Objectives:
To evaluate audiologic consequences of gunshot wounds (GSWs) to the temporal bone (TB), and to correlate hearing outcomes with neurologic and vascular injuries adjacent to the temporal ...bone.
Study design:
Retrospective case series.
Setting:
University-based level-one trauma center.
Methods:
Retrospective review of 35 patients surviving TB ballistic injury, 2012 to 2021. Main outcomes were audiologic results. Demographics, concomitant injuries, CT, and interventions were reviewed.
Results:
Mean age was 30.7 years; 80% male. Seventeen patients (48.6%) underwent audiologic testing. Mean pure tone average (PTA) was 75 ± 35 dB, bone line average 41 ± 26 dB, and speech discrimination score (SDS) 60 ± 43%. Nineteen (54.3%) demonstrated facial nerve injury (FNI), who were more likely to show SNHL especially anacusis, though their mean PTA and SDS were not statistically different from those without (P = .30 and .47, respectively). Radiographic review of those with sensorineural loss (SNHL, 6/17) revealed otic capsule-disrupting fracture (n = 2), pneumolabyrinth (n = 2), intracranial hemorrhage (n = 3). Those with mixed loss (6/17) showed otic capsule-sparing fracture (n = 6), EAC injury (n = 5), ossicular discontinuity (n = 2), and intracranial hemorrhage (n = 4). Two with mastoid tip fractures alone had normal audiograms. Audiometric outcomes were not predicted by concomitant CSF leak, spinal injuries, vascular injuries, cranial neuropathies, or traumatic brain injury.
Conclusions:
All patterns of hearing loss—conductive, sensorineural, mixed and normal—may be seen following TB ballistic injuries. Trauma severe enough to disrupt the facial nerve is more likely to cause anacusis. However, all should be formally evaluated, since ballistic injuries complicated by neurologic or vascular damage do not necessarily correlate with worse audiologic outcomes, while patients with minimal fractures may demonstrate losses.
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NUK, OILJ, SAZU, UKNU, UL, UM, UPUK
While the implications of ossification on cochlear implantation (CI) have been extensively described, there is a paucity of data regarding the fibrotic stage. We examined the outcomes of different ...insertion techniques for managing intracochlear fibrosis.
Retrospective review of case series with case-control comparison.
University-based tertiary-referral otology-neurotology practice.
Between 2009 to 2020, 384 patients underwent CI. Of those, 7 patients (8 ears) demonstrated intracochlear fibrosis.
CI performed 1-4 months following meningitis/labyrinthitis and 12-24 months after idiopathic sudden SNHL. Fibrosis removal (38%) or dilation (63%) permitted implantation. A styleted-electrode was used in 63% due to dense fibrosis.
Postoperative audiometry with CI in place, additional comparisons with audiometric outcomes in age-matched controls.
Full insertion achieved in all except one ear with partial ossification. Mean ipsilateral pure tone average (PTA) improved to 29 ± 15 dB and speech discrimination to 72 ± 28%. Fibrosis removal vs. dilation resulted in no PTA differences (p = 0.76). Poorest outcomes occurred with the longest time to surgery.
Good CI audiologic outcomes in the setting of cochlear fibrosis can be achieved and are independent of technique. Instead, they vary with time to implantation. Every attempt should be made to intervene as early as possible.
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IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Background
A prospective, stratified, randomized, double‐blind, placebo‐controlled study was conducted to observe the impact of preoperative calcitriol supplementation on serum calcium levels ...following total thyroidectomy.
Methods
Subjects were randomized 1:1 to receive 1 μg calcitriol or placebo for 1 week preceding thyroidectomy. The primary outcome measure was change in serum calcium from baseline to 18 h post‐thyroidectomy. Subjects were also assessed for incidence of symptomatic hypocalcemia, length of stay, readmission for hypocalcemia, and intravenous calcium supplementation.
Results
Forty‐seven patients underwent thyroidectomy; 23 received preoperative calcitriol supplementation, and 24 received placebo. Repeated measures regression demonstrated no difference in postoperative serum calcium over time (p = 0.22). There were no occurrences of hypocalcemia, intravenous calcium supplementation, or readmission in either group. No difference was observed in length of stay (p = 0.38). One patient in the calcitriol group developed Grade 3 hypercalcemia.
Conclusions
Preoperative calcitriol supplementation had no impact on postoperative serum calcium levels compared to placebo.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Objective:
To present a case of primary middle ear mucosal melanoma and perform a comprehensive literature review of middle ear and eustachian tube mucosal melanoma.
Patient:
A 61-year-old female ...presented with no prior history of melanoma and 3 months of aural fullness. A middle ear mass demonstrated primary mucosal melanoma. The mass extended from mesotympanum into hypotympanum, epitympanum, protympanum, eustachian tube, and mastoid antrum. Additionally, a nonenhancing expansile lesion of the petrous apex was noted on magnetic resonance imaging.
Intervention:
Subtotal temporal bone resection with transotic approach to the petrous abnormality was performed. Postoperative adjuvant radiation and immunotherapy were given.
