Mitchell J. Ramsey

Superior semicircular canal dehiscence presenting as conductive hearing loss without vertigo.

Objective: The objective of this study was to describe superior semicircular canal dehiscence (SSCD) presenting as otherwise unexplained conductive hearing loss without vestibular symptoms. Study Design: Retrospective. Setting: Tertiary referral center. Patients: The study comprised 8 patients (10 ears), 5 males and 5 females aged 27 to 59 years. All 10 ears had SSCD on high-resolution computed tomography scan of the temporal bone. Diagnostic Tests and Results: All 10 ears had significant conductive hearing loss. The air–bone gaps were largest in the lower frequencies at 250, 500, and 1000 Hz; the mean gaps for these 3 frequencies for the 10 ears were 49, 37, and 35 dB, respectively. Bone-conduction thresholds below 2000 Hz were negative (−5 dB to −15 dB) at one or more frequencies in 8 of the 10 ears. There were no middle ear abnormalities to explain the air–bone gaps in these 10 ears. Computed tomography scan and laboratory testing indicated lack of middle ear pathology; acoustic reflexes were present, vestibular evoked myogenic potentials (VEMPs) were present with abnormally low thresholds, and umbo velocity measured by laser Doppler vibrometry was above mean normal. Middle ear exploration was negative in six ears; of these six, stapedectomy had been performed in three ears and ossiculoplasty in two ears, but the air–bone gap was unchanged postoperatively. The data are consistent with the hypothesis that the SSCD introduced a third mobile window into the inner ear, which in turn produced the conductive hearing loss by 1) shunting air-conducted sound away from the cochlea, thus elevating air-conduction thresholds; and 2) increasing the difference in impedance between the oval and round windows, thus improving thresholds for bone-conducted sound. Conclusion: SSCD can present with a conductive hearing loss that mimics otosclerosis and could explain some cases of persistent conductive hearing loss after uneventful stapedectomy. Audiometric testing with attention to absolute bone-conduction thresholds, acoustic reflex testing, VEMP testing, laser vibrometry of the umbo, and computed tomograph scanning can help to identify patients with SSCD presenting with conductive hearing loss without vertigo.

Corticosteroid treatment for idiopathic facial nerve paralysis: a meta-analysis.

Objective A meta‐analysis was designed to evaluate facial recovery in patients with complete idiopathic facial nerve paralysis (IFNP) by comparing outcomes of those treated with corticosteroid therapy with outcomes of those treated with placebo or no treatment.

Facial Nerve Grading System 2.0

Objective: To present an updated version of the original Facial Nerve Grading Scale (FNGS), commonly referred to as the House-Brackmann scale. Study Design: Controlled trial of grading systems using a series of 21 videos of individuals with varying degrees of facial paralysis. Results: The intraobserver and interobserver agreement was high among the original and revised scales. Nominal improvement is seen in percentage of exact agreement of grade and reduction of instances of examiners differing by more then one grade when using FNGS 2.0. FNGS 2.0 also offers improved agreement in differentiating between grades 3 and 4. Conclusion: FNGS 2.0 incorporates regional scoring of facial movement, providing additional information while maintaining agreement comparable to the original scale. Ambiguities regarding use of the grading scale are addressed.

Carcinoid Tumor of the Middle Ear: Clinical Features, Recurrences, and Metastases

Objective: Present four new cases of carcinoid tumor of the middle ear, two of which developed late recurrences and regional metastases. Review the literature to identify the clinical features, rate of recurrence, and incidence of metastasis of carcinoid tumor of the middle ear.

Postauricular periosteal-pericranial flap for mastoid obliteration and canal wall down tympanomastoidectomy.

Objective: To describe an effective technique for mastoid cavity obliteration in canal wall down tympanomastoidectomy for chronic otitis media and review its efficacy in producing a dry, low-maintenance, small mastoid cavity. Design: Retrospective clinical study of a consecutive series of procedures from 1995 to 2000. Setting: Tertiary referral center and institutional academic practice in otology and neurotology. Patients: Sixty consecutive procedures for active chronic otitis media with a minimum follow-up of 12 months (mean, 31 mo; range, 12–80 mo). Intervention: All patients had canal wall down mastoidectomy with simultaneous tympanoplasty including split-thickness skin grafting. An inferiorly pedicled, periosteal-pericranial flap was used in conjunction with autologous bone pate to obliterate the mastoid cavity. The additional length provided by the pericranial extension of the flap permitted it to reach superior to the lateral canal and into the sinodural angle, with improved coverage of bone pate and better reduction of cavity size. Outcome Measures: The primary outcome measure was control of suppuration and creation of a dry, low-maintenance mastoid cavity, which was assessed using a previously developed semiquantitative scale. This scale includes a temporal dimension to assess control of infection. Secondary outcome measures included postoperative complications (i.e., hematoma, infection, flap necrosis, and meatal stenosis) and incidence of recurrent or residual cholesteatoma. Results: Forty-nine ears (82%) maintained a small, dry, healthy mastoid cavity. Five ears (8%) had intermittent otorrhea easily controlled by topical treatment. Six ears (10%) had suboptimal control of otorrhea, of which four had meatal stenosis. There were no residual or recurrent cholesteatomas. Outcomes remained stable over progressively longer follow-up, up to 80 months. Conclusion: Obliteration of a canal wall down mastoid cavity by a postauricular periosteal-pericranial flap with autologous bone pate is a reliable and effective technique that results in a dry, trouble-free mastoid cavity in 90% of patients with active chronic otitis media.

