Otology & Neurotology最新文献

{"title":"Elective Versus Corrective Cochlear Implant Revision Surgery of Legacy Internal Devices.","authors":"Samuel P O'Rourke, Margaret T Dillon, Samantha P Scharf, Andrea B Overton, Matthew M Dedmon","doi":"10.1097/MAO.0000000000004444","DOIUrl":"10.1097/MAO.0000000000004444","url":null,"abstract":"<p><strong>Objective: </strong>To assess the time course of speech recognition restoration for recipients of legacy devices who underwent cochlear implant revision (CIR) surgery in the presence or absence of device failure.</p><p><strong>Study design: </strong>Retrospective review.</p><p><strong>Setting: </strong>Tertiary academic referral center.</p><p><strong>Patients: </strong>Forty-four adult recipients of a first- or second-generation internal device who underwent CIR surgery.</p><p><strong>Interventions: </strong>Cases were categorized by whether the CIR surgery was elective (n = 18) or corrective due to a hard (n = 7) or soft (n = 19) failure.</p><p><strong>Main outcome measures: </strong>Aided consonant-nucleus-consonant (CNC) word recognition scores were queried for the following visits: best performance pre-CIR and 3, 6, and 12 months post-CIR. A linear mixed effects model evaluated the main effects of visit, CIR category, and age at CIR surgery, and the interaction of interval and revision category on CNC scores.</p><p><strong>Results: </strong>Limited surgical challenges were reported (n = 4), which included one case of incomplete insertion of the new device. Post-CIR CNC scores were similar to the best pre-CIR scores by 6 months post-CIR ( p = 0.055). There was a significant effect of age ( p = 0.006), with better performance observed for younger adults. The time course of speech recognition restoration post-CIR did not differ significantly for cases of corrective CIR due to hard or soft failures or elective CIR ( F(2,40) = 0.08, p = 0.923).</p><p><strong>Conclusions: </strong>Legacy CI users who undergo corrective or elective CIR may experience a similar time course in restoration of speech recognition post-CIR. Legacy device recipients considering elective CIR to access technology upgrades should be counseled on the associated potential risks and benefits.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":"388-392"},"PeriodicalIF":1.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143449724","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":"Characteristics of Medial and Lateral Wall Cochlear Implant Arrays Demonstrated with Cone Beam CT and Evoked Electrical Auditory Brainstem Responses.","authors":"Fadwa Alnafjan, Melville J da Cruz, Catherine M McMahon","doi":"10.1097/MAO.0000000000004431","DOIUrl":"10.1097/MAO.0000000000004431","url":null,"abstract":"<p><strong>Hypothesis: </strong>This study investigates how electrode array types-straight versus perimodiolar-affect cochlear implant (CI) placement (i.e., modiolar proximity and angular depth) and outcomes using cone beam computed tomography (CBCT) and evoked electrical auditory brainstem responses (eABR).</p><p><strong>Background: </strong>Cochlear implants (CIs) have revolutionized auditory rehabilitation, yet optimizing electrode placement remains crucial for improving speech perception and pitch discrimination. Array designs influence electrode proximity to neural structures, impacting neural stimulation efficacy.</p><p><strong>Methods: </strong>We analyzed 108 patients using CBCT to compare straight and perimodiolar electrode arrays (each with 22 electrodes) in terms of angular depth, spiral diameter, intracochlear positioning index (ICPI), electrode to modiolus, medial-lateral distance (EMML), and wrapping factor. A subset of 50 patients underwent eABR assessments across cochlear regions.</p><p><strong>Results: </strong>Significant differences were found between array types. Straight arrays showed less variability with consistent lateral placement compared to perimodiolar arrays. Measurements revealed differences: wrapping factor (M = 0.692 vs. 0.826; t(11) = 8.104, p = 0.000), angular depth (M = 351.2° vs. 437°; t(11)=4.527, p = 0.000), spiral diameter (M = 3.24 mm vs. 5.027 mm; t(11)=11.1, p = 0.000), and modified ICPI (M = 0.628 vs. 0.783; t(11)=9.742, p = 0.000). eABR results showed larger average amplitudes with straight arrays in basal and mid regions (p < 0.05), suggesting potentially enhanced neural stimulation and a more focused stimulation with perimodiolar arrays.