Results:
Five months postoperatively, the patient developed an isolated cutaneous metastatic focus treated with wide local excision and has had no further evidence of recurrence to date. Upon comprehensive literature review, patients with primary middle ear melanomas (n = 10) present with otorrhea (50%), aural fullness (40%), and hearing loss (30%) most commonly, while hearing loss (81.8%) and aural fullness (54.5%) were the most common presenting symptoms for eustachian tube melanomas (n = 11). Patients were treated with combinations of surgery, radiation, and/or chemotherapy. Middle ear melanoma demonstrated particularly poor outcomes, with 70% mortality, 20% local recurrence, and 50% distant metastasis, whereas eustachian tube origin demonstrated 9.1%, 18.2%, and 36.4%, respectively.
Conclusions:
Middle ear and eustachian tube mucosal melanomas are exceedingly rare, with middle ear melanomas demonstrating a worse prognosis. Multimodality therapy is commonly used; however, outcomes are poor, with high mortality among affected patients.
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NUK, OILJ, SAZU, UKNU, UL, UM, UPUK
Current clinical practice for fixation of the cochlear implant receiver-stimulator (RS) may not follow recommended manufacturer's guidelines. We investigated short- and long-term RS migration using a ...subperiosteal pocket technique via serial objective position measurements since previous literature provided only subjective or short-term evaluation.
Retrospective review.
Tertiary referral center.
We reviewed all patients who underwent cochlear implantation by the senior author between 2012 and 2018. At least two comparison measurements were available for 73 implants in 62 patients, 72.6% adults and 27.4% children.
RS placement using a subperiosteal pocket technique.
Distance between the pinna and RS magnet in the early (<6 mo) and late (>6 mo) postoperative period.
In the early postoperative period, mean RS distance was 57.0 mm (SD 9.4 mm) from the pinna compared with baseline intraoperative distance of 55.8 mm (SD 8.4 mm), p = 0.44. With some shifts closer and some farther from the pinna, there was a 3.0 mm mean absolute value migration (median 2 mm, SD 3.8 mm, range 0-15 mm). Fourteen implants (25.9%) migrated >5 mm in the early period, 35.7% closer, and 64.3% farther from pinna. In the late postoperative period, mean RS final distance was 56.6 mm (SD 10.1 mm), compared with its baseline of 59.0 mm (SD 9.2 mm), p = 0.29. Seven implants (19.4%) demonstrated shifts >5 mm, with a mean 3.6 mm shift (median 2 mm, SD 4.5 mm, range 0-17 mm).
A subperiosteal pocket technique demonstrated objective RS migration in 20 to 25% of adult and pediatric patients, nearly all of which were not clinically apparent unless measured. Additionally, none of these patients experienced associated symptoms or device failures.
To provide long-term follow up of a unique patient with history of massive petrous apex congenital cholesteatoma.
75-year-old man who presented at age 18 with left Gradenigo-like syndrome.
Staged ...left radical mastoidectomy and open transsphenoidal marsupialization. Followed with routine in-office cholesteatoma debridement.
Bony erosion on computed tomography (CT), monitoring for new symptoms.
Interval development of sensorineural component of hearing loss due to cochlear fistulization. Very slow skull base bony erosion continues without neck destabilization. No new or recurrent cranial neuropathies have developed.
Marsupialized cholesteatoma may be followed with routine debridement and interval imaging for monitoring over many decades.
Hypocalcemia is the most common complication after total thyroidectomy and can result in prolonged hospital admissions and increased hospital charges.
To determine the effectiveness of preoperative ...calcium and calcitriol supplementation in reducing hypocalcemia following total thyroidectomy.
A retrospective cohort study was conducted at a tertiary care center in 65 patients undergoing total thyroidectomy by a single surgeon. Patients were divided into 2 groups: those receiving preoperative as well as postoperative supplementation with calcium carbonate, 1000 to 1500 mg, 3 times daily and calcitriol, 0.25 to 0.5 µg, twice daily, and those receiving only postoperative supplementation with those agents at the same dosages. Data on patients who underwent surgery between January 1, 2008, and December 31, 2011, were acquired, and data analyses were conducted from March through June 2012, and from October through December 2016.
Calcium and calcitriol therapy.
Postoperative serum calcium levels and development of postoperative hypocalcemia.
