Sensorineural Hearing Loss in Cholesteatoma.

Objective: To determine whether middle ear cholesteatoma is associated with, sensorineural hearing loss, and whether patient age, cholesteatoma growth pattern, or, air bone gap size contribute to inner ear impairment. Study Design: Cross-sectional comparative. Setting: A tertiary hospital. Patients: The subjects were 115 patients with middle ear cholesteatoma in one ear, and normal video-otoscopy in the contralateral ear (CLE). Interventions: Otoendoscopy, pure-tone audiometry. Main Outcome Measures: Bone conduction (BC) threshold differences between the normal CLE and the cholesteatoma ear. Comparisons of these differences between different cholesteatoma growth patterns. Correlation between the air bone gap size in the ear with cholesteatoma and the difference in bone conduction thresholds between both ears. Results: The cholesteatoma ear was associated with greater BC thresholds than the CLE. With regard to different cholesteatoma growth patterns, the differences between associated BC thresholds were also significant in all groups at all frequencies, with the exception of the two routes of cholesteatoma group at 500 Hz. Comparing BC threshold differences, they were greater in the adult group at 500 Hz. The correlation between the air bone gap media in the ear with cholesteatoma and the difference in bone conduction thresholds between both ears was direct and moderate. Conclusion: Cholesteatoma was associated with greater BC thresholds at all frequencies tested. The differences were independent of cholesteatoma growth patterns. As bigger the air bone gap in the ear with cholesteatoma, greater the inner ear damage. Copyright (C) 2016 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Sanna Classification and Prognosis of Cholesteatoma of the Petrous Part of the Temporal Bone: A Retrospective Series of 81 Patients.

Objective: To determine how classification of petrous bone cholesteatomas (PBCs) using the 5-point Sanna classification can predict major structural involvement, facial nerve outcomes, hearing outcomes, postoperative complications, and disease recurrence. Study Design: Retrospective case series. Setting: Tertiary referral center in Bergamo, Italy. Patients: Eighty-one sequential patients with radiologic and surgically confirmed diagnoses of PBC treated at a single tertiary referral center during a 20-year period. Main Outcome Measures: Major structural involvement, facial nerve outcomes, hearing outcomes, postoperative cerebrospinal fluid leak, and disease recurrence were evaluated on the basis of Sanna classification. Results: Using the Sanna classification, 70% (57) were supralabyrinthine, 12% (10) infralabyrinthine, 7% (6) infralabyrinthine-apical, 5% (4) apical, and 5% (4) massive. Massive classification was statistically significantly associated with cochlear involvement (p = 0.009) and internal auditory canal involvement (p = 0.02). The infralabyrinthine-apical class was associated with carotid canal involvement (p = 0.03). Facial nerve interruption was observed in 35% of patients and most frequently in the apical group (75%). Neither hearing nor facial nerve outcomes were associated with Sanna classification. House-Brackmann score improved or was maintained postoperatively in 89% of patients. Conclusion: The Sanna classification provides anatomic detail on location of PBCs and is predictive of IAC, cochlear, and carotid artery involvement. However, classification systems for this rare condition continue to pose a challenge in being able to accurately predict facial nerve and hearing outcomes in surgical obliteration of PBC. Copyright (C) 2016 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Isolated Vestibular Suppression Impairment With Vestibular Migraine: A Phenotypic CANVAS Variant.

Hypothesis: Cerebellar Ataxia with Neuropathy and Vestibular Areflexia (CANVAS) is likely to have a genetic basis. We describe the unique eye movement features of a possible phenotypic CANVAS variant. Background: The patient comes from a large CANVAS kindred (four out of nine siblings) and has sensory neuropathy, cerebellar eye signs, and vestibular migraine (VM), but otherwise normal vestibular function. Methods: We recorded eye and head movements using the gold standard scleral search coil technique: in the patient, a close relative with mild sensory neuropathy, and a normal control. Results: At >=0.8 Hz vestibulo-ocular reflex suppression (VORS) was significantly smaller in the patient. At 1 Hz, the patient's VORS was almost two times worse than the control, and five times worse at 1.6 Hz. The patient's VORS deficiency was observed with the naked eye as an inability to keep the eye stationary during imposed sinusoidal head rotation at ~1 Hz. At

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The Use of Temporoparietal Fascial Flap to Eliminate Wound Breakdown in Subtotal Petrosectomy for Chronic Discharging Ears.

