Otology & neurotology open最新文献

Objective: To evaluate the hearing-related quality of life (HR-QoL) instruments utilized to assess pediatric cochlear implant (CI) users and determine which quality of life domains are most relatable to each stage of childhood development.

Databases reviewed: PubMed, OVID Medline, Embase.

Methods: Our systematic review included a search of the PubMed, OVID Medline, and Embase databases using relevant MeSH terminology. Inclusion criteria captured the following: 1) pediatric CI users, 2) QoL measurement outcomes, 3) written in the English language, and 4) numerical data of survey scores readily available. Our study was adherent to the Meta-analysis Of Observational Studies in Epidemiology reporting guidelines.

Results: Among 1597 studies screened, 20 met the inclusion criteria. Among 1369 pediatric CI patients surveyed, nearly one-third of the studies administered a pediatric and parental version of the generic KINDL QoL questionnaire. Both children and adolescents with CI scored similarly in the generic HR-QoL and in the specialized Peds QoL questionnaire (CI) (scores displayed in mean ± SD; children: 67.11± 12.6; adolescents: 69.40± 12.42). CI users in both age groups scored lower than their age-matched normal hearing peers (NHP) (79.11 ± 11.63) and to their parents (78.19 ± 10.18) on both the generic and CI-specific QoL questionnaires. The highest scores across studies among CI users were observed under the physical and psychosocial well-being domains.

Conclusions and relevance: Children and adolescents with CI experience similar physical and psychosocial functioning QoL aspects, though lower than their NHP. Disagreement was observed between most pediatric and parental QoL reports among children and adolescents at QoL assessment, suggesting parents may not be reliable reporters on their child's overall QoL. These data provide a basis for future discussions aimed at designing standardized HR-QoL measures for pediatric CI users.

Objective: To explore the associations between social determinants of health (SDOH) and the access to, delivery of, and outcomes of cholesteatoma care.

Study design: Retrospective review.

Setting: Multisite tertiary care institution.

Methods: Seventy-five adults (aged 18-83) with cholesteatoma who completed SDOH questionnaires were included. Outcome measures included SDOH risk factor prevalence (stress, housing instability, financial resource strain, social connectedness, food insecurity, intimate partner violence), disease severity, hearing loss degree at presentation, mean time from symptom onset to diagnosis, postoperative improvements in air-bone gaps (ABG), complication rates, and two-stage surgery rates.

Results: Stress (n = 45; 60%) was the most prevalent SDOH risk factor. Females (n = 23; 79.3%; P = 0.05; d = -0.24]), younger adults (mean age = 45; P = 0.01; d = -0.69), and individuals with lower education (n = 23; 82.1%; P = 0.04; d= -0.26) were more likely to have at least one SDOH risk factor. Patients with SDOH risk factors had better preoperative air pure tone averages (mean [SD] = 39.7 [16]; P = 0.01; d = -0.69) than patients without SDOH risk factors (mean [SD] = 50.1 [13.5]); but the ABG was similar between groups (P = 0.16; d = -0.38). No differences were identified in any measure of cholesteatoma care between patients with and without SDOH risk factors.

Conclusion: Stress is a prevalent SDOH risk factor among patients with cholesteatoma, but it might not influence cholesteatoma care. Though female sex, younger age, and lower education levels were associated with having at least one SDOH risk factor, these also might not influence cholesteatoma care. Intentional study of larger, more heterogeneous populations is necessary to validate these observations.

Introduction: Cochlear implantation (CI) is associated with postoperative vestibular dysfunction in the implanted ear; however, limited data on baseline vestibular function in these patients exists. Bilateral vestibular weakness is associated with detrimental effects on quality of life. As such, it is important to identify patients with a preexisting bilateral weakness and consider this information in surgical planning.

Methods: Retrospective cohort study of the CI candidate population. All patients underwent routine preoperative vestibular evaluation, irrespective of symptoms.

