Otology & Neurotology最新文献

Objective: To evaluate the morphology of the crista fenestra (CF) using three-dimensional reconstruction based on high-resolution computed tomography (HRCT) and to examine the influence of CF height on the insertion approach used for CI632/532 implants.

Study design: Retrospective study.

Setting: Tertiary referral center.

Patients: Forty-five ears of 37 patients who received CI632/532 implants were included.

Interventions: HRCT images were reconstructed into three-dimensional images, and CF structures were identified. The patients were divided into two group based on the insertion approach: round window approach (RW; n = 27) and extended round window approach (eRW; n = 18). To evaluate CF interference, 10 cases in the eRW group in which the sheath or electrode did not pass through the RW before widening the RW niche (nRW group) were specifically included in the analysis.

Main outcome measure: The identified CF cross-sections were confirmed by HRCT axial sectioning, and CF heights were measured.

Results: The mean CF height was significantly greater in the nRW group than in the RW group (0.97 vs. 0.78 mm).

Conclusion: CF was identified using three-dimensional computer graphics (3DCG) and the CF height on the HRCT axial sections. Thus, measuring the CF height using 3DCG reconstruction can facilitate the preoperative selection of the electrode insertion approach.

Objective: To review audiological experiences and early hearing outcomes from the early feasibility study of a fully implanted cochlear implant.

Study design: Prospective cohort.

Setting: Tertiary academic medical center.

Patient: Three adults (two-male, one female) with bilateral sensorineural hearing loss.

Interventions: Implantation with a fully implanted cochlear implant as part of an early feasibility study.

Outcomes: Postoperative unaided and aided pure-tone audiometry, tympanometry, mapping parameters, speech perception, battery life, and quality-of-life assessment.

Results: All patients in the early feasibility study of this fully implanted cochlear implant now use their devices regularly. Preoperative and postoperative audiometric measurements showed that their residual hearing in the implanted ear decreased slightly after surgery but was preserved. All patients had type A tympanograms after their transient middle ear effusion resolved. Electrical stimulation levels were comparable to those routinely used in traditional cochlear implants. Two of the three patients use a hearing aid in the implanted ear for additional gain and show significant improvement in speech perception since implantation. Average battery life before recharging is 4 days. All patients are regular users with two showing improvement in quality-of-life metrics after receiving the fully implanted cochlear implant.

Conclusion: The patient experience and hearing outcomes from the early feasibility study of a novel fully implanted cochlear implant are detailed in this study and demonstrate ease of operation and daily use by all participants. All patients obtained hearing, but two of three use a hearing aid with their device to overcome unanticipated implant circuitry noise and achieve improved speech perception scores. Current work is focused on reducing this system noise to allow for the device to be used as intended, without a hearing aid.

Hypothesis: Hearing instability in Slc26a4 -insufficiency mice may be due to differential expression of genes related to ion homeostasis and activated macrophages.

Background: Hearing instability (HI) disorders, defined by either hearing fluctuation or sudden loss, remain incompletely understood. Recent studies have described a Slc26a4 (pendrin)-insufficiency mouse model (DE17.5) that offers a genetically driven model for HI, although deep audiometric and immunohistologic phenotyping of this model remains poorly characterized.

Methods: Homozygous DE17.5 mice with (F) and without (NF) HI were delineated by serial auditory brainstem responses (ABR) between postnatal days 30 and 60 and compared with adult phenotypically wild-type Slc26a4 -heterozygous controls without evidence of HI (Het). HI was defined as a change in threshold of at least 15 dB in at least two frequencies or at least 20 dB in at least one frequency from the previous week. Stria vascularis (SV) cell type-specific gene expression, endolymphatic hydrops (EH), endocochlear potential (EP), and macrophage activation were analyzed and compared between the cohorts.

Results: F mice demonstrated significant reductions in the expression of cell type-specific genes related to ion homeostasis and increased macrophage activation within the SV compared with NF and Het cohorts. Both F and NF DE17.5 homozygous mice demonstrated reductions in EP and increased EH compared with the Het cohort.

