Otology & Neurotology最新文献

{"title":"Crista Fenestra Heights Measured by HRCT Predicts the Necessity for Extended Round Window Approach for Slim Modiolar Electrode.","authors":"Atsumu Teramura, Akinori Kashio, Toshihito Sahara, Hajime Koyama, Teru Kamogashira, Shinji Urata, Rumi Ueha, Tatsuya Yamasoba","doi":"10.1097/MAO.0000000000004335","DOIUrl":"https://doi.org/10.1097/MAO.0000000000004335","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the morphology of the crista fenestra (CF) using three-dimensional reconstruction based on high-resolution computed tomography (HRCT) and to examine the influence of CF height on the insertion approach used for CI632/532 implants.</p><p><strong>Study design: </strong>Retrospective study.</p><p><strong>Setting: </strong>Tertiary referral center.</p><p><strong>Patients: </strong>Forty-five ears of 37 patients who received CI632/532 implants were included.</p><p><strong>Interventions: </strong>HRCT images were reconstructed into three-dimensional images, and CF structures were identified. The patients were divided into two group based on the insertion approach: round window approach (RW; n = 27) and extended round window approach (eRW; n = 18). To evaluate CF interference, 10 cases in the eRW group in which the sheath or electrode did not pass through the RW before widening the RW niche (nRW group) were specifically included in the analysis.</p><p><strong>Main outcome measure: </strong>The identified CF cross-sections were confirmed by HRCT axial sectioning, and CF heights were measured.</p><p><strong>Results: </strong>The mean CF height was significantly greater in the nRW group than in the RW group (0.97 vs. 0.78 mm).</p><p><strong>Conclusion: </strong>CF was identified using three-dimensional computer graphics (3DCG) and the CF height on the HRCT axial sections. Thus, measuring the CF height using 3DCG reconstruction can facilitate the preoperative selection of the electrode insertion approach.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142605596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In Memoriam: Dr. Bill Lippy, 1928-2024.","authors":"","doi":"10.1097/MAO.0000000000004334","DOIUrl":"https://doi.org/10.1097/MAO.0000000000004334","url":null,"abstract":"","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142605751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidental Findings on MRIs for Asymmetric Sensorineural Hearing Loss: A Clinical and Economic Analysis.","authors":"Lawrance Lee, Albina S Islam, Lauren Sterlin, Daniel H Coelho","doi":"10.1097/MAO.0000000000004353","DOIUrl":"10.1097/MAO.0000000000004353","url":null,"abstract":"<p><strong>Background: </strong>The gold-standard assessment of asymmetric sensorineural hearing loss (ASNHL) is contrast-enhanced MRI. Although rates of identifying a vestibular schwannoma are low (<5%), it is generally accepted as cost-effective. Yet, the impact of incidentalomas is rarely considered. This study aims to characterize the incidence of incidentalomas in the workup of ASNHL and quantify the associated socioeconomic burden.</p><p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Single academic institution in a midsized city in the United States.</p><p><strong>Methods: </strong>Radiology records were queried for MRI's ordered for ASNHL between January 2012 and November 2022. Results were characterized as \"group 1: normal,\" \"group 2: abnormal read/normal variant,\" \"group 3: abnormal-likely cause of ASNHL,\" or \"group 4: abnormal-follow-up needed.\" Subsequent costs of workup for group 4 were estimated using Medicare Physician Fee Schedule for Medicare costs, US Congressional Budgeting Office data for private insurer costs, and USC-Brookings Schaeffer Initiative for Health Policy estimates for uninsured individuals.</p><p><strong>Results: </strong>Six hundred patients met the inclusion criteria. Eighteen (3.0%) were categorized in group 3, whereas 40 (6.7%) were categorized in group 4. Of these patients, 7.5% (n = 3) had interventions to manage their incidental findings. Estimated per patient cost for further workup of incidental findings amounted to approximately $744, $1,534, and $2,260 for Medicare, private insurance, and uninsured costs, respectively.</p><p><strong>Conclusion: </strong>Incidentalomas occur over twice as often as retrocochlear pathologies responsible for ASNHL. Although the number of patients requiring treatment for incidentaloma is low, the economic impact is not insubstantial and should be considered for both individual patients and health system payers.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142505275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Daytime Somnolence and Sleep Apnea Are Associated With Dizziness in the Elderly.","authors":"Betsy Szeto, Bradley Kesser","doi":"10.1097/MAO.0000000000004325","DOIUrl":"10.1097/MAO.0000000000004325","url":null,"abstract":"<p><strong>Objective: </strong>Dizziness is a debilitating multifactorial disorder commonly affecting the elderly. Daytime somnolence and sleep apnea have been linked to dizziness, but previous studies were limited by small sample sizes. The purpose of this study was to examine the relationship between dizziness and daytime somnolence and sleep-disordered breathing, in a nationally representative sample of elderly adults, while adjusting for possible confounders and mediators.</p><p><strong>Study design: </strong>Data from the National Health and Nutrition Examination Study (NHANES; 2017-2020 prepandemic data) were analyzed in a cross-sectional manner using survey methods.</p><p><strong>Setting: </strong>Community-based setting in the United States.</p><p><strong>Participants: </strong>A total of 1,490 nationally representative participants aged ≥70 years.</p><p><strong>Main outcomes: </strong>Multivariable logistic regression was used to examine the relationship between dizziness and daytime somnolence, snoring, and apnea, while adjusting for covariates (gender, age, body mass index, and various medical conditions that may confound this relationship).</p><p><strong>Results: </strong>Frequent daytime somnolence five or more times monthly (odds ratio, 2.13; 95% confidence interval, 1.49-3.06) and presence of apnea (odds ratio, 1.65; 95% confidence interval, 1.20-2.27) were found to be associated with greater odds of dizziness when adjusting for medical comorbidities. A significant association was not found between snoring and dizziness.</p><p><strong>Conclusions and relevance: </strong>In the elderly, daytime somnolence and apnea were independently associated with increased odds of dizziness, even after adjusting for medical comorbidities. Daytime somnolence and sleep apnea should be added to the differential diagnosis in this patient population. Optimizing sleep may help reduce symptoms of dizziness in this population, but prospective studies would be required to confirm these findings.Level of evidence: 4.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142133409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deep Phenotyping of a Mouse Model for Hearing Instability Disorders.","authors":"J Dixon Johns, Samuel Mawuli Adadey, Dillon Strepay, Rafal Olszewski, Michael Hoa","doi":"10.1097/MAO.0000000000004345","DOIUrl":"10.1097/MAO.0000000000004345","url":null,"abstract":"<p><strong>Hypothesis: </strong>Hearing instability in Slc26a4 -insufficiency mice may be due to differential expression of genes related to ion homeostasis and activated macrophages.</p><p><strong>Background: </strong>Hearing instability (HI) disorders, defined by either hearing fluctuation or sudden loss, remain incompletely understood. Recent studies have described a Slc26a4 (pendrin)-insufficiency mouse model (DE17.5) that offers a genetically driven model for HI, although deep audiometric and immunohistologic phenotyping of this model remains poorly characterized.</p><p><strong>Methods: </strong>Homozygous DE17.5 mice with (F) and without (NF) HI were delineated by serial auditory brainstem responses (ABR) between postnatal days 30 and 60 and compared with adult phenotypically wild-type Slc26a4 -heterozygous controls without evidence of HI (Het). HI was defined as a change in threshold of at least 15 dB in at least two frequencies or at least 20 dB in at least one frequency from the previous week. Stria vascularis (SV) cell type-specific gene expression, endolymphatic hydrops (EH), endocochlear potential (EP), and macrophage activation were analyzed and compared between the cohorts.</p><p><strong>Results: </strong>F mice demonstrated significant reductions in the expression of cell type-specific genes related to ion homeostasis and increased macrophage activation within the SV compared with NF and Het cohorts. Both F and NF DE17.5 homozygous mice demonstrated reductions in EP and increased EH compared with the Het cohort.</p><p><strong>Conclusions: </strong>Deep phenotyping of DE17.5 mice demonstrates changes in EP and EH compared with control; however, the HI phenotype was associated with differential ion homeostasis gene expression and increased macrophage activation in the SV. This provides potential further insights into the underlying pathogenesis and possible immunologic contributions of HI in humans.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142505274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Term Outcomes of Sigmoid Sinus Wall Reconstruction for Pulsatile Tinnitus Due to Sigmoid Sinus Wall Anomalies.","authors":"Adaobi Eleanor Ahanotu, Kimberly Oslin, Marjohn Rasooly, David J Eisenman","doi":"10.1097/MAO.0000000000004352","DOIUrl":"10.1097/MAO.0000000000004352","url":null,"abstract":"<p><strong>Objective: </strong>To assess the long-term outcomes of sigmoid sinus wall reconstruction (SSWR) in patients with pulsatile tinnitus (PT) with sigmoid sinus wall anomalies (SSWAs).