Book Review.

No abstract available

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Aminoglycoside or Quinolone Ear Drops in the Postoperative Management of Tympanoplasty: What Choice Do We Have?.

No abstract available

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Stress and Unusual Events Exacerbate Symptoms in Meniere's Disease: A Longitudinal Study.

Hypothesis: Stress and unusual events are associated with a higher likelihood of attacks and increased symptom severity in Meniere's disease (MD). Background: MD is an unpredictable condition which severely impacts the quality of life of those affected. It is thought that unusual activity and stress may act as an attack trigger in MD, but research in this area has been limited to date. Methods: This was a longitudinal study conducted over two phases. A mobile phone application was used to collect daily data on Meniere's attacks and individual symptoms (aural fullness, dizziness, hearing loss, and tinnitus), as well as prevalence of unusual events (phase I), and stress levels (phase II). There were 1,031 participants (730 women, mean age 46.0 yr) in phase I and 695 participants (484 women, mean age 47.7 yr) in phase II. Panel data regression analyses were employed to examine for associations between unusual events/stress and attacks/symptoms, including the study of 24 hours lead and lag effects. Results: Unusual events and higher stress levels were associated with higher odds of Meniere's attacks and more severe symptoms. The odds of experiencing an attack were 2.94 (95% confidence interval [CI] 2.37, 3.65) with reporting of unusual events and increased by 1.24 (95% CI 1.20, 1.28) per unit increase in stress level. Twenty-four hour lead (OR 1.10 [95% CI 1.07, 1.14]) and lag (OR 1.10 [95% CI 1.06, 1.13]) effects on attacks were also found with increases in stress. Conclusion: This study provides the strongest evidence to date that stress and unusual events are associated with attacks and symptom exacerbation in MD. Improving our understanding of stress and unusual events as triggers in Meniere's may reduce the uncertainty associated with this condition and lead to improved quality of life for affected individuals. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Preventing Facial Nerve Stimulation by Triphasic Pulse Stimulation in Cochlear Implant Users: Intraoperative Recordings.

Hypothesis: Triphasic pulse stimulation of the auditory nerve can prevent unintended facial nerve stimulation (FNS) due to a different electromyographic (EMG) input-output function compared with biphasic pulses. Background: FNS is sometimes observed in cochlear implant (CI) users as an unpleasant side effect of electrical stimulation using biphasic pulse patterns (BPP). Clinical remedies to alleviate FNS are 1) to extend stimulus phase duration or 2) to completely deactivate the electrode. In some cases, these options do not provide sufficient FNS reduction or are detrimental to subject performance. Stimulation using triphasic pulse patterns (TPP) has been shown to prevent FNS more effectively, yet the underlying mechanism remains unclear. Methods: EMG potentials of muscles innervated by the facial nerve (orbicularis oculi and oris muscles) were recorded to quantitatively compare the effect of BPP and TPP stimulation on FNS. Recordings were conducted in five subjects during CI surgery. In two exemplary cases, different leading phase polarities in alternating and non-alternating order were tested. Results: Compared with our previous study in awake patients using surface electrodes (Bahmer and Baumann, 2016), intraoperative recordings using subdermal electrodes showed lower noise content and allowed higher sampling resolution. While inter-subject variation remained high, intra-subject results for different electrode positions were comparable: FNS was strongly reduced for cathodic-first TPP stimulation. In contrast, exemplary cases showed little reduction for anodic-first TPP as well as for alternating stimulation. Conclusion: FNS in CI users can be reduced using TPP stimulation, but the ameliorative effect appears to be dependent on the leading stimulus polarity. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Resolution of Persistent Post-Stapedotomy Vertigo With Migraine Prophylactic Medication.

Objective: To describe persistent post-stapedotomy vertigo (PSV) and its treatment using migraine prophylaxis. Patients: A retrospective review of all patients with persistent PSV spanning 10 years at a tertiary academic hospital was performed. Patients who experienced persistent vertigo for a minimum of 3 months after surgery were included. Those with possible perilymph fistula, long prosthesis, and benign paroxysmal positional vertigo were excluded. Interventions: All patients received instructions on migraine dietary and lifestyle changes and Vitamin B2 and magnesium. In addition, prophylactic treatment with nortriptyline, verapamil, or a combination thereof was started. Main Outcome Measure: Changes in vertigo frequency was the main outcome variable. The secondary outcome variables included the time period and medications necessary to achieve symptomatic resolution. Results: Four women and one man with an average age of 53 years were identified that met criteria for persistent PSV indicating an incidence of 0.9% at our institution. The onset of vertigo symptoms was on average 20 days postoperatively. All five patients had daily vertigo episodes and experienced complete resolution with no vertigo episodes after treatment. Symptomatic resolution was achieved over an average of 9 weeks after initiating treatments. Conclusions: Persistent PSV beyond 3 months is a rare occurrence and its treatment can be challenging when there is no evidence of an underlying pathology. This subset of patients may be suffering from migraine, which was triggered postoperatively. Treatment with migraine prophylaxis in this cohort of patients may result in resolution of vertigo. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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High Incidence of Bell's Palsy After Mastoidectomy: a Longitudinal Follow-up Study.

Objective: The objective of this study was to compare the prevalence of Bell's palsy in participants who underwent mastoidectomy (to treat chronic otitis media) and nonmastoidectomy participants (control). Methods: Using the national cohort study from the Korean Health Insurance Review and Assessment Service, mastoidectomy patients (2,045) and control participants (8,180) were matched 1:4 for age, sex, income, and region of residence. The prevalence of Bell's palsy in both the groups was measured from 0 to 10 years postoperation. Results: In a sample of 1,025,340 Korean individuals, 7,070 were diagnosed or treated with Bell's palsy between 2002 and 2013; the annual incidence of Bell's palsy was 0.057%. The overall prevalence of Bell's palsy was three times higher in the mastoidectomy group (1.27%) than control group (0.49%) (p

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Do Measurements of Inner Ear Structures Help in the Diagnosis of Inner Ear Malformations? A Review of Literature.

Objective: We conducted an extensive review of the literature relevant to inner ear measurements in normal and malformative conditions to select reproducible methods and normative ranges that may be used in clinical practice. Data Sources and Study Selection: A review of the published literature was performed in the English language using PubMed with appropriate keywords. We selected only those articles containing normative values of inner ear structures. Data Extraction and Data Synthesis: The following measurements were identified as reproducible and sensitive for the diagnosis of inner malformations: cochlear height in coronal plane; maximal diameter of bony island of lateral semicircular canal; width of vestibular aqueduct: 1) at midpoint; 2) at operculum in axial plane; cochlear canal and cochlear width in multiplanar reconstructions (MPR)/axial; cochlear length. The following cutoffs for normal inner ears are proposed based on the comparative analysis of the literature: cochlea height: >4.3 mm; lateral semicircular canal bony island: >3 mm; vestibular aqueduct: 1.4 mm and 5.4 mm. Conclusion: Measurements of inner ear structures can help in the interpretation of computed tomography images. They increase the sensitivity in detecting inner ear malformations, especially cochlear hypoplasia now considered more common than previously thought. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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