Of the 65 patients who underwent total thyroidectomy 27 (42%) were men; mean (SD) age was 49.7 (16.7) years. Thirty-three patients received preoperative calcium and calcitriol supplementation, and 32 patients received only postoperative therapy. In the preoperative supplementation group, 15 of 33 (45%) patients underwent complete central compartment neck dissection and 11 of 33 (33%) had lateral neck dissection, compared with 16 of 32 (50%) and 12 of 32 (38%), respectively, patients without preoperative supplementation. The mean measured serum calcium level in those without preoperative supplementation vs those with supplementation are as follows: preoperative, 9.6 vs 9.4 mg/dL (absolute difference, 0.16; 95% CI, -0.12 to 0.49 mg/dL); 12 hours postoperative, 8.3 vs 8.6 mg/dL (absolute difference, -0.30; 95% CI, -0.63 to 0.02 mg/dL); and 24 hours postoperative, 8.4 vs 8.5 mg/dL (absolute difference, -0.13; 95% CI, -0.43 to 0.16 mg/dL). In patients not receiving preoperative supplementation, 5 of 32 (16%) individuals became symptomatically hypocalcemic vs 2 of 33 (6%) in the preoperative supplementation group; an absolute difference of 10% (95% CI, -6.6% to 26.3%). Compared with the group not receiving preoperative supplementation, the mean SD length of stay was significantly shorter in the preoperative supplementation group (3.8 1.8 vs 2.9 1.4 days; absolute difference, -0.9; 95% CI, -1.70 to -0.105 days). Preoperative supplementation resulted in an estimated $2819 savings in charges per patient undergoing total thyroidectomy.
Preoperative calcium and calcitriol supplementation, in addition to routine postoperative supplementation, was associated with a reduced incidence of symptomatic hypocalcemia, length of hospital stay, and overall charges following total thyroidectomy.
Objective
Superior semicircular canal dehiscence (SSCD) causing conductive hearing loss with present reflexes is a known reason for stapes surgery failure. However, concomitant SSCD and otosclerosis ...occur rarely. We present a case series of SSCD diagnosed in positively identified otosclerosis patients.
Methods
Retrospective review of clinical case series in two tertiary‐referral neurotologic practices was performed. Clinical histories, operative findings, audiograms, and computed tomography (CT) images were reviewed for patients diagnosed with both SSCD and otosclerosis. Patients with present stapedial reflexes were excluded. Comprehensive literature review was performed.
Results
Four cases were identified. Three reported improved hearing with partial or complete closure of the air‐bone gap (ABG), including one patient with far‐advanced otosclerosis. One patient had no improvement in pure tone average or ABG. One patient reported worsening of preoperative autophony and pulsatile tinnitus, but none developed new postoperative third‐window symptoms. CTs demonstrated both SSCD and otosclerosis.
Conclusion
Failure to close the ABG in patients with positively identified otosclerosis intraoperatively may be due to SSCD as an occult concomitant diagnosis. SSCD should be considered as a possible cause of persistent conductive hearing loss after stapes surgery.
Level of Evidence
4 Laryngoscope, 130:1023–1027, 2020
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Background
Kaposiform hemangioendothelioma (KHE) is a rare vascular tumor affecting infants and young children. Although benign, it can be associated with an aggressive locally growing tumor and/or a ...life-threatening Kasabach–Merritt phenomenon (KMP). To date, only reviews of limited cases have been performed. We, therefore, conducted a comprehensive literature search to collect relevant data and make recommendations for future treatment trials.
Methods
Review of the available literature between 1993 and 2017 revealed a total of 105 publications involving 215 patients of less than 21 years of age. To this, we added 12 from our department and 4 from the Cooperative Weichteilsarkomstudie database.
Results
We found that KMP was present in 79% of the infants, in 47% of the 1–5-year olds, in 43% of the 6–12-year olds, and in 10% of the 13–21-year-old patients. KMP was present in nearly all (94%) patients with retroperitoneal tumors and in all patients with extra-regional tumors. The median size of a KHE without KMP was 12 cm
2
as compared to 49 cm
2
when associated with a KMP. With complete (not further classifiable if R0 or R1) resection, all patients were cured. If inoperable, response regarding KMP/regression of tumor size was seen in 29/28% with steroid-, 47/39% with vincristine-, 44/43% with interferon alpha-, 65/61% with anti-platelet agents-, and in 97/100% with sirolimus-containing therapies.
Conclusions
Patients with progressive KHE should undergo resection whenever it is considered a safe option. If inoperable, sirolimus should be the first choice for treating KMP and reducing tumor size.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
As biomolecular approaches for hearing restoration in profound sensorineural hearing loss evolve, they will be applied in conjunction with or instead of cochlear implants. An understanding of the ...current state-of-the-art of this technology, including its advantages, disadvantages, and its potential for delivering and interacting with biomolecular hearing restoration approaches, is helpful for designing modern hearing-restoration strategies. Cochlear implants (CI) have evolved over the last four decades to restore hearing more effectively, in more people, with diverse indications. This evolution has been driven by advances in technology, surgery, and healthcare delivery. Here, we offer a practical treatise on the state of cochlear implantation directed towards developing the next generation of inner ear therapeutics. We aim to capture and distill conversations ongoing in CI research, development, and clinical management. In this review, we discuss successes and physiological constraints of hearing with an implant, common surgical approaches and electrode arrays, new indications and outcome measures for implantation, and barriers to CI utilization. Additionally, we compare cochlear implantation with biomolecular and pharmacological approaches, consider strategies to combine these approaches, and identify unmet medical needs with cochlear implants. The strengths and weaknesses of modern implantation highlighted here can mark opportunities for continued progress or improvement in the design and delivery of the next generation of inner ear therapeutics.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
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