Edward E. Dodson

Nerve of Origin, Tumor Size, Hearing Preservation, and Facial Nerve Outcomes in 359 Vestibular Schwannoma Resections at a Tertiary Care Academic Center

Objective: To determine nerve of origin, tumor size, hearing preservation rates, and facial nerve outcomes in a retrospective cohort study of patients undergoing translabyrinthine (TL), middle cranial fossa (MCF), and retrosigmoid/suboccipital (SO) approaches to vestibular schwannomas (VS).

Tumor growth and audiometric change in vestibular schwannomas managed conservatively

Objective To prospectively define the correlation between changes in tumor volume and audiometric function in vestibular schwannomas managed conservatively.

Dizziness in the Elderly

Vertigo, unsteadiness, and other balance-related symptoms are common among older adults. These complaints should be taken seriously because they can lead to falls, injuries, loss of independence, and even death. This article provides a review of the underlying causes for the increased prevalence of dizziness with age, and discusses how specific test procedures may need to be modified for older individuals. Issues related to the management of these symptoms in the aging population are also considered.

Predictive Factors in Pediatric Stapedectomy

Objective/Hypothesis The objective of the study was to investigate predictive factors in the postoperative hearing outcomes in pediatric stapedectomy.

Melatonin: Can it Stop the Ringing?:

Objectives: We sought to report the efficacy of oral melatonin as treatment for chronic tinnitus and to determine whether particular subsets of tinnitus patients have greater benefit from melatonin therapy than others. Methods: This was a prospective, randomized, double-blind, crossover clinical trial in an ambulatory tertiary referral otology and neurotology practice. Adults with chronic tinnitus were randomized to 3 mg melatonin or placebo nightly for 30 days followed by a 1-month washout period. Each group then crossed into the opposite treatment arm for 30 days. The tests audiometric tinnitus matching (TM), Tinnitus Severity Index (TSI), Self Rated Tinnitus (SRT), Pittsburgh Sleep Quality Index (PSQI), and Beck Depression Inventory (BDI) were administered at the outset and every 30 days thereafter to assess the effects of each intervention. Results: A total of 61 subjects completed the study. A significantly greater decrease in TM and SRT scores (p < 0.05) from baseline was observed after treatment with melatonin relative to the effect observed with placebo. Male gender, bilateral tinnitus, noise exposure, no prior tinnitus treatment, absence of depression and/or anxiety at baseline, and greater pretreatment TSI scores were associated with a positive response to melatonin. Absence of depression and/or anxiety at baseline, greater pretreatment TSI scores, and greater pretreatment SRT scores were found to be positively associated with greater likelihood of improvement in both tinnitus and sleep with use of melatonin (p < 0.05). Conclusions: Melatonin is associated with a statistically significant decrease in tinnitus intensity and improved sleep quality in patients with chronic tinnitus. Melatonin is most effective in men, those without a history of depression, those who have not undergone prior tinnitus treatments, those with more severe and bilateral tinnitus, and those with a history of noise exposure.

Growth of benign and malignant schwannoma xenografts in severe combined immunodeficiency mice

Objectives: Models for the development of new treatment options in vestibular schwannoma (VS) treatment are lacking. The purpose of this study is to establish a quantifiable human VS xenograft model in mice.

Does packing the eustachian tube impact cerebrospinal fluid rhinorrhea rates in translabyrinthine vestibular schwannoma resections

Objective: To calculate cerebrospinal fluid (CSF) leak rates for translabyrinthine (TL), middle cranial fossa (MCF), and retrosigmoid/suboccipital (SO) craniotomies performed for removal of vestibular schwannoma (VS) and analyze whether packing the eustachian tube (ET) in TL VS resections impacts CSF rhinorrhea rates. Study Design: Retrospective. Setting: Tertiary care center. Methods: Chart review. Results: Three hundred fifty-nine VS resections were reviewed in 356 patients ranging from 10 to 86 years of age. Two hundred thirty-one TL, 70 MCF, 53 SO, and 5 combined TL/SO procedures were analyzed. Total CSF leak rates (incisional, otorrhea, and rhinorrhea) were 14.2% for TL, 11.4% for MCF, and 13.2% for SO approaches. Differences in overall CSF leak rates were not statistically significant. For those who underwent TL craniotomies, 2 groups of patients were identified based on whether their ETs were packed during surgery. In 1 group, the incus was removed, the aditus enlarged, the ET packed, and the middle ear filled with muscle. In the second group, the aditus, epitympanum and middle ear were packed without removing the incus, and the ET was not packed. Of 148 patients who had their ET packed, 12 developed CSF rhinorrhea (8.1%). The CSF rhinorrhea rate for patients who did not have ET packing was 5.9% (3 of 51 patients). This difference was not statistically significant (p = 0.80). When Proplast was used to pack the ET (121 patients), the CSF rhinorrhea rate was 5.8%. Unfortunately, this material extruded in 4 of 121 patients (3.3%) and presented clinically as delayed purulent otorrhea. Conclusion: Cerebrospinal fluid leak rates were similar in patients undergoing TL, SO, and MCF approaches, and CSF rhinorrhea was not decreased by ET packing. Patients whose ETs are packed with Proplast are at risk for extrusion and otorrhea years after their initial VS resection.

