Abstract: Background Various authors have described conductive hearing loss (CHL), defined as an air-bone gap on audiometry, in patients without obvious middle ear pathologic findings. Recent investigations have suggested that many of these cases are due to disorders of the inner ear, resulting in pathologic third windows.

Abstract: BACKGROUND Idiopathic Sudden Sensorineural Hearing Loss (ISSNHL), commonly defined as greater than 20 dB of unilateral hearing loss in at least 3 frequencies occurring within 3 days, has a reported incidence of 5 to 20 per 100,000 patients per year. Untreated, it has a recovery rate of 32 to 65%. Although accepted therapy is high-dose prednisone taper (HDPT), recent publications suggest that intratympanic dexamethasone (IT-Dex) therapy may improve hearing recovery. METHODS This multicenter, double-blinded, placebo-controlled, randomized study seeks to compare hearing results in ISSNHL patients who have received HDPT alone, IT-Dex alone, or IT-Dex and HDPT (combination therapy). Fifty-one patients with a less than 6-week history of ISSNHL were randomized to 1 of 3 arms and followed prospectively. Group A (17 patients) received IT-Dex therapy with placebo taper, whereas Group B (18 patients) were administered HDPT and placebo intratympanic injections. Patients in Group C (16 patients) were administered IT-Dex and HDPT, otherwise known as combination therapy. Injections (IT-Dex/placebo) and audiograms were performed weekly for 3 weeks, and a final audiogram was obtained 4 weeks after the final injection. RESULTS Patients receiving combination therapy (IT-Dex + HDPT) in Group C had an average improvement in speech discrimination score of 44 percentage points and a 40-dB improvement in pure-tone average (PTA). Patients in Group C had statistically significant improvements in speech discrimination score compared with Group B patients (HDPT alone; p < 0.05). When defining a significant improvement in PTA as greater than 15 dB, there was a statistically significant difference between the groups in the proportion of patients achieving hearing improvement. Furthermore, the proportion of patients achieving a significant PTA improvement in Group C was statistically greater than patients in Group B (p < 0.02). Logistic regression analysis indicates that patients receiving combination therapy demonstrated better odds of hearing recovery than patients in both of the other groups (p < 0.05), when all 3 groups were adjusted for age, vertigo, initial hearing levels, and time delay between onset of hearing loss and treatment. Lastly, combination therapy patients recovered their hearing more quickly than patients in the other groups (p < 0.05). CONCLUSION The results of this study suggest that ISSNHL patients treated with IT-Dex + HDPT (combination therapy) have a higher likelihood of hearing recovery than those treated with HDPT alone.

Abstract: Hypothesis:Local application of dexamethasone-21-dihydrogen-phosphate (Dex-P) to the round window (RW) membrane of guinea pigs produces a substantial basal-apical concentration gradient in scala tympani (ST) perilymph.Background:In recent years, intratympanically applied glucocorticoids are increasi

Abstract: Hypothesis:To aid in realistic counseling of patients at the time of their first visit concerning their chances for recovery, we created a simple prognostic model for predicting hearing recovery in idiopathic sudden sensorineural hearing loss (ISSHL).Background:An important element of research on IS

Abstract: Objective:To examine the outcome of cochlear implantation in children with auditory neuropathy (AN) and cochlear nerve deficiency (Group A). Results are compared with a cohort of children with AN and normal cochlear nerves (Group B).Study Design:Retrospective cohort study.Setting:The Sydney Cochlear

Abstract: Hypothesis:Intratympanic (IT) application of dexamethasone will reduce ototoxicity associated with systemic cisplatin therapy.Background:Cisplatin is a common chemotherapeutic drug often dose-limited by ototoxicity attributed to the formation of reactive oxygen and nitrogen species damaging critical

Abstract: Objective:To examine speech perception outcomes and determine the impact of length of deafness and time between implants on performance in the sequentially bilateral implanted population.Study Design:Retrospective review.Setting:Tertiary academic referral center.Patients:Forty-three children (age, <

