Otology & Neurotology最新文献

Objective: To compare the feasibility and outcomes of vestibular rehabilitation (VR) for persistent postural-perceptual dizziness (PPPD) with those for chronic unilateral vestibular hypofunction (UVH).

Study design: Prospective study.

Setting: Tertiary referral center.

Patients: Nineteen consecutive patients with chronic UVH lasting for >3 months and 15 with PPPD.

Interventions: The VR program consisted of gaze stabilization exercises, static or dynamic balance exercises and gait training, and habituation exercises that exposed patients to a provocative stimulus. Patients were asked to perform VR for at least 20 min a day.

Main outcome measures: Status of VR (i.e., continuation/discontinuation) and outcomes were assessed 1 month after the introduction of VR using the Dizziness Handicap Inventory for handicaps in daily life due to dizziness, the Niigata PPPD Questionnaire (NPQ) for symptom exacerbations of PPPD, and the Hospital Anxiety and Depression Scale for anxiety and depression.

Results: No patients in the chronic UVH group discontinued VR, whereas six patients in the PPPD group discontinued VR owing to symptom exacerbations, showing a significant difference. VR did not decrease any symptom scale, except for the NPQ-motion subscore, in patients with PPPD who continued VR, whereas it decreased all clinical symptom scales, except for the NPQ-motion subscore, in patients with chronic UVH.

Conclusions: Patients with PPPD had a higher rate of VR discontinuation than those with chronic UVH, and VR was less effective in patients with PPPD who even continued treatment than in those with chronic UVH. Therefore, VR on PPPD should be optimized.

Objective: This study aims to evaluate the potential association of perioperative hearing outcomes with frailty by Modified 5-Item Frailty Index (mFI-5).

Design: Retrospective cross-sectional study.

Setting: Single-institutional study conducted at a tertiary care hospital between January 2018 and January 2022.

Patients: All adult patients older than 50 years who underwent cochlear implantation (CI).

Interventions: Cochlear implantation.

Main outcomes measures: Hearing outcomes were measured using pre-CI and longitudinal post-CI quiet AzBio scores. Frailty was determined by mFI-5 scores (0 = not frail, 1 = prefrail, and 2+ = frail). Univariable and multivariable linear regressions, ordinal logistic regressions, and time-to-event curves were used to determine perioperative speech perception and likelihood of high-performance hearing (defined as ≥70% on AzBio).

Results: Of the 126 patients, the median age was 70 (63-77) years, 50% (63) were female, and 39% (49) identified as non-Hispanic Black, Hispanic, or other. By mFI-5 scoring, 38% (48) had no frailty, with 34% (43) and 28% (35) scoring 1 and 2+, respectively. When adjusting for age, sex, race, and BMI, scoring 1 point on mFI-5 was associated with significantly lower pre-implantation and post-implantation AzBio scores (pre: = -15 [-26, -3.4], p < 0.05; post: = -14 [-25, -3.0], p < 0.05). When controlling for all covariates, prefrailty and frailty were associated with significantly decreased likelihood of high-performance hearing (prefrailty OR: 0.22 [0.07, 0.63], p < 0.01; frailty OR: 0.31 [0.10, 0.92], p < 0.05). Time-to-event curves demonstrate significantly reduced likelihood of reaching high-performance hearing within 7 months after CI in patients with mFI-5 scores >0 (p < 0.05).

Conclusion and relevance: Our findings suggest that prefrailty is associated with worse pre-CI and post-CI hearing and lower likelihood of high-performance hearing within 7 months post-CI. Preoperative frailty screening in adult CI candidates may better inform providers of patients' long-term risk-to-benefit.

Introduction: Sudden sensorineural hearing loss (SSNHL) is idiopathic in 70-90% of cases with 10-30% linked to vascular injuries, viral infections, or autoimmune inner ear disease (AIED). AIED contributes to less than 1% of all hearing losses, categorized into primary, affecting only the inner ear, and secondary, associated with systemic autoimmune diseases (SAID). This study examines the prevalence and features of AIED in SSNHL in a tertiary referral center.

