Otology & Neurotology最新文献

Objective: To investigate the audiological benefits and surgical outcomes of Osia 2 System implantation in patients with conductive and mixed hearing loss (CHL and MHL), over a 6-month follow-up.

Design: Prospective, single-arm clinical study.

Setting: Single tertiary hospital.

Patients: Eighteen patients with CHL or MHL who are unable to use hearing aids, between May 2023 and July 2024.

Intervention: Osia 2 implantation through a minimal incision along the hairline.

Main outcomes and measures: Audiological evaluations including pure tone audiometry (PTA), speech audiometry (SA), recognition of hearing in noise tests (HINT), sound localization tests (LT), and the Abbreviated Profile of Hearing Aid Benefit (APHAB) questionnaire. Surgical outcomes and complications were also assessed preoperatively and postoperatively.

Results: Of the 18 patients (11 men; mean age: 61.94 y), 15 had implantation alone (mean operation time: 53.67±10.43 min), and 13 under local anesthesia. No complications were observed. Significant improvements in aided PTA, with a gain of 35.56±22.22 dB HL at 4 kHz one month postoperatively. In SA, the mean speech recognition threshold, most comfortable level, and speech discrimination score also improved. In the HINT, the signal-to-noise ratio improved with various noise and stimulus orientations. In the LT, localization ability improved when stimuli were from the implant side. The APHAB score improved over time.

Conclusions: The Osia 2 System provides effective audiological improvements in patients with CHL or MHL, unable to use hearing aids. With high-frequency amplification through a piezoelectric actuator and a minimal incision technique, the Osia 2 System offers reliable performance and safety.

Objective: To describe the clinical presentation and course of 2 cochlear implant (CI) recipients with a titanium allergy.

Patients: A 66-year-old female and a 41-year-old female both underwent unilateral cochlear implantation, immediately after which they experienced otalgia that persisted and negatively impacted their ability to wear their CI external processor.

Interventions: Patch testing for cochlear implant allergy was performed. Surgical explantation of the CI with the exposed titanium to remove the allergen was recommended, with a subsequent surgery offered with implantation of a CI fully encased in silicone after resolution of otalgia.

Main outcome measures: Clinical resolution of otalgia, including the ability to use a cochlear implant without discomfort.

Results: Both CI patients were confirmed to have a titanium allergy through patch testing. One patient experienced complete resolution of otalgia, while the second patient continued to have otalgia for at least 6 months following CI explantation. The first patient was subsequently implanted with a different CI in which the titanium components were fully encased in silicone and has remained pain-free and able to use her CI on an everyday basis 2 years post-implantation.

Conclusions: A high index of suspicion for patient allergy to cochlear implants is warranted in CI recipients presenting with otherwise unexplained and persistent otalgia following CI surgery, and even more so in those with a prior history of hypersensitivity reactions.

Objective: To evaluate endolymphatic hydrops (EH) in patients with Meniere disease (MD) using high-resolution 7-tesla (7T) MRI volumetry with the goal of identifying anatomic differences that might clarify MD's etiology and inform therapeutic strategies.

Study design: Prospective cohort study.

Setting: Tertiary referral center.

Patients: Twelve adults with MD and 5 healthy controls met the inclusion criteria.

Interventions: Participants underwent 7T MRI, including axial T2-weighted and 3D-FLAIR sequences, before and 4 hours after intravenous gadolinium-based contrast agent administration. Images were coregistered and subtracted to identify endolymph as a negative signal, followed by blinded manual segmentation.

Main outcome measures: Volumetric measurements of the membranous labyrinth [utricle+semicircular canals duct (SCC), saccule, cochlear duct, and total endolymph].

Results: Fifteen MD-affected ears were compared with 10 healthy control ears. Median endolymph volumes were significantly larger in MD-affected ears in the utricle and SCC (99.53 vs. 55.29 mm 3 , P =0.033) but not in the saccule ( P =0.56) or cochlear duct ( P =0.21). The ratio of endolymph to total fluid inner ear fluid was also greater in MD-affected ears compared with controls (62.3% vs. 44.0%). Unaffected MD ears did not differ from their affected counterparts across compartments.

Conclusions: In vivo 7T MRI volumetry revealed significantly greater EH in the utricle and SCC of MD-affected ears versus controls, demonstrating its utility for characterizing EH and guiding more precise diagnostics and therapies. Future work must refine methods to reliably distinguish the utricle-saccule boundary-through improved imaging protocols or automated segmentation-to assess saccular hydrops in living patients.

Objectives: To identify patient factors and speech perception outcomes associated with selection of a remote programming cochlear implant (CI) strategy over traditional in-person programming 2-week post-activation.

Study design: Prospective cohort study.

Setting: Single high-volume, tertiary care adult CI center.

Patients: Adult patients with sensorineural hearing loss and poor speech recognition meeting criteria for cochlear implantation.

