Syed F. Ahsan

Cochlear Implantation Concurrent With Translabyrinthine Acoustic Neuroma Resection

Objectives/Hypothesis Cochlear implants provide successful auditory rehabilitation for patients with profound sensorineural hearing loss who do not derive at least marginal benefit from conventional hearing aids. Patients with neurofibromatosis type 2 can present with bilateral profound sensorineural hearing loss caused by bilateral vestibular schwannomas. Auditory rehabilitation in these patients can be challenging. We present the case of one such patient who underwent a concurrent translabyrinthine vestibular schwannoma resection and cochlear implantation in the same ear.

Evaluation of hearing and auditory nerve function by combining ABR, DPOAE and eABR tests into a single recording session.

In this article, we describe an efficient method for testing both auditory receptor and auditory nerve function in a single recording session. Auditory receptor function is tested in response to pure tone, tone burst and click acoustic stimuli (i.e. distortion products of otoacoustic emissions, DPOAE; and auditory-evoked brainstem responses, ABR). The function of the auditory neurons and nerve is measured in response to direct electric current stimulation (i.e. electrically evoked auditory brainstem responses, eABR). All measurements were obtained from anesthetized laboratory rats during single recording sessions using hardware and software stimulation and analysis programs developed by Intelligent Hearing Systems, Miami, FL.

Congenital Torticollis and Saccular Dysfunction: A Case Report

IMPORTANCE This is the first report, to our knowledge, of a child with torticollis due to saccular dysfunction. OBSERVATION An 18-month-old infant with torticollis was referred for postural imbalance and observed rotary nystagmus. The infant had undergone physical therapy treatment of left torticollis for nearly 15 months. Cervical vestibular evoked myogenic potentials (cVEMPs) were recorded to assess saccular function and caloric stimulation and positional and rotational testing were performed to evaluate other vestibular receptors. The child demonstrated abnormal cVEMP findings, with a low-amplitude response on the left, which indicated left-sided saccular dysfunction. The patients rotary-torsional nystagmus suggested positional vertigo secondary to abnormal saccular function. CONCLUSIONS AND RELEVANCE This case highlights that saccular dysfunction should be considered when timely resolution of congenital torticollis is not obtained with physical therapy. Early detection of abnormal saccular function in infants and young children with CPT is necessary to ensure appropriate intervention. Further study needs to be done to confirm our findings.

Distortion-product otoacoustic emissions in nonacoustic tumors of the cerebellopontine angle

OBJECTIVES : The goal of the present study was to compare the frequencies of cochlear and noncochlear patterns of distortion-product otoacoustic emissions (DPOAEs) in patients with nonacoustic (non-AN) tumors of the cerebellopontine angle (CPA)/internal auditory canal with those in patients with acoustic neuroma (AN). STUDY DESIGN AND SETTING : We conducted a prospective study of patients with non-AN internal auditory canal/CPA tumors treated between 1992 and 1999 in a tertiary care setting. We collected data on behavioral pure tone average, speech discrimination score, acoustic immittance tests, DPOAEs, and tumor size. DPOAEs were divided into those with a cochlear or a noncochlear pattern. Comparisons were made with a control group of patients with AN of the CPA. RESULTS : Twenty-four patients were included in the study: 12 patients in the non-AN group and 12 patients in the AN group. In the non-AN group, 5 (42%) patients had a cochlear pattern and 7 (58%) had a noncochlear pattern. In the AN group, 7 (58%) patients had a cochlear pattern and 5 (42%) had a noncochlear pattern. The differences between the non-AN and AN groups were statistically significant. In the non-AN group, patients with a cochlear-pattern DPOAE had significantly smaller tumors (P = 0.03) and a trend (P = 0.07) toward higher speech discrimination score. Age and pure tone average were not significantly different in the non-AN tumor patients. In the AN group, none of the study parameters were significantly related to the pattern of DPOAE. CONCLUSIONS : ANs appear to differ from other tumors of the CPA in their propensity to cause sensory versus neural hearing loss. A larger series of patients would be useful to confirm these preliminary findings.

