Larry B. Lundy

Prevalence of vestibular and balance disorders in children.

Objective: Determine the prevalence of vestibular and balance disorders in children, rate of complaints of imbalance, and odds ratio of related diagnoses. Patients and Methods: Retrospective review of pediatric health system during a 4-year period for International Classification of Diseases, 9th Revision, codes related to balance disorders. Identified records were searched for chief complaints related to balance and for codes of related otologic and neuro-otologic diagnoses. Results: A total of 561,151 distinct patient encounters were found. Unspecified dizziness was diagnosed in 2,283 patients (0.4%). Also, 22% presented with balance complaints. Peripheral disorders were diagnosed in 159, and central disturbances were diagnosed in 109 (prevalence < 0.0002%). Cumulative prevalence of diagnoses related to balance was 0.45% (2,546/561,151). Of all patients, 5,793 (1.03%) had chief complaint related to balance, and 2,076 (35.84%) were also diagnosed with vestibular disorder. Moreover, 38% with peripheral disturbances and 21% with central disturbances had balance complaints. Odds ratio of syncope was 21× higher than the general pediatric population in patients with unspecified dizziness, and sensorineural hearing loss was 43 times higher in those with peripheral vestibular disorders. In patients with central disorders headache was 16× higher (p < 0.05). Conclusion: The prevalence of balance disorders in children is low. Children diagnosed with these disorders typically do not present with chief complaint related to balance. Significant associations exist between sensorineural hearing loss, syncope, and headache in children diagnosed with balance disorders.

A comparison of the biocompatibility of three absorbable hemostatic agents in the rat middle ear

Absorbable gelatin sponge (Gelfoam) has been used for many years in middle ear surgery. Although the sponge is generally well tolerated, fibrosis occasionally forms in the mesotympanum; some studies indicated that the absorbable gelatin sponge may be responsible. Many of these studies lack statistical analysis. We prospectively studied three absorbable hemostatic agents in the middle ear of adult male Sprague-Dawley rats to determine which promotes fibrosis to the greatest degree: absorbable gelatin sponge (Gelfoam), absorbable gelatin sheet (Gelfilm), or absorbable collagen sheet (Instat). The materials were implanted in the middle ear through a post-auricular approach and the temporal bones were serially harvested at different time intervals so we could examine histologic changes. The nonimplanted ear served as surgical control. Examination of the specimens at 6, 8, and 10 weeks by light microscopy revealed that although absorbable gelatin film and collagen-absorbable hemostat are well tolerated in this animal model, absorbable gelatin sponge promoted the presence of fibrosis to a significantly greater degree, (p = 0.0344). We conclude that absorbable gelatin sponge promotes fibrosis more frequently than do collagen-absorbable hemostat and absorbable gelatin film in this animal model.

Retrospective analysis of outcomes after stapedotomy with implantation of a self-crimping Nitinol stapes prosthesis

OBJECTIVE: To review hearing results after implantation of a self-crimping stapes prosthesis. STUDY DESIGN AND SETTING: Analysis of hearing results in patients implanted with a self-crimping stapes prosthesis at two academic hospitals from 2000 to 2004. RESULTS: Seventy-nine ears were divided into short-term and intermediate follow-up groups. The mean postoperative air-bone gap (ABG), preoperative minus postoperative ABG, and preoperative minus postoperative bone conduction values were 5.7, 21.4, and 4.1 dB, respectively, for the short-term group, and 6.3, 22.3, and 4.7dB, respectively, for the intermediate group. The ABG was <10 dB in 88 percent of the short-term group and in 79 percent of the intermediate group. CONCLUSIONS: The self-crimping Nitinol stapes prosthesis provides excellent short-term and intermediate postoperative hearing results, and may overcome the limitations of stapes prostheses requiring manual crimping. SIGNIFICANCE: This paper provides evidence for the use of a self-crimping Nitinol stapes prosthesis, which may simplify hearing restoration surgery for stapes fixation.