Conclusions: Deep phenotyping of DE17.5 mice demonstrates changes in EP and EH compared with control; however, the HI phenotype was associated with differential ion homeostasis gene expression and increased macrophage activation in the SV. This provides potential further insights into the underlying pathogenesis and possible immunologic contributions of HI in humans.

Background: The gold-standard assessment of asymmetric sensorineural hearing loss (ASNHL) is contrast-enhanced MRI. Although rates of identifying a vestibular schwannoma are low (<5%), it is generally accepted as cost-effective. Yet, the impact of incidentalomas is rarely considered. This study aims to characterize the incidence of incidentalomas in the workup of ASNHL and quantify the associated socioeconomic burden.

Study design: Retrospective cohort study.

Setting: Single academic institution in a midsized city in the United States.

Methods: Radiology records were queried for MRI's ordered for ASNHL between January 2012 and November 2022. Results were characterized as "group 1: normal," "group 2: abnormal read/normal variant," "group 3: abnormal-likely cause of ASNHL," or "group 4: abnormal-follow-up needed." Subsequent costs of workup for group 4 were estimated using Medicare Physician Fee Schedule for Medicare costs, US Congressional Budgeting Office data for private insurer costs, and USC-Brookings Schaeffer Initiative for Health Policy estimates for uninsured individuals.

Results: Six hundred patients met the inclusion criteria. Eighteen (3.0%) were categorized in group 3, whereas 40 (6.7%) were categorized in group 4. Of these patients, 7.5% (n = 3) had interventions to manage their incidental findings. Estimated per patient cost for further workup of incidental findings amounted to approximately $744, $1,534, and $2,260 for Medicare, private insurance, and uninsured costs, respectively.

Conclusion: Incidentalomas occur over twice as often as retrocochlear pathologies responsible for ASNHL. Although the number of patients requiring treatment for incidentaloma is low, the economic impact is not insubstantial and should be considered for both individual patients and health system payers.

Introduction: Cochlear implants (CIs) provide access to sound and help mitigate the negative effects of hearing loss. As a field, we are successfully implanting more adults with greater amounts of residual hearing than ever before. Despite this, utilization remains low, which is thought to arise from barriers that are both intrinsic and extrinsic. A considerable body of literature has been published in the last 5 years on barriers to adult CI uptake, and understanding these barriers is critical to improving access and utilization. This scoping review aims to summarize the existing literature and provide a guide to understanding barriers to adult CI uptake.

Methods: Inclusion criteria were limited to peer-reviewed articles involving adults, written in English, and accessible with a university library subscription. A cutoff of 20 years was used to limit the search. Barriers uncovered in this review were categorized into an ecological framework.

Results: The initial search revealed 2,315 items after duplicates were removed. One hundred thirty-one articles were reviewed under full-text, and 68 articles met the inclusion criteria.

Discussion: Race, ethnicity, and reimbursement are policy and structural barriers. Public awareness and education are societal barriers. Referral and geographical challenges are forms of organizational barriers. Living context and professional support are interpersonal barriers. At the individual level, sound quality, uncertainty of outcome, surgery, loss of residual hearing, and irreversibility are all barriers to CI uptake. By organizing barriers into an ecological framework, targeted interventions can be used to overcome such barriers.

Objective: To assess the long-term outcomes of sigmoid sinus wall reconstruction (SSWR) in patients with pulsatile tinnitus (PT) with sigmoid sinus wall anomalies (SSWAs).

Study design: Single-center retrospective review.

Setting: Tertiary referral center.

Patients: Patients who underwent SSWR for PT with SSWAs more than 5 years prior to study initiation.

Interventions: Therapeutic-all patients underwent sinus wall reconstruction for pulsatile tinnitus with sigmoid sinus anomalies.

Main outcome measures: The primary outcomes were complete or partial resolution of PT lasting at least 5 years postoperatively and short-term relief from PT after surgery with long-term recurrence as determined by a self-assessment questionnaire and corroborated by the medical record.

