Otology & Neurotology最新文献

Objective: To determine the prevalence of anatomic obstructions, including pseudomembranes and tissue plugs, in the round window niche among human temporal bone specimens. To identify patient factors associated with these obstructions.

Background: Effective drug delivery to the inner ear is critical for intratympanic and emerging intracochlear therapies for sensorineural hearing loss (SNHL). Both rely on access to the round window membrane (RWM), which may be obstructed by pseudomembranes or tissue plugs that impair therapeutic efficacy. This is the largest survey to date of RWM obstructions and their associated factors.

Materials and methods: Temporal bone specimens with SNHL and normal hearing were selected from Massachusetts Eye and Ear, University of Pittsburgh, and Hospital Nacional de Niños using the NIDCD National Temporal Bone Registry. Exclusion criteria included prior otologic surgery, middle ear disease, and congenital anomalies. Histopathologic analysis was performed.

Results: Two hundred seventy-nine temporal bones were analyzed (215 SNHL, 64 controls). Among adults, 43.2% had pseudomembranes and 19.2% had tissue plugs. Among children (age ≤18), 10.0% had pseudomembranes and 50.0% had tissue plugs. Results did not differ by hearing status. Pseudomembranes were significantly associated with age older than 18 [odds ratio (OR): 8.01] and reactive middle ear mucosa (OR: 1.83). Tissue plugs were associated with age 18 or younger (OR: 9.03) and presence of mesenchyme (OR: 2.53). Meniere disease (OR: 0.07) and ototoxicity (OR: 0.11) were associated with fewer pseudomembranes.

Conclusions: RWM obstructions are common, with pseudomembranes or tissue plugs present in 2/3 of ears. Adults were more likely to have pseudomembranes, while children were more likely to have tissue plugs. These findings may impact inner ear drug delivery strategies.

Hypothesis: Endolymph volumes within the cochlea and vestibule differ between Meniere's disease (MD) and similar-age controls.

Background: Magnetic resonance imaging (MRI) has potential to diagnose endolymphatic hydrops (EH). In this study, we utilize archival human temporal bones (HTB) to establish objective reference values for endolymph volumes within the cochlea and vestibule in patients with MD and in age-similar controls, for correlation with future MRI studies.

Methods: Nineteen HTBs were selected for 3-dimensional reconstruction and volume analysis, including 12 HTBs with MD and 7 age-similar control HTBs. HTBs were segmented and volumes of interest were measured allowing for calculation of the vestibular and cochlear endolymphatic ratios (vELR and cELR), representative of the degree of EH within the vestibule and cochlea.

Results: Endolymph volumes within the vestibule and cochlea were significantly higher in MD HTBs. There was no difference in volumes of the bony vestibule and cochlea. The vELR and cELR were significantly larger in MD. Control HTB measurements were utilized to establish the upper bound of normal for the vELR and cELR, which were determined to be 33.2% and 8.84%, respectively.

Conclusions: Endolymph volumes and the corresponding vELR and cELR values were significantly higher in MD, indicative of EH. Through the ELR, this study provides objective anatomic reference values directly comparable to MRI studies of EH. A threshold for the vELR and cELR is proposed, above which a diagnosis of EH may be warranted.

Objective: Previous work has shown that music re-engineering can enhance music enjoyment in cochlear implant (CI) recipients. In this study, we investigate the impact of the mechanism of stimulus delivery on music enjoyment by comparing direct streaming (DS) with external audio (EA).

Study design: Prospective cohort study.

Setting: Academic cochlear implant center.

Patients: Eligibility criteria included (1) age 18 years or above, (2) unilateral or bilateral CI, (3) at least 3 months' status post cochlear implantation, and (4) English-speaking.

Interventions: Patients were assigned to listen to music excerpts through DS or external audio (EA). A retest with the opposite stimulus modality was requested 2 weeks after the initial visit.

Main outcome measures: Patients rated music excerpts from various genres on 3 metrics: musicality, naturalness, and pleasantness. These scores were combined to create a total enjoyment score.