</p><p><strong>Conclusion: </strong>Our findings underscore the importance of electrode array type in CI outcomes, emphasizing the need for precise positioning to optimize neural stimulation and clinical outcomes. Personalized array selection based on CBCT assessments may lead to improved speech perception, pitch discrimination, and overall auditory function. Future research should aim to refine stimulation strategies to maximize CI benefits, particularly where direct measurements strongly correlate with clinical outcomes compared to derived measurements.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":"46 4","pages":"364-371"},"PeriodicalIF":1.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143616642","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":"Preoperative cVEMP Results Predict Developing Prolonged Dizziness After Vestibular Schwannoma Surgery.","authors":"Masafumi Ueno, Makoto Hosoya, Marie N Shimanuki, Takanori Nishiyama, Hiroyuki Ozawa, Naoki Oishi","doi":"10.1097/MAO.0000000000004467","DOIUrl":"10.1097/MAO.0000000000004467","url":null,"abstract":"<p><strong>Objective: </strong>To assess pretreatment factors including preoperative vestibular function tests evaluated using cVEMP and caloric tests, which correlate with the development of prolonged dizziness after vestibular schwannoma resection.</p><p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Academic tertiary referral centers.</p><p><strong>Patients: </strong>Patients with vestibular schwannoma who underwent surgery and completed preoperative vestibular function tests and questionnaires.</p><p><strong>Intervention: </strong>Diagnostic.</p><p><strong>Main outcome measures: </strong>Participants were divided into prolonged dizziness and nonprolonged dizziness groups according to their postoperative DHI scores. The rates of abnormal results of preoperative vestibular function tests (caloric test, cVEMP), including other factors such as preoperative HADS scores, were compared. Furthermore, univariate logistic regression analysis was performed with the DHI score at 3 months as the dependent variable.</p><p><strong>Results: </strong>Of the whole 45 participants, 14 (31%) developed prolonged dizziness postoperatively. The proportion of participants with abnormal cVEMP results was significantly lower in the prolonged dizziness group (7.1%) than in the nonprolonged dizziness group (42%). Other factors did not show any significant differences. Univariate analysis showed that only the cVEMP results correlated with the postoperative DHI score (OR = 9.39, 95% CI [1.56, 181.3], p < 0.05). About 70% of patients with prolonged dizziness continued to exhibit high DHI scores at 6 months after surgery; however, about half of them recovered by 1 year.</p><p><strong>Conclusion: </strong>Vestibular schwannoma patients with normal preoperative cVEMP results tended to develop prolonged dizziness after resection compared to those with abnormal results. Preoperative cVEMP results enable physicians to predict whether vestibular schwannoma patients undergoing resection would likely develop prolonged dizziness postoperatively.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":"46 4","pages":"453-459"},"PeriodicalIF":1.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143616608","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":"Cochlear Implantation Outcomes in Older Adults, Ages 80-90.","authors":"Kevin Y Zhan, Karmela Dizdar, Dorina Kallogjeri, James Bao, Sabina Dang, Jordan Varghese, David Lee, Amit Walia, Nedim Durakovic, Cameron C Wick, Craig A Buchman, Jacques A Herzog, Matthew A Shew","doi":"10.1097/MAO.0000000000004452","DOIUrl":"10.1097/MAO.0000000000004452","url":null,"abstract":"<p><strong>Objective: </strong>To assess whether postoperative speech recognition after cochlear implantation (CI) differ between age groups of 80 to 89 and 90+.