 2003 and 2006. The first stage involves placement of a Medpor framework beneath a temporoparietal fascia flap, followed by a second-stage procedure for lobule transposition and BAHA implantation. Twenty-five patients (28 ears) were evaluated. Aesthetic quality of the implants was excellent, with a high degree of framework detail visible, and a postauricular crease created in all patients. All patients were satisfied with the cosmetic result. There were no major Medpor complications such as infection, extrusion, loss of implant, or flap necrosis, and a 10.7% incidence of minor complications requiring operative revision. BAHA significantly improved hearing in all patients, with a complication rate of 31.8%, mainly skin overgrowth and cellulitis. The Medpor/BAHA dual plastic-otologic approach to microtia-atresia has produced excellent cosmetic results and hearing outcomes, which compare favorably to traditional microtia-atresia repair. This is a 2-stage aesthetic and functional protocol with an acceptably low rate of complications, which safely and efficiently achieves both aesthetic and functional goals.

Single-stage BAHA implantation in adults and children: Is it safe?

Objective Most surgeons perform pediatric bone-anchored hearing aid (BAHA) implantation in two stages. This study examined the safety and efficacy of single-stage BAHA implantation in adults and children. Methods Retrospective review of 32 ears: 18 pediatric (ages 6 to 13 years) and 14 adult patients who underwent single-stage BAHA surgery between 2002 and 2006. Results A total of eight (25%) ears experienced complications. Overall, four (13%) ears required revision in the operating room. In the pediatric group, there were three (16.7%) ears with skin complications; two required operative revision. In the adult group, there were five (36%) ears with skin complications; two required operative revision. Conclusions In both adults and children, the single-stage technique for BAHA implantation is safe and efficient. All complications were related to skin reaction. Safety profiles for 1- and 2-stage surgery are similar, although the single-stage procedure is more cost effective, avoids a second procedure, and provides for earlier hearing rehabilitation.

Image-guided surgical navigation in otology.

To evaluate the efficacy of image‐guided surgical navigation (IGSN) in otologic surgery and establish practice guidelines.

Surgical management of complications after hearing aid fitting

Objectives: Standard procedures for hearing aid fitting performed in accordance with established guidelines are well tolerated, safe, and effective. In this article, we present unusual complications after hearing aid fitting that required surgical management.

Otologic disease in aids patients: Ct correlation

The contrast‐enhanced computed tomographic (CT) scans of the temporal bone and brain in 18 patients with otologic disease and acquired immunodeficiency syndrome (AIDS)1 were retrospectively reviewed. Seven scans revealed middle ear and mastoid disease; three scans were consistent with central nervous system (CNS) pathology; and eight scans demonstrated no abnormalities. CT scanning was found useful in localizing otopathology and diagnosing CNS toxoplasmosis, aural polyps, osteomyelitis, mastoiditis, and middle ear effusion due to hypertrophic lymphoid tissue. The authors conclude that AIDS patients with sensorineural hearing loss should undergo contrast‐enhanced brain CT scans to rule out CNS pathology; AIDS status does not alter criteria for CT scanning in patients with conductive hearing loss; and that images of the nasopharynx should be included on temporal bone CT scans of patients with conductive hearing loss in order to exclude eustachian tube obstruction by hypertrophic lymphoid tissue 1330

Otologic surgery in patients with HIV-1 and AIDS ☆ ☆☆

Otologic disease in patients infected with HIV occurs frequently and usually represents rhinologic disease and associated eustachian tube dysfunction rather than manifestations of HIV infection. As in all patients, the decision to operate on an HIV-infected individual who would benefit from major otologic surgery is a balance between the risks of the procedure and the possible benefits to the patient. Many concerns regarding wound infection and healing have been raised. The objective of this study is to evaluate the outcome of otologic procedures in this population. The charts of 9 men and 4 women were reviewed. Seven patients (54%) met the Centers for Disease Control and Prevention criteria for AIDS. Patients with chronic otitis media (46%) underwent tympanomastoidectomies, and the cases of acute mastoiditis (31%) were managed with simple mastoidectomies. Other procedures included repair of cerebrospinal fluid leak (15%) and stapedectomy (8%). Two patients had early complications and died during their hospitalizations. Three patients had prolonged hospital courses requiring long-term antibiotics. These 5 patients underwent urgent procedures and were severely immunocompromised. Of the remaining 8 patients only 2 had AIDS, and all had an uncomplicated postoperative course. Six of these patients were followed up for more than 1 year, and only 2 developed subsequent otologic disease.

