Operative Mortality Rates of Acoustic Neuroma Surgery: A National Cancer Database Analysis.

Introduction: Optimal acoustic neuroma (AN) management involves choosing between three treatment modalities: microsurgical excision, radiation, or observation with serial imaging. The reported in-hospital mortality rate of surgery for AN in the United States is 0.5%. However, there has yet to be a nationwide examination of the AN surgery mortality rate encompassing the period beyond initial hospital discharge. Methods: The National Cancer Data Base (NCDB) from 2004 to 2013 identified AN patients receiving surgery. Multivariate logistic regression assessed 30-day operative mortality, adjusting for several variables including patient age, race, sex, income, geographic region, primary payer for care, tumor size, and medical comorbidities. Results: Ten thousand one hundred thirty six patients received surgery as solitary treatment for AN. Mortality at 30 days postoperatively occurred in 49 patients (0.5%); only a Charlson/Deyo score of 2 (odds ratio [OR] = 6.6;95% confidence interval [CI] = 2.6-16.6; p = 0.002) was predictive of increased mortality. No other patient demographic including African-American race, minimum age of 65 or government insurance was predictive of 30-day operative mortality. Conclusions: The 30-day mortality rate following surgery for AN is 1 of 200 (0.5%), equivalent to the established in-hospital operative mortality rate, and 2.5 times higher than the cumulative assessment from single-center studies. No patient demographic other than increasing medical comorbidities reached significance in predicting 30-day operative mortality. The nearly identical rates of 30-day and in-hospital mortality from separate nationwide analyses indicate that nearly all of the operative mortality occurs before initial postoperative discharge from the hospital. This mortality rate provides a framework for comparing the true risks and benefits of surgery versus radiation or observation for AN. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Improvements in Gait With Hearing Aids and Cochlear Implants.

Objective: To evaluate whether wearing auditory assistive devices can improve gait and dynamic balance. Patients: Three adult users of bilateral hearing assistive devices: one with cytomegalovirus exposure wearing cochlear implants, one with Meniere's disease wearing hearing aids, and one with presbystasis wearing hearing aids. Intervention: Rehabilitative intervention involved participants performing gait and dynamic posture tasks with and without their hearing assistive devices. Main Outcome Measures: Gait velocity and Mini-BESTest score. Results: The participant with Meniere's disease showed a clinically significant improvement in gait in the aided versus the unaided condition (20.5 cm/s higher velocity and five point better Mini-BESTest score). The other two participants also improved with augmented audition, but to a lesser degree. Conclusions: Bilateral hearing augmentation may promote clinically significant improvements in gait, although the effects are not uniform among patients. Hearing aids or cochlear implants may be important interventions for improving stability during walking in some people with hearing loss. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Facial Nerve Bifurcation in Congenital Oval Window Atresia.

No abstract available

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Book Review.

No abstract available

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