Results: Thirty-five patients (37 ears) out of 58 eligible patients 5 years postoperatively from SSWR completed the survey. Short-term and long-term success rates of SSWR are 97.3% (36/37 ears) and 83.8% (31/37 ears), respectively. Of the patients, 13.5% (5/37 ears) experienced recurrence of PT on the same side following initial resolution. Of our patients, 8.6% had a confirmed diagnosis of idiopathic intracranial hypertension (IIH) after a follow-up period of more than 5 years.

Conclusions: Sinus wall reconstruction is an effective procedure for long-term control of PT in patients with SSWAs, with an acceptable safety profile and very low additional risk of exacerbating or provoking complications associated with IIH.

Objective: To assess growth rates of residual vestibular schwannoma after subtotal and near-total surgical resection and establishing staging system for risk of residual tumor growth.

Study design: Retrospective cohort study.

Setting: Tertiary referral center.

Patients: Patients with residual vestibular schwannoma after surgical resection from 2011 to 2023 identified on postoperative MRI defined as near-total resection (NTR, less than 5 mm of remaining tumor), subtotal resection (STR; 5-10 mm) and debulking (>10 mm).

Main outcome measures: Tumor growth of 2 mm or more after subtotal or near-total surgical resection of vestibular schwannoma.

Results: A total of 56 patients (54% female; mean, standard deviation [SD] age 51 [17] yr) had residual tumor. Mean preoperative tumor size was 3.0 (1.1) cm, and residual tumors involved both sides with similar frequency (right: 52%). Quantitatively, 29% were NTR, 32% were STR, and 39% were debulking. With an average follow-up of 27 (SD 31) months, tumor growth occurred in 11 (20%), tumor shrinkage occurred in 16 (29%), and tumors were unchanged in 29 (51%) cases. Growing residual tumors were treated with radiation (7 patients) or a second surgical resection (4 patients). Multivariable analysis identified lower patient age, larger preoperative tumor size, and larger residual tumor size in risk of residual growth. A residual VS tumor staging system (Age, Tumor, Residual [ATR]) is proposed with most tumors in stage II (22, 42%) or stage III (23, 44%), whereas 7 (14%) tumors are stage I.

Conclusions: Approximately 80% of residual VS are stable or shrink in size. Initial observation is advocated after incomplete resection and long-term follow up is needed. Patient age less than 55 years, larger preoperative tumor size, and larger postoperative residual tumor size appear predictive of residual tumor growth.Level of Evidence: 4.

Introduction: Electric-acoustic stimulation (EAS) provides cochlear implant (CI) recipients with preserved low-frequency acoustic hearing in the implanted ear affording auditory cues not reliably transmitted by the CI including fundamental frequency, temporal fine structure, and interaural time differences (ITDs). A prospective US multicenter clinical trial was conducted examining the safety and effectiveness of a hybrid CI for delivering EAS.

Materials and methods: Fifty-two adults (mean age 59.9 yr) were enrolled in the study and followed up to 5 years postactivation. Testing included unaided and aided audiometric thresholds, speech perception (Consonant-Nucleus-Consonant [CNC] words in quiet and AzBio sentences +5 dB SNR), and patient-reported outcomes (Speech, Spatial, and Qualities of Hearing Scale).

Results: Functionally aidable hearing, defined as low-frequency pure-tone average (125-500 Hz) <80 dB HL, was maintained for 77% of patients through 1 year, with 66.7% maintaining through 5 years. Speech perception was significantly improved at all postoperative timepoints compared with preoperative performance with hearing aid(s), and patient-reported outcomes indicated significantly improved subjective speech understanding, spatial hearing, and sound quality. Participants with preserved acoustic hearing using EAS reported significantly higher subjective spatial hearing and sound quality than participants with electric-only hearing in the implanted ear.

Discussion: Patients with high-frequency hearing loss demonstrate significant long-term benefit with a hybrid CI including high rates of functional hearing preservation, significantly improved speech perception, and subjective patient-reported outcomes. EAS with binaural acoustic hearing affords benefit for subjective spatial hearing and sound quality beyond CI listening configurations using monaural acoustic hearing.