Materials and methods: We conducted a prospective study from November 2021 to December 2022 including SSNHL patients who exhibited symptoms like hearing loss or tinnitus. Evaluations included tympanometry, pure tone audiometry, and blood tests, with suspected AIED cases further assessed by rheumatologists using Lobo's diagnostic criteria. Treatment responses were monitored through regular audiometry updates.

Results: Out of 694 SSNHL patients, 43 (6.2%) were diagnosed with AIED, of which 36 (83.7%) had primary AIED and 7 (16.3%) had secondary AIED linked to conditions like Sjögren's syndrome and systemic lupus erythematosus. Treatment response was seen in 19.4% of primary and 42.9% of secondary AIED cases.

Conclusion: The prevalence of AIED in SSNHL patients was found to be 6.2%, with a notable fraction also suffering from SAID. Responses to treatment were positive in about a third of these cases, highlighting the importance of interdisciplinary management for this rare yet significant cause of SSNHL.

Objective: To compare the diagnostic capability of Pöschl reformations created from temporal bone CT (TBCT) and high-resolution noncontrast CT head exams (HR-NECTH) to detect and classify superior semicircular canal (SSC) abnormalities.

Study design: Retrospective case review.

Setting: Tertiary referral center.

Patients: Individuals with normal and abnormal SSC who received TBCT and HR-NECTH.

Interventions: Pöschl reformations of each patient's temporal bones (TB) were created using TBCT and HR-NECTH. Screenshots displaying the SSC were randomized into an interpretation test sent to neuroradiologists who interpreted the SSC as normal/abnormal and classified abnormalities as thinning (SST)/dehiscence (SSD).

Main outcome measure: Analysis of responses to interpretation test, interrater reliability, and sensitivity, specificity, and positive/negative predictive values of Pöschl reformations from TBCT and HR-NECTH.

Results: Fourteen patients were enrolled, 28 TB were reviewed. Sixteen TB demonstrated SST/SDD and 12 were normal as per gold standard TBCT. Interpretation test displaying screenshots of the SSC, in a randomized, blinded fashion, was completed by four neuroradiologists. Analysis of TBCT and HR-NECTH Pöschl reformation interpretations yielded no statistically significant difference in proportion of true/false-positive/negative responses (χ2 = 3.37, p = 0.83), similar and substantial interrater reliability (k = 0.78 vs. 0.73, respectively), and similar sensitivity, specificity, and positive/negative predictive values (0.86, 1, 1, 0.84 vs. 0.78, 0.96, 0.96, 0.77, respectively). Neuroradiologists also correctly classified SST/SSD on TBCT and HR-NECTH Pöschl reformations at a rate of 70.9% vs. 78.0%, respectively.

Conclusion: Pöschl reformations created from HR-NECTH demonstrated similar diagnostic capability as those created from TBCT to detect and classify SSC abnormalities.

Objective: This study aims to evaluate the necessity of ear packing in otological operations where the annulus fibrosus is not elevated, focusing on graft success rates and postoperative hearing outcomes.

Methods: A randomized controlled prospective clinical trial was conducted at a tertiary care hospital involving 200 patients aged 18 years and above undergoing myringoplasty for inactive chronic suppurative otitis media. Patients were randomly assigned to receive either ear packing with absorbable gelatin sponge (Gelfoam®) or no packing. The primary outcome is graft success assessed via microscopic examination at 3 and 6 months post-surgery. Secondary outcomes include hearing gains measured by pure-tone audiometry at 500-, 1000-, 2000-, and 4000-Hz frequencies.

Results: At 3 months, the graft take rate was 92% in the ear packing group and 90% in the no packing group, with no statistically significant difference ( p = 0.63). At 6 months, the graft take rate was 90% in the packing group and 88% in the no packing group ( p = 0.67). Hearing improvements, as measured by air conduction thresholds, were also similar between the two groups ( p = 0.73).

Conclusion: This study demonstrates that myringoplasty without ear packing yields comparable graft take rates and hearing improvements to traditional myringoplasty with ear packing. These findings suggest that omitting ear packing in appropriate cases may simplify the procedure without compromising patient outcomes.