Positive Outcomes and Surgical Strategies for Bilateral Cochlear Implantation in a Child With X-Linked Deafness

Objectives: To recognize that bilateral cochlear implantation (CI) in X-linked deafness is safe, describe techniques to maximize successful electrode placement and minimize surgical risks, and recognize that normalization of hearing as well as language acquisition is achievable. Methods: A 6-month-old male patient presented with bilateral profound sensorineural hearing loss and was confirmed to have X-linked deafness secondary to POU3F4 gene mutation. Due to lack of benefit from amplification, he underwent bilateral CI in a staged fashion at 12 (right) and 15 months (left) of age. A transmastoid-facial recess approach was used bilaterally utilizing perimodiolar electrodes. High-flow gushers were controlled with muscle plugs. C-arm fluoroscopy was used during insertion of electrodes. Results: Follow-up data are available for 12 months. No complications were encountered, including no postoperative cerebrospinal fluid (CSF) leakage or facial stimulation. Postoperative audiograms in aided conditions showed hearing thresholds <40 dB. At 11 months following activation of his second CI, he scored in the normal range for his chronological age on standardized language measures. Conclusion: With careful preparation and the assistance of intraoperative fluoroscopy, CI in patients with congenital X-linked deafness can be done safely. Performing bilateral CI followed by dedicated auditory-verbal rehabilitation may allow patients to achieve normal language development.

Positive Outcomes and Surgical Strategies for Bilateral Cochlear Implantation in a Child with X-Linked Deafness

Objectives: (1) Recognize that bilateral cochlear implantation (CI) in X-linked deafness is surgically feasible and safe. (2) Recognize that improvement in hearing as well as language acquisition is an achievable goal. Methods: This is a retrospective case review at a tertiary care center of one patient who presented with bilateral profound sensorineural hearing loss at age 6 months. He lacked auditory brainstem responses in both ears and was confirmed to have congenital X-linked deafness secondary to POU3F4 gene mutation. Because of lack of benefit from amplification, he underwent bilateral CI in a staged fashion at 12 (right ear) and 15 months (left ear) of age. Results: The patient underwent transmastoid-facial recess approach and received Nucleus Freedom implants (Cochlear Ltd) in both ears, utilizing perimodiolar electrodes. High-flow gushers were encountered bilaterally and resolved with temporalis muscle plugs. C-arm fluoroscopy was used during insertion of electrodes in both ears. Follow-up data were available for 12 months. No complications were encountered, including no postoperative CSF leakage or facial stimulation. Postoperative audiograms in aided conditions showed hearing thresholds <40 dB. At 11 months following activation of his second CI, he scored in the normal range for his chronological age on standardized language measures, the Receptive Expressive Emergent Language Test-3 and the Preschool Language Scale-5. Conclusions: With careful preparation and the assistance of intraoperative fluoroscopy, cochlear implantation in patients with congenital X-linked deafness can be done safely. Performing bilateral CI followed by dedicated auditory-verbal rehabilitation may allow patients to trend toward normal language development.

Transmastoid Approach to Spontaneous Temporal Bone CSF Leaks: Hearing Improvement and Success of Repair

Objectives: 1) Recognize that transmastoid repair of spontaneous CSF leaks is safe and effective. 2) Recognize that improvement in conductive hearing loss is an achievable goal with this approach. Methods: This is a retrospective case review at a tertiary academic medical center of 17 consecutive patients (18 ears) who presented with spontaneous temporal bone CSF leaks over an 8-year period. Clinical data, imaging, audiometry, operative reports, and postoperative course were reviewed. The primary outcome was success of the repair. The secondary outcome was hearing preservation. Results: Median age was 57.5 years. Mean body mass index was 39.27mg/kg2. All presented with chronic otorrhea after tympanostomy tube placement and conductive/mixed hearing loss. The mean preoperative air-bone gap was 19dB. A transmastoid approach alone was used in 17 cases; 1 underwent middle fossa craniotomy approach. Defects were located over the tegmen mastoideum and tegmen tympani. Most repairs used autologous mastoid bone, temporalis fascia, and tissue sealant. Primary surgical repair was successful in 17 cases; 1 patient with persistent postoperative otorrhea subsequently underwent middle fossa craniotomy, but no frank leakage was found. No complications were encountered. The average improvement in postoperative air-bone gap was 12dB. Closure of the air-bone gap to <10dB occurred in over 80% of the cases. Conclusions: The transmastoid approach for repair of temporal bone CSF leak is safe and highly successful. Furthermore, the majority of patients in this series had excellent hearing results with closure of their air-bone gap to <10dB, which has not been previously described.