Results: Of 180 preoperative videonystagmographies, 39.4% showed vestibular weakness determined by caloric testing. Of these, 26.8% exhibited bilateral weakness. Patients with bilateral weakness had higher body mass index (31.6 kg/m²) than those with unilateral weakness or normal function (26.2 and 27.4 kg/m², P = 0.007). Further analysis of the audiologic data in the worse-hearing ear revealed worse hearing at 250, 500, and 1000 Hz (P < 0.05). Hearing threshold of 60 dB or worse at 250 Hz was the best prognostic indicator for bilateral weakness. At a threshold of 60 dB at 250 Hz, all patients with bilateral weakness are captured (100% sensitivity), with a specificity of 34.5%.

Conclusion: More than one-third of CI candidates have some degree of underlying vestibular dysfunction and 10.5% exhibit preexisting bilateral weakness. This study indicates that audiologic data may be a useful prognostic indicator of preexisting bilateral vestibular weakness. Given the well-documented detrimental effects of bilateral vestibular weakness on quality of life, we recommend that all patients who meet this cutoff undergo vestibular testing to assess for an underlying weakness.

Purpose: Tinnitus treatments are often scientifically evaluated using self-report questionnaires as primary outcome measures. However, guidelines for the appropriate application of these tools in research study designs are limited. This study aims to determine if any tinnitus outcome measure is validated for use in determining symptom change in response to treatments administered with hyperacute follow-up (less than 5 days).

Databases reviewed: PubMed, Embase, and Web of Science.

Methods: A literature review was conducted of peer-reviewed articles on the psychometric properties of tinnitus outcome measures. A total of 594 articles were identified with 7 articles included for final review. Psychometric data, including the minimum clinically important difference and the time from intervention to outcome measurement (data collection interval), were extracted.

Results: The final review included 5 studies on the Tinnitus Functional Index and 2 on the Tinnitus Handicap Inventory. The time intervals for intervention follow-up were defined as: 0-1 days = immediate, 2-5 days = hyperacute, 6-10 days = acute, 11-31 days = subacute, and >31 days = chronic. Two studies utilized chronic time intervals and 4 studies had follow-up in the subacute interval. The final study reported a wide follow-up range from hyperacute to subacute. No studies evaluated psychometrics with an immediate interval.

Conclusion: There is no psychometrically validated tinnitus outcome measure for immediate treatment intervals and little evidence for hyperacute or acute intervals. Further research into the validity of tinnitus measurement tools in various time frames is required for the guidance of future study design.

Background: Persistent oscillating vertigo (POV) can be triggered by motion, when it is called mal de débarquement syndrome (MdDS) but can also occur from nonmotion triggers such as neck injury, inflammation, or homeostatic derangements (nonmotion POV [nmPOV]). The pathology underlying MdDS and nmPOV is unknown but shared symptoms include rocking/bobbing/swaying vertigo, headache, cognitive slowing, and fatigue.

Methods: We present a case series of patients with MdDS and nmPOV whose symptoms were relieved after treatment of extracranial venous compression in the neck and thoracic outlet.

Results: POV, regardless of the trigger, was associated with compressions at one or more of the following locations: 1) internal jugular vein (IJV) between the transverse process of the atlas and the styloid process, 2) IJV under the sternocleidomastoid muscle (SCM), and 3) subclavian vein at the thoracic outlet. Compressions were typically bilateral and in tandem. Catheter venography showed dynamic obstruction and shunting of venous blood to the petrosal sinuses around the inner ear and the vertebral veins. Relief of these obstructions with styloidectomy, stenting, neurotoxin to SCM and anterior scalene, SCM partial myotomy, and thoracic outlet decompression significantly relieved POV even with unilateral decompression.

Conclusions: Oscillatory perceptions of POV whether MdDS or nmPOV may be from the detection of low amplitude pulsations induced by venous outflow obstruction in areas of high freedom of motion (occipito-atlanto junction, mid-neck, and thoracic outlet). Impaired venous outflow and raised venous pressure around the inner ear could lead to continuous peripheral stimulation of the vestibular system and downstream central effects.

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.