Robert A. Battista

Early results with titanium ossicular implants

Objective To report the efficacy of titanium middle ear prosthesis for ossicular reconstruction. Study Design Retrospective chart reviews were performed for 25 patients who had undergone titanium ossicular implants between January 1, 1999, and June 1, 20001. Setting Tertiary otology referral center. Patients All patients had a minimum of 6 months of postoperative follow-up and no evidence of recurrent otologic disease. Intervention All patients had undergone ossiculoplasty using titanium middle ear implants. Main Outcome Measures Comparisons of preoperative and postoperative pure tone averages were performed. Air-bone gap closures and implant extrusion rates were measured. Results Overall mean pure tone averages improved 22.2 dB with air-bone gap improvement at 20.9 dB. Fifty-six percent of patients achieved air-bone gap less than 20 dB postoperatively. The overall extrusion rate was 4%. However, with the placement of cartilage graft interposed between the prosthesis and the tympanic membrane, no extrusion was observed. Conclusion Titanium implants provide comparable hearing improvement compared with other materials. The extrusion rate seems quite low if cartilage interposition graft is inserted. Its ease of handling, biocompatible properties, and sound conducting properties improve its efficacy as an ossicular implant.

Intratympanic dexamethasone for profound idiopathic sudden sensorineural hearing loss

OBJECTIVES: To determine hearing recovery by using intratympanic dexamethasone for profound, idiopathic sudden sensorineural hearing loss (ISSNHL). STUDY DESIGN AND SETTING : A prospective, clinical study was performed of 25 consecutive patients seen with profound ISSNHL. Patients received 4 intratympanic treatments of dexamethasone over the course of 2 weeks. Complete hearing recovery was defined as the final pure-tone average (PTA) within 10 dB of baseline. Partial recovery was defined as a final PTA with >50% hearing. The hearing in the contralateral ear was used as baseline. RESULTS : The average time to treatment was 28 days. Two patients had significant hearing recovery, and 1 additional patient had partial recovery. The 2 patients with significant hearing recovery were treated within 9 days of onset of hearing loss. CONCLUSIONS : By using the treatment protocol and definition of hearing recovery of this study, intratympanic dexamethasone does not result in significant hearing improvement for patients with profound ISSNHL. There is a possible trend for improved hearing results if intratympanic treatment is performed within 11 days of onset of hearing loss.

Audiometric findings of patients with migraine-associated dizziness.

Objective: The objective of this study was to determine whether the audiometric findings of migraine-associated dizziness could be used to better distinguish migraine-associated dizziness from Ménière’s disease. Study Design: A retrospective chart review. Setting: Tertiary, otology/neurotology practice. Patients: Two groups of patients were studied, a migraine-associated dizziness and a Ménière’s disease group. There were 76 and 34 patients in the migraine-associated dizziness and Ménière’s disease groups, respectively. Interventions: None. Main Outcome Measures: Initial and follow-up pure-tone average and low-frequency pure-tone average were recorded for both groups. Independent samples t tests were used to test for mean differences in pure-tone average and low-frequency pure-tone average. Results: Pure-tone average and low-frequency pure-tone average were significantly worse for patients in the Ménière’s disease group at both the initial and follow-up assessments. Three patients in the migraine-associated dizziness group had an elevated pure-tone average (≥26 dB) and/or low-frequency pure-tone average at initial and/or follow-up assessment. The remaining 73 migraine-associated dizziness patients had normal hearing. In the Ménière’s disease group, only two patients had a normal pure-tone average and low-frequency pure-tone average at both initial and follow-up evaluations. The hearing difference between the two groups was significant even when controlling for age and duration of dizziness symptoms. Conclusion: Audiometric findings of patients with migraine-associated dizziness are most often normal. Unlike Ménière’s disease, the sensorineural hearing loss in migraine-associated dizziness rarely progresses. These audiometric findings may help to distinguish migraine-associated dizziness from Ménière’s disease when diagnostic ambiguity exists between these two diagnoses.

Twenty-year review of revision stapedectomy

Objective To evaluate surgical findings and techniques, patient management techniques, and audiometric results of 522 revision stapedectomies. Study Design Retrospective chart review. Setting Tertiary otologic referral center. Patients A total of 522 revision stapedectomies over a 20-year period in Warren, Ohio, and Israel. The audiologic criterion for revision was an air-bone gap greater than 20 dB over the three-frequency range 0.5 to 2 kHz. Results Of the 522 revision cases, a total of 483 patients were operated on to improve hearing. The remainder of the patients were operated on for various other noted reasons. Closure of the air-bone gap to within 10 dB was achieved in 71% of patients (343 of 483). The mean pure-tone average improvement was 17.8 dB, with an average postoperative air-bone gap of 7.3 dB. The most common surgical findings were prosthesis malfunction at the oval window, incus, or both (58%). Since beginning the use of the Argon laser for surgical problems, the success rate has increased to 80%. A subgroup of 35 Argon laser revision stapedectomies resulted in a larger hearing gain (25.2 dB) and 91.4% closure of the air-bone gap to less than 10 dB. Conclusions More than 70% of revision stapedectomy cases for hearing improvement have had successful closure of their air-bone gap. Since the introduction of the laser 5 years ago, the success rate has increased to 80%. In those specific cases where the laser was required, the success rate increased to 91.4%. Regardless of the revision technique, hearing results were the least successful when the incus could not be used for reconstruction.