Saline Irrigation in the Prevention of Otorrhea After Tympanostomy Tube Placement

Objectives: Comparison of intraoperative saline irrigation to otic drops in the prevention of postoperative otorrhea in children with middle ear effusion undergoing bilateral myringotomy with ventilation tubes.

Telehealth and Humanitarian Assistance in Otolaryngology

A significant worldwide need exists for humanitarian assistance in the specialty of otolaryngology. The field of telehealth has provided applications that have successfully expanded access to care in many fields of medicine, in both developed and developing countries. Collaboration, planning, and persistence are essential to developing successful telehealth applications. This article describes the need for otolaryngologic specialty care, current humanitarian outreach within the field of otolaryngology, and examples of successful programs that incorporate telehealth in otolaryngology care.

Military Otolaryngology Resident Case Numbers and Board Passing Rates during the Afghanistan and Iraq Wars

Objective During the wars in Iraq and Afghanistan, the US military has continued to train medical residents despite concern that postgraduate medical education at military training facilities has suffered. This study compares the experience of otolaryngology residents at military programs with the experience of their civilian counterparts. Study Design Retrospective review. Setting Academic military medical centers. Subjects and Methods Resident caseload data and board examination passing rates were requested from each of the 6 Department of Defense otolaryngology residency programs for 2001 to 2010. The American Board of Otolaryngology and the Accreditation Council for Graduate Medical Education provided the national averages for resident caseload. National board passing rates from 2004 to 2010 were also obtained. Two-sample t tests were used to compare the pooled caseloads from the military programs with the national averages. Board passing rates were compared with a test of proportions. Results Data were available for all but one military program. Regarding total cases, only 2001 and 2003 showed a significant difference (P < .05), with military residents completing more cases in those years. For individual case categories, the military averages were higher in Otology (299.6 vs 261.2, P = .033) and Plastics/Reconstruction (248.1 vs 149.2, P = .003). Only the Head & Neck category significantly favored the national average over the military (278.3 and 226.0, P = .039). The first-time board passing rates were identical between the groups (93%). Conclusion Our results suggest that the military otolaryngology residency programs are equal in terms of caseload and board passing rates compared with civilian programs over this time period.

Incidence of carcinoma in tonsil asymmetry

mance. Temporal bone imaging can define the relationship of the FMT to the promontory, oval window niche, and incus, but it is unable to accurately define the axis of the FMT. Conclusions: Surgical placement of the Vibrant Soundbridge can be complicated by the anatomic variation of the temporal bone. These variations, however, did not prevent successful placement of the device. While temporal bone imaging techniques are helpful, they are limited by the size of the FMT and by the fact that the stapes cannot always be imaged accurately enough to provide a reliable point of reference.

The Pacific Island Health Care Project: Utilization of Otolaryngology and Impact on Graduate Medical Education

Objectives: (1) Assess otolaryngology–head and neck subspecialist utilization within a large telemedicine program. (2) Examine the impact of that program on graduate medical education. Methods: A retrospective review of the Pacific Island Health Care Project records from 1998 to 2012 was performed to identify the number and type of telehealth consultations for patients with disorders of the head and neck. Consultations were categorized into diagnostic groups to evaluate referral patterns. Medical records from patients referred through the program were reviewed to determine the number and types of surgical procedures performed. Results: Four thousand telehealth consultations were sent to a single medical center with consultants representing all major medical and surgical subspecialties. A total of 730 teleconsultations were submitted for primary disorders of the head/neck, representing 18.3% of all consultations. The 3 most common reasons for teleconsultation included: benign or malignant head/neck mass (nonthyroid); thyroid mass; and cleft lip/palate. A total of 242 patients were referred for definitive surgical management. Seven hundred fifty-eight coded procedures were performed on those patients resulting in 383 key index procedures. Conclusions: Otolaryngology as a specialty is well suited for telemedicine applications. This study demonstrates a high utilization of otolaryngology indicating a high degree of referral feasibility and a high requirement for head and neck specialist consultation. This program had a large impact on graduate medical education, not only in terms of increased experience with complex patient care and operative case numbers, but also less tangible benefits relating to opportunities for residents to develop key competencies required for successful graduate medical training.