Robert W. Jyung

Malpractice in otology.

Objective (1) Analyze otologic procedural malpractice litigation in the United States of America. (2) Discuss ways to prevent future malpractice litigation. Study Design and Setting Case series with record review. Methods The study is a case series with review of court records pertaining to otologic procedures using the Westlaw legal database. The phrase medical malpractice was searched with terms related to otology and neurotology obtained from the AAO-HNS website. Results Of the 47 claims that met inclusion criteria, 63.8% were decided in the physician’s favor, 25.5% were decided in the plaintiff’s favor (average payment

Direct manipulation is better than passive viewing for learning anatomy in a three-dimensional virtual reality environment

446,697), and 10.6% were settled out of court (average payment

Prevalence of Cochlear-Facial Dehiscence in a Study of 1,020 Temporal Bone Specimens.

372,607). Cerumen removal was the most common procedure leading to complaint (21.3%) and the most likely procedure to lead to payment (50.0%). Hearing loss was the most common injury claimed among all cases (53.2%) and resulted in a high proportion of cases that led to payment (40.0%). Other common alleged injuries were facial nerve injury (27.7%), tympanic membrane perforation (23.4%), need for additional surgery (42.6%), and lack of informed consent (31.9%). In addition, cases resulting from acoustic neuroma or stapedectomy resulted in higher payments to the plaintiffs (average

Cochlear-facial dehiscence--a newly described entity.

3,498,597 and

Reconstruction of cranial base defects using the Medpor Titan implant: cranioplasty applications in acoustic neuroma surgery.

2,733,000, respectively). Conclusions Malpractice trials were resolved in the defendant’s favor in the majority of cases. Cerumen removal was the most common procedure leading to complaint and the procedure most likely to result in payment. Hearing loss was the most common injury cited. Payment was highest in acoustic neuroma and stapedectomy cases.

Quantification of angiogenesis in otosclerosis.

Abstract With the advancement of virtual reality (VR) technologies, medical students may now study complex anatomical structures in three-dimensional (3-D) virtual environments, without relying solely upon high cost, unsustainable cadavers or animal models. When coupled with a haptic input device, these systems support direct manipulation and exploration of the anatomical structures. Yet, prior studies provide inconclusive support for direct manipulation beyond passive viewing in virtual environments. In some cases, exposure to an “optimal view” appears to be the main source of learning gains, regardless of participants’ control of the system. In other cases, direct manipulation provides benefits beyond passive viewing. To address this issue, we compared medical students who either directly manipulated a virtual anatomical structure (inner ear) or passively viewed an interaction in a stereoscopic, 3-D environment. To ensure equal exposure to optimal views we utilized a yoked-pair design, such that for each participant who manipulated the structure a single matched participant viewed a recording of this interaction. Results indicate that participants in the manipulation group were more likely to successful generate (i.e., draw) the observed structures at posttest than the viewing group. Moreover, manipulation benefited students with low spatial ability more than students with high spatial ability. These results suggest that direct manipulation of the virtual environment facilitated embodiment of the anatomical structure and helped participants maintain a clear frame of reference while interacting, which particularly supported participants with low spatial ability.

Lateral skull base Inflammatory pseudotumor: A systematic review

Objective: To determine the prevalence of cochlear-facial dehiscence (CFD) and to examine the influence of otic capsule area, age, sex, and race on CFD. Study Design: Descriptive study of archived temporal bone specimens. Materials and Methods: Targeted sections from 1,020 temporal bone specimens were scanned and examined for CFD. Cochlear-facial partition width (CFPW) and otic capsule area (OCA), a marker of bone thickness, were measured using image analysis software. Demographic data were analyzed using multiple linear regression analysis. Results: The mean CFPW was 0.23u200amm (range, 0–0.92u200amm; SD, 0.15u200amm). Six patients were completely dehiscent (0.59%). Fallopian canal width, age, sex, race, and OCA were found to be significant predictors of CFPW. Age was found to be negatively correlated with CFPW (&bgr;u200a=u200a−0.001) (pu200a<u200a0.005). Thicker CFPW was associated with males (&bgr;u200a=u200a0.024) and non-Caucasian individuals (&bgr;u200a=u200a0.031). The mean OCA for dehiscent specimens (mean, 9.48 mm2; range, 6.65–11.58 mm2; SD 3.21 mm2) was significantly smaller than the mean OCA for nondehiscent specimens, (mean, 12.88 mm2; range, 6.63–21.92 mm2; SD, 2.47 mm2) (pu200a<u200a0.01). Conclusion: CFD occurred in nearly 0.6% of specimens in this temporal bone collection. Close to 35% of patients were sufficiently thin (<0.1u200amm) to appear dehiscent on computed tomography scanning. Smaller OCA correlated with thinner CFPW, suggesting a developmental factor. Older, female, and Caucasian patients may have a greater risk for CFD and its associated symptoms.