Methods: Patients with an advanced bionics CI were offered the choice of an in-person or remote programming session 2 weeks after CI activation. Patients who opted for an in-person follow-up represented the standard of care. Patients who opted for a virtual follow-up had the same programming that would be completed in-person and were asked to complete an additional questionnaire rating their perceived mobile device proficiencies. All patients were seen for a 1-month post-activation appointment and outcomes were compared between the 2 cohorts.

Results: Forty-one adult CI recipients completed either an in-person (N=21) or remote programming (N=20) visit 2 weeks post-activation. Average age at implantation was significantly younger (67.35 y) for the remote programming cohort compared with those opting for an in-person visit (75.57 y). Mobile Device Proficiency Questionnaire (MDPQ-16) indicated a wide range of mobile device proficiencies among patients who opted for remote programming. No significant differences in changes in questionnaires or aided speech perception testing post-implantation were noted between the in-person and remote programming cohorts at the 1-month visit.

Conclusions: A remote programming visit is an acceptable option for all adult CI recipients, even those early in their CI journey or with limited mobile device proficiencies.

Hypothesis: The pH of an intratympanic gel influences the level of protection against the ototoxic effects of systemic cisplatin.

Background: Nucleophiles reduce cisplatin-induced ototoxicity by chemically inactivating cisplatin and counteracting oxidative stress. pH is a factor influencing cisplatin's reactivity. Here, intratympanic administration of a hyaluronan-based gel containing the nucleophile sodium thiosulfate (STS) was used to investigate the role of pH in otoprotection.

Methods: Guinea pigs (n=32) received a unilateral transtympanic injection of a hyaluronan-based gel (0.10 to 0.15 mL) with either STS at pH 6.5 or pH 8.0, or NaCl at pH 6.5 or pH 8.0. The contralateral ear served as control. After 30 minutes, cisplatin (8 mg/kg b.w., i.v.) was administered. Cochleae were harvested 4 days later for hair cell quantification.

Results: Mean percentage of outer hair cell (OHC) loss per mm in the region ≤10 mm from the round window had a median absolute intraindividual difference of 6.0% (quartiles 1 and 2: 3.8% to 11%; P =0.012; n=8) in group STS pH 6.5 and 5.8% (1.8% to 18%; P =0.046; n=6) in group STS pH 8.0, favoring the gel-treated ear. The corresponding numbers in the NaCl groups were -0.2% (-2.2 to 8.7%; P =1.000; n=8) in group NaCl pH 6.5 and 3.3% (-8.1% to 22%; P =0.237; n=7) in group NaCl pH 8.0. The difference between nontreated and gel-treated ears did not differ significantly between the 2 STS groups.

Conclusion: STS in a hyaluronan-based gel reduced OHC loss equally well at both pH levels, while NaCl was ineffective.

Objective: Prestin enables outer hair cell (OHC) function in cochlear amplification and has been implicated in tinnitus. An experimental study of salicylate toxicity, known to cause tinnitus in humans, demonstrated increased expression of prestin. As prestin is quantifiable in the blood, we hypothesized that if prestin expression is increased in tinnitus patients, then serum prestin levels in those with tinnitus compared with those without tinnitus are elevated.

Study design: A prospective, case-control study.

Setting: Single-institution tertiary care center.

Patients: Patients with or without tinnitus.

Intervention: Diagnostic.

Main outcome measure: Serum prestin was quantified through automated Western blot electropherograms. Key covariates, including age, hearing threshold, and daily noise exposure, were accounted for in multivariate analyses.

Results: Eighty-nine participants (49 with chronic tinnitus and 40 controls) underwent audiometry, noise dosimetry, and blood sampling. The metrics of the 97 kDa prestin isoform were significantly increased in the tinnitus group, with differences in age, hearing thresholds, and daily noise exposure between the 2 groups accounted for in multivariate analyses. Correlations between prestin isoform expression and noise exposure seen in controls were disrupted in the tinnitus group, shifting from the 97 kDa isoform to the 140 kDa isoform.

Conclusions: These findings suggest OHC dysfunction involving prestin in those with tinnitus. Furthermore, the 97 kDa isoform of serum prestin represents a promising candidate biomarker in those with tinnitus. Prestin as a biomarker may serve to stratify tinnitus patients according to origin (eg, cochlear vs. central), inform further investigations of the pathophysiology of tinnitus, and potentially develop targeted treatments.

Hypothesis and background: The objective of this study was to analyze cervical and ocular vestibular-evoked myogenic potentials to electrical stimulation (e-cVEMPs and e-oVEMPs) by straight lateral wall cochlear implant electrodes with respect to response numbers, amplitudes, latencies, and thresholds.

Methods: E-VEMPs were recorded in adult Synchrony cochlear implant (CI) patients stimulating with electric pulse trains. The stimulation electrode was successively varied between apical stimulation at electrode E3, medial stimulation at E6, and basal stimulation at E10 and E11. VEMPs to bone conducted vibration (BCV) were recorded as a reference in all participants.

