Otology & Neurotology最新文献

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.

Objectives: To describe the reasons leading to cochlear reimplantation and discuss implications related to technological failures and manufacturer recalls.

Study design: Retrospective cohort study over a 40-year period.

Setting: Tertiary academic referral center.

Patients: Children and adults who underwent cochlear reimplantation between May 1, 1984, and May 1, 2024. Patients were evaluated, treated, and followed at our center.

Intervention: Cochlear reimplantation.

Main outcome measures: Incidence of cochlear reimplantation, reasons for explantation, and delay between implantation and reimplantation, stratified by age and device manufacturer.

Results: A total of 3885 cochlear devices were implanted (66% adults). We report 257 reimplantations, including 86 (33%) pediatric cases at a mean age of 9.6 years. Patients were affected by 4 industry-issued recalls. The overall reimplantation rate was 6.6%, with comparable rates in children (6.5%) and adults (6.7%). Manufacturer-specific reimplantation rates were 12.6% for Advanced Bionics, 3.4% for Cochlear, 8.9% for Oticon, and 1.8% for MED-EL. Recalls and hard failures equally accounted for 70.8% of reimplantations. On average, reimplantations occurred 6.5 years after implantation, and 5.8 years in pediatric cases. Reimplantation delays were significantly reduced for recalls compared with hard failures (-3.7 y; P <0.01) and other causes (-4.7 y; P <0.01). About half (50.4%) of reimplantations occurred within 5 years, and 80.2% within 10 years.

Conclusions: This study highlights the complexity of cochlear reimplantation from both technological and human perspectives in a large population. Given the multifaceted burdens of cochlear reimplantation, future efforts should focus on improving device reliability and care pathways to reduce the need for reimplantation.

Objective: To identify patient characteristics associated with improvements in speech recognition scores (SRS) and Cochlear Implant Quality of Life (CIQOL-35) scores following cochlear implantation.

Study design: Multi-institutional prospective cohort.

Setting: Tertiary medical centers.

Patients: Two hundred thirty-five adult CI users with bilateral hearing loss.

Main outcome measures: Pre-CI and 12-month post-CI CIQOL-35, CNC word (CNC), and AzBio quiet (AzBio) scores were obtained. On the basis of improvement beyond established minimally detectable change values for each CIQOL domain and 95% CIs of pre-CI SRS as compared with post-CI, the cohort was divided into 4 groups for each CIQOL domain/SRS pair: (A) CIQOL and SRS improvement, (B) CIQOL improvement only, (C) SRS improvement only, and (D) no CIQOL or SRS improvement.

Results: Correlations between CIQOL and SRS improvements were weak ( r =0.02-0.17). Grouped by CIQOL-Global/AzBio after 12 months post-CI, 51% of patients were classified as Group A, 4% as Group B, 39% as Group C, and 7% as Group D; percentages were similar for CIQOL-Global/CNC outcomes. Patients without CIQOL improvement had higher pre-CI CIQOL scores than patients who improved ( d =0.58-2.19), and patients without SRS improvement had higher pre-CI SRS scores than patients who improved (CNC: d =1.35-2.89, AzBio: d =1.09-2.78). Patients in Group D for the Entertainment domain were older than patients in Group A. Other patient factors were not significantly associated with the odds of improvement.

Conclusions: Patients with higher baseline scores for a given outcome measure are less likely to improve following cochlear implantation. SRS and CIQOL score improvements were weakly correlated. The vast majority of patients (93%) improved in one or both outcome measures.

Introduction: Arachnoid cysts (AC) are benign, cerebrospinal fluid (CSF)-filled sacs. In the cerebellopontine angle (CPA), these cysts may be intimately associated with cranial nerves, the brainstem, and the cerebellum. There are small series associating CPA AC with sensorineural hearing loss, vestibulopathy, and facial paresis. To date, there is a paucity of data regarding factors related to AC that might predict which cysts are associated with sensorineural hearing loss (SNHL). Herein, we investigate the characteristics of AC in the CPA for patients with SNHL.

Methods: A single-institution, retrospective study of pediatric patients with AC and audiological evaluations from 2009 to 2024 was conducted. ACs in the CPA were categorized based on contact with the CN VII/VIII complex. The data collected included cyst location, estimated volume, the presence/degree of CN VIII distortion, nerve length, site of contact, and audiologic data. Descriptive statistics analyzed associations between AC and SNHL in the absence of other known pathologies.

Results: A total of 19 patients had 21 ACs involving the CPA. From this group, 11 patients had 11 cysts with contact/distortion of the CN VIII complex (study group), while 8 patients had 10 cysts without contact with the CN VIII (control group). Four (36%) patients in the study group had SNHL ipsilateral to the AC, significantly more than controls ( P <0.03). While the study group had significantly larger cysts ( P <0.03), there was no association with the amount of distortion, length of CN VIII, or contact with the root entry zone (REZ).