Fascial sling technique for dural reconstruction after translabyrinthine resection of acoustic neuroma: technical note

Dehiscence of the cochlear otic capsule has recently been described as a pathologic entity. We describe two cases of cochlear‐facial dehiscence, which are the first reported: a 69‐year‐old male who complained of hearing loss, autophony, and pulsatile tinnitus and a 41‐year‐old female who complained of left‐sided hearing loss, pulsatile tinnitus, and vertigo. In both, computed tomography (CT) showed bony dehiscence between the facial nerve and cochlea. Cochlear‐facial dehiscence is another example of otic capsule dehiscence that produces symptoms of third‐window lesions. When patients present with symptoms of third‐window lesions and CT does not show superior canal dehiscence, cochlear‐facial dehiscence should be considered. Laryngoscope, 124:283–289, 2014

Fat graft-assisted internal auditory canal closure after retrosigmoid transmeatal resection of acoustic neuroma: Technique for prevention of cerebrospinal fluid leakage

INTRODUCTION Reconstruction of cranial defects is an essential component of skull base surgery as it aids in restoring functionality, providing coverage of intradural structures, and achieving optimal cosmesis. In acoustic neuroma surgery, tumor removal and subsequent reconstruction of the skull base defect are equally important elements. All three approaches utilized in acoustic neuroma surgery (retrosigmoid, translabyrinthine, and middle fossa) benefit from cranioplasty. In the retrosigmoid approach, the use of cranioplasty to cover the suboccipital bony defect has been shown to reduce the severity of postoperative headaches. Cerebrospinal fluid (CSF) leakage rates have decreased in patients who undergo cranioplasty of the temporal bone defect following the translabyrinthine approach, most likely due to applied pressure to the underlying fat graft. Finally, temporal hollowing resulting in unsightly sunken defects can be prevented with reconstruction of the squamous temporal defect created after a middle fossa approach. The ideal material for reconstruction should provide structural support and soft tissue coverage, and be inert and durable, easy to shape and contour, and applicable to a variety of different skull base defects. Although autologous bone has a desirable biocompatibility profile, it must be harvested from a donor site, which may be undesirable due to longer operative times, increased risk of infection, and difficulty with graft contouring. Also, there is a limited amount of autologous bone available, which is an additional drawback. Other alternative reconstructive materials include titanium mesh, hydroxyapatite cement, polymethyl methacrylate (PMMA), and porous polyethylene. Each has its own advantages and disadvantages. The Medpor Titan implant (Porex Surgical, Inc., Newnan, GA) is a material that is composed of a hybrid of titanium mesh, surrounded on both sides by a sheet of high-density porous polyethylene. Titanium is a commonly used metal for cranioplasty. Its malleability allows for easy contouring of the implant, while its high tensile strength ensures superior protection for intracranial components. Porous polyethylene is an inert material that has been used in the past for a variety of applications, including craniomaxillofacial and orbital reconstruction. It is composed of high-density polyethylene with interconnected pores that allow for tissue growth into the implant. The utilization of porous polyethylene with embedded titanium has been described for orbital reconstruction, but to date there is no literature present about its use in cranioplasty of temporal bone defects after acoustic neuroma surgery. In this report, we describe our cranioplasty technique for the skull base reconstruction of bony defects created after acoustic neuroma surgery using the Medpor Titan implant. The surgical nuances are illustrated in each of the three acoustic neuroma approaches, including retrosigmoid, translabyrinthine, and middle fossa approach.

Concomitant, Contralateral Vestibular Schwannoma Concomitant, Contralateral Vestibular Schwannoma and Epidermoid Cyst

Objectives/Hypothesis: The determinants of clinical versus histologic otosclerosis are unknown, but angiogenesis is associated with active disease. We hypothesized that quantification of angiogenesis in otosclerotic human temporal bones could reveal significant differences between clinical and histologic cases.