Vanessa S. Rothholtz

Skull base osteomyelitis: the effect of comorbid disease on hospitalization.

Objectives/Hypothesis: Skull base osteomyelitis is a rare disease that has a high morbidity and mortality rate if diagnosis and treatment are delayed. Our objective was to perform a more detailed analysis of skull base osteomyelitis in the inpatient population. We also provide a more comprehensive evaluation of comorbid disease and severity of illness in this population and describe their effects on the duration and cost of hospital stay.

Temporary Suppression of Tinnitus by Modulated Sounds

Despite high prevalence of tinnitus and its impact on quality life, there is no cure for tinnitus at present. Here, we report an effective means to temporarily suppress tinnitus by amplitude- and frequency-modulated tones. We systematically explored the interaction between subjective tinnitus and 17 external sounds in 20 chronic tinnitus sufferers. The external sounds included traditionally used unmodulated stimuli such as pure tones and white noise and dynamically modulated stimuli known to produce sustained neural synchrony in the central auditory pathway. All external sounds were presented in a random order to all subjects and at a loudness level that was just below tinnitus loudness. We found some tinnitus suppression in terms of reduced loudness by at least one of the 17 stimuli in 90% of the subjects, with the greatest suppression by amplitude-modulated tones with carrier frequencies near the tinnitus pitch for tinnitus sufferers with relatively normal loudness growth. Our results suggest that, in addition to a traditional masking approach using unmodulated pure tones and white noise, modulated sounds should be used for tinnitus suppression because they may be more effective in reducing hyperactive neural activities associated with tinnitus. The long-term effects of the modulated sounds on tinnitus and the underlying mechanisms remain to be investigated.

Femtosecond laser ablation of the stapes

A femtosecond laser, normally used for LASIK eye surgery, is used to perforate cadaveric human stapes. The thermal side effects of bone ablation are measured with a thermocouple in an inner ear model and are found to be within acceptable limits for inner ear surgery. Stress and acoustic events, recorded with piezoelectric film and a microphone, respectively, are found to be negligible. Optical microscopy, scanning electron microscopy, and optical coherence tomography are used to confirm the precision of the ablation craters and lack of damage to the surrounding tissue. Ablation is compared to that from an Er:YAG laser, the current laser of choice for stapedotomy, and is found to be superior. Ultra-short-pulsed lasers offer a precise and efficient ablation of the stapes, with minimal thermal and negligible mechanical and acoustic damage. They are, therefore, ideal for stapedotomy operations.

A novel method to determine standardized anatomic dimensions of the osseous external auditory canal.

Objective To introduce a novel method for measuring the dimensions of the osseous external auditory canal (OEAC) on computed tomographic images of the temporal bone. Study Design Radiology case series. Setting Tertiary care medical center. Patients A retrospective review of high-resolution computed tomographic images of the temporal bones of 69 patients (120 ears) between the ages of 5 and 85 years (mean, 29.1 yr) was performed. Main Outcome Measures Using a novel method to measure dimensions of the OEAC in the parasagittal planes, 6 defined dimensions as well as length and shape of the OEAC were studied at the annulus, midcanal, and the border of the bony cartilaginous junction. Results There was no statistically significant difference in OEAC dimensions between the male and female subjects or patients with and without a history of chronic otitis media within similar age groups. The length of the OEAC was significantly different between age groups of 5 to 12 and older than 13 years. The 6 defined dimensions were statistically different between the age groups of 5 to 8 years and older. These dimensions were not statistically different between the age groups of 9 to 12, 13 to 18, and older than 18 years. The most prevalent shape of the OEAC was conical (64%). Conclusion Standardized anatomic dimensions of the OEAC provide important measurements for design of novel in-the-canal hearing aids and specialized earplugs and assist in defining average sizes for canalplasty procedures.

Porencephalic cyst: a review of the literature and management of a rare cause of cerebrospinal fluid otorrhea.