</p><p><strong>Study design: </strong>Single-center retrospective review.</p><p><strong>Setting: </strong>Tertiary referral center.</p><p><strong>Patients: </strong>Patients who underwent SSWR for PT with SSWAs more than 5 years prior to study initiation.</p><p><strong>Interventions: </strong>Therapeutic-all patients underwent sinus wall reconstruction for pulsatile tinnitus with sigmoid sinus anomalies.</p><p><strong>Main outcome measures: </strong>The primary outcomes were complete or partial resolution of PT lasting at least 5 years postoperatively and short-term relief from PT after surgery with long-term recurrence as determined by a self-assessment questionnaire and corroborated by the medical record.</p><p><strong>Results: </strong>Thirty-five patients (37 ears) out of 58 eligible patients 5 years postoperatively from SSWR completed the survey. Short-term and long-term success rates of SSWR are 97.3% (36/37 ears) and 83.8% (31/37 ears), respectively. Of the patients, 13.5% (5/37 ears) experienced recurrence of PT on the same side following initial resolution. Of our patients, 8.6% had a confirmed diagnosis of idiopathic intracranial hypertension (IIH) after a follow-up period of more than 5 years.</p><p><strong>Conclusions: </strong>Sinus wall reconstruction is an effective procedure for long-term control of PT in patients with SSWAs, with an acceptable safety profile and very low additional risk of exacerbating or provoking complications associated with IIH.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142505277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Residual Vestibular Schwannomas: Proposed Age-Tumor-Residual (ATR) Staging System to Predict Future Growth.","authors":"Douglas J Totten, Evan C Cumpston, William Schneider, Charles W Yates, Mitesh V Shah, Rick F Nelson","doi":"10.1097/MAO.0000000000004339","DOIUrl":"10.1097/MAO.0000000000004339","url":null,"abstract":"<p><strong>Objective: </strong>To assess growth rates of residual vestibular schwannoma after subtotal and near-total surgical resection and establishing staging system for risk of residual tumor growth.</p><p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Tertiary referral center.</p><p><strong>Patients: </strong>Patients with residual vestibular schwannoma after surgical resection from 2011 to 2023 identified on postoperative MRI defined as near-total resection (NTR, less than 5 mm of remaining tumor), subtotal resection (STR; 5-10 mm) and debulking (>10 mm).</p><p><strong>Main outcome measures: </strong>Tumor growth of 2 mm or more after subtotal or near-total surgical resection of vestibular schwannoma.</p><p><strong>Results: </strong>A total of 56 patients (54% female; mean, standard deviation [SD] age 51 [17] yr) had residual tumor. Mean preoperative tumor size was 3.0 (1.1) cm, and residual tumors involved both sides with similar frequency (right: 52%). Quantitatively, 29% were NTR, 32% were STR, and 39% were debulking. With an average follow-up of 27 (SD 31) months, tumor growth occurred in 11 (20%), tumor shrinkage occurred in 16 (29%), and tumors were unchanged in 29 (51%) cases. Growing residual tumors were treated with radiation (7 patients) or a second surgical resection (4 patients). Multivariable analysis identified lower patient age, larger preoperative tumor size, and larger residual tumor size in risk of residual growth. A residual VS tumor staging system (Age, Tumor, Residual [ATR]) is proposed with most tumors in stage II (22, 42%) or stage III (23, 44%), whereas 7 (14%) tumors are stage I.</p><p><strong>Conclusions: </strong>Approximately 80% of residual VS are stable or shrink in size. Initial observation is advocated after incomplete resection and long-term follow up is needed. Patient age less than 55 years, larger preoperative tumor size, and larger postoperative residual tumor size appear predictive of residual tumor growth.Level of Evidence: 4.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142505294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hearing Science Accelerator: Sudden Sensorineural Hearing Loss-Executive Summary of Research Initiatives.","authors":"William H Slattery, Ali Andalibi, Simon Angeli, Seilesh Babu, Kristina Bolt, William Britt, Jay C Buckey, John Butman, Sujana Chandrasekhar, Katharine Fernandez, David Haynes, Ronna Hertzano, Keiko Hirose, Michael Hoa, Sarah Hodge, Marissa Howard, Anil Lalwani, Lance Liotta, Alessandra Luchini, Norma de Oliveira Penido, Kourosh Parham, Stefan Plontke, Alicia Quesnel, Steven Douglas Rauch, James Saunders, Reimar Schlingensiepen, Seth Schwartz, Douglas R Stewart, Andrea Vambutas, Brian Westerberg, Nick Andresen","doi":"10.1097/MAO.0000000000004341","DOIUrl":"10.1097/MAO.0000000000004341","url":null,"abstract":"","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142546675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increasing Utilization of Intratympanic Injections among Medicare Fee-for-Service Providers.","authors":"Rance J T Fujiwara, Donald Tan, Joe Walter Kutz","doi":"10.1097/MAO.0000000000004337","DOIUrl":"10.1097/MAO.0000000000004337","url":null,"abstract":"<p><strong>Objective: </strong>To characterize national practice patterns and geographic variations in intratympanic injections among Medicare providers.</p><p><strong>Study design: </strong>Retrospective cross-sectional analysis of intratympanic injections performed in the Medicare fee-for-service population from 2013 to 2021.</p><p><strong>Setting: </strong>Center for Medicare & Medicaid Services Physician and Other Practitioners database.</p><p><strong>Participants: </strong>Providers performing outpatient intratympanic injections, documented by Current Procedural Terminology code 69801.</p><p><strong>Interventions: </strong>Intratympanic injections.</p><p><strong>Main outcome measures: </strong>The number of intratympanic injections performed by individual providers, states, and geographic regions, as well as reimbursements, was analyzed annually.</p><p><strong>Results: </strong>A total of 159,236 in-office intratympanic injections were performed. The Center for Medicare & Medicaid Services reimbursed $25,407,086; out-of-pocket patient costs were $6,591,514. The mean Medicare reimbursement rate and out-of-pocket cost per injection were $159.56 and $41.38, respectively. From 2013 to 2021, the number of intratympanic injections increased from 13,117 to 20,711 injections, representing a 57.9% increase. On linear regression, an additional 989.9 injections were performed each year (95% CI 766.4-1,213.4, p < 0.001). The number of providers performing injections also increased from 1,828 to 2,834 from 2013 to 2021 ( b = 125.6 [95% CI 111.3-140.0], p < 0.001). The population-controlled annual mean number of injections varied substantially across the United States, ranging from 12.0 injections per 100,000 beneficiaries in Oklahoma to 255.2 injections per 100,000 beneficiaries in Alabama.</p><p><strong>Conclusions: </strong>The number of intratympanic injections administered in the Medicare population has increased from 2013 to 2021. There is variability in practice patterns and utilization of intratympanic injections among otolaryngologists in the United States.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142505276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Term Prospective Quality-of-Life Outcomes in 445 Patients with Sporadic Vestibular Schwannoma.","authors":"Matthew L Carlson, Eric E Babajanian, Christine M Lohse, Nicole M Tombers, Michael J Link","doi":"10.1097/MAO.0000000000004328","DOIUrl":"10.1097/MAO.0000000000004328","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the long-term changes in sporadic vestibular schwannoma (VS) disease-specific quality-of-life (QOL) outcomes.</p><p><strong>Study design: </strong>Prospective longitudinal study using the Penn Acoustic Neuroma Quality of Life (PANQOL) Scale.</p><p><strong>Setting: </strong>National survey.</p><p><strong>Patients: </strong>Patients with sporadic VS who completed a baseline survey before treatment and at least one follow-up survey recruited through the authors' center and through the Acoustic Neuroma Association.</p><p><strong>Interventions: </strong>Observation, microsurgery, radiosurgery.</p><p><strong>Main outcome measures: </strong>Changes in PANQOL scores from baseline to most recent survey.</p><p><strong>Results: </strong>Among 445 eligible patients the mean duration of follow-up was 4.4 (SD, 2.3) years, including 122, 218, and 105 in the observation, microsurgery, and radiosurgery groups, respectively. Patients managed with observation ( p = 0.03) or microsurgery ( p < 0.001) demonstrated improvement in anxiety scores. Changes in facial function scores differed significantly by management group ( p = 0.01), with patients undergoing microsurgery demonstrating a mean decline of 10 points in facial function scores compared with mean declines of 3 for those managed with observation or radiosurgery. Hearing loss scores decreased similarly over time for all three groups ( p = 0.3). There were minimal changes in total PANQOL scores over time across all management groups ( p = 0.5).</p><p><strong>Conclusions: </strong>Long-term changes in total QOL among VS management groups are not significantly different. Microsurgery may continue to confer an advantage regarding improvement in anxiety postoperatively, but with a greater decline in facial function when compared to observation or radiosurgery. Long-term declines in hearing loss scores were not statistically significantly different among groups.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142505278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}