Results: The study included 20 ears (cases) of 19 patients (mean age of 54.8 y, SD: 11.3 y). E-VEMPs could be measured in 18 cases (95%), and VEMPs to BCV were elicited in 12 cases (60%). Response rates to basal stimulation at E10 and E11 were higher compared with medial and apical stimulation. The difference was significant for e-cVEMPs. For basal stimulation, e-VEMP amplitudes were comparable to BCV-stimulated VEMPs and increased with increasing stimulation level. E-VEMP thresholds were within clinical fitting levels for basal stimulation electrodes and close to or below hearing thresholds for some participants.

Conclusion: Vestibular co-stimulation by straight lateral wall electrodes was demonstrated by the presence of e-VEMPs in 95% of participants. Basal electrode contacts are more likely to lead to vestibular co-stimulation compared with medial and apical electrodes, and vestibular co-stimulation can occur before electric stimuli become audible. Vestibular co-stimulation can, therefore, occur during daily CI use, while the effect on everyday balance function is unknown yet.

Hypothesis: Cases historically presumed to be perilymphatic fistula of the round and/or oval window may be cases of third window syndrome due to inner ear dehiscence.

Background: Perilymphatic fistula (PLF) is a condition where a pathologic external connection of the perilymphatic space is present, often with an associated otic capsule or stapes defect. Recently, it has become evident that otic capsule defects in locations that lack perilymphatic fluid leak can cause clinical symptoms. Such clinical entities are deemed "third window" syndromes-among which superior semicircular canal dehiscence is the most common.

Materials and methods: Human temporal bone specimens underwent histopathologic study of cases previously suspected to have PLF at the oval or round window. These specimens were further scrutinized for the presence of an alternate site of inner ear dehiscence that may have potentially caused a third window syndrome.

Results: Thirty-one out of 34 of the cases (61 ears) from a previously published study on PLF were reviewed. Altogether, dehiscences were noted at the following locations: cochlea-facial (11), superior semicircular canal (5), endolymphatic sac-jugular bulb (4), cochlea-internal auditory canal (3), posterior semicircular canal (2), and an enlarged/patent cochlear aqueduct (2). One patient with a histologic dehiscence had an audiogram consistent with third window syndrome.

Conclusions: The findings suggest that many clinical cases historically presumed to be PLF of the round and/or oval window may, in fact, be cases of third window syndrome due to inner ear dehiscence with pathology at sites other than the oval or round windows.

Objective: To evaluate the feasibility and describe the surgical outcomes of an exclusively endoscopic transcanal approach for reconstructing the external auditory canal (EAC) in patients with temporomandibular joint (TMJ) herniation.

Patients: This study included 3 consecutive patients with symptomatic, spontaneous TMJ herniation. The primary indication for surgery was discomfort from the herniation that persisted for more than 3 months.

Intervention: All patients underwent reconstruction of the anterior EAC wall using a titanium mesh through an exclusively endoscopic transcanal approach.

Main outcome measures: The primary outcomes were technical feasibility of the procedure, operative time, and postoperative results, including any complications.

Results: The endoscopic procedure was successfully completed in all 3 patients without conversion to an open approach. The mean operative time was 75.3 minutes (range: 65 to 85 min). During a mean follow-up of 23.3 months, 2 patients had a complete resolution of symptoms without complications. One patient experienced mesh extrusion 8 months after surgery, which required removal of the mesh. The feasibility of most surgical steps was rated as 'adequate'.

Conclusions: An exclusively endoscopic transcanal approach is a feasible technique for repairing TMJ herniation into the EAC. This method provides excellent visualization of the surgical field and avoids external incisions. Although these preliminary results are promising, larger studies are necessary to confirm the long-term efficacy and safety of this technique.

Objective: To compare the prevalence and patterns of transverse sinus stenosis (TSS) in patients with lateral skull base spontaneous cerebrospinal fluid (sCSF) leaks and idiopathic intracranial hypertension (IIH), to clarify its role in leak pathogenesis and implications for venous-directed therapies.

Study design: Retrospective case-control study.

Setting: Single tertiary care institution.

Patients: Adults with lateral skull base sCSF leaks confirmed by clinical, laboratory, or surgical findings, and adults with IIH without cranial CSF leaks meeting Modified Dandy criteria.

Intervention: Independent magnetic resonance venography evaluation by 2 fellowship-trained neuroradiologists.

Main outcome measures: Presence, laterality, and severity of TSS.

Results: Eighteen patients with sCSF leaks and 78 patients with IIH were included. The rate of individual TSS, including both unilateral and bilateral cases, was higher in the IIH cohort than in the sCSF leak cohort (bilateral TSS: n=66, 84.6% vs. n=6, 33.3%; P <0.001). Severe bilateral TSS was observed more in the IIH cohort (n=40, 51.3%) compared with the sCSF leak cohort (n=1, 5.6%; P <0.001).

Conclusions: Though patients with lateral skull base sCSF leaks have TSS, the significantly lower rate compared with patients with IIH suggests that TSS may play a lesser role in the pathogenesis of lateral skull base defects. These findings indicate that the role of transverse sinus stenting in lateral skull base sCSF leaks remains uncertain and highlight the need to further investigate local remodeling processes when considering the role of venous sinus stenting in this population.