</p><p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Tertiary academic referral center.</p><p><strong>Patients: </strong>Older adult (80+ years old) bilateral sensorineural hearing loss patients undergoing CI.</p><p><strong>Interventions: </strong>Therapeutic, CI.</p><p><strong>Main outcome measures: </strong>Speech testing battery at 3, 6, and 12 months postoperatively. Self-reported balance and vertigo symptoms were also assessed.</p><p><strong>Results: </strong>A total of 221 patients were included in this study, with 171 cases ages 80 to 89 and 50 cases ≥90 years old. A total of 60.3% had an abnormal preoperative cognitive screen based on either Montreal Cognitive Assessment or Mini Mental State Examination. No major demographic or clinical variables were noted across age groups. Mean 1 year postoperative speech scores were as follows for ages 80 to 89 versus 90+, respectively: CNC 50% (±21%) versus 47% (±18%), AzBio Quiet 54% (±26%) versus 50% (±25%), and AzBio +10SNR 28% (±21%) versus 21% (±17%). Age, abnormal cognitive screen, duration of hearing loss, and comorbidity measures such as BMI, Adult Comorbidity Evaluation-27, and American Society of Anesthesiology physical status class were not correlated with any speech measure. Overall rates of persistent self-reported balance symptoms at activation were 22.7%, decreasing to 7.5% at 1 year. Datalogging was >11 hours use on average for both age groups.</p><p><strong>Conclusions: </strong>CI speech recognition in the 80 to 89 and 90+ age range significantly improved from preoperative scores. No major speech recognition differences were identified between age groups. Age at implantation, abnormal cognitive screening, and comorbidity status did not influence speech perception, which suggests that candidacy in older adult CI patients should not be withheld strictly due to these parameters.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":"46 4","pages":"381-387"},"PeriodicalIF":1.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143616644","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":"Silk Devices for Tympanic Membrane Repair Show No Ototoxicity in a Rat Model.","authors":"Kristin M Barry, Sharon L Redmond, Wilhelmina H A M Mulders, Filippo Valente","doi":"10.1097/MAO.0000000000004456","DOIUrl":"10.1097/MAO.0000000000004456","url":null,"abstract":"<p><strong>Hypothesis: </strong>Implantation of ClearDrum ® , a biodegradable silk fibroin device, into the middle ear (ME) cavity in a rat model will not affect hearing thresholds as measured by auditory brainstem response.</p><p><strong>Background: </strong>Chronic otitis media (COM) is a recurrent middle ear infection often accompanied by tympanic membrane perforation. Our laboratory has developed a biodegradable silk fibroin device (ClearDrum®) designed to treat tympanic membrane perforations in COM. ClearDrum ® acts as a prosthetic eardrum, providing a substrate on which tympanic membrane cells can grow and acts as a long-lasting implant.</p><p><strong>Methods: </strong>Two formulations were tested based on silk/glycerol and silk/polyurethane blends. Animals were anesthetized, and either a ClearDrum ® formulation or an autologous cartilage graft was surgically implanted into the middle ear. Thresholds of the auditory brainstem response (ABR) were measured at the time of implantation and at 4 and 12 weeks post-implantation to assess hearing after the implantation. After the final measurements at 12 weeks, middle ear and cochlea were harvested for histological assessment.</p><p><strong>Results: </strong>No significant differences in ABR thresholds between male and female animals were found at any timepoint. Results showed that there were no detrimental effects of either Cleardrum ® formulation on ABR thresholds as compared with implantation of autologous cartilage and no presence of inflammation within the middle ear or cochlea.</p><p><strong>Conclusion: </strong>Our ABR data suggest no substantial ototoxic effects on outer or inner hair cells and provides some support toward clinical translation of ClearDrum devices.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":"460-469"},"PeriodicalIF":1.