Otology & Neurotology最新文献

Objective: The aim of the current study was to investigate the influence of duration, time point, and etiology of deafness on cochlear implant user rates, and to investigate the long-term hearing performance in single-sided deaf patients.

Study design: Retrospective study.

Setting: Tertiary care hospital.

Patients: 77 subjects with single-sided deafness.

Intervention: Unilateral cochlear implantation between 2009 and 2022.

Main outcome measures: Patients were categorized into users and nonusers. Duration of deafness, onset of deafness, etiology, and further demographic data were collected. Pure tone audiometry, Freiburg numbers, and monosyllables test were carried out at activation, as well as 1 year, 2 to 3 years, and 5 years after cochlear implant activation.

Results: Most patients who lost their hearing after the age of 10 years were cochlear implant users, while patients who lost their hearing earlier and were implanted with a significant delay were likely nonusers. Even patients implanted more than 10 years after the hearing loss regularly used the cochlear implant, if deafness occurred at the age of 10 years or later. Implanted patients showed an improvement of hearing from activation to 1 year postoperatively as well as stable hearing thresholds for 5 years.

Conclusions: The timing of hearing loss influences cochlear implant user rates. Patients who acquired single-sided deafness above the age of 10 years use the device regularly even if the duration of deafness was more than 10 years. This challenges the 10-year cutoff for cochlear implant indication. Furthermore, results show good long-term hearing thresholds and speech understanding for cochlear implant patients who use their device regularly.

Objective: This study aims to identify 18 F-FDG-PET imaging features for improving treatment response evaluation in patients with necrotizing otitis externa (NOE), aiding in the difficult differentiation between sterile inflammation and active infection.

Study design: Retrospective cohort study.

Setting: Tertiary hospital.

Patients: Patients diagnosed with NOE between 2011 and 2022. NOE criteria included otalgia, otorrhea, granulation, and radiological features consistent with osteomyelitis.

Intervention: 18 F-FDG-PET/computed tomography (CT) parameters were derived from manually delineated regions of interest and were evaluated on both pretreatment and end-of-treatment scans.

Main outcome measures: Recurrent disease of NOE after end-of-treatment 18 F-FDG-PET scans.

Results: This study comprised 20 NOE patients, including 5 (25%) experiencing recurrent disease after the end-of-treatment scan. The end-of-treatment 18 F-FDG-PET parameters of maximal and peak standardized uptake value (SUVmax and SUVpeak) were significantly higher in recurrent cases ( p = 0.025 and p = 0.025, respectively). Both parameters demonstrated good discrimination ability in predicting recurrence, with optimal cutoffs yielding 100% sensitivity and 67% specificity. Other parameters, including mean SUV and total lesion glycolysis (TLG), did not yield significant results, neither did the calculated difference in uptake between end-of-treatment and pretreatment scans.

Conclusions: SUVpeak on 18 F-FDG-PET was the preferred parameter for treatment response evaluation of NOE at the end-of-treatment scan. A high residual SUVpeak may adequately detect patients at risk for recurrent disease, which may necessitate prolonged treatment, while low SUVpeak is found in patients with low risk for recurrent disease permitting safe treatment cessation.

Objective: To evaluate hearing preservation (HP) outcomes for patients with small sporadic vestibular schwannomas (VS) who elect to undergo microsurgical resection.

Study design: Retrospective study.

Setting: Tertiary single-academic institution.

Patients: Individuals 18 years or older with small sporadic VS (≤15 mm) who underwent microsurgical resection from 2018 to 2023.

Interventions: Microsurgical resection via a middle cranial fossa (MCF) or retrosigmoid (RS) approach.

Main outcome measures: Postoperative HP (word recognition score ≥ 50%) and facial nerve function.

Results: Of the 230 consecutive patients with small sporadic VS who elected to undergo microsurgical resection, hearing was preserved in 61% of patients. When stratified by tumor size, patients with tumors ≤10 mm had a 72% hearing preservation rate. On multivariate analysis, the most important prognostic factors for hearing preservation were the presence of preoperative vertigo (OR, 0.33; 95% CI, 0.17-0.52) and tumor size. Patients with tumors between 0 to 5 mm and 5.1 to 10 mm had 3.62 higher odds (95% CI, 1.39-9.4) and 2.52 higher odds (95% CI, 1.30-4.9) of hearing preservation, respectively, when compared to patients with tumors that were larger than 10 mm. At the time of last follow-up, a House-Brackmann (HB) 1 or 2 was maintained in 95% (n = 218) patients.

Conclusions: Microsurgical resection for patients with small VS is associated with good hearing preservation and excellent facial nerve outcomes. Because larger tumor size portends poorer hearing outcomes, for patients who elect to undergo microsurgical resection for hearing preservation, proactive surgical intervention when tumors are ≤10 mm should be considered to increase the likelihood of hearing preservation.

Objectives/hypothesis: This scoping review aims to provide an overview of existing semi-automated and fully automated methods for technical skill and performance assessment in otologic and neurotologic procedures.

Study design: Scoping review.

Databases reviewed: Ovid MEDLINE (PubMed), Ovid EMBASE, Web of Science Core Collection, and IEEE Xplor Digital Library.

Methods: A literature search was conducted according to PRISMA-ScR. Included studies were full-text articles that detailed an automated method of technical skill and performance assessment in otologic/neurotologic procedures. Extracted elements included general study characteristics (publication year, study objective, validity type, surgical procedure, and setting) and assessment approach characteristics (method of analysis, metrics assessed, source of metric data, degree of automation, and use of artificial intelligence [AI]).

Results: A total of 1,141 studies were identified from the literature search. After deduplication, title/abstract screening, and full-text review, 21 studies met the inclusion criteria. All but one of the included studies focused on mastoidectomy. Most studies assessed performance exclusively in VR-simulated mastoidectomy (n = 12) as opposed to cadaveric, 3D-printed, or live dissections. The majority of studies concentrated on establishing internal validity of their assessment methods (n = 13). Performance metrics were primarily obtained through motion analysis and final product analysis. Only a minority of studies used AI, which typically involved machine learning regression or classification to predict skill levels based on automatically extracted metrics.

Conclusion: This scoping review explores the developing landscape of automated technical skill and performance assessment in otology and neurotology. Though progress has been made in automating assessment in the field, most investigations are narrowly focused on performance in VR-simulated mastoidectomy and lack external validity evidence. AI and computer vision (CV), which have advanced automated assessment in other surgical fields, have been underutilized in assessing performance in otology and neurotology. Future work must explore the development and validation of automated assessment approaches across a wider range of otologic and neurotologic procedures. Incorporation of novel AI/CV techniques may facilitate real-time integration of automated assessment in a broader range of simulated procedures and live surgical settings.

Objectives: To examine the relationship between angular insertion depth (AID), modiolar proximity, and speech recognition outcomes for cochlear implant (CI) recipients of a precurved electrode array.

Study design: Retrospective review.

Setting: Tertiary academic referral center.

Patients: Thirty-five adult CI recipients (n = 40 ears) of precurved electrode arrays listening with a CI-alone device.

Interventions: Cochlear implantation with postoperative computed tomography.

Main outcome measures: Consonant-nucleus-consonant (CNC) word recognition at 6 months post-activation.

Results: A multivariate regression model demonstrated that both deeper apical AID and closer modiolar proximity in the basal turn were independently associated with better CNC word scores at 6 months (F2,37 = 7.264, p = 0.002). A deeper basal insertion depth was positively correlated with apical AID (r = 0.754, p < 0.001) but negatively correlated with modiolar proximity in the basal turn (r = -0.766, p < 0.001).

Conclusions: These data suggest that both apical cochlear coverage and modiolar proximity independently confer speech recognition benefit with a precurved array. However, these benefits are mutually exclusive for current precurved array designs as a deeper basal insertion depth results in greater apical coverage but lateralization of electrodes away from the modiolus in the basal turn. Future work is needed to elucidate mechanisms behind these findings that may motivate electrode array design modifications to further optimize outcomes for CI users.

Objective: Chronic suppurative otitis media (CSOM) is typically classified into two distinct types: CSOM (without cholestetoma) and CSOM with cholesteatoma (CCSOM). The main microbial agents in both types are Pseudomonas aeruginosa, Staphylococcus aureus, and Klebsiella pneumoniae. It is believed that the virulence of the infecting microorganisms and their biofilm production capacity play a role in the chronicity and persistence of the disease. The aim of this study was to investigate the pathogen microorganisms with their biofilm formation in CSOM, CCSOM, and their recidivism.

Materials and methods: A cohort of 57 patients was separated into four subgroups as primary CSOM (CSOM, CCSOM) and postoperatively recurring/residual CSOM [(R)CSOM, (R)CCSOM] groups. A control group was formed of 10 patients who underwent tympanotomy for conductive hearing loss without any known past/present ear inflammation. In all 67 patients, ear swabs for culture and the tissue samples for biofilm studies were obtained pre- or intraoperatively.

Results: The most common bacteria grown in the culture mediums were Pseudomonas spp., S. aureus, coagulase-negative Staphylococcus, and coliform bacteria. In the SEM study, biofilms were detected in 9 of 15 CCSOM and 6 of 14 CSOM, and in 13 of 14 (R)CCSOM and 11 of 14 (R)CSOM ears. Statistical analysis showed significantly higher rates of biofilm formation in both recidivist cholesteatomatous and noncholesteatomatous CSOM groups than their primary counterpart groups.

Conclusion: The findings that biofilm is more prevalent in the recidivist cases substantiated that biofilm formation is correlated with the persistence and additionally aggressiveness of the disease in both CSOM types. S. aureus appeared as the leading biofilm-producing bacterium.

Background: The aim of this study was to relate response patterns of electrocochleography (ECochG) recordings during cochlear implantation to pre- and postoperative hearing.

Methods: Thirty subjects with either flat (FA, n = 9) or sloping (SA, n = 21) audiograms before cochlear implantation were prospectively included. Real-time ECochG recordings were conducted via the cochlear implant. The difference curve (DIF) signal of the ECochG recordings was analyzed regarding alteration of the waveform, amplitude changes, and relative phase shifts during insertion.

Results: Five subjects (56%) with FA and 13 (62%) with SA exhibited DIF signal drops in the early phase of the insertion. In subjects with FA, alterations of the DIF signal waveform in the early phase of the insertion occurred in 8 subjects (90%), whereas such changes were detectable in only 2 out of 21 subjects (10%) with SA ( p < 0.001). DIF signal drops with relative phase shifts of >0.7 radians but without alterations of the waveform occurred in 5 subjects (56%) with FA and 11 (52%) with SA. Such drops were associated with larger postoperative hearing losses than DIF signal drops without phase changes in both groups (FA: 43 versus 20 dB, p = 0.045; SA: 30 versus 14 dB, p = 0.001).

Conclusion: Residual cochlear function in basal regions leads to alteration of the DIF signal waveform during insertion, probably not associated with cochlear injury. A decrease of the DIF signal amplitude with a simultaneous relative phase shift but no alteration of the waveform is associated with greater loss of residual hearing independent from the preoperative hearing.

Objectives: To assess a decade of experience of treating patients with high hearing risk cerebellopontine angle (CPA) epidermoid lesions and examine factors influencing postoperative outcomes, particularly hearing preservation.

Study design: Retrospective chart review.

Setting: Single tertiary-referral center.

Patients: Adults with CPA epidermoid lesions who presented with hearing loss or evidence of lesion involving vestibulocochlear nerve.

Interventions: The studied intervention was microsurgical resection.

Main outcome measures: Main outcome measures included extent of resection, hearing preservation rate for patients with postoperative audiograms, and disease progression.

Results: Twenty-three adults with an average tumor volume of 15.63 ± 16.2 cm3 were included. Five lesions (22%) involved the full internal auditory canal (IAC), 11 (48%) had partial involvement, and 5 (22%) were IAC sparing. Most patients with IAC involvement (88%) had circumferential invasion of the canal. Patients underwent either a retrosigmoid (18, 79%) or combined retrolabyrinthine transpetrosal approach (5, 22%), and gross total resection was achieved in most cases (13, 57%). Of 12 patients with postoperative audiograms, 10 (83%) had preoperative hearing preserved. There was no statistically significant change in hearing scores with treatment based on preoperative extent of IAC involvement. Ten patients (43%) had residual lesions postoperatively, and 6 exhibited progression. One patient ultimately required reoperation 6 years after initial surgery.

