Otology & Neurotology最新文献

Hypothesis: International consensus exists on optimal measures for reporting outcome from cholesteatoma surgery. This consensus can be used to create a core outcome set (COS) for publication standards.

Background: Systematic reviews show that the quality of published evidence available to inform surgical decision-making in the management of cholesteatoma is limited with inadequate distinction between residual and recurrent cholesteatoma, use of survival analysis or audiometric reporting standards.

Methods: The International Otology Outcome Group (IOOG) followed COS-STAD and COS-STAR guidelines to develop a COS document. A systematic literature review, which included stakeholder consultation, guided outcome selection. Using a Delphi process, IOOG members and the boards of 5 large otological societies refined the document using on-line survey and email. Consensus was defined as ≥85% agreement among participants across 2 survey rounds. Final outcome measures were categorized as principle (mandatory) or suggested (recommended) standards.

Results: Principle reporting standards included: distinction of residual from recurrent cholesteatoma, with use of survival analysis for outcome at 5 years, description of technique for detection of residua, use of audiometric reporting standards, and distinction between complications from cholesteatoma and surgery. Suggested standards covered reporting of cholesteatoma severity, surgical nomenclature, and further audiometric measures. Patient-reported outcome measures are recognized as important, but too few responses were received to define an optimal PROM.

Conclusion: This COS provides a consensus-based framework for standardized reporting in cholesteatoma surgery. Adoption of the COS as a publishing standard should improve the quality of evidence available to guide surgical care.

Objective: To explore the existing evidence on novel imaging modalities that may aid in prognostication of vestibular schwannoma (VS) clinical outcomes across various management approaches.

Study design: Scoping review.

Setting: Not applicable.

Patients: Individuals diagnosed with VS.

Interventions: Novel imaging techniques.

Main outcome measures: Tumor growth and response to medical therapy.

Results: A total of 18 articles were included in this review. Of these, 7 focused on pretreatment prognosis, 6 evaluated radiosurgery outcomes, 4 examined microsurgery outcomes, and 1 assessed response to bevacizumab. The imaging modalities investigated included radiomics (n = 10), positron emission tomography (PET; n = 2), dynamic contrast-enhanced MRI (DCE-MRI; n = 2), both PET and DCE-MRI (n = 1), magnetic resonance elastography (MRE; n = 1), contrast-enhanced CT (CE-CT; n = 1), and slip interface imaging (SII; n = 1). Radiomic studies yielded encouraging results in predicting tumor growth after wait-and-scan and radiosurgery, with reported accuracies ranging from 52% to 88%, sensitivities from 13% to 95%, specificities from 50% to 94%, and area under the curves from 0.65 to 0.99. PET studies identified several promising ligands associated with tumor growth during wait-and-scan, suggesting a potential role in prognostication. DCE-MRI also demonstrated associations with tumor growth and treatment response to bevacizumab. Studies on MRE, CE-CT, and SII identified novel imaging parameters associated with tumor stiffness and adhesion.

Conclusions: Several emerging imaging modalities hold potential for improving clinical outcome prognostication in VS. Techniques such as radiomics, PET, and DCE-MRI have shown promising results; however, the supporting evidence is still limited and heterogeneous. Further research is necessary to validate and refine these approaches to enhance their clinical utility.

Objective: The debate regarding the optimal cochlear implant (CI) electrode array-perimodiolar (PM) versus lateral wall (LW)-has intensified with evolving technology. Comparing electrode designs is challenging due to variability in patient characteristics. This study compares PM versus LW electrodes placed in opposite ears of the same patients.

Study design: Retrospective chart review.

Setting: Tertiary referral center.

Patients: Individuals undergoing bilateral cochlear implantation with a LW electrode in one ear and a PM in the other from 2003 to 2023.

Intervention: Bilateral cochlear implantation with each electrode type.

Main outcome measures: Demographics and audiologic data (4-frequency pure tone average (PTA), consonant-nucleus-consonant (CNC) scores, and AzBio scores in quiet and noise). Outcomes were compared using Wilcoxon Signed Ranks Test with SPSS version 27.