Objective: To discuss the first reported case of spontaneous cerebrospinal fluid (CSF) otorrhea caused by a massive CSF-containing porencephalic cyst. Study Design: A case report and review of the literature (MEDLINE 1962-2005). Setting: A tertiary neurotologic referral center. Patient: A 65-year-old woman with congenital hemiplegia presented with left-sided spontaneous CSF otorrhea of 4-month duration. An audiogram revealed a mixed hearing loss. High-resolution computed tomography revealed a thinning of the tegmen and epitympanum without an obvious defect. Magnetic resonance imaging revealed a massive porencephalic cyst essentially replacing the entire left cerebral hemisphere. Intervention: A transmastoid approach with three-layered closure was used to successfully repair the sieve-like defects that were discovered in her tegmen. Results: The patient remains free of drainage, and the conductive hearing loss has resolved. Conclusion: Spontaneous CSF otorrhea caused by a porencephalic cyst is an uncommon cause of conductive hearing loss that has never been reported before. Only a few cases of traumatic CSF otorrhea/rhinorrhea associated with a porencephalic cyst have been reported. A high level of suspicion, a &bgr;2-transferrin assay, and appropriate radiographic imaging are required for diagnosis in adults without a history of trauma, meningitis, chronic ear disease, or previous ear surgery.

Knowledge and education of primary care physicians on management of children with hearing loss and pediatric cochlear implantation

Author(s): Wu, Edward C; Zardouz, Shawn; Mahboubi, Hossein; Ashtiani, Ali K; Shahriari, Shawhin; Ziai, Kasra; Rothholtz, Vanessa S; Djalilian, Hamid R

Epidemiological Factors Influencing Access to Cochlear Implantation and Language Skills of Deaf and Hard-of-Hearing Children

Objectives: Determine the epidemiologic relationship of family demographics and educational resources with parental knowledge of and willingness for their children to receive cochlear implantation (CI) and deaf and hard-of-hearing (DHH) children’s language skills. Methods: More than 200 parents of DHH children were surveyed at local schools, specialized camps, and clinics in Southern California. Data on family (income, insurance status, education level, hearing status, primary language) and children characteristics (school type, language skills, rehabilitation measures) were solicited. Results: Sixty-six surveys were included in the analysis. Six children had already undergone CI. Of those children without CI, 62% had been presented with the option of CI by a healthcare professional and 24% were willing to have their child undergo CI. Willingness for children to undergo CI was statistically higher in families with at least one normal hearing parent (P = .04), annual income less than

Endoscopic Removal of Subcutaneous Pyogenic Granuloma of the Nasal Radix

15,000 or more than

Primary Care Physicians' Knowledge of Cochlear Implantation

75,000 (P = .01), and children enrolled in specialized schools for DHH (P = .01). Risks of surgery (17%) and negative feedback from others(14%) were the leading reasons for unwillingness to undergo CI. Number of spoken words was greater among DHH children who attended public schools (P = .04) or had more than one form of curriculum (P = .04). Conclusions: A significant gap exists between the number of CI candidates and families aware of the option. Willingness to undergo CI is related to familial income and hearing status. On average, DHH children in public schools enrolled in a mainstream curriculum appear to have better language skills.

Customized Electric Suppression of Tinnitus in CI Subjects

Objective: This case report describes the removal of a subcutaneous pyogenic granuloma (lobular capillary hemangioma) on the left nasal bone in a 51-year-old woman. A minimally invasive surgical approach using rhinoplasty techniques combined with endoscopes is described, along with indications and contraindications for use. Method: The nontender nasal mass developed over 5 weeks. It was soft like a lipoma and clearly subcutaneous with no visible puncta or cutaneous irregularity, and was lateral to the nasal bones between radix and rhinion. The patient wanted to avoid a skin incision at all costs. Results: Under anesthesia, an intercartilagenous incision was made and sharp dissection over the upper lateral cartilage and nasal bone was performed to approach the mass. Using endoscopes and dissectors, the mass was removed with a cuff of soft tissue. It appeared blue and grossly consistent with a vascular neoplasm. Frozen section evaluation was nondiagnostic. Final histopathology showed the characteristic lobular configuration with a central branching vessel with solid growth pattern of endothelial proliferation. At 12 weeks no contour defect along lateral nasal sidewall was appreciated. The indications and limitations of this minimally invasive approach will be discussed. Conclusion: This presentation of a pyogenic granuloma is rare and unusual. An endonasal rhinoplasty approach utilizing endoscopy instrumentation spared the patient a cutaneous scar. This approach should be considered for patients with similar deep subcutaneous benign neoplasms over the osseous or cartilage nasal framework as it spares a visible incision.