Cartilage cap occlusion technique for dehiscent superior semicircular canals

Objective: Assessment of a cartilage cap occlusion of dehiscent superior semicircular canals via a transmastoid and tegmen mini-craniotomy approach surgical technique. Study Design: Retrospective case review. Setting: Tertiary referral center. Patients: Thirty-seven patients over a 2 year time period underwent cartilage cap occlusion of a dehiscent superior semicircular canal. Intervention: Therapeutic. Main Outcome Measure: Subjective improvement and/or resolution of dizziness postoperatively. Results: Of 37 patients, 29 (78%) felt much better and had resolution of their dizziness. Of 37 patients, 5 (14%) felt some definite improvement, although not complete resolution. Two patients (5%) felt their dizziness was neither better nor worse, and 1 patient (3%) felt dizziness was worse after surgery. Conclusion: The cartilage cap occlusion technique of dehiscent superior semicircular canals via a transmastoid and tegmen mini-craniotomy approach is a good option for managing symptomatic patients with a dehiscent superior semicircular canal.

Dizziness handicap after cartilage cap occlusion for superior semicircular canal dehiscence.

Objective To evaluate the change in self-reported dizziness handicap after surgical repair using the cartilage cap occlusion technique in cases of superior canal dehiscence (SCD). Study Design Repeated measures, retrospective chart review. Setting Tertiary referral center. Patients Twenty patients over a 2-year period who underwent surgical repair of SCD using the cartilage cap occlusion technique. Intervention Therapeutic. Main Outcome Measure Preoperative and postoperative Dizziness Handicap Inventory (DHI) questionnaires were completed (median, interquartile range). Results Preoperative (48, 28–56) and postoperative (33, 19–50) total scores were not significantly different. Scores for patients with moderate/severe preoperative DHI scores (DHI, >30; n = 14) demonstrated significant change (p = 0.001, Wilcoxon paired sample test), whereas those with mild scores did not (DHI, ⩽30; n = 6; p = 0.67). Conclusion Change in DHI score is variable. As described by DHI score, patients with higher preoperative handicap may demonstrate significant improvement after surgery, whereas those with mild handicap may not. These results are similar to previous reports and indicate that the cartilage cap occlusion technique may provide an alternative to middle fossa craniotomy approach for surgical management of symptomatic SCD.

Facial Nerve Schwannomas: Review of 80 Cases Over 25 Years at Mayo Clinic

OBJECTIVE To elucidate the long-term clinical behavior, treatment, and outcomes of sporadic facial nerve schwannoma (FNS) in a large cohort of patients managed in the post-magnetic resonance imaging era. PATIENTS AND METHODS Retrospective review at a single tertiary health care system (January 1, 1990, through December 31, 2015), evaluating 80 consecutive patients with sporadic FNS. RESULTS Ninety-eight patients with FNS were identified; 10 with incomplete data and 8 with neurofibromatosis type 2 were excluded. The remaining 80 patients (median age, 47 years; 58% women) were analyzed. Forty-three (54%) patients presented with asymmetrical hearing loss, 33 (41%) reported facial paresis, and 21 (26%) reported facial spasm. Seventeen (21%) exhibited radiologic features mimicking vestibular schwannoma, 14 (18%) presented as a parotid mass, and 5 (6%) were discovered incidentally. Factors predictive of facial nerve paresis or spasm before treatment were female sex and tumor involvement of the labyrinthine/geniculate and tympanic facial nerve segments. The median growth rate among growing FNS was 2.0 mm/y. Details regarding clinical outcome according to treatment modality are described. CONCLUSION In patients with FNS, female sex and involvement of the labyrinthine/geniculate and tympanic segments of the facial nerve predict a higher probability of facial paresis or spasm. When isolated to the posterior fossa or parotid gland, establishing a preoperative diagnosis of FNS is challenging. Treatment should be tailored according to tumor location and size, existing facial nerve function, patient priorities, and age. A management algorithm is presented, prioritizing long-term facial nerve function.

Small Fenestra Laser Stapedotomy

Educational objectives: To understand the indications and techniques of laser stapedotomy and to discuss the pros and cons of different laser modalities.