Otology & neurotology open最新文献

Objectives: Ramsay Hunt syndrome (RHS) refers to a reactivation of the varicella-zoster virus in the distribution of the facial nerve, but it can involve other cranial nerves as well. In patients with polyneuropathy, the vestibulocochlear nerve is most involved after the facial nerve. The clinical manifestations and long-term vestibular outcomes in these patients remain unclear. This report aims to characterize the clinical course of this rare subset of RHS patients.

Methods: This study is a retrospective case series. The study was conducted in a tertiary care institution. Patients with RHS polyneuropathy presenting with vestibular deficit were reviewed over a 30-year period. Case details including initial presentation, House-Brackmann grade, treatment regimen, vestibular examination and testing, MRI findings, and follow-up time were extracted.

Results: A total of 22 patients were identified. The mean age of diagnosis was 53 years and the average follow-up time was 23 months. Most patients demonstrated complete facial paralysis (88%) upon presentation. Nystagmus was rarely recorded during physical examination (18%, n = 4). For those patients who underwent MRI of the internal auditory canal (n = 17), 59% demonstrated enhancement of the facial nerve, with a notable absence of vestibulocochlear nerve abnormality. Of the patients who underwent vestibular testing, all demonstrated unilateral caloric weakness on videonystagmography (VNG; 66% ± 22%, n = 8).

Conclusions: Patients with RHS polyneuropathy and vestibular complaints do not consistently demonstrate objective vestibular physical examination or imaging findings on presentation. However, VNG consistently demonstrates significant unilateral weakness on caloric stimulation. Most patients in our sample continued to have vestibular complaints at latest follow-up.

The University of Miami Ear Institute (UMEI) was conceived and founded by Dr. W. Jarrard (Jerry) Goodwin in 1990, then Chairman of the University of Miami Department of Otolaryngology-Head and Neck Surgery. Dr. Goodwin's goal was to establish a state-of-the-art institution featuring world-renowned experts in otology, audiology, cochlear implants, balance disorders, skull base surgery, and research. With the support of many within and outside the University, he succeeded in this endeavor and appointed Thomas J. Balkany the first director of the Ear Institute. Under Dr. Balkany's leadership, the institute continued to evolve alongside the growing University of Miami Department of Otolaryngology, pioneering developments in pediatric cochlear implant surgery and postoperative care and basic science research. Dr. Balkany transitioned from UMEI Director in 2010, succeeded by Dr. Fred F. Telischi, and subsequently Dr. Simon I. Angeli who is the current Ear Institute Director. The Ear Institute experienced exponential growth in clinical services, research, education, and advocacy throughout the 2nd decade of the 21st century. Renamed the UHealth Ear Institute, its organizational structure evolved to meet new challenges. In its 34-year history, the UHealth Ear Institute has transformed from an idea into a nationally and internationally recognized center of excellence. It remains dedicated to advocating for universal hearing health, ensuring access to hearing health services, providing exceptional patient care, advancing innovative research, and training future specialists.

Objective: To better characterize the cochlear apex in relation to surgically relevant landmarks to guide surgeons and improve procedural success of apical electrode placement.

Study design: Retrospective image analysis.

Setting: Tertiary referral center.

Patients: Cochlear implant recipients with available preoperative computed tomography (CT) imaging.

Intervention: None.

Main outcome measure: Cochlear dimensions and cochlear apex distance measures to surgically relevant middle ear landmarks and critical structures.

Results: Eighty-two temporal bone CT scans were analyzed utilizing multiplanar reformats. The average lateral width of promontory bone over the cochlear apex was 1.2 mm (standard deviation [SD], 0.3). The anteroposterior distance from the round window (avg, 4.2 mm; SD, 0.5), oval window (avg, 3.3 mm; SD, 0.3), cochleariform process (avg, 2.3; SD, 0.5), and superior-inferior distance from the cochleariform process (avg, -0.9; SD, 0.8) to the cochlear apex were measured. The relationship of the cochlear apex to critical structures was highly variable.A newly developed stapes vector was created and found to mark the posterior/superior boundary of the apex in 94% of patients. When a vector parallel to the stapes vector was drawn through the round window, it marked the anterior/inferior boundary of the cochlear apex in 89% of patients.

Conclusions: This study assists in characterizing cochlear apex anatomy and its relation to surrounding structures as a means of improving procedural accuracy and reducing trauma during apical cochleostomy. Understanding both distance relationships and expected boundaries of the apex could help to inform future surgical approaches.

Objective: To evaluate for equivalence in postoperative changes of speech recognition scores in a veteran patient population undergoing cochlear implantation (CI) compared to matched nonveteran patients.

Study design: Retrospective chart review.

Setting: Tertiary referral center.

Patients: A total of 83 veteran patients who underwent CI at a single Veterans Affairs Medical Center (VA cohort) were matched to 83 nonveteran patients from the Health Insurance Portability and Accountability Act-secure, Encrypted, Research, Management and Evaluation Solution database (HERMES cohort) based on age, sex, and baseline Consonant-Nucleus-Consonant (CNC) scores.

Intervention: Patients underwent CI.

Main outcome measures: Comparison of postoperative CNC and Arizona Biomedical Institute recognition scores.

Results: The mean difference and lower confidence interval of CNC scores between matched Veterans Affairs and HERMES cohorts were within a -ΔNI boundary of -15% at the 3-month (mean = 6.15, lower confidence interval = -2.38), 6-month (mean = 7.36, lower confidence interval = -2.21), and 12-month (mean = 4.03, lower confidence interval = -4.88) postoperative time points. The mean difference and lower confidence interval of Arizona Biomedical Institute scores between cohorts were within the -ΔNI boundary of -30% at 3 months (mean = 1, lower confidence interval = -8.71), 6 months (mean = 0.31, lower confidence interval = -12.30), and 12 months (mean = 0.72, lower confidence interval = -10.48).

Conclusion: Our veteran population demonstrated improvements in speech recognition scores after CI comparable to a matched nonveteran population. Although veterans face unique factors that affect their hearing, access to medical care, and baseline general health, these findings affirm appropriate veteran candidates should be offered CI.