Abstract: Intratympanic (IT) therapies are growing in popularity in the management of vertigo in Meniere’s disease. The success of IT gentamicin has been examined in a number of series and summarized in several meta-analyses (1–3). Although vertigo control is achieved in more than 85% of the subjects in these series, hearing loss and posttreatment disequilibrium remain significant concerns. The success of “titration protocols” for IT gentamicin has inevitably led to the attempt to use non-ablative IT steroids to control vertigo attacks in Meniere’s disease in a similar way. A PubMed search found 29 articles related to IT steroid treatment for Meniere’s disease over the last decade. IT steroids may have an anti-inflammatory effect on the labyrinth as suggested by the beneficial response in inner ear disorders with likely immune causes (4). In addition, recent in vitro physiology studies suggest that steroid perfusion of labyrinthine tissues can affect sodium and fluid transport (5). Trune et al. (6) have identified a mouse with progressive stria vascularis dysfunction and hearing loss in which steroids with mineralocorticoid effects ameliorate the inner ear dysfunction. Therefore, it is also possible that the effects of IT steroids in Meniere’s disease include an ion or water transport mechanism. One of the first reports regarding the effects of IT steroids for Meniere’s disease showed 80% improvement in vertigo and a 74% reduction in tinnitus in 61 patients (7). The use of IT and intravenous corticosteroids showed short-term control of vertigo in 96.4% and an improvement in hearing loss in 67.9% of 28 patients in Shea’s stages I to III of Meniere’s disease (8). These and other preliminary results led Silverstein et al. (9) to conduct a prospective, randomized, double-blind study to compare IT dexamethasone with sodium hyaluronate versus saline with sodium hyaluronate. IT dexamethasone did not show benefit over placebo for improving vertigo, hearing loss, or tinnitus in this small study of subjects with late-stage Meniere’s disease (Shea’s stage IV). However, other authors have reported good vertigo control rates in the short term after IT steroid treatment. Sennaroglu et al. (10) found that 72% of their subjects had satisfactory control of vertigo, 16% had improvement of hearing, and only 8% had worsening of hearing after IT dexamethasone treatment. In a retrospective study, Barrs (11) reported control of vertigo with one or more courses of IT injections of dexamethasone in 47% of patients with intractable Meniere’s disease. A recent prospective, placebo-controlled study with 2 years’ follow-up demonstrated complete control of vertigo in 82% of those with IT steroid treatment versus 57% with placebo treatment (12). Despite these mixed preliminary results, IT steroid therapy appears to be increasing in clinical practice. This is no doubt influenced by the convenience and ease of repeating these office-based treatments. Moreover, minimal side effects have been reported related to the IT steroid therapy (mainly tympanic membrane perforation and inflammatory middle ear changes). The current study was conducted to determine if one or more IT steroid injections could provide sufficient relief from vertigo or disequilibrium in Meniere’s disease that ablative treatments were subsequently avoided. For that purpose, we reviewed records from the previous 8 years in an academic neurotology practice for subjects who were patients with unilateral Meniere’s disease that was unresponsive to medical therapy. The subjects were offered ablative therapy with IT gentamicin, but they were given the option of IT dexamethasone as a nonablative treatment first. We sought 3 important outcome measures: 1) the number and dates of IT dexamethasone injections, 2) the number of subjects who abandoned IT dexamethasone in favor of ablative treatments and when they did so, and 3) the number who continued with IT dexamethasone injections after 2 years from the first injection.

Abstract: Introduction:More than 3,000 patients have received a cochlear implant in Hannover.Methods:A group of 864 patients was selected from the main group for the analysis of speech perception development. Depending on the term of introduction of new implant technology, the viewed group was divided into 5

Abstract: Objective:The traditional surgical repair for superior semicircular canal dehiscence (SSCD) involves either canal plugging or resurfacing via the middle cranial fossa approach. We describe a novel transmastoid occlusion technique.Study Design:Retrospective case review.Setting:Tertiary referral cente

Abstract: Epidemiological and family studies support an association between migraine, episodic vertigo, and Meniere’s disease, but reports on detailed pedigrees are limited (1–9). Several childhood periodic symptoms not temporally associated with headache such as cyclical vomiting, abdominal migraines, and benign paroxysmal vertigo of childhood are recognized as precursors to the development of migraine headaches (10). This indicates that the susceptibility to migraine may manifest as these “migraine equivalents” during different periods of a person’s life. Episodic vertigo, for example, has been shown to occur as commonly as visual auras in migraine patients, often without associated headache (11–13). Aural symptoms and even fluctuating hearing loss has been noted in migraine patients raising the possibility that Meniere’s disease, in some patients, might be directly related to their susceptibility to migraine. If Meniere’s disease could develop as part of a spectrum of migraine-associated symptoms (perhaps as a “complication”), then one would expect to see combinations of migraine, Meniere’s disease, and Meniere’s-like symptoms run within families because there has been growing evidence that migraine has a strong genetic basis. To show the association between migraine, episodic vertigo, and Meniere’s disease, we report 6 families in which these syndromes were highly associated, indicating that there may be a pathophysiological link between them.

Abstract: Objective:To review systematically the literature for the current criteria and strategies used to diagnose acute mastoiditis in children.Method:A comprehensive literature search was performed in PubMed, Embase, and the Cochrane Library of studies on the diagnosis of acute mastoiditis in children pub

Abstract: Objective:The penetrating electrode auditory brainstem implant (PABI) is an extension of auditory brainstem implant (ABI) technology originally developed for individuals deafened by neurofibromatosis type 2. Whereas the conventional ABI uses surface electrodes on the cochlear nuclei, the PABI uses 8

Abstract: Objective: To evaluate the effectiveness and issues associated with a research totally implantable cochlear implant (TIKI). Study Design: Limited patient trial. Setting: Tertiary referral center. Patients: Three adult human subjects with severe-to-profound sensorineural hearing loss. Interventions: Subjects were implanted with a research TIKI developed by Cochlear Limited and the Co-operative Research Centre for Cochlear Implant and Hearing Aid Innovation. The TIKI has a lithium ion rechargeable battery, a package-mounted internal microphone, and sound-processing electronics that enable the use of Binvisible hearing[ without the use of an externaldevice. The TIKIalso functionswithan externalESPrit 3G sound processor as a conventional cochlear implant. The standard surgical technique was modified to accommodate the larger device package. Postoperatively, subjects used TIKI in both invisible hearing and the conventional ESPrit 3G modes. Main Outcome Measures: Device use was recorded in both invisible hearing and ESPrit 3G listening modes. Performance of the internal battery and microphone was assessed over time. Psychophysical MAP data were collected, and speech perception was measured at 1, 3, 6, and 12 months postoperatively in both listening modes. Results: There were no surgical or postoperative complications. All subjects use both invisible hearing and conventional ESPrit 3G modes. Speech perception outcomes for all patients showed improvement from preoperative scores. As a consequence of the reduced sensitivity of the implanted microphone, speech perception results using the invisible hearing mode were significantly lower than the ESPrit 3G mode. Subjects reported some body noise interference that limited use of the invisible hearing mode; however, all continue to use the invisible hearing mode on a limited daily basis. The rechargeable battery functioned well, with a cycle time indicating the lowpower implant design is effective and will deliver long battery life. Conclusion: This study demonstrates that the challenges in developing a safe and effective TIKI can be overcome. Three subjects implanted with the research TIKI all reported benefit from routine use. For each subject, hearing outcomes using invisible hearing mode were not as good as when using the external ESPrit 3G sound processor in the conventional mode. Key Words: Cochlear implantsVTotally implantable. Otol Neurotol 29:114Y119, 2008.