Objective: To find out if the use of the vascularized temporo-parietal fascial flap (TPFF) reduces postoperative infection or wound breakdown in subtotal petrosectomy for chronic discharging ears. Patients: A retrospective review on 26 subtotal petrosectomies with blind pit closures on chronic discharging ears performed by a single surgeon between 2000 and 2015 was performed. All patients had a minimum follow-up period of 6 months. Intervention: Eleven mastoid cavities were obliterated with abdominal fat, and 15 cavities were obliterated with TPFF. There was no concomitant cochlear implant or middle ear implant. Main Outcome Measure(s): All postoperative wound infections or delay in wound healing were recorded into a database. The complication rates of the fat obliteration group were compared using Fisher's exact test with those for the TPFF obliteration group. Results: In the fat obliteration group, 4 out of 11 patients had documented postoperative complications. Three had wound breakdown with exposure of the fat that required revision surgery. Another patient had postauricular abscess without the wound actually broken down. On the other hand, all the ears in the TPFF obliteration group (100%) were completely free of wound infection, wound breakdown, or any complication. The difference between the two groups was statistically significant (p = 0.022). Conclusion: Many authors have encountered postoperative infection or wound breakdown in subtotal petrosectomy with fat obliteration in the treatment of chronic otitis media. Using a richly vascularized temporo-temporal fascial flap to protect the blind pit closure in such patients reduces postoperative infection and wound breakdown. Copyright (C) 2016 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Meniett Therapy for Meniere's Disease: An Updated Meta-analysis.

Objective: To re-evaluate the efficacy of Meniett therapy for the treatment of Meniere's disease (MD). Data Sources: PubMed, Embase, Cochrane Library, Clinicaltrials.gov, ChiCTR, and the CNKI database were searched for articles in English and Chinese published before August 31, 2015. Study Selection: Included in this meta-analysis were studies that dealt with outcomes of Meniett therapy for the treatment of MD, including randomized controlled clinical trials, case-control studies, and prospective or retrospective cohort studies, with sample sizes of >=10 subjects. Data Extraction: Keywords included endolymphatic hydrops, Meniere's disease, pressure, Meniett, and transtympanic micropressure treatment. Data Synthesis: Fourteen studies were included, involving a total of 345 MD patients. Data were analyzed using the Meta package in R. Dichotomous outcomes were expressed as risk ratios with 95% confidence intervals, and weighted mean differences with 95% confidence intervals were used to present continuous outcomes. Heterogeneity of the included studies was quantitatively assessed by [chi]2 and I2 tests. Fixed-effects models were used for I2

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Vestibular Migraine: Vestibular Symptom May Identify Different Subgroups.

Objective: The objective of this study was to evaluate patients with vestibular migraine and analyze whether different vestibular symptoms were able to discriminate different subgroups. Patients: Eighty-three patients (73 women, mean age 42 yr) who fulfilled the criteria for vestibular migraine were selected. Intervention: Participants were divided into two groups according to their vestibular symptoms: spontaneous vertigo (SV) or triggered vertigo (TV). In each group, migraine subtype (migraine with aura and migraine without aura) was further analyzed. Results: The SV group comprised 40 patients (35 women, mean age 42.6 yr) of which 26 had migraine with aura. The TV group comprised 43 patients (38 women, mean age 41.3 yr) of which 34 had migraine without aura. A significant difference in the presence of spontaneous vertigo was noted, proving more frequent in the migraine with aura group, whereas TV was more frequent in the migraine without aura group ([chi]2 test, p

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Visual Cross-Modal Re-Organization in Children with Cochlear Implants

by Julia Campbell, Anu Sharma

Background

Visual cross-modal re-organization is a neurophysiological process that occurs in deafness. The intact sensory modality of vision recruits cortical areas from the deprived sensory modality of audition. Such compensatory plasticity is documented in deaf adults and animals, and is related to deficits in speech perception performance in cochlear-implanted adults. However, it is unclear whether visual cross-modal re-organization takes place in cochlear-implanted children and whether it may be a source of variability contributing to speech and language outcomes. Thus, the aim of this study was to determine if visual cross-modal re-organization occurs in cochlear-implanted children, and whether it is related to deficits in speech perception performance.

Methods

Visual evoked potentials (VEPs) were recorded via high-density EEG in 41 normal hearing children and 14 cochlear-implanted children, aged 5–15 years, in response to apparent motion and form change. Comparisons of VEP amplitude and latency, as well as source localization results, were conducted between the groups in order to view evidence of visual cross-modal re-organization. Finally, speech perception in background noise performance was correlated to the visual response in the implanted children.

Results

Distinct VEP morphological patterns were observed in both the normal hearing and cochlear-implanted children. However, the cochlear-implanted children demonstrated larger VEP amplitudes and earlier latency, concurrent with activation of right temporal cortex including auditory regions, suggestive of visual cross-modal re-organization. The VEP N1 latency was negatively related to speech perception in background noise for children with cochlear implants.

Conclusion

Our results are among the first to describe cross modal re-organization of auditory cortex by the visual modality in deaf children fitted with cochlear implants. Our findings suggest that, as a group, children with cochlear implants show evidence of visual cross-modal recruitment, which may be a contributing source of variability in speech perception outcomes with their implant.

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