Otology & Neurotology最新文献

Objective: To investigate the association between postoperative antibiotic prophylaxis and the risk of infections leading to implant explantation or hospitalization, with a follow-up of up to 12 years.

Study design: Retrospective cohort study.

Setting: Tertiary medical institution.

Patients: Adult patients (≥18 yr) receiving cochlear implant surgery between 2010 and 2022.

Intervention: Postoperative oral prophylactic antibiotic treatment for 4 to 10 days.

Main outcome measures: The medical records of patients receiving cochlear implants were assessed (n = 927). Two groups were formed: group A, receiving postoperative oral antibiotic treatment (period: 2010-2015) (n = 526), and group B, not receiving postoperative oral antibiotic treatment (period: 2016-2022) (n = 401). The two groups were compared regarding infections leading to hospitalization or explantation, and baseline characteristics.

Results: In total, 28 patients (3.0%) had infections requiring explantation or hospitalization. Of these, 13 were explantations (1.4%). The infection rate in group A was 2.9%, compared with 3.2% in group B, with an odds ratio of 1.2 in group B (p = 0.646). Group B had a 2.2 odds ratio of explantation caused by infection compared with group A (p = 0.179). We observed a significant correlation between severe infections in patients previously having otologic surgery (7.7%, p = 0.011) and in patients with previous issues of chronic otitis (16.7%, p = 0.005).

Conclusion: Occurrence of postoperative infection leading to explantation and hospitalization was not significantly associated with the use of postoperative antibiotic prophylaxis. However, infections were higher in patients not receiving antibiotic prophylaxis, despite having a lower risk of postoperative infection.

Objective: This investigation aims to determine whether community-level social determinants of health (SDoH) influenced acoustic neuroma outcomes more profoundly than individual-level SDoH through the use of multivariate models and census-level socioeconomic status (SES) measures.

Study design: Observational, retrospective cohort study. Setting: Specially Authorized Head-Neck SEER 2020 Dataset.

Patients: 23,330 adult (20+ yr) patients diagnosed with acoustic neuroma from 2010 to 2018.

Main outcome measures: Age-adjusted multivariate regressions and hazard models were performed for individual level (sex, race-ethnicity) and community-level factors (Yost Index-SES, rurality-urbanicity) to assess for differences in acoustic neuroma treatment, including delay of intervention, treatment receipt, and overall survival.

Results: Lower Yost-SES/community-level SES had a markedly positive association with an increase in all-cause mortality (HR, 1.55; 95% CI, 1.41-1.71) and negative association with stereotactic radiotherapy treatment (OR, 0.93; 95% CI, 0.86-0.99; p = 0.040). Patients with poor Yost-SES had a significantly positive association with receipt of surgical resection (OR, 1.13; 95% CI, 1.07-1.20; p < 0.001).

Conclusions: Data generated from this investigation suggest that community-level SDoH, particularly Yost-SES, have more detrimental care and prognostic disparities in acoustic neuroma treatment compared with individual-level factors.

Hypothesis: Western blot analysis of human prestin in the blood reveals multiple bands, rather than a single band.

Background: Previously, using the ELISA method, prestin was shown to be a good biomarker of outer hair cell (OHC) health and sensorineural hearing loss that could be measured in the blood. Recently, we found that a Western blot approach in an experimental model demonstrated three prestin bands providing greater insights into prestin in the blood and its origins. This approach has not yet been explored in humans.

Methods: Serum samples from 25 healthy human subjects were analyzed. An automated Western blot for each sample was generated, and bands were analyzed and compared with transient evoked otoacoustic emission levels (TEOAE).

Results: There were five bands at ~32, ~50, ~94, ~139, and ~171 kDa, respectively. Notably, the ~50-kDa band consistently was the most prominent. When the subjects were divided based on TEOAE level, those with high emission levels had a significantly larger ~94-kDa band than those with low emission levels.

Conclusions: Western blot characterization of OHC biomarker prestin in humans shows that the band closest to the previously estimated molecular weight of prestin (81 kDa) is related to a functional measure of OHCs. This finding increases confidence in the value of serum prestin as a biomarker. The Western blot method appears to offer higher-resolution information on serum prestin. Future work will be carried out under pathological conditions to inform on the application of this quantitative method in clinical settings.

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.

Objective: We aimed to investigate the effect of adding "rapid decelerations" and "vibrations" during a SemontPLUS maneuver on the dynamics of the inner ear and the success rate of canalolithiasis repositioning.

Methods: We used a previously described upscaled (5×) in vitro model of the posterior semicircular canal of the inner ear to analyze the trajectory of a single and clumped surrogate otolith particle (metallic sphere) during a SemontPLUS maneuver (-60 degrees below earth horizontal) on a repositioning chair (TRV). We compared the angular displacement of these particles with and without the application of "vibrations" or "rapid decelerations" using TRV. We recorded the success rates of the SemontPLUS maneuver for each condition.

Results: After the first step of the SemontPLUS, the application of "vibrations" increased the angular displacement of single particles from 119.9 to 125.9 degrees and clumps from 106.7 to 122.8 degrees. Clumps traveled shorter distances than single particles. "Rapid decelerations" also increased the angular displacement from 119.9 to 123.4 degrees and from 106.7 to 111.7 degrees for singles and clumps, respectively. "Vibrations" and "rapid decelerations" applied on the in vitro model resulted in enhanced repositioning success rates to 60 and 73%, respectively.

Conclusions: Adding "rapid decelerations" or "vibrations" to the SemontPLUS maneuver increased otolith particle displacement and improved the repositioning success rates in an in vitro model. However, the effect size of these additional modalities on angular displacement is small, and their use in clinics to improve repositioning in the SemontPLUS would have to be supported by further clinical trials.

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.

Objective: This study aims to identify 18F-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: 18F-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 18F-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 18F-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 18F-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.

Hypothesis: Extracochlear electric-acoustic stimulation (EAS) between the round window membrane and the basal part of the cochlear bone exhibits distinct auditory brainstem response (ABR) characteristics.

Background: The use of EAS in individuals with residual hearing is becoming increasingly common in clinical settings. Ongoing research has explored the characteristics of EAS-induced responses in hearing cochleae.

Methods: This study explored a novel extracochlear EAS approach using round window membrane-cochlear bone stimulation to maintain cochlear integrity. The electrodes stimulate the basal part of the cochlea and spare the apex, making the model ideal for EAS candidates with profound high-frequency hearing loss and residual low-frequency hearing. ABR analyses of EAS were conducted to compare responses to acoustic, electrical, and combined stimulations.

Results: The threshold of EAS was higher than that of acoustic stimulation (AS) or electric stimulation (ES). The maximum peak height of the amplitude (MPHA) in the EAS showed sound pressure level (SPL)- and electric current-dependent changes, with superior performance at higher SPLs. The MPHA latency shift index analysis demonstrated significant differences between the EAS and the AS or ES only. In the context of EAS, neural responses occurring before 4 ms are defined as early responses, which are related to the stimulus. Late responses, occurring after 4 ms, suggest distinct physiological mechanisms that may involve synaptic actions or specific interactions within the EAS.

Conclusion: Extracochlear EAS provides insights into its physiological implications, proposes a method for clinical application, and offers a potential avenue for improving hearing preservation and performance.

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.