Conclusions: Preoperative hearing was preserved in the majority of the patients who underwent resection of CPA epidermoids via a retrosigmoid or transpetrosal approach. CPA epidermoids often invaded the IAC; however, degree of invasion was not associated with hearing outcomes.

Background: This study was aimed at investigating the effectiveness of music combined with cognitive behavioral therapy (music-CBT) and its underlying therapeutic mechanisms in treating chronic subjective tinnitus.

Methods: Twenty-seven participants with chronic subjective tinnitus who underwent a 3-month music-CBT were initially involved in this retrospective study. The resting-state electroencephalograms (EEG) and behavioral assessments of pre- and post-music-CBT, including tinnitus handicap inventory (THI), tinnitus functional index (TFI), visual analog scales (VAS), Pittsburgh sleep quality index (PSQI), and Hamilton depression rating scale (HAMD-24) were collected and analyzed.

Results: Following music-CBT, there was a significant reduction in global behavioral assessment scores, with median changes of ΔTHI = 26.0 (p < 0.001), ΔTFI = 23.7 (p < 0.001), ΔVAS = 2.0 (p < 0.001), ΔPSQI = 2.0 (p = 0.002), and ΔHAMD-24 = 2.0 (p < 0.001). Enhanced functional connectivity was seen among the frontal, parietal, and temporal cortices and significantly decreased characteristic path length (ΔCPL in delta = 0.016, p = 0.031; ΔCPL in theta = 0.012, p = 0.013), increased global efficiency (ΔGE in delta = -0.014, p = 0.037; ΔGE in theta = -0.006, p = 0.021), and local efficiency (ΔLE in delta = -0.015, p = 0.037; ΔLE in theta = -0.012, p = 0.015) were also noted. Additionally, associations were identified between ΔPSQI and ΔTHI (rho = 0.546, p = 0.003) and ΔTFI (rho = 0.462, p = 0.015); between ΔHAMD-24 and ΔCPL (rho = -0.389, p = 0.045), ΔGE (rho = 0.395, p = 0.041), and ΔLE (rho = 0.405, p = 0.036).

Conclusion: Optimized cognitive and emotional responses to tinnitus are linked to functional integration within the frontal-parietal-temporal brain network. Early node indicators for tinnitus relief may be the precuneus, middle frontal gyrus, middle temporal gyrus, and the right inferior parietal lobule.

Objective: To investigate whether degree of asymmetric hearing impairment influences patient-reported outcome measures and objective hearing results in primary stapedotomy.

Study design: Register study.

Setting: Data from the Swedish Quality Register for Otosclerosis Surgery consisting of 90% of stapes operations performed in Sweden.

Main outcome measure: The 984 patients eligible for inclusion were categorized on the basis of preoperative hearing impairment: unilateral, bilateral asymmetric, or bilateral symmetric. Pure-tone audiometry and patient-reported outcome measures were analyzed, and Glasgow benefit plots were constructed. Ordinal logistics regression analyses were performed to adjust for factors influencing PROMs associated with degree of asymmetric hearing.

Results: Over 90% of patients across all groups reported improved or much improved hearing ability post-surgery. Ninety-five percent of patients who rated their hearing as worse or much worse after surgery had an air-conductive gain of <20 dB PTA4. Individuals with unilateral hearing impairment were more likely to report lower satisfaction with hearing function and daily life activities after surgery compared with those with bilateral hearing impairment, especially bilateral symmetric hearing impairment. In terms of hearing function, the bilateral symmetric hearing impairment group showed a significant decrease in the log odds of reporting lower satisfaction with a coefficient of -0.71 (95% confidence interval, -1.13 to -0.33), whereas the bilateral asymmetric hearing impairment group showed a nonsignificant decrease with a coefficient of -0.14 (95% confidence interval, -0.41 to 0.14) compared with the unilateral hearing impairment group. Tinnitus was more frequent in those with unilateral hearing impairment.

Conclusion: Those with preoperative unilateral hearing impairment were more likely to express lower satisfaction with the results, compared with patients with bilateral impairment. Our findings suggest that the degree of bilateral hearing impairment should be considered in preoperative counseling, to better align with patient expectations regarding the benefit of surgery. An estimated air-conductive gain of at least 20 dB PTA4 was favorable for patient satisfaction.