Harold H. Kim

Hearing aids : A review of what's new

OBJECTIVE: To review the recent innovations in hearing aid technology. STUDY DESIGN: Review of the literature. SETTING: Private tertiary referral otology/neurotology practice. RESULTS: Recent innovations including digital signal processing (DSP), directional microphone technology, and open mold hearing aid fitting have resulted in improved satisfaction with current hearing aids. CONCLUSION: Current hearing aid technology with its innovations better meet needs of individuals who are hard of hearing. SIGNIFICANCE: The image commonly held of hearing aids by the general public is a negative one that can be improved with greater education.

Trends in the diagnosis and the management of Meniere's disease : Results of a survey

OBJECTIVE: To determine the practices of the American Neurotology Society (ANS) membership in the evaluation and treatment of the Menieres patient. STUDY DESIGN: Prospective. INTERVENTION: Questionnaire. MAIN OUTCOME MEASURE: Respondents’ response to questions pertaining to the diagnostic and therapeutic practices in the management of Menieres disease. RESULTS: Three hundred members of ANS were mailed a 15-item questionnaire. Two hundred three responded, for a 67.7% response rate. For the diagnosis of Menieres disease, 1 in 3 practitioners relied solely on history, physical exam, and audiometry, whereas 2 in 3 relied in part on adjunctive tests, such as electrocochleography (ECOG) and electronystagmography (ENG). Two in 3 practitioners pursued retrocochlear studies on initial evaluation, with the overwhelming majority using MRI. In treating Menieres disease, conservative medical management was preferred. For medically recalcitrant Menieres disease, endolymphatic sac surgery (ESS) was the most commonly employed initial intervention (50%), followed by transtympanic gentamicin (38%). Currently, <10% routinely recommend the Meniett device. Eighty-three percent include ESS as a therapeutic option for medically recalcitrant Menieres disease. The vast majority continue to perform surgical labyrinthectomies and vestibular nerve sections for Menieres disease. CONCLUSIONS: Menieres disease continues to pose a difficult diagnostic and therapeutic problem, resulting in heterogeneous approaches to both evaluation and treatment. Despite the 1995 American Academy of Otolaryngology guidelines in the diagnosis of Menieres disease, most clinicians rely in part on ENG or ECOG in diagnosing Menieres disease. Furthermore, despite the passing of 20 years since the publications claiming a purely placebo effect, ESS is the most commonly employed initial surgical treatment for Menieres disease. (Otolaryngol Head Neck Surg 2005;132: 722-6.)

Should Ossicular Reconstruction Be Staged Following Tympanomastoidectomy

Objectives: To determine whether ossicular reconstruction (OCR) performed concurrent with tympanomastoidectomy for cholesteatoma results in significantly different hearing results when compared to OCR performed in a separate, staged procedure.

A Minimally Invasive Technique for the Implantation of Bone-Anchored Hearing Devices

Objective To describe and evaluate a novel technique for the implantation of bone conduction hearing devices as compared with a common, conventional technique. Study Design Case series with chart review. Setting Tertiary referral otology and neurotology practice. Methods Individuals who underwent the implantation of bone-anchored hearing devices between January 1, 2004, and December 31, 2011, were identified. Demographic data, surgical indications, surgical technique used, surgical time, and complications were recorded. Soft tissue complications were graded on the Holgers classification scheme. Group 1 was defined as those undergoing a traditional technique using a dermatome with subcutaneous tissue reduction. Group 2 was defined as those undergoing the described technique for implantation of the coupling hardware with minimal subcutaneous soft tissue reduction. Results Forty patients underwent the procedure, with 11 patients comprising group 1 and 29 patients comprising group 2. Group 2 required a shorter operative time (32.3 vs 56.1 minutes, P < .0001). Of patients in group 1, 2 of 11 developed soft tissue complications, whereas 5 of 29 in group 2 developed soft tissue complications (P = 1.000). Most soft tissue complications were reversed with conservative wound care. Conclusion Surgery was performed faster with similar postoperative outcomes in individuals undergoing implantation of bone-anchored hearing devices using the described technique that necessitated minimal soft tissue reduction.