Results: Thirty-six subjects with a mean age of 63 years (SD 16.23, range 20 to 86) participated in the study. Twenty-four returned for retesting with the opposite stimulus delivery. Across all tests, there was a preference for EA over DS (mean difference +0.81, P <0.0001). Within the unilaterally implanted subjects, CI + deaf ear group scored EA significantly lower than both the CI + NH and CI + HA/impaired hearing groups ( P <0.0001). There was no difference between EA and DS in bilaterally implanted users. In total, 83.3% of subjects reported that utilization of the audio mixer increased music enjoyment, and 77.8% of subjects expressed a desire to use it on music of their own choosing.

Conclusions: Subjects with unilateral CI demonstrated a preference for EA over DS, which was consistent after retest with randomization. In CI-only conditions (bilateral CI or CI + deaf), subjects had a slight preference for DS or no difference. EA and DS should not be considered equivalent methods of stimulus delivery in the assessment of music enjoyment in unilateral CI recipients.

Objective: To report the long-term hearing outcomes after ossiculoplasty using the new semi-synthetic TORP.

Study design: Prospective study.

Setting: Tertiary referral center.

Methods: From April to May 2023, 18 ossiculoplasties using the new semi-synthetic TORP were performed by the first author. In all patients, the new semi-synthetic TORP was placed between the stapes footplate and the tympanic membrane, both in the presence and absence of the stapes superstructure. The primary outcome was the long-term postoperative air-bone gap (ABG). Hearing stability over time was assessed by comparing short- and long-term postoperative ABG. Secondary outcomes included postoperative air-conduction pure-tone average (ACPTA), word recognition scores, and the percentage of patients achieving ABG ≤20 dB. The extrusion rate was also evaluated.

Results: At short-term follow-up (mean: 8.5 mo), the ABG improved from a mean of 33.5 dB (SD=8.7) to 12.2 dB (SD=5.98); 88.8% of patients (16/18) achieved ABG ≤20 dB. The short-term postoperative ABG was significantly improved compared with preoperative values (t=27.7; P <0.05). At long-term follow-up (mean 24.5 mo), the ABG improved to 13.2 dB (SD=5.49), with 83.3% of patients (15/18) achieving ABG ≤20 dB (t=15.3; P <0.05). No statistically significant difference was observed between short-term and long-term ABG (t=0.45; P > 0.05). The extrusion rate was 0%.

Conclusions: The new semi-synthetic TORP ossiculoplasty demonstrated excellent and stable long-term hearing outcomes with no extrusion.

Objective: To determine long-term audiological and subjective outcomes of cochlear implantation in children with congenital single-sided deafness (SSD), with emphasis on factors potentially influencing the degree of benefit.

Study design: Retrospective single-center study.

Setting: Tertiary referral center.

Subjects: Twenty congenitally deaf children with a mean age at implantation of 2.6 (±1.7) years and a mean cochlear implant (CI) experience of 6.8 (±3.2) years were included.

Intervention: Unilateral cochlear implantation.

Main outcome measure: Assessment of speech understanding in quiet (Freiburger/Göttinger/Mainzer tests) and in noise (OLSA/OLKiSA), sound localization ability (RMS, MAE), subjective assessments by parents and children adapted to the developmental age (SSQ, E-HAK, Bochum questionnaires), and CI usage time.

Results: Significant improvements were observed in speech in noise with speech from the implanted and noise from the normal hearing side (SNR 1.08 dB without vs. -1.67 dB with CI, P =0.0021), in sound localization measured by RMS (69.76 degrees without vs. 52.38 degrees with CI, P =0.0040), and in the subjective assessment using the SSQ ( P <0.005) and the E-HAK ( P =0.018). No clear correlation was found between the subjective rating by parents or children and the objective benefits with the implant. There was considerable interindividual variability in outcome, which could not be explained solely by age at implantation, duration of CI usage, or CI experience.