Results: Thirty-two patients met inclusion criteria. Median age at PM and LW implantation was 64.5 (Q1-Q3: 46.8 to 71.9) and 69.6 (50.6 to 76.3) years, respectively. CNC scores were significantly higher in PM arrays: 66% (51 to 71) vs. 42% (26 to 70), P=0.008. AzBio scores in quiet (75% vs. 67%, P=0.082) and noise (59% vs. 63%, P=1.000) showed no significant differences. Battery life was longer in the PM group (33.5 vs. 30 hours), though not statistically significant (P=0.819).

Conclusion: PM arrays offer improved CNC word understanding when compared with LW arrays, but do not offer a significant improvement in battery life or AzBio scores. To our knowledge, this is the first study to compare these outcomes using each patient as their own control, thereby controlling for the majority of patient factors that could influence performance.

Background: The erosive effect of chronic otitis media impairs the middle ear's ossicles. Alloplastic materials or autologous incus can be used for ossicular repair. Perichondrial roll is simple to use and saves considerable operative time and cost, especially in developing countries where ossicular prosthesis and bone substitutes are not affordable for the majority of patients.

Objective: To evaluate the use of the perichondrial roll in the reconstruction of the long process of the incus.

Subjects and methods: This study involved 62 patients diagnosed with chronic suppurative otitis media characterized by central perforation, presenting with dry and quiescent ears, and exhibiting an eroded long process of the incus, all of whom underwent tympanoplasty using perichondrial roll and bone pate for reconstruction of the long process of the incus. Audiological evaluations were done for all patients, including preoperative and postoperative evaluation of the air-bone gap and the average pure tone threshold.

Results: The mean air pure tone threshold was 21.6 dB after surgery and 41.7 dB before. The air pure tone thresholds after surgery improved significantly compared with those before (P<0.01). Before surgery, the air-bone gap was 29.6 dB at 0.5 kHz, 30.5 dB at 1 kHz, and 23.9 dB at 2 kHz. At the completion of 6 months of follow-up, the air-bone gap was 6.9 dB at 0.5 kHz, 7.1 dB at 1 kHz, and 7.3 dB at 2 kHz. The air-bone gap revealed a significant improvement in hearing (P<0.001).

Conclusion: Perichondrial roll for bridging the gap between the long process of incus and stapes head seems to be a useful and effective method in ossiculoplasty.

Purpose: To investigate changes in hearing sensitivity post cochlear implantation with MED-EL and Advanced Bionics (AB) lateral wall electrode arrays, with a focus on characterizing delayed onset hearing loss (doHL) and concurrent electrode impedance changes.

Methods: A retrospective review of 96 adult cochlear implant (CI) recipients (101 ears; MED-EL: 51, AB: 50). Hearing sensitivity was assessed using the low-frequency pure tone average (LFPTA; 125, 250, 500 Hz). Immediate decrements in hearing sensitivity were considered separately from delayed decrements. The incidence, degree, and timing of doHL were characterized. Electrode impedances were considered for individuals with doHL compared with those with stable hearing.

Results: Median immediate hearing loss was 19 dB across manufacturers. At initial activation, 73% of subjects had functional (LFPTA <80 dB HL) hearing. When all subjects with variable postoperative time periods were included, the incidence of doHL was 27% with a median degree of 24 dB. The median time doHL occurred was 76 weeks. Most (79%) subjects were categorized with gradual decrements rather than precipitous. No MED-EL subjects with doHL experienced concurrent impedance changes; 3 AB subjects did. Incidence of doHL rose to 31% and 44% when considering the subset of subjects with at least 1 year and 2 years of postoperative follow-up, respectively.

Conclusion: DoHL that was precipitous in nature was observed less frequently than previously reported. Although precipitous hearing loss tended to occur shortly after surgery, most instances of doHL occurred later than anticipated. The absence of concurrent impedance changes for recipients of MED-EL electrode arrays is consistent with previous reports.

Objective: Cochlear implant (CI) non-use and minimal-use are important, but sparsely investigated parameters. This study investigates the risk of becoming a CI non-user or a minimal-user in a post-lingual deafness adult population.

Study design: Retrospective cohort study.