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143449717","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":"Cochlear Implantation in Vestibular Schwannoma Surgery: Diagnostic Accuracy Analysis of Intraoperative Monitoring with Intracochlear Electrode.","authors":"Elisabetta Zanoletti, Stefano Concheri, Giulia Tealdo, Diego Cazzador, Valerio M Di Pasquale Fiasca, Sebastiano Franchella, Giuseppe Impala', Davide Brotto","doi":"10.1097/MAO.0000000000004437","DOIUrl":"10.1097/MAO.0000000000004437","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the role of intraoperative cochlear nerve (CN) electric monitoring with MED-EL intracochlear test electrode (ITE) in assessing the CN functional integrity.</p><p><strong>Setting: </strong>Tertiary referral center.</p><p><strong>Patients: </strong>Patients with intrameatal or 2 to 13 mm in the cerebello-pontine angle vestibular schwannoma (VS), not suitable for hearing preservation surgery but eligible for tumor resection via translabyrinthine approach and simultaneous cochlear implant (CI) rehabilitation.</p><p><strong>Intervention: </strong>ITE was used to register electrically evoked auditory brainstem response (eABR) before and after VS resection. All patients with anatomical preservation of CN underwent CI, regardless of eABR results, which served as the index test and was compared with postoperative sound perception by CI stimuli (gold standard test).</p><p><strong>Results: </strong>Twelve of seventeen cases allowed anatomical preservation of CN and were considered for the study. Seven of twelve cases demonstrated sound detection with CI, and six of twelve showed some degree of speech discrimination. eABR test with ITE achieved an accuracy of 66.7%, a sensitivity of 42.9%, and a specificity of 100%. Positive and negative predictive values were 100% and 55.6%, respectively.</p><p><strong>Conclusion: </strong>When eABR can be evoked with ITE, the attempt of CI was likely to be successful, whereas in cases of eABR absence, other factors should be considered to reduce unsuccessful CI and not preclude rehabilitation in patients who would benefit from CI. Further studies and longer follow-up are needed to analyze the role of ITE in VS surgery with CI.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":"437-445"},"PeriodicalIF":1.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11939092/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preventing Cisplatin-Induced Hearing Loss in Adults: A Systematic Review and Meta-Analysis.","authors":"Erin E Briggs, Ethan M Kallenberger, Shaun A Nguyen, Peter R Dixon, Allyson V Drawdy, Alexandra E Kejner, John M Kaczmar, Jason G Newman, W Greer Albergotti","doi":"10.1097/MAO.0000000000004446","DOIUrl":"10.1097/MAO.0000000000004446","url":null,"abstract":"<p><strong>Objective: </strong>Ototoxicity is a known side effect of cisplatin chemotherapy. The efficacy of various medications used to prevent or reduce ototoxicity in adults receiving cisplatin has not been thoroughly described in the literature.</p><p><strong>Data sources: </strong>CINAHL, Cochrane Library, PubMed, and SCOPUS.</p><p><strong>Review methods: </strong>Literature was searched between 1990 and 2024. Studies evaluating interventions to prevent hearing loss in adults receiving cisplatin were included. Audiometric data including pure tone threshold, pure tone average, and incidence of hearing loss were extracted from included studies.</p><p><strong>Results: </strong>Eight studies (N = 431 total patients) pertaining to cisplatin-induced hearing loss in adults were included. Of these studies, six were randomized control trials (N = 372 patients) and two were prospective cohort studies (N = 59 patients). The cytoprotective treatments included diethyldithiocarbamate (intravenously), dexamethasone (intratympanic), N -acetylcysteine (intratympanic), sodium thiosulfate (intravenously), calcium gluconate (intravenously), and aspirin (PO). The treatment group had an incidence in overall hearing loss of 63.3% compared to the 66.2% incidence in the control group ([95% CI, -6.2 to 11.9] p = 0.53). Patients treated with dexamethasone had lower degrees of hearing loss compared to those treated with N -acetylcysteine. However, neither of these interventions were superior to the control group.