Simon C. Parisier

A review of twenty congenital cholesteatomas of the middle ear in children.

Cholesteatomas, arising within the middle ear space behind an intact tympanic membrane, have been detected more frequently in recent years. This article reviews 19 children (with a mean age of 4.3 years) who underwent surgery over a 7-year period for removal of cholesteatomas from behind intact tympanic membranes. Most of these children were referred by pediatricians who had detected an asymptomatic whitish middle ear mass. Many had histories of treatment for otitis media. Patients with similar histories were excluded from the series if there had been a prior perforation, myringotomy, or otologic surgery. In the series, one fourth of the children had associated congenital malformations, and there were 3 times as many boys as girls. In two thirds of the cases, the cholesteatoma was manifested as an anterior-superior middle ear mass that seemed to arise from the processus cochleariformis, undersurface of malleus area. Many could be removed via an extended anterior tympanotomy operative approach. The results of surgery are reviewed. The possible origins of these localized cholesteatomas are considered. Are they congenital defects that arise from misplaced keratinizing epithelium? Do they arise from mesenchymal cells whose differentiation is stimulated by inflammatory changes within the middle ear?

Facial nerve paralysis following cochlear implant surgery.

Objectives Facial nerve paralysis is a rare but devastating complication of cochlear implant surgery. The aims of the study were to define the incidence of facial nerve paralysis in our series and understand possible mechanisms of injury.

Ciprofloxacin: drug of choice in the treatment of malignant external otitis (MEO).

Ciprofloxacin, a fluorinated quinolone with high efficacy against Pseudomonas aeruginosa, was used in the treatment of 10 consecutive patients with malignant external otitis. All patients had skull base osteomyelitis documented by nuclear and computed tomography (CT) scans. Dosages of 1.5 g of ciprofloxacin daily were used for a mean average of 10 weeks. All patients were considered cured with a minimum follow‐up of 18 months after completion of therapy. A new classification of malignant external otitis (MEO) is presented.

Outcome Analysis of Cochlear Implant Reimplantation in Children

Objectives We review our e‐perience gained in performing cochlear reimplantation in 25 children who have had multichannel cochlear implant device failure at the Cochlear Implant Center of the Manhattan Eye, Ear and Throat Hospital and Lenox Hill Hospital (New York, NY), to assess the feasibility of cochlear reimplantation in children and the effect of reinsertion on audiological performance.

Specific language growth in young children using the CLARION® Cochlear Implant

General and specific language growth was evaluated in 10 children who had received the CLARION® Multi-Strategy™ Cochlear Implant during the clinical trial. The mean age at implantation was 37 months, and the children were followed for 18 months thereafter. Language comprehension and use were assessed with the Peabody Picture Vocabulary Test, the Reynell Developmental Language Scales, and mean length of utterance (MLU). The mean vocabulary scores indicated a 42-month increase in 18 months. The mean language comprehension increased from 20.4 to 40.8 months, and language use increased from 21.5 to 38.1 months. The mean MLU increased from 1.8 words to 4.8 words during the test period. Results indicated the children learned language at the same rate as their hearing peers of the same language age (except for vocabulary, which was faster), but retained a language delay relative to their hearing peers of the same chronological age.

Revision cochlear implant surgery: causes and outcome.

OBJECTIVE: To review experience with cochlear implant reimplantations, including effect of reinsertion on audiological performance. STUDY DESIGN AND SETTING: Retrospective review of cochlear implant reinsertions in patients seen in a private tertiary neurotologic practice. Forty-three patients (8 adults and 35 children) underwent revision cochlear implant surgery for device failure or upgrade. Findings at initial and repeat operations were noted, including number of electrodes inserted, and speech perception performance data were obtained when available. RESULTS: Five complications occurred in the reinsertion operations, 2 (6%) intraoperative cerebral spinal fluid leaks and 3 (7%) postoperative flap break-downs with implant extrusion. Number of electrodes inserted was unchanged in 40/43 patients. Speech perception abilities remained stable or improved. CONCLUSION: Cochlear reimplantation is technically feasible and allows for continued auditory stimulation. SIGNIFICANCE: Patients facing reimplantation must be aware of the possibility of differences in sound quality and speech recognition performance with their replacement device, but speech perception ability will typically remain the same or improve.

Radiographic findings in progressive necrotizing malignant external otitis

Twenty‐three cases of progressive necrotizing (malignant) external otitis were reviewed. Radiographic evaluation was correlated with clinical disease. CT scanning accurately demonstrated subtle foci of involvement in the skull base which may be clinically unsuspected or go undetected with other studies. Central skull base erosion indicates advanced disease and selects those patients requiring extended antibiotic therapy. Soft tissue thickening of the parapharyngeal space and roof of the nasopharynx also implies advanced disease requiring prolonged therapy. Soft tissue improvement can be visualized on CT. While CT scanning demonstrates the progression of bony disease, it cannot be used to follow resolution of central skull base osteomyelitis. Radionuclide scans provide information regarding the overall extent of the inflammatory process.

Glomus Tumors in Patients of Advanced Age: A Conservative Approach†

Objectives: Identify and discuss controversies in the management of paragangliomas in elderly patients.

Cochlear Implantation in Children With Otitis Media

Objective To describe the outcome of cochlear implantation in a cohort of pediatric patients with a history of otitis media.

Management of labyrinthine fistulas caused by cholesteatoma

The surgical management of labyrinthine fistulas caused by cholesteatoma remains controversial. Forty cases (41 ears) of labyrinthine fistulas were reviewed. This represented 10% of our total series of cholesteatomas in adults and children (426 ears). Clinical presentation, extent of disease, results of fistula testing and audiometric studies, and radiographic findings were analyzed. A canal wall-down procedure was performed in all but one patient. Generally an attempt was made to completely remove the cholesteatoma, to graft the fistulous area, and to reconstruct the middle ear mechanism in one stage. The matrix was preserved in patients with large fistulas where the involved ear was the only hearing one, when the matrix was adherent to the underlying optic duct, and in selected elderly persons. Long-term followup did not reveal a significant difference in hearing, degree of vertigo, or incidence of recidivism when those patients in whom the matrix was removed were compared with those in whom the matrix was preserved. The importance of recognizing the presence of a labyrinthine fistula preoperatively is stressed, along with the need to be prepared for an unexpected fistula. Operative management is described.