Objectives: Recent studies suggest that hearing loss is associated with balance dysfunction and an increased risk of falls. The purpose of this study was to investigate whether adults with unilateral hearing loss (UHL) have an underlying vestibular dysfunction and whether vestibular testing explains balance function and fall risk.

Study design: Cross-sectional.

Setting: Urban otology practice and a human motion laboratory.

Patients: We recruited 41 healthy controls (mean age, 52 years; range, 22-78 years) and 29 adults with stable UHL (mean age, 53 years; range, 18-80 years) who denied symptoms of dizziness (Dizziness Handicap Inventory average, 1.86; range, 0-14). UHL occurred an average of 4 years (range from sudden loss, 4 months to 27.5 years) prior to testing.

Interventions: We conducted the caloric portion of the videonystagmography test, video head impulse test (vHIT), and a battery of balance tests: standing on foam with eyes closed, timed up and go test, four square step test, 10-meter walk, and a virtual reality (VR) assessment of postural control.

Main outcome measures: Hearing was quantified by four-frequency pure-tone average (PTA). Caloric weakness was defined as asymmetry greater than 25%. Participants self-reported falls over the past 12 months and history of vertigo. Performance on balance tests was quantified by time to completion or duration of hold. Performance on the VR assessment was quantified by root-mean-square velocity of head sway.

Results: Proportion of unilateral caloric weakness was significantly higher in the UHL group (25%) than the control group (12%). Five participants with UHL refused caloric testing. vHIT gains of lateral canals were normal in both groups. The majority of participants in the UHL group experienced vertigo at the onset of hearing loss (72%). There were five fallers in the UHL group (17%) and three in the control group (7%). Participants with caloric weakness or vertigo at onset did not differ from those without in age or in any of the balance tests. Participants with history of falls differed in head sway and duration of hold standing on foam with eyes closed.

Conclusions: Individuals with UHL are more likely to have caloric weakness than healthy controls; however, these findings are not correlated with functional outcomes or history of falls. Postural control testing using virtual reality or standing on foam with eyes closed may help detect those at a risk for falls.

Objective: The physician-scientist workforce is shrinking in the United States. Academic otologists/neurotologists face a diverse set of barriers to successful careers. We aimed to characterize the factors affecting contemporary otology/neurotology surgeon-scientists.

Study design: An electronic survey was distributed to faculty members of the American Neurotology Society and the American Otological Society in 2021. The survey queried demographics, practice setting, compensation, and barriers to conducting research for respondents in academic practice.

Results: One hundred fifty-seven otologists/neurotologists responded to the survey, corresponding to an overall response rate of 25%. Of the respondents, 94 were in academic practice. The median protected research time was 0.5 days/wk, whereas the mode was zero. Across academic rank, salary compensation was lower for academic surgeons with active research funding and for female academic surgeons as compared with their male counterparts. Grant-funded female academic surgeons had significantly worse compensation compared with rank-matched male surgeons with similar protected time. No grant-funded female earned more than the 30th percentile for their rank. Identified barriers to research were pressure to maintain clinical productivity, insufficient protected time, and personal/family demands. Respondents highlighted several areas for improvement: compensation for research activity, administrative support, and improved grant funding mechanisms for clinician-scientists.

Conclusions: Otology/neurotology surgeon-scientists face barriers to research, including limited protected time, poor administrative support, increasingly competitive funding environments, and misaligned compensation models. New initiatives by the National Institute on Deafness and other Communication Disorders aim to increase the surgeon-scientist workforce, but their success may depend upon removing identified barriers at the level of academic institutions.

Background: Vestibular schwannoma (VS) is a common intracranial tumor that affects patients' quality of life. Reliable imaging techniques for tumor volume assessment are essential for guiding management decisions. The study aimed to compare the ABC/2 method to the gold standard planimetry method for volumetric assessment of VS.

Methods: A retrospective review was conducted on patients with VS diagnosed between 2007 and 2022 at Yale New Haven Hospital. Both ABC/2 and planimetry methods were used for tumor volume assessment, and their correlations were evaluated.

Results: Among 140 patients, the mean tumor volumes using the planimetry and ABC/2 methods were 1307.99 ± 142.13 and 1482.76 ± 165.75 mm3, respectively. A strong correlation was observed between the methods (r = 0.99, p < 0.0001). For patients who underwent follow-up scans, the ABC/2 method accurately detected tumor volume changes over time. Subgroup analysis based on tumor size also displayed a significant positive correlation across all size categories.

Conclusion: The ABC/2 method demonstrates a high correlation with the planimetry method for VS volume assessment and can be a reliable, less time-intensive alternative in clinical settings. However, it generally overestimates tumor volume compared to planimetry. Subgroup-specific correction formulae were provided to enhance the accuracy of ABC/2-derived measurements. Future studies may explore the integration of these methods for improved clinical decision making.

Objective: To compare fall risk scores of hearing aids embedded with inertial measurement units (IMU-HAs) and powered by artificial intelligence (AI) algorithms with scores by trained observers.

Study design: Prospective, double-blinded, observational study of fall risk scores between trained observers and those of IMU-HAs.

Setting: Tertiary referral center.

Patients: Two hundred fifty participants aged 55-100 years who were at risk for falls.

Interventions: Fall risk was categorized using the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) test battery consisting of the 4-Stage Balance, Timed Up and Go (TUG), and 30-Second Chair Stand tests. Performance was scored using bilateral IMU-HAs and compared to scores by clinicians blinded to the hearing aid measures.

Main outcome measures: Fall risk categorizations based on 4-Stage Balance, Timed Up and Go (TUG), and 30-Second Chair Stand tests obtained from IMU-HAs and clinicians.

Results: Interrater reliability was excellent across all clinicians. The 4-Stage Balance and TUG showed no statistically significant differences between clinician and HAs. However, the IMU-HAs failed to record a response in 12% of TUG trials. For the 30-Second Chair Stand test, there was a significant difference of nearly one stand count, which would have altered fall risk classification in 21% of participants.

Conclusions: These results suggest that fall risk as determined by the STEADI tests was in most instances similar for IMU-HAs and trained observers; however, differences were observed in certain situations, suggesting improvements are needed in the algorithm to maximize accurate fall risk categorization.

Hypothesis: The objective of this study is to obtain comprehensive morphometric measurements of the incomplete partition type II (IP-II) cochlea to provide a better understanding of intracochlear anatomy and important considerations for electrode selection and insertion.

Background: IP-II is the most common bony inner ear malformation that often requires cochlear implantation. Currently, there is significant controversy on electrode selection due to a lack of research that can provide reliable, high-resolution measurements.

Methods: Three-dimensional reconstructions of the cochlea were made from hematoxylin and eosin-stained slides from 11 archival human temporal bones from 8 adult IP-II patients (one paired) and 2 fetuses. Detailed measurements of the angular and linear length of the spiral ganglion neurons and cochlear duct at the modiolar and lateral wall of the scala tympani as well as cross-sectional areas and vertical height measurements of the scala tympani at 90-degree intervals were measured.

Results: The spiral ganglia neurons terminated at 540.5 ± 45.4 degrees, which corresponded to the beginning of the interscalar septal defect. The corresponding Rosenthal's canal length was 12.75 ± 0.82 mm, and the lateral wall length was 23.95 ± 1.04. The average cochlear duct length was 32.44 mm ± 1.58 mm, corresponding to an average angular distance of 951.6 ± 80 degrees. The modiolar height demonstrated less variation within the scala tympani but was significantly smaller at 0 and 90 degrees compared with the normal cochlea. The lateral wall height was also significantly smaller at 0, 180, and 540 degrees. There was a drastic decrease in lateral wall height at 540 degrees to 0.4 mm, which is smaller than the apical dimension of many electrodes.

Conclusion: This is the first study to provide detailed morphometric measurements of the IP-II cochlea including spiral ganglion neuron length and scala tympani height. These measurements directly relate to electrode selection for cochlear implantation.