Conclusion: Although the CI is predominantly rated positively by parents and children, a thorough counseling regarding the anticipated benefits is required. Multicenter studies with well-documented data on potential influencing factors will provide greater clarity in the future.

Objectives: To investigate the validity of the CT-based virtual endoscopy (VE) in predicting round window (RW) accessibility during cochlear implant (CI).

Patients: A prospective case series study included 40 CI patients.

Intervention: Radiological rating was performed by 2 CI surgeons using CT scan DICOM data and OsiriX software, through which virtual mastoidectomy and posterior tympanotomy were simulated to predict RW accessibility, which was graded as favorable or unfavorable. An intraoperative rating was performed, and RW visibility was classified as visible or nonvisible.

Main outcome measures: We established a correlation between preoperative virtual RW accessibility and intraoperative RW visibility. Inter-rater and intrarater reliability were done for CT VE.

Results: The mean age was 24 months, with males accounting for 58% of cases and right ears being implanted in 88% of cases. Intraoperative rating: we reported 29 cases with visible RW and 11 cases with nonvisible RW. Radiological rating: rater 1 documented 28 cases with favorable RW accessibility and 12 cases of unfavourability. Rater 2 documented 27 cases with favorable RW accessibility and 13 cases that were unfavorable. A correlation was established between both methods and revealed an average accuracy of 96%. Inter-rater reliability had an intraclass correlation coefficient of 0.971.

Conclusion: We reported a novel method for predicting RW accessibility using 3D CT-based virtual endoscopy. This method is valid, reliable, reproducible, and feasible with a high accuracy rate.

Objective: To provide an updated account of tympanoplasty success rates in Inuit patients of Northern Quebec and to explore optimal surgical techniques for this population.

Background: Chronic otitis media and tympanic membrane perforations are highly prevalent among Inuit populations in Northern Quebec.

Materials and methods: A retrospective chart review was conducted of Inuit patients who underwent tympanoplasty with or without ossicular chain reconstruction at the Inuulitsivik Health Center in Puvirnituq, Quebec, Canada, between January 2015 and January 2024. The primary outcome was otoscopic confirmation of an intact tympanic membrane postoperatively. Secondary outcomes included pre- and post-procedure audiometric parameters and postoperative complications.

Results: A total of 197 patients (median age 16.4, IQR: 12.2;31.7) and 224 tympanoplasties were included (195 primary and 29 revision surgeries). Postoperative examination revealed successful closure of the tympanic membrane in 113/174 (64.9%) of patients with appropriate otoscopic follow-up, however, varied widely according to the type of graft used. Cartilage tympanoplasties had a closure rate of 86.7% (39/45 patients), compared with 63.0% (51/81) for tympanoplasties using a perichondrium or fascia as a graft, and 48.9% (23/47) for simple myringoplasties using fat and/or a hyaluronic acid scaffold (EpiDisc; P < 0.001). The median follow-up was 1.8 years (IQR: 0.9; 3.5).

Conclusion: While tympanoplasty may improve audiometric parameters and recurrent otorrhea, outcomes in Inuit patients are modest. This study emphasized the superior closure rates with cartilage grafts, which may help improve outcomes in this population. Further efforts should focus on addressing broader health care disparities to ensure better access to specialized surgical care and postoperative follow-up in Inuit communities.

Objective: This report presents for the first time a case of triple otic capsule dehiscence (OCD) of the labyrinthine-vascular type, with 2 dehiscences treated simultaneously and effectively by a recently described endovascular approach.

Study design: Case report.

Setting: Single otology/neurotology clinic.

Subject: A 47-year-old male with triple otic capsule dehiscence (OCD) and associated symptoms.

Main outcome measures: Improvement in the Tinnitus Handicap Inventory (THI) and Dizziness Handicap Inventory (DHI) scores.