Conclusions: Arachnoid cysts in the cerebellopontine angle are associated with ipsilateral SNHL; however, it remains unclear which factors predict SNHL beyond contact/compression of the CN VIII complex. All patients with CPA AC should be referred for audiometric evaluation.

Objective: To determine whether there is a correlation between intraoperative electrocochleography (ECochG) audiograms and postoperative audiometric air and bone conduction thresholds.

Study design: Single institution, retrospective cohort study.

Setting: Tertiary care cochlear implant (CI) center.

Patients: Patients 11 years of age and older (n=12) with pure-tone audiometry thresholds ≤80 dB HL at 500 Hz who received Advanced Bionics CIs completed between 2019 and 2023.

Methods: Intraoperative ECochG was employed to monitor CI insertion in real-time, in an effort to minimize insertion trauma. ECochG was monitored with acoustic stimulation. Subsequently, intraoperative ECochG audiograms were completed immediately following insertion. Postoperative air and bone conduction audiograms were performed at activation, 1, 3, and 6 months postactivation and were compared with intraoperative ECochG audiograms.

Results: Intraoperative ECochG audiogram was found to be closely associated with both activation ( r =0.45, P =0.005) and 6-month ( r =0.50, P =0.0009) air conduction (AC) audiograms, but not associated with bone conduction (BC) audiograms. An air-bone gap was present at activation and persisted 6 months post activation, with a gradual decline but not closure over time.

Conclusion: Intraoperative postinsertion ECochG audiograms can predict long-term AC thresholds in patients undergoing cochlear implantation. Persistent air-bone gaps documented at activation suggest an immediate impact of the electrode array on the conductive component, rather than the effect of delayed scar tissue formation following implantation.

Introduction: This study investigates how physical activity and fear avoidance beliefs change over time in patients with acute/subacute unilateral vestibulopathy (UVP), compared to those with chronic UVP. It also explores which baseline factors influence activity changes and the relationship between physical activity and fear avoidance beliefs over time.

Materials and methods: In this prospective cohort study, adults with UVP were followed over 10 weeks. Physical activity was measured using accelerometry, and fear avoidance beliefs were assessed via the Vestibular Activities Avoidance Instrument. Subgroup analyses compared acute/subacute and chronic UVP, as well as high- and low-risk groups for persistent complaints. Mixed model analysis identified factors associated with changes in physical activity, and correlations assessed the relationship between activity and fear avoidance beliefs.

Results: Acute/subacute UVP patients increased physical activity significantly over time (+198 min/week), while the chronic group showed no substantial change. Factors such as time since onset, baseline fear avoidance, and etiology influenced activity changes. At baseline, higher fear avoidance was moderately associated with lower activity, though this link weakened at follow-up. Within the acute/subacute group, those at low risk for persistent complaints had consistently higher activity levels than both high-risk and chronic patients.

Discussion: The findings highlight a connection between fear avoidance beliefs and physical activity, particularly in acute/subacute UVP. These insights underscore the importance of evaluating fear avoidance in early stages and suggest a role for psychological factors in designing tailored treatment strategies.

Objective: To examine national trends in the hospitalization of patients with malignant otitis externa (MOE), with a specific focus on the proportion of admissions to teaching versus nonteaching hospitals.

Study design: Retrospective cohort study using a national database (National Inpatient Sample).

Setting: United States inpatient hospitalizations from 1998 to 2021.

Patients: Adult patients (18 y or older) admitted with a primary diagnosis of malignant otitis externa.

Interventions: Not applicable.

Main outcome measures: Admission to a teaching versus a nonteaching hospital. Multivariate logistic regression identified demographic and clinical factors associated with hospital-type admission. Temporal trends were analyzed over the 24-year period.

Results: A total of 16,540 MOE admissions were identified. Admissions to teaching hospitals increased by 290.6% from 1998 to 2021, while nonteaching hospital admissions decreased by 55.8%. Teaching hospitals accounted for 57.7% of all MOE admissions and treated patients with higher comorbidity burdens. On multivariate analysis, factors independently associated with teaching hospital admission included Black race (OR: 2.56, P <0.001), Hispanic ethnicity (OR: 1.54, P =0.004), Medicaid insurance (OR: 1.60, P =0.001), diabetes with complications (OR: 1.86, P <0.001), HIV/AIDS (OR: 5.08, P =0.01), and metastatic cancer (OR: 8.66, P =0.02). Each successive year increased the odds of teaching hospital admission by 8% (OR: 1.08, P <0.001).

Conclusions: MOE admissions in the U.S. have shifted significantly toward teaching hospitals over the past 2 decades, with these centers treating patients with greater medical complexity and immunocompromising conditions. These findings underscore the increasing centralization of MOE care at academic centers, raising important considerations about health care access, equity, and resource allocation.

Level of evidence: Level III.