Comprehensive handbook of pediatric audiology - second edition

10.1080/14992027.2016.1195020<br/>Traci Flynn

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Comprehensive handbook of pediatric audiology - second edition

10.1080/14992027.2016.1195020<br/>Traci Flynn

from #Audiology via ola Kala on Inoreader http://ift.tt/1W37SPw
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Comprehensive handbook of pediatric audiology - second edition

10.1080/14992027.2016.1195020<br/>Traci Flynn

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Therapy of Vestibular Paroxysmia, Superior Oblique Myokymia, and Ocular Neuromyotonia.

Therapy of Vestibular Paroxysmia, Superior Oblique Myokymia, and Ocular Neuromyotonia.

Curr Treat Options Neurol. 2016 Jul;18(7):34

Authors: Strupp M, Dieterich M, Brandt T, Feil K

Abstract
OPINION STATEMENT: Neurovascular compression syndromes are characterized by recurrent attacks of neurological symptoms and clinical signs depending on the cranial nerve affected. It is assumed that pulsatile compression of the nerve is caused mainly by an artery. The result is segmental demyelination of the transition zone or the central part of the cranial nerve, which is covered by oligodendrocytes, and subsequent ephaptic axonal transmission. Compression of the vestibular nerve can cause attacks of spinning or non-spinning vertigo: vestibular paroxysmia. Compression of the trochlear nerve is characterized by attacks of monocular oscillopsia: superior oblique myokymia. Damage to ocular motor nerves due to local radiation or rarely neurovascular compression can also lead to oscillopsia and double vision precipitated by sustained excentric gaze: ocular neuromyotonia. It is important to note that controlled trials have so far not been performed for any of these three syndromes, mainly because of their low prevalence. Therefore, treatment recommendations are based on single cases or small case series and thus have the lowest level of evidence. The sodium channel blockers carbamazepine (50 to 200 mg tid) or oxcarbazepine (100 to 300 mg tid) are evidently effective in most of the patients who have these three syndromes. However, one should always keep in mind the contraindications, side effects, and interactions with other drugs of carbamazepine ( http://ift.tt/1Ou1j6T ) All patients require regular laboratory examinations. Alternatives are other sodium channel blockers such as phenytoin (100 to 300 mg tid), gabapentin (100 to 600 mg tid), or valproic acid (100 to 300 mg tid). Furthermore, there are also few reports on the effects of beta blockers, which may be explained by their reduction of the amplitude of blood pressure. Patients who do not respond to pharmacotherapy require further diagnostics to determine the possibility of other etiologies. Some of these patients benefit from surgical decompression of the affected nerve.

PMID: 27306762 [PubMed]

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The Impact of Electrode Array Length on Hearing Preservation in Cochlear Implantation.

Objective: The aim of the study was to determine the degree of hearing preservation (HP) and its relation to electrode array length after cochlear implantation using different thin flexible electrode arrays (TFEA). Study Design: Retrospective analysis. Intervention: One hundred twenty adult patients with preoperative residual hearing received a cochlear implant with a TFEA: 46 received a TFEA20, 34 a TFEA24, and 40 a TFEA28 mm. Main Outcome Measures: Pure-tone audiometry (125-1500 Hz) was performed preoperatively, at initial fitting, and at 3, 6, and 12 months postoperatively. Median hearing loss (HL) was determined for each of the three array groups. The pre- to postoperative pure-tone average difference was scaled into three groups (15 to 30 dB) for array group. Results: At initial fitting, median HL of 17.5 dB (TFEA20), 20 dB (TFEA24), and 24 dB (TFEA28) was observed. At 12 months, medial HL of 15 dB (TFEA20), 19.4 dB (TFEA24), and 32.5 dB (TFEA28) was observed. At initial fitting, a HL of

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Stapedotomy With Adipose Tissue Seal: Hearing Outcomes, Incidence of Sensorineural Hearing Loss, and Comparison to Alternative Techniques.

Objective: To evaluate hearing outcomes and incidence of sensorineural hearing loss (SNHL) after stapedotomy with adipose tissue seal, and to compare adipose tissue sealing with alternative techniques. Study Design: Retrospective chart review. Setting: Tertiary referral center. Patients: Primary stapedotomy was performed in 179 patients using a KTP laser, microdrill, piston prosthesis, and adipose tissue seal of the oval window fenestra between 1991 and 2015. An additional 123 patients underwent stapes surgery with alternative techniques. Interventions: Stapes surgery for otosclerosis. Audiograms were performed preoperatively and 3 months postoperatively. Main Outcome Measures: Hearing outcomes were measured as percentage of cases with closure of the air-bone gap (ABG) to within 10 and 15 dB. SNHL was identified as cases with decrement in bone conduction thresholds greater than 10 or 5 dB. The median postoperative ABG and change in bone conduction thresholds were compared between the primary stapedotomy group (KTP laser with adipose tissue seal) and various subgroups with alternative techniques. Results: We found excellent hearing outcomes after primary stapedotomy with adipose tissue seal. The ABG closed to within 10 dB in 81.01% of cases and within 15 dB in 93.30% of cases. We observed a low rate of SNHL without any cases of profound hearing loss. 1.67% of cases had a decrement in bone conduction greater than 10 dB while 6.14% of cases had a decrement greater than 5 dB. Stapedotomy with adipose tissue seal compared favorably with alternative techniques with respect to hearing outcomes and SNHL. Conclusions: Adipose tissue is an effective and cost-efficient tissue seal during stapedotomy with excellent hearing outcomes and low incidence of SNHL. Copyright (C) 2016 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Temporal Lobe Gliosarcoma After Gamma Knife Radiosurgery for Vestibular Schwannoma.

Objective: Secondary tumorigenesis after exposure to ionizing radiation is a well-described phenomenon. The probability of developing a malignancy after stereotactic radiosurgery (SRS) is theoretically less than conventional external beam radiation therapy; however, the exact risk remains unknown. Such information is important for patient counseling when considering treatment of benign conditions such as vestibular schwannoma (VS). The objective of the current report is to describe a case of a temporal lobe gliosarcoma developing 3 years after radiosurgical treatment of a sporadic VS. Setting: Tertiary academic referral center. Patient: A 54-year-old man was diagnosed with a left-sided 1.6 cm cerebellopontine angle mass, consistent with VS. After reviewing treatment options, the patient proceeded with radiosurgery, and a tumor volume of 2.4 cm3 was treated with a marginal dose of 12.5 Gy prescribed to the 50% isodose line. Results: Serial magnetic resonance imaging (MRI) revealed good treatment response, demonstrated by central necrosis and tumor shrinkage. However, 3 years after treatment, the patient presented to the emergency department for a month long history of progressive word finding difficulties. Imaging revealed a 5 cm temporal lobe mass consistent with a high-grade glial neoplasm. He subsequently underwent stereotactic resection and final pathology confirmed World Health Organization Grade IV gliosarcoma. Conclusion: De novo malignancy after radiosurgery for VS is rare. We present only the second case of a gliosarcoma arising within the low-dose radiation field of the radiosurgery treatment plan. Some of the challenges of establishing causality between radiation treatment and secondary tumor development are discussed. The reporting of malignancy after radiation therapy, and even microsurgery, warrants continued vigilance. Copyright (C) 2016 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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