</p><p><strong>Conclusions: </strong>These results show no difference in reducing the incidence nor severity of hearing loss between the treatment and control groups. Standardization of evaluated frequencies and ototoxicity grading scales will improve investigators' ability to compare various treatments. Unfortunately, the power of this study is limited by the sample size.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":"351-357"},"PeriodicalIF":1.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143449285","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":"Quality of Information Provided by Artificial Intelligence Chatbots Surrounding the Management of Vestibular Schwannomas: A Comparative Analysis Between ChatGPT-4 and Claude 2.","authors":"Daniele Borsetto, Egidio Sia, Patrick Axon, Neil Donnelly, James R Tysome, Lukas Anschuetz, Daniele Bernardeschi, Vincenzo Capriotti, Per Caye-Thomasen, Niels Cramer West, Isaac D Erbele, Sebastiano Franchella, Annalisa Gatto, Jeanette Hess-Erga, Henricus P M Kunst, John P Marinelli, Richard Mannion, Benedict Panizza, Franco Trabalzini, Rupert Obholzer, Luigi Angelo Vaira, Jerry Polesel, Fabiola Giudici, Matthew L Carlson, Giancarlo Tirelli, Paolo Boscolo-Rizzo","doi":"10.1097/MAO.0000000000004410","DOIUrl":"10.1097/MAO.0000000000004410","url":null,"abstract":"<p><strong>Objective: </strong>To examine the quality of information provided by artificial intelligence platforms ChatGPT-4 and Claude 2 surrounding the management of vestibular schwannomas.</p><p><strong>Study design: </strong>Cross-sectional.</p><p><strong>Setting: </strong>Skull base surgeons were involved from different centers and countries.</p><p><strong>Intervention: </strong>Thirty-six questions regarding vestibular schwannoma management were tested. Artificial intelligence responses were subsequently evaluated by 19 lateral skull base surgeons using the Quality Assessment of Medical Artificial Intelligence (QAMAI) questionnaire, assessing \"Accuracy,\" \"Clarity,\" \"Relevance,\" \"Completeness,\" \"Sources,\" and \"Usefulness.\"</p><p><strong>Main outcome measure: </strong>The scores of the answers from both chatbots were collected and analyzed using the Student t test. Analysis of responses grouped by stakeholders was performed with McNemar test. Stuart-Maxwell test was used to compare reading level among chatbots. Intraclass correlation coefficient was calculated.</p><p><strong>Results: </strong>ChatGPT-4 demonstrated significantly improved quality over Claude 2 in 14 of 36 (38.9%) questions, whereas higher-quality scores for Claude 2 were only observed in 2 (5.6%) answers. Chatbots exhibited variation across the dimensions of \"Accuracy,\" \"Clarity,\" \"Completeness,\" \"Relevance,\" and \"Usefulness,\" with ChatGPT-4 demonstrating a statistically significant superior performance. However, no statistically significant difference was found in the assessment of \"Sources.\" Additionally, ChatGPT-4 provided information at a significant lower reading grade level.</p><p><strong>Conclusions: </strong>Artificial intelligence platforms failed to consistently provide accurate information surrounding the management of vestibular schwannoma, although ChatGPT-4 achieved significantly higher scores in most analyzed parameters. These findings demonstrate the potential for significant misinformation for patients seeking information through these platforms.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":"432-436"},"PeriodicalIF":1.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143449659","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":"A Massive Ear Canal Mass Resulting from an Embedded Arthropod.","authors":"Rachel Grimes, Savannah Stockton, Amanda Barrett, Pramila Moideen, Sarah Hodge","doi":"10.1097/MAO.0000000000004439","DOIUrl":"10.1097/MAO.0000000000004439","url":null,"abstract":"<p><strong>Objective: </strong>To describe a case of a massive ear mass obstructing the external auditory canal (EAC) attributed to an embedded arthropod, highlighting the diagnostic and therapeutic challenges posed by unