Gerd M. E. Claes

Skin reactions following BAHA surgery using the skin flap dermatome technique

The objectives of the study were to determine the incidence of skin reactions and complications associated with bone-anchored hearing aid (BAHA) implantation. The study is a retrospective case review done in a tertiary referral center. One hundred thirty-eight consecutive patients between 1998 and 2008 underwent implantation of a BAHA and were regularly seen for follow-up. Indications included conductive or mixed hearing loss where a hearing aid cannot be used and since 2000 also had contralateral single-sided perceptive hearing loss. BAHA implantation was done by creating a pedicled flap using the skin flap dermatome technique. Postoperative incidence of skin reactions and complications were measured. Significant postoperative complications requiring revision surgery occurred 37 times in 30 patients. Normal skin healing was seen in 52 patients (63.4%), while abnormal skin healing occurred in 30 patients (36.6%). This study showed that skin problems occur more often than expected. Because of the skin problems with the skin flap technique, the authors have switched to the linear incision technique, hoping to decrease the incidence of skin problems.

Lack of Diagnostic Value of High-Pass Noise Masking of Auditory Brainstem Responses in M??ni??re's Disease

Introduction: Different electrophysiologic tests were developed to ascertain or detect endolymphatic hydrops (ELH). Recently, Cochlear Hydrops Analysis Masking Procedure (CHAMP), a new auditory brainstem response (ABR) technique, proved to be able to separate normal controls from definite Ménières disease (MD) with 100% sensitivity and 100% specificity. Objective: To evaluate the applicability and diagnostic value of CHAMP in a series of MD and non-MD patients with otovestibular complaints. Study Design: An observational retrospective study. Setting: Tertiary referral centre. Patients: Forty-five patients, of which 28 patients had MD. Interventions: Cochlear Hydrops Analysis Masking Procedure test was conducted, and audiometric data and clinical information were collected. All responses were blindly evaluated and divided into three categories: (1) test suggestive for cochlear/ELH, (2) test within normal ranges, and (3) test not interpretable. Main Outcome Measures: Sensitivity and specificity, evaluation of diagnostic value. Results: Forty-nine percent of the tests were found to be not interpretable. Of the remaining responses, 13 tests were suggestive for ELH, and 16 tests were within normal ranges. This yields a sensitivity of 31% and a specificity of 28%. There was no significant difference between the mean latency difference (mean [SD]) for Wave V of the MD group (0.43 ms [0.37]) and the non-MD group (0.65 ms [0.44]). Using logistic regression analysis, we found that CHAMP test did not contribute to the ability to discriminate between hydropic and nonhydropic ears. Conclusion: In contrast to studies assessing CHAMP performance in Ménière patients and normal controls, the present study revealed this new test offers no discriminative value in differentiating Ménières from non-MD subjects with otovestibular symptoms.

Systematic review of the literature on Nitinol prostheses in surgery for otosclerosis : assessment of the adequacy of statistical power

Objective: To perform a systematic review of observational studies reporting hearing outcome in primary stapes surgery where a heat-crimping prosthesis was used. Data Sources: Medline, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, TRIP database, Clinical Trials Registry, ISI Web of Knowledge, and Web of Science. The search was performed on January 1, 2010, including articles published ahead of print. No language restrictions. Study Selection: Inclusion criteria for qualitative synthesis were a population of otosclerosis patients, intervention being primary stapes surgery with a nickel titanium alloy (Nitinol) heat-crimping prosthesis, and hearing outcome. Inclusion criteria for quantitative analysis: application of audiometry guidelines of the American Academy of Otolaryngology-Head and Neck Surgery Committee on Hearing and Equilibrium for evaluation of conductive hearing loss. Data Extraction: Strategy and reporting based on Cochrane, Quality of Reporting of Meta-analyses, and Meta-analysis of Observational Studies in Epidemiology statements. A bias assessment tool was developed according to Cochrane guidelines. Data Synthesis: A quantitative synthesis was performed, but because of the heterogeneity in postoperative follow-up periods and outcome measures reported, we were not able to pool these data. A sample size analysis was performed to indicate the sample needed to demonstrate a statistically significant difference in hearing outcome between both interventions. Hearing outcome superiority of the Nitinol heat-crimping prosthesis over manually crimping prosthesis types was not demonstrated. Conclusion: Superiority could probably not be demonstrated because of insufficient sample size. Research addressing technical improvements in stapes surgery should agree on a base sample size able to detect the smallest difference that is clinically important or accept the null hypothesis. With data gathered in the Common Otology Database as basis, a sample size of at least 413 patients is needed in both the intervention and the control group. Other clinical outcome measures also should be explored.