Setting: Tertiary medical institution.

Materials and methods: All adult patients (18 years or above) who received CI surgery at a single center from 2010 to 2022 (n=599) were invited to participate in a questionnaire study concerning the CI usage after surgery. The questionnaire information was combined with data from medical records. Non-use was defined as never/rarely usage of the device. Minimal-users were patients who reported <4 hours of daily use, and patients considering ceasing to use their device, and not included in the non-use group.

Results: In total, 472 (78.8%) patients replied to the questionnaire regarding CI usage. Hereof, 20 patients (4.2%) were non-users and 26 patients (5.5%) were minimal-users with mean follow-up times of 8.4±3.4 years. Rehabilitation was provided for 97% of the participants by a speech-language pathologist for 6 to 12 months. Abnormal cochlear anatomy was associated with CI non-use (odds ratio=5.7, 95% confidence interval [1.1-30.8], P=0.04). No additional correlations were found between non-users, minimal-users, and CI users.

Conclusion: The CI non-user rate was 4.2% and these patients experienced lower QoL compared with CI users. In addition, 5.5% of the patients were minimal-users. In adults with abnormal cochlear anatomy, an increased risk of non-use was identified, reflecting the need for thorough information regarding surgical outcomes in this specific subgroup of patients.

Objective: Auditory nerve monitoring through electrically evoked compound action potentials (eCAP) can be used to assess cochlear neural integrity during vestibular schwannoma (VS) resection. Herein, we report on 5 cochlear implant (CI) patients who underwent VS resection with present eCAP responses both intraoperatively and postoperatively. Patients either did not perceive any sound through their CI or rapidly adapted to electrical stimulation, suggesting that the presence of eCAP does not guarantee auditory nerve function in patients with VS resection.

Patients: Five patients who underwent simultaneous VS translabyrinthine resection and cochlear implantation.

Interventions: Simultaneous cochlear implantation and translabyrinthine microsurgical VS resection.

Main outcome measure: Electrically evoked compound action potential.

Results: All patients had eCAP responses present during their VS resection and for at least 50 days post-surgery. Three of the 5 patients did not perceive any sound with their cochlear implant. This shows that the presence of an eCAP alone does not guarantee a functional auditory nerve or auditory perception. The other 2 patients could hear non-speech sounds, but these sounds quickly became inaudible, indicating that their auditory nerve lacked the ability to integrate the electrical stimulus over time.

Conclusions: The presence of an eCAP response does not guarantee auditory sensation through a CI. Although eCAP measurements provide insight into the function of the distal end of the nerve, it does not ascertain integrity or function of the larger auditory nerve pathway. Therefore, eCAPs should not be used in isolation to monitor auditory nerve function during VS resection.

Objective: To review the effects of perioperative steroid delivery on cochlear impedances in human patients.

Data bases reviewed: PubMed, Web of Science, Embase, Ovid, and Cochrane databases were reviewed from inception through March 2025.

Methods: The Preferred Reporting Items for Systematic Reviews (PRISMA) reporting guidelines were used. Studies comparing cochlear impedances among patients who underwent cochlear implantation either with or without perioperative steroids were included. Data were collected on method, timing, and dose of steroid administration and cochlear impedance in the perioperative period.

Results: Twelve studies were included in the review, which described 4 different routes of steroid delivery: intratympanic (3), intracochlear (7), drug-eluting electrodes (1), and intravenous±oral steroids (1). Nine studies revealed a significant association between steroid use during at least one point in the perioperative period to include 2 intracochlear studies and the intravenous±oral steroids study. Intratympanic steroid delivery reduced impedances up to 6 months postoperatively, whereas intracochlear and drug-eluting electrodes had persistent reductions in impedance up to 1 year. There was significant heterogeneity in study outcomes that limited the ability to perform a meta-analysis.

Conclusions: Based on studies meeting inclusion criteria, local delivery of steroids via intratympanic, intracochlear, and drug-eluting formulations appear to lower cochlear impedances for a variable duration postoperatively. Oral steroids do not appear to affect cochlear impedances postoperatively. More studies are necessary to further elucidate the relationship between steroids and cochlear impedance.