Otoprotective Effects of Dexamethasone in the Management of Pneumococcal Meningitis: an Animal Study†

Objective: To determine whether treating pneumococcal meningitis with a combined antibiotic and steroid regime will prevent cochlear damage, a common pneumococcal meningitis side effect.

Long-Term Effects of Cerebellar Retraction in the Microsurgical Resection of Vestibular Schwannomas†

Objective: To determine the long‐term effects, if any, of the greater cerebellar retraction that is required for retrosigmoid vestibular schwannoma versus resection as compared with the minimal, if any, cerebellar retraction required for translabyrinthine versus resection.

Titanium mesh for functional reconstruction of the mastoid cortex after mastoidectomy.

Objective: To describe a rapid and effective means of reconstructing the mastoid cortex after mastoidectomy for chronic otitis media with and without cholesteatoma. Study Design: Retrospective. Setting: Tertiary referral otology clinic. Patients: Those undergoing tympanoplasty and mastoidectomy for chronic otitis media. Intervention: After tympanoplasty and mastoidectomy, the mastoidectomy defect was reconstructed using titanium mesh with subsequent closure as routine. Main Outcome Measures: Evaluation of soft-tissue ingrowth into the mastoid 12 to 24 months after surgery and clinical evaluation of the postauricular surgical site for accentuation of the postauricular sulcus. Results: In 99 patients, the mastoidectomy defect was reconstructed using titanium mesh. None was found to have pitting of the postauricular sulcus. One patient had partial extrusion of the mesh through the ear canal. No instance of wound infection was observed. Soft-tissue growth into the mastoid cavity was found to be minimized. Conclusion: Titanium mesh is a rapid and effective means of minimizing soft-tissue ingrowth into the mastoid and preventing accentuation of the postauricular sulcus after mastoid surgery.

Cochlear Preservation After Meningitis: An Animal Model Confirmation of Adjunctive Steroid Therapy†

Objective/Hypothesis: The objective of the present study was to determine whether treating pneumococcal meningitis with a combined antibiotic and steroid regime will prevent cochlear damage, a common pneumococcal meningitis side effect.

PREFERRED TECHNIQUE IN OSSICULOPLASTY

Conductive hearing loss of up to 60 dB SL can result from ossicular discontinuity in the presence of an intact tympanic membrane. Reconstruction of the ossicular chain can be curative with preference being given to autologous products. For those cases where reconstruction with autologous products is not possible, synthetic prosthesis is necessary. Ossicular prostheses vary in regards to the construction material. The three most commonly used ossicular prostheses are derived from high density polyethylene sponge, hydroxyapatite, and titanium. This article reviews our techniques in ossicular reconstruction utilizing prosthetic products and reviews the literature regarding postoperative outcomes.

Management of early-stage Hodgkin's lymphoma. The radiation oncology experience at Northwestern University/Northwestern Memorial Hospital.

Early-stage Hodgkins lymphoma patients treated with radiotherapy alone or combined modality therapy were retrospectively analyzed for survival, patterns of failure, salvage, and toxicity. Of 75 evaluable patients, 47 were given radiotherapy alone and 28 were given combination radiotherapy and chemotherapy. Of the patients studied, 26 were clinical stage I and 49 were clinical stage II, with nine patients upstaged at laparotomy. Minimum follow-up was 2 years, with a median of 81 months. Complete response rate was 95%. Relapse-free survival and overall survival were 89% and 96%, respectively, at 2 years; 78% and 86% at 5 years; and 76% and 82% at 10 years. Of 16 patients who relapsed (21%), 13/47 patients were treated with radiotherapy and 3/28 were treated with combined modality therapy. Salvage rates were higher in those treated with radiotherapy alone. There were 13 deaths: six from disease, two from treatment-related complications, and five from second primary malignancies. There was a higher incidence of second malignancies and deaths due to complication in patients treated with combined modality therapy. Radiotherapy alone or with chemotherapy is an effective modality in the treatment of Hodgkins lymphoma. Treatment should be selected properly to optimize results and decrease complications.