Abstract: Objective:To determine the incidence and type of complications, as well as patient satisfaction, associated with the Baha system.Study Design:Retrospective case review.Setting:The Silverstein Institute, Sarasota, Florida, and the Columbia University Medical Center, New York, New York.Patients:Patien

Abstract: OBJECTIVE: To study the audiologic outcome of bone-anchored hearing aid (BAHA) application in patients with congenital unilateral conductive hearing impairment. STUDY DESIGN: Prospective audiometric evaluation on 20 patients. SETTING: Tertiary referral center. PATIENTS: The experimental group comprised 20 consecutive patients with congenital unilateral conductive hearing impairment, with a mean air-bone gap of 50 dB. METHODS: Aided and unaided hearing was assessed using sound localization and speech recognition-in-noise tests. RESULTS: Aided hearing thresholds and aided speech perception thresholds were measured to verify the effect of the BAHA system on the hearing acuity. All patients fulfilled the criteria that the aided speech reception thresholds or the mean aided sound field thresholds were 25 dB or better in the aided situation. Most patients were still using the BAHA almost every day. Sound localization scores varied widely in the unaided and aided situations. Many patients showed unexpectedly good unaided performance. However, nonsignificant improvements of 3.0 (500 Hz) and 6.9 degrees (3,000 Hz) were observed in favor of the BAHA. Speech recognition in noise with spatially separated speech and noise sources also improved after BAHA implantation, but not significantly. CONCLUSION: Some patients with congenital unilateral conductive hearing impairment had such good directional hearing and speech-in-noise scores in the unaided situation that no overall significant improvement occurred after BAHA fitting in our setup. Of the 18 patients with a complete data set, 6 did not show any significant improvement at all. However, compliance with BAHA use in this patient group was remarkably high. Observations of consistent use of the device are highly suggestive of patient benefit. Further research is recommended to get more insight into these findings.

Abstract: OBJECTIVES: To evaluate the benefits of cochlear implantation in postlingually deafened adults and estimate the clinical relevance of these benefits. STUDY DESIGN: Prospective intervention study. SETTING: Tertiary referral hospital. PATIENTS: Forty-four postlingually deafened adults. INTERVENTIONS: Cochlear implantation with a Clarion CII HiFocus 1 or HiRes 90K. MAIN OUTCOME MEASURES: The Health Utility Index Mark II (HUI2) and Nijmegen Cochlear Implant Questionnaire were administered to quantify health-related QoL (HRQoL); utilities were obtained from the HUI2 and time trade-off instrument. Speech perception scores were analyzed. Patient factors were correlated with postimplant HRQoL and speech perception scores. Clinical significant benefit was estimated using the minimal clinically significant difference (MID) and effect size (ES). RESULTS: The results show a significant improvement in HRQoL and speech perception (p <0.001). The improvement in HRQoL is mainly obtained in the first months after implantation and is largest in the categories concerning physical functioning (hearing). A shorter duration of deafness (p = 0.003) and higher educational level (p = 0.015) were significant predictors of better speech perception. Cochlear implantation proved to be a cost-effective procedure. By using the MID and ES, we found important clinical improvements on 6 health domains of the Nijmegen Cochlear Implant Questionnaire and on the sensation domain of the HUI2 in most patients; all but 1 of the ESs were large. CONCLUSION: Cochlear implants have a large and significant positive impact on HRQoL and speech perception and are cost-effective. These improvements are clinically relevant as measured by the MID

Abstract: Hypothesis:A period of unilateral implant use before bilateral implantation affects timing of brainstem processes measured by the electrically evoked auditory brainstem response (EABR).Background:EABR latencies decrease with unilateral implant use potentially disrupting binaural timing cues importan