Long-term Hearing Preservation After Resection of Vestibular Schwannoma: A Systematic Review and Meta-analysis

OBJECTIVE The objective is to perform a systematic review and meta-analysis of the literature on the long-term results of hearing preservation after vestibular schwannoma resection. DATA SOURCES Ovid/Medline, PubMed, Embase, and the Cochrane library from January 1980 to January 2015. STUDY SELECTION Inclusion criteria: age ≥18 years, minimum 10 patients in the treatment group, hearing preserving microsurgery, no previous radiation treatment, serviceable hearing at immediate postop follow-up, hearing outcomes reported using Gardner Robinson or the American Academy of Otolaryngology-Head and Neck Surgeons hearing grading scales, and average follow-up of 5 years. Preoperative, immediate postoperative, and last follow-up audiograms were required. Exclusion criteria included neurofibromatosis type 2 patients and surgery for salvage therapy or decompression. DATA EXTRACTION Quality evaluated using Methodological Index for Non-Randomized Studies. DATA SYNTHESIS Meta-analysis was performed using R v3.2.2, Metafor package v 1.9-7. Cohens D was used to determine effect size. Ten reports had at least 5-year follow-up and used standardized hearing grading scales. The systematic review found that if hearing was preserved at Class A or B at early postop visit, the chance of preserving hearing at 5 years was excellent. Those who maintained speech discrimination score ≥ 89% at the early postoperative follow-up had better long-term hearing preservation. The meta-analysis reveals that only preoperative and postoperative pure-tone average was associated with long-term hearing preservation. CONCLUSION Long-term (>5 yr) hearing durability rates are generally very good. Most studies do not report patient and tumor characteristics, therefore precluding combining studies for meta-analysis. Only preoperative and postoperative postoperative pure-tone average was associated with long-term hearing durability.

Meta-analysis of Meniett Therapy for Ménière’s Disease

Objectives: Evaluate the efficacy of Meniett micropressure treatment for Ménière’s disease by performing a meta-analysis of all relevant treatment studies. Methods: Systematic review of the English literature using Medline, Ovid, and Cochrane library from January 1996 to December 2012. We selected all studies for which the Meniett micropressure device was used to treat patients with definitive unilateral Ménière’s disease. We did not include isolated case reports and general reviews. Random and fixed models were used to estimate overall effect size. Results: Of 80 abstracts screened for relevancy, 18 studies were selected for further review. For hearing, only 9 studies reported pure tone average (PTA) pre- and post-Meniett application. The difference in PTA between pre- and post-micropressure device application was not significant (P = 0.72). Seven studies reported American Academy of Otolaryngology (AAO) functional score pre- and post-treatment. Analysis shows significant improvement of AAO functional score after treatment (P = 0.04). Eight studies reported frequency of vertigo before and after treatment. The treatment was found to be significant in reducing frequency of vertigo (P < 0.0001). Conclusions: The Meniett device appears to be a safe, non-destructive treatment alternative for patients refractory to initial medical therapy for Ménière’s disease. The overall body of literature on the efficacy of the Meniett device is sparse and is an obvious limitation of this analysis, yet the data obtained will help to enlighten practitioners on the usefulness of the Meniett device.

Evaluation of Noise Exposure Secondary to Wind Noise in Cyclists

Objective Determine if the noise levels of wind exposure experienced by cyclists reach levels that could contribute to noise-induced hearing loss. Study Design Industrial lab research. Setting Industrial wind tunnel. Subjects and Methods A commercial-grade electric wind tunnel was used to simulate different speeds encountered by a cyclist. A single cyclist was used during the simulation for audiometric measurements. Microphones attached near the ears of the cyclist were used to measure the sound (dB sound pressure level) experienced by the cyclist. Loudness levels were measured with the head positioned at 15-degree increments from 0 degrees to 180 degrees relative to the oncoming wind at different speeds (10-60 mph). Results Wind noise ranged from 84.9 dB at 10 mph and increased proportionally with speed to a maximum of 120.3 dB at 60 mph. The maximum of 120.3 dB was measured at the downwind ear when the ear was 90 degrees away from the wind. Conclusions Wind noise experienced by a cyclist is proportional to the speed and the directionality of the wind current. Turbulent air flow patterns are observed that contribute to increased sound exposure in the downwind ear. Consideration of ear deflection equipment without compromising sound awareness for cyclists during prolonged rides is advised to avoid potential noise trauma. Future research is warranted and can include long-term studies including dosimetry measures of the sound and yearly pre- and postexposure audiograms of cyclists to detect if any hearing loss occurs with long-term cycling.