Results: The first OCD was located between the internal jugular vein (IJV) and the posterior semicircular canal (SCC), and the second OCD was located between the vestibular aqueduct (VA) and the IJV. The third OCD, situated between the superior SCC and the superior petrosal sinus, remained untreated since it was considered less contributive to the patient's symptoms. The procedure involved (1) stenting of the right jugular vein combined with (2) coiling of a small portion of the vein in contact with the homonymous vestibular aqueduct. Early clinical signs, along with the audio-vestibular assessment, also suggested the diagnosis of right-sided endolymphatic hydrops. The outcome was uneventful, and the long-term follow-up showed promising results as the menieriform-like vertigo attacks disappeared after the procedure. THI and DHI scores were significantly improved. Auditory symptoms, including tinnitus, also progressively improved, especially after the fitting of a hearing aid.

Conclusions: Multiple OCD (not only dehiscence of the superior SCC) should be systematically looked for on high-resolution computed tomography, given that a combined endovascular approach could be carried out in multiple labyrinthine-vascular forms.

Study design: Prospective data analysis.

Objective: The intraoperative measurement of auditory brainstem responses (ABR) enables the assessment of the coupling efficiency in active middle ear implant surgeries. Furthermore, auditory steady-state response (ASSR) measurements can offer additional frequency-specific evaluations. This study aims to examine the efficacy of intraoperative ASSR and ABR measurements and optimize implant placement during surgery.

Materials and methods: Tertiary referral center with an extensive active middle ear implant program. Main outcome measures: Intraoperative ABR and ASSR measurements were conducted using a standard ABR system and the AcoustiAP adapter. After the surgical procedure, vibrogram thresholds were measured. The statistical analysis determined correlations between intraoperative ASSR and ABR thresholds, preoperative bone conduction, and postoperative vibrogram thresholds.

Results: All patients underwent successful intraoperative recording of ABR and ASSR measurements. The ASSR thresholds exhibited a high correlation with bone conduction thresholds at 1000 Hz, 2000 Hz, and 4000 Hz. Furthermore, ASSR thresholds demonstrated robust correlations with postoperative vibrogram thresholds.

Conclusion: Intraoperative ASSR measurements can provide valuable real-time feedback for ensuring optimal placement during implantation due to their good correlation with bone conduction. The high correlation between intraoperative ASSR and postoperative vibrogram thresholds indicates that ASSR can also assess postoperative hearing outcomes. Further development and implementation of these measurements in the clinical routine might improve surgical outcomes by enabling more precise frequency-specific assessments, improving both coupling efficiency and postoperative hearing results.

Objective: To examine the associations between cannabis use-individually and in combination with e-cigarettes or cigarettes-and obstructive eustachian tube dysfunction (OETD) among US adults.

Methods: Cross-sectional review of participants from the National Health and Nutrition Examination Survey (2015 to 2018) with complete data on tympanometry and drug and smoking questionnaires (n=2777). Cannabis and e-cigarette use were categorized as never, nonregular, or regular use. Cigarette smoking was categorized as never, former, or current use. OETD was defined as middle ear pressure less than -100 Decapascals. Multivariable logistic regression analyses were performed to determine associations.

Results: Among US adults, 4.9% (95% CI: 3.4%-7.0%) had tympanometry findings consistent with OETD. Regular cannabis use, defined as >15 days of use in the last 30 days, was significantly associated with OETD (OR: 1.95, 95% CI: 1.02-3.72) in a multivariable model adjusting for e-cigarette, cigarette use, and other relevant demographic and clinical factors. Both ever and regular cigarette use were significantly associated with OETD (OR: 1.62, 5% CI: 1.02-2.56; OR: 2.18, 95% CI: 1.27-3.74, respectively), while e-cigarette use (ever, nonregular, or regular) was not independently associated with OETD in multivariable models. The combined use of all 3 substances was associated with greater odds of OETD (OR: 2.10, 95% CI: 1.23-3.58).

Conclusions: This study suggests that regular cannabis use and combined use of cannabis, e-cigarettes, and cigarettes are associated with greater odds of OETD. Future research is needed to better understand the effect of cannabis, independently and in combination with other substances, on OETD.