Abstract: Objective: The primary goal of cholesteatoma surgery is com- plete eradication of the disease. To lower the recurrence rate in the pediatric population in canal wall up techniques and to avoid the disadvantages of canal wall down techniques, the bony obliteration technique with epitympanic and mastoid obliteration has been developed. The objective of this study was to evaluate the long-term surgical outcome and recurrence rate of this technique in children. Study Design: Retrospective case review. Setting: Tertiary referral center. Patients: Fifty-two children (G16 yr) were operated on in 90.4% (n = 47) for a primary or recurrent cholesteatoma and in 9.6% (n = 5) for an unstable cavity. Intervention: In all cases, we closed the tympanoattical barrier and the posterior tympanotomy with sculpted cortical bone and then completed obliteration of the epitympanum and mastoid with bone pate ´. A reconstruction of the middle ear was per- formed by means of an allograft tympanic membrane including the malleus handle and a sculpted allograft malleus or incus for columellar reconstruction. Main Outcome Measures: Recurrent rate; residual rate; func- tional outcome; hygienic status of the ear; long-term safety issues. Results: The mean follow-up time was 49.5 months (range, 12Y101.3 mo). Recurrent cholesteatoma occurred in 1.9% (n = 1). Residual cholesteatoma was detected in 15.4% (n = 8) of the cases. Postoperative hearing results revealed a median gain on pure-tone averages of 14.3 dB and a median postopera- tive air-bone gap of 25.6 dB. Conclusion: The mastoid and epitympanic BOT is an effec- tive technique to lower the recurrence rate of cholesteatoma in the pediatric population. Follow-up by magnetic resonance imaging provides a safe, noninvasive method for postopera- tive detection of residual cholesteatoma. Key Words: Bone pateVCholesteatomaVMastoid obliterationVMastoidectomy. Otol Neurotol 00:00Y00, 2008. The primary goal of the surgical treatment of chronic otitis media with cholesteatoma is the complete eradica- tion of the disease (no residual disease), whereas second- ary goals are the prevention of recurrent disease, the improvement of the hygienic status of the ear, and the preservation or improvement of hearing (1). Due to higher rates of recurrent and residual disease, children present a greater challenge than adults (2Y6). Various techniques have been advocated in order to reach these goals. The canal wall down (CWD) mastoidectomy provides lower recurrence rates, but it often requires regular cavity clean- ing and is associated with recurrent infection, water intol- erance, caloric-induced vertigo, and the diminished ability to wear a hearing aid (7,8). The canal wall up (CWU) technique preserves the normal bony anatomy, avoids the disadvantages associated with cavities, and has shown better hearing results, but it has a significantly higher recurrence rate. Retraction pocket formation in CWU ears can lead to recurrent cholesteatoma. The bony obliteration technique (BOT) consists of the meti- culous bony reconstruction of the canal wall and of seal- ing off the middle ear by means of sculpted cortical bone chips and then by a complete obliteration of the drilled- out epitympanum and mastoid with bone pate ´. This seems to dramatically lower the incidence of recurrent disease. In this report, we describe our experience with the BOT in a pediatric series of cholesteatoma cases and in cases with an unstable cavity after CWD surgery for cholesteatoma. The indications, the surgical outcome including the recur- rence rate, the residual rate, the functional results, and the otoscopic and imaging follow-up, are discussed. Our results should be considered preliminary until the com- plete 5- and 10-year follow-up results become available.

Abstract: Objective:To evaluate the value of corticosteroids in the treatment of vestibular neuritis (VN).Design:Prospective controlled randomized.Methods:Thirty VN patients, 15 in the study and 15 in the control group, were the subjects of the study. The study group was treated by 1 mg/kg prednisone for 5 da

Abstract: Objective To develop a screening version of the Tinnitus Handicap Inventory (THI-S) and establish its psychometric characteristics. Design : Prospective clinical study to analyze 1) the level of predictability between THI and THI-S; 2) test-retest reliability of the THI-S; 3) 95% confidence intervals (critical difference scores) for the THI-S; and 4) a THI-S cutoff score used for referral purposes. Setting Head and Neck Institute at the Cleveland Clinic, a tertiary care medical center. Patients : Thirty-three patients reporting tinnitus as their primary complaint. Interventions There was, on average, a 16-day interval between test-retest administrations of the THI-S. Main outcome measure Comparability of scores between the THI and the THI-S and test-retest reliability of the THI-S was assessed using Pearson product-moment correlations. The level of agreement between the 2 administrations of the THI-S was evaluated using Bland-Altman repeatability plots. Results Comparability between the THI and THI-S was high (r = 0.90). Test-retest reliability of the THI-S was adequate (r = 0.81), as well as the level of agreement between administrations as demonstrated by the Bland-Altman plot. Based on 95% confidence intervals, pretreatment and posttreatment scores would have to differ by more than 10 points for intervention efforts to be considered significant. A 6-point cutoff score was analyzed as an appropriate fence for referral. Conclusion The THI-S is a psychometrically robust screening measure of activity limitation and participation restriction.

Abstract: Hypothesis: Localization acuity will emerge in deaf children who receive bilateral cochlear implants (BI-CIs) before the age of 3 years but not in age-matched children who use a single device. Background: There is a growing clinical trend in which infants with severe-to-profound sensorineural hearing loss are receiving BI-CIs by 3 years. Although there is general agreement that better communicative and educational outcomes are achieved when the first implant is provided at a young age, there are few behavioral data showing the functional benefits of providing infants with BI-CIs. One potential benefit of BI-CIs is improved localization acuity, which develops within the first few years of life. Methods: Two groups of children with chronological ages ranging from 26 to 36 months participated: 1) children with normal hearing (n = 8) and 2) children with severe-to-profound sensorineural hearing loss (n = 18). Of the children who are deaf, 10 used BI-CIs, and 8 used unilateral cochlear implants. Localization acuity was measured with a single interval 2-alternativeforced choice right/left discrimination task, and minimum audible angles were computed at a performance level of 80% correct. Behavioral data were collected using the observer-based psychophysical procedure. Results: Preliminary results show that the observer-based psychophysical procedure is a feasible method to measure localization acuity in children with normal hearing and in deaf children with cochlear implants and that localization acuity is emerging in toddlers with BI-CIs but not yet in toddlers with unilateral

Abstract: OBJECTIVE To evaluate the auditory brainstem implant (ABI) performances in neurofibromatosis type 2 (NF2) and non-NF2 patients. STUDY DESIGN Retrospective cohort study. SETTING Tertiary referral center. PATIENTS Between 1996 and 2006, 31 adult patients (mean age, 41 yr; range, 17-65 yr) were implanted with a 21-electrode Nucleus device (Cochlear Inc., Lane Cove, Australia). The population comprised 23 NF2, 3 postmeningitis bilateral ossified cochleas, 3 solitary vestibular schwannomas on the only hearing ear, 1 inner ear malformation, and 1 bilateral cochlear destruction by otosclerosis. INTERVENTION Auditory brainstem implant was placed through a translabyrinthine or a retrosigmoid approach. MAIN OUTCOME MEASURES Auditory brainstem implant was evaluated by open-set words and sentences in sound, vision, and sound-plus-vision modes. RESULTS In NF2 patients, 16 (70%) were daily users of their implants. In these patients, the open-set dissyllabic word recognition was 36 +/- 6.0 % for vision-only mode, 33 +/- 6.5 % for sound-only mode, and 65 +/- 8.0 % in vision-plus-sound mode with a high interindividual variation. Negative prognostic factors were long duration of total hearing loss (>10 yr), low number of active electrodes (<10), and local complications (meningitis, hematoma). Six non-NF2 patients (75%) were daily ABI users. The performances of patients with ossified cochleas were similar to best NF2 cases. CONCLUSION A clear benefit of ABI could be evidenced in NF2 patients, especially in case of small tumor and short duration of hearing loss. Auditory brainstem implant may also be indicated in patients with bilateral profound hearing loss and a predictable failure of cochlear implantation.