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.)

Gamma knife radiosurgery for vestibular schwannoma.

In 1951, Dr. Lars Leksell from Sweden conceived of what is now known as gamma knife radiosurgery (GKRS). Since Leksell first treated a patient who had a vestibular schwannoma in 1967, there has been a year-to-year increase in the number of patients treated with the gamma knife for vestibular schwannoma. This article outlines the technique of GKRS and discusses the current results of its use to treat vestibular schwannomas. Other topics discussed include tumor control, treatment of recurrent/residual and cystic vestibular schwannomas, and the results of treatment of neurofibromatosis type 2.

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.

Sound Localization in Unilateral Deafness With the Baha or TransEar Device

OBJECTIVE To evaluate the sound localization capabilities of patients with unilateral, profound sensorineural hearing loss who had been treated with either a bone-anchored hearing device (Baha BP100) or a TransEar 380-HF bone-conduction hearing device. STUDY DESIGN Nonrandomized, prospective study. SETTING Tertiary referral private practice. PATIENTS Patients with unilateral, profound sensorineural hearing loss treated with a BP100 (n = 10) or a TransEar (n = 10) device. Patients wore the hearing device for at least 1 month and had normal hearing in the contralateral ear. Ten patients with normal, bilateral hearing were used for control. INTERVENTIONS Sound localization of a 3-second recorded sound with and without a TransEar or Baha device was assessed using an array of 7 speakers at head level separated by approximately 45 degrees. The recorded sounds were that of a barking dog or a police siren. Randomized trials of 4 presentations per speaker were given for each hearing condition. MAIN OUTCOME MEASURES Sound localization was assessed by the accuracy in response and the generalized laterality of response. RESULTS The mean accuracy of speaker localization was 24% and 26% for the aided condition using the BP100 and TransEar devices, respectively. The mean accuracy of laterality judgment was 59% and 69% for the aided condition using the BP100 and TransEar devices, respectively. These results were only slightly better than chance. There was no statistical difference in localization accuracy or laterality judgment between the BP100 and TransEar groups. CONCLUSION Neither the BP100 nor the TransEar device improved sound localization accuracy or laterality judgment ability in patients with unilateral, profound sensorineural hearing loss compared with performance in the unaided condition.

THE BONE-ANCHORED HEARING DEVICE (BAHA)

Abstract The bone-anchoring hearing device (BAHA) is an osseointegrated system that is used for hearing rehabilitation through direct bone conduction. The indications for the BAHA include unilateral and/or bilateral conductive or mixed hearing loss, and unilateral profound sensorineural hearing loss. When used for unilateral profound sensorineural hearing loss, the BAHA acts as a bone conduction CROS (contralateral routing of off-side signal) device transmitting the signal from the deaf side through the skull to the contralateral cochlea. The surgical procedure to place the abutment and titanium screw is straightforward. In general, the satisfaction rate is very high for patients using the BAHA system.

A Technique to Prevent Cerebrospinal Fluid Leakage After Translabyrinthine Approach

INTRODUCTION Because of recent advances in microsurgical technique, th morbidity and mortality of acoustic neuroma surgery have dr matically fallen over the past several d cades. 7 However, despite these advances, cerebrospinal fluid ( SF) leak continu s to occur. A r cent large s ri s of acoustic neuroma cases documented an overall SF leak rate of 7%. CSF leak is not typically a lifethreat ning complication, but it does pr dispose the patient to an inc1·e sed risk of developing meningitis or brain absc ss. Various techniques have be n described to prevent SF leak after the translabyrinthine approach for acoustic neuroma r moval. The most commonly reported technique involves packing of the eustachian tube after opening the facial r cess. In this t chnique the incus is r mov d, the mucosa of the eustachian tube is scarified, and th eustachian tube is plugged with muscle, fat, Proplast, ossicles, or bone wax. The middle ear cavity is filled with muscle or fat tissue. • Fibrin glue or polytetrafluorthyl n has also b en use to prevent CSF leak. Pr vfously, the senior authors (R.J.w., R.A.B.) scarified the eustachian tube and middl ar mucosa and packed the ustachian tube with the incus, which was followed by packing the middl ear with muscle. The technique to prev nt SF leak has b en modified and the results of the modifi d technique are described. Th records of all patients with the diagnosis of an acoustic neuroma who w re referred to the Chicago Oto!-