Erosion of the Long Process of the Incus in Revision Stapes Surgery: Malleovestibular Prosthesis or Incus Reconstruction With Hydroxyapatite Bone Cement?

Objective To study hearing outcome in revision stapedotomy cases where extensive erosion of the long process of the incus was observed in a consecutive series where a malleovestibular prosthesis was used versus a consecutive series where hydroxyapatite (HA) bone cement was used to rebuild the eroded long process of the incus and integrate the prosthesis. Patients Twenty revision cases of surgically treated otosclerosis where extensive incus erosion was observed during revision surgery. Intervention In the earlier consecutive series, 10 cases were treated with malleovestibular prostheses. In the later consecutive series, 10 cases were treated with HA bone cement to rebuild the incus-prosthesis interface. Main Outcome Measures Air-bone gap, bone-conduction thresholds, and air-conduction thresholds were evaluated preoperatively and at 1 to 3 months. Last audiometry available also was reported (median, 12 mo). Pure-tone averages were calculated according to the guidelines of the Committee on Hearing and Equilibrium for the evaluation of conductive hearing loss. Raw data were displayed in an Amsterdam Hearing Evaluation Plot. Results Six male patients and 14 female patients were included. Age varied from 34 to 75 years (median, 53 yr). The median postoperative air-bone gap at last follow-up audiometry was 15.6 in the malleovestibular prosthesis group and 13.1 dB in the HA bone cement group. No short-term or intermediate-term adverse reactions or unsuspected bone conduction deteriorations were seen. Conclusion HA bone cement can be successfully used to reconstruct the long process of the incus in case of extensive erosion of the long process. Intermediate-term hearing outcome is comparable to the outcome of a series of similar cases treated with malleovestibular prostheses. Because the placement of a malleovestibular prosthesis is technically more difficult and presents a high risk to the inner ear, we think HA bone cement can be a useful alternative in these difficult cases.

Does ‘Cochlear Ménière’s Disease’ Exist? An Electrocochleographic and Audiometric Study

Introduction: According to current diagnostic criteria, patients exhibiting only cochlear symptoms without vertigo cannot be diagnosed with Ménière’s disease (MD). The recently reported Ménière’s Disease Index (MDI) combines audiometric and electrocochleographic parameters in a multidimensional measure correlating with the clinical degrees of MD. Materials and Methods: Twenty-one patients with hearing loss, tinnitus and aural fullness, but without vertigo, underwent transtympanic electrocochleography. Based on the previously reported formula, the MDI value for every patient was calculated. Results: Mean MDI value was 5.7 on a scale from 0 (mean value of non-MD patients) to 10 (mean value of definite MD patients). Conclusions: We can thus hypothesize that, based on audiometry and electrocochleography, ‘cochlear MD’ patients may represent a separate clinical entity with Ménière-like pathophysiology or underlying endolymphatic hydrops.

Accuracy of computer navigation in ENT surgery: the influence of the matching strategy

OBJECTIVE To measure the effect of 4 different matching strategies on the accuracy of computer navigation on the face and within the nose and rhinopharynx. DESIGN Survey. SETTING Laboratory study. SUBJECTS Six human cadavers studied within 24 hours of death. INTERVENTIONS A commercially available navigation system with infrared optical tracking was used for computer navigation on the face and within the nose of the subjects after matching with external fiducials or with 3 different configurations of anatomical landmarks. Navigation errors were measured and correlated to matching strategies and compared through statistical analysis. RESULTS Matching with external fiducials on the face results in smaller navigation error than matching with anatomical landmarks. The configuration of matching strategies with anatomical landmarks also significantly determines the accuracy of computer navigation, especially when different locations of accuracy measurement are considered. CONCLUSION Statistically significant findings have shown that the choice of a matching strategy is a major factor in the accuracy of computer navigation for ear, nose, throat surgery. Arch Otolaryngol Head Neck Surg. 2000;126:1462-1466