Revision Stapes Surgery: The Malleus to Oval Window Wire-Piston Technique†

Objective To determine the effectiveness of the malleus to oval window wire‐piston revision stapes surgery technique.

Large jugular bulb abnormalities involving the middle ear.

Objective Jugular bulb abnormalities (JBA), such as jugular bulb diverticula (JBD) or large jugular bulbs, rarely present in the middle ear. We review a large series of temporal bone histopathologic specimens to determine their prevalence and present a series of cases of JB abnormalities involving the middle ear (JBME) that shed light on the probable mechanism for their development. Patients 1,579 unique temporal bone specimens and individuals with radiographically-diagnosed JBME. Intervention Histopathologic and clinical review of temporal bone specimens and patient presentations, radiographic findings, treatments and outcomes. Main Outcome Measure Shared characteristics of JBME. Results There were 17 cases of JBME in 1,579 temporal bone (1.1%), of which, 15 involved the inferior mesotympanum below the level of the round window membrane (RWM), whereas 2 encroached upon the RWM or ossicles. In addition, 4 clinical cases of large JBME extending above RWM were encountered; these occurred in both sexes with ages spanning from young to old (7–66 yr). They presented with conductive hearing loss (n = 3), ear canal mass (n = 1), and intraoperative bleeding (n = 1). Radiologically, they had multiple diverticula of the JB on the side with JBME, with 1 patient demonstrating growth on serial imaging studies. All patients who underwent additional imaging had marked hypoplastic contralateral transverse sinus. Conclusion JBME abnormalities are rare, present across age groups, and may demonstrate serial growth over time. They are usually associated with multiple other diverticula within the same JB. Our clinical series suggests that JBME’s development and uniquely aggressive behavior results from contralateral transverse sinus outflow obstruction.

Psychometric validity of the Cochlear Implant Function Index (CIFI): a quality of life assessment tool for adult cochlear implant users

Abstract Objective The Cochlear Implant Function Index (CIFI) is created to assess adult cochlear implant (CI) auditory effectiveness in real world situations. Our objective is to evaluate the CIFI as a reliable psychometric tool to assess 1) reliance on visual assistance, 2) telephone use, 3) communication at work, 4) ‘hearing’ in noise, 5) in groups, and 6) in large room settings. Study Design Based upon Guttman scaling properties, the CIFI elicits implanted respondents functional level with auditory independence from Level 1 (still requiring signing) to level 4 (without any help beyond CI). A blinded, retrospective questionnaire is anonymously answered by cochlear implant recipients. Setting CI centers of tertiary care medical centers, CI support group, and an interactive web page of a hearing and speech center in a large metropolitan region. Subjects 245 respondents from a varied adult CI population implanted for one month to 19 years prior to answering the questionnaire. Intervention An assessment tool of CI function. Main Outcome Measure A coefficient of reproducibility (CR) for the Guttman scale format equal or greater than 0.90, indicating good scalability. Results CR in the CIFI was above 0.90. Effective scalability and mean scores from 2.5 to 3.5 for the six areas examined (1.00−4.00) were achieved. Conclusion The psychometric properties of this user friendly survey demonstrate consistently good scalability. Based on these findings, the CIFI provides a validated tool that can be used for systematic comparisons between groups of patients or for follow-up outcomes in patients who use cochlear implants. Further study is indicated to correlate CIFI scores with sound and speech perception scores. Copyright

Sinus Disease in the Immunocompromised Host

Sinusitis in the immunocompromised person can be a fulminant or even fatal illness. Aggressive treatment with intravenous antibiotics and surgery is often warranted. We report 13 cases of sinusitis in immunocompromised patients who, having failed medical treatment, required surgical management of their sinus disease. Among the patients whose sinuses were cultured intraoperatively, 63% grew Staphylococcus aureus. Most of the patients showed improvement in their infections, and none had complications of surgery.