Incidence of Cisplatin Induced Ototoxicity in Adults with Head and Neck Cancer

Objective. To elucidate the incidence of cisplatin induced ototoxicity in adult patients, with a focus on an adult population. Study Design. IRB approved retrospective study. Methods. The charts of patients who underwent cisplatin therapy from 1995 to present were reviewed. Inclusion criteria were (1) cisplatin as the primary chemotherapeutic agent and (2) hearing evaluation performed prior to and after treatment. Audiometric thresholds were measured by presenting pure-tone stimuli at 0.25 to 10.0 kHz. Criteria for hearing loss were based on the Chang criteria. Cochlear radiation doses were also calculated in patients with primary tumors in their head and neck or brain. Results. There were 1565 patients that had undergone therapy with cisplatin from 1995 to 2014, which 30 met inclusion criteria. Eight were patients treated for head and neck or brain cancer. Evaluation with ANOVA testing identified statistically significant decline in audiometric scores for WRS and pure tone frequencies 500, 2000, 4000, 6000, and 8000 Hz in the right ear. Overall, hearing loss was noted with 63% incidence and in patients who received radiation to their cochlea and cisplatin. Conclusion. The incidence of cisplatin induced ototoxicity was significant and even more prevalent in those patients receiving both cisplatin and radiation to their cochlea.

Incidence of Cisplatin Ototoxicity in Head and Neck Cancer Patients

Objectives: Elucidate the incidence of cisplatin-induced ototoxicity in patients treated for head and neck cancer. Methods: This was an institutional review board approved retrospective study of patients treated with cisplatin for cancer at a tertiary referral hospital. The charts of patients of any age that had undergone cisplatin therapy from 1995 to the present were reviewed. We then narrowed this group down to those who had a diagnosis of cancer of the head and neck (hypopharyngeal, laryngeal, nasopharyngeal, oropharyngeal, scalp/face skin cancer, temporal, thyroid) and had pre- and posttreatment audiologic testing. Results: There were 1565 patients that had undergone therapy with cisplatin from 1995 to 2014. Of those, 203 patients had pre- and posttreament audiologic testing. Twenty patients had diagnosis of cancer involving the head and neck. The cochlear radiation doses were also collected from these patients. Preliminary results demonstrate that patients with head and neck cancer that were treated with cisplatin and had a sizable cochlear radiation dose had significantly more permanent hearing loss following treatment. Conclusions: The incidence of cisplatin induced ototoxicity was significantly more prevalent in head and neck cancer patients. These patients should be thoroughly screened and protective precautions should be taken to limit ototoxicity in this population.

Comparison of Two FTSG Suturing Technique Outcomes

undergoing microvascular free flap reconstructions. 2) Identify clinical factors that may be related to free flap complications and failures. METHOD: Retrospective analysis was performed on 600 patient medical records of all patients undergoing free microvascular tissue transfers at The Johns Hopkins Hospital from 1998 to 2008. Indications for surgery included surgical defects related to oncologic resection, benign tumors, trauma, non-healing wounds, hernia repairs, and congenital anomalies. Clinical parameters studied included patient demographics, past medical history, comorbidities, medication history, intra-operative surgical case characteristics, free flap monitoring techniques, postoperative course, complications leading to surgical re-exploration, and flap salvage rate. Univariate and multivariate statistical analysis and modeling was performed on clinical parameters to assess their potential contribution to free flap complications and outcomes. RESULTS: Pressors, anticoagulants, blood transfusions, advanced age, smoking, diabetes, and peripheral vascular disease did not appear to be associated with an increase in flap complications or failures. The flap monitoring method or duration of monitoring did not affect free flap outcomes. The number of free flap complications, re-explorations and intra-operative fluid balance showed statistical significance with regards to overall flap failures. Prolonged postoperative intubation time showed a small trend towards significance. The overall complication rate was greater than 10% and failure rate was less than 5% as defined by a non-viable flap. CONCLUSION: Microvascular free flaps are robust and have a relatively low surgical failure rate. Fluid balance has to be closely monitored in the intra and peri-operative time period, and fluid excess should be minimized. The number of complications and re-explorations should be limited to avoid free flap failure.