Abstract: Objectives The present study was aimed to compare gain and speech intelligibility measured in quiet and in noise between the Signia hearing aid and the Vibrant Soundbridge (VSB), both devices using the same sound processing technology. Patients A prospective longitudinal study was performed. Six patients with a steeply sloping high-frequency hearing loss were selected. Intervention The protocol comprised 3 months' hearing aid use, VSB implantation, and 3 months' VSB use. Main outcome measures Patient performances were evaluated unaided and aided by audiologic assessments, including free-field thresholds and word recognition tasks in quiet and in noise. Results Statistical analysis revealed a slight decrease in overall frequencies in pure-tone audiometry after surgery; however, this decrease did not exceed 5 dB and was not different from the changes that occurred in the contralateral nonimplanted ear. The measures of aided and unaided hearing thresholds showed statistically significant larger gains with the VSB than with the hearing aid. In quiet, speech performances were poorer unaided than with either device. Because of ceiling effects, statistically significant higher scores with the VSB than with the hearing aid were only observed at the lowest intensity level. In noise, speech intelligibility was reported to be better with the VSB compared with both unaided and with the hearing aid at 5 signal-to-noise ratios. Conclusion This prospective study demonstrated that direct-drive stimulation provided by the VSB allows better speech performances than acoustic stimulation for rehabilitation of patients with steeply sloping high-frequency hearing losses.

Abstract: Objectives: To review the presentation, microbiology, and long-term results of treating otogenic cranial base osteomyelitis to develop a prognosis-based disease classification system. Patients and Methods: Thirty-eight patients with otogenic cranial base osteomyelitis treated between 1989 and 2002 were studied. Patient demographics, presentation, pathogens, details of therapy, and disease-specific survival were recorded. Patients were stratified using Technetium-99 single-photon emission computerized tomography (SPECT) at presentation into 4 grades: I, mild uptake; II, focal mastoid/temporal bone uptake not reaching midline; III, petrous temporal bone uptake reaching midline; and IV, uptake crossing midline, involving the contralateral temporal bone. Actuarial analysis was used to identify prognostic factors. Results: There were 27 men. The average age at presentation was 65 ± 16 years (range, 19-95 yr). The median age-adjusted Charlson comorbidity score was 5, and 63% of patients were diabetic. The most common presenting symptoms were pain and otorrhea, and 8 patients had cranial nerve neuropathy. Pseudomonas aeruginosa was the most common bacterial pathogen (n = 28; 74%), and 9 patients had fungal or mixed infections. On average, antibiotics were administered for 161 days, and 6 patients had concomitant surgery. The average follow-up was 33 months, and 3-year disease-specific survival was 76%. Univariate predictors of survival were the SPECT grade, fungal/mixed infections, Charlson score, immune compromise, and cranial nerve neuropathy. The only independent predictor of survival on multivariate Cox regression was the SPECT stage at presentation. Conclusion: Cranial base osteomyelitis is associated with significant morbidity and mortality and requires prolonged treatment. Long-term outcome can be predicted from the initial SPECT scan.

Abstract: Objective:To assess word recognition and pitch-scaling abilities of cochlear implant users first implanted with a Nucleus 10-mm Hybrid electrode array and then reimplanted with a full length Nucleus Freedom array after loss of residual hearing.Background:Although electroacoustic stimulation is a pro

Abstract: Optical coherence tomography (OCT) is a novel, noninvasive imaging technique that uses low-coherence interferometry to produce cross-sectional images of tissue microstructures (1). It uses light to discern differences in tissue microstructure and uses coherence gating to localize the origin of the reflected optic signal. OCT is analogous to B-mode ultrasonography but uses broadband near-infrared light to produce images with a resolution approaching that of light microscopy (10–15 μm) (1,2). OCT relies on differences in tissue optical properties to generate contrast, with axial resolution on the order of 10 μm and of a depth of penetration of approximately 1 to 2 mm, depending on turbidity. Axial resolution is inversely proportional to the coherence length of the sources. Lateral resolution is diffraction limited and therefore dependent on the optical design of each device. Although OCT has been used as a measurement tool in ossiculoplasties and stapedectomies (3), in vivo use of OCT in the human tympanic membrane (TM) has not previously been reported. In the head and neck, OCT applications have primarily focused on characterizing cancer and other disease processes in the larynx (4), because OCT is ideal for imaging the thin, layered structures of the vocal fold epithelium and lamina propria. Most OCT applications in the study of the middle and inner ear have focused on either animal investigations or human temporal bone studies (5–10). In this study, we use OCT to image and characterize the TM in both normal and pathologic conditions. Successful OCT imaging of the TM will allow the clinician to obtain structural information on the TM, supplementing planar two-dimensional images obtained during routine clinical examination. This is the first report on the in vivo high-resolution cross-sectional anatomy of human TM using OCT.

Abstract: OBJECTIVE: Evaluation of the management and survival of patients treated for temporal bone squamous cell carcinoma. STUDY DESIGN: A retrospective analysis. SETTING: Tertiary care, academic referral center. PATIENTS: Twenty-eight patients underwent primary treatment for squamous cell carcinoma of the temporal bone. INTERVENTIONS: The patients were staged using the modified Pittsburgh staging system. Patients underwent a local resection, lateral temporal bone resection, or a subtotal lateral temporal bone resection usually followed by radiotherapy. MAIN OUTCOME MEASURE: The survival rate of patients grouped by tumor size was calculated. RESULTS: Staging revealed 12 pT1, 2 pT2, 4 pT3, and 10 pT4 tumors. The mean follow-up was 34 months (2-132 mo). The Kaplan-Meier survival curves showed survival rates at 5 years of 83 and 25% for the stages pT1 and pT4, respectively. The pooled survival curves showed survival rates at 5 years of 85 and 46% for the stages pT1p/T2 and pT3/pT4, respectively. CONCLUSION: Long-term prognosis of the carcinoma of the external auditory canal mainly depends on the stage and primary treatment. Surgery may consist of a lateral temporal bone or subtotal temporal bone resection; in T3 and T4 tumors, resection may be combined with a superficial parotidectomy. If disease is diagnosed in the neck or parotid, then a neck dissection and total parotidectomy may also be performed. Additional radiotherapy should be provided in incompletely resected T1 and all T2 and T3 tumors and part of the T4 tumors. T4 tumors may be treated according to their subclassification based on the anatomic extension.

Abstract: HYPOTHESIS Tight fixation of stapes prostheses yields better functional results because sound transmission from the incus to the prosthesis is improved. BACKGROUND The optimal prosthesis to use for otosclerosis surgery is still a matter of debate. It has been proposed that using prostheses made of Nitinol, a shape-memory metal, produces better functional results with less variability and reduced risk for middle and inner ear damage. This is thought to be because heat activation rather than manual crimping of the prosthesis loop forms a tighter fixation. METHODS Functional results of two groups were compared 1 year after surgery. In one group were 75 cases of stapedotomy performed using Nitinol prostheses. Results were analyzed prospectively and compared with 75 retrospectively analyzed matched controls with conventional stapes prostheses. Crimping quality was measured in 23 patients by intraoperative laser Doppler interferometry (LDI). Causality was assessed by correlating results of intraoperative LDI and postoperative pure-tone thresholds. RESULTS Nitinol and conventional prostheses yielded postoperative air-bone gaps (ABGs) of 8.0 and 11.6 dB with 71 and 43% ABG closure within 10 dB, respectively. Intraoperatively, sound transmission was improved by 2.5 dB with the Nitinol prostheses as compared with conventional prostheses. These differences were statistically significant. Intraoperative fixation quality was positively correlated to functional outcome, but results were not statistically significant. CONCLUSION Tight fixation, as provided by Nitinol prostheses leads to improved functional results because of better sound transmission properties at the incus-prosthesis interface. The improvement in ABG closure is in the range of 3 dB pure-tone average and more pronounced at higher frequencies. Nitinol prostheses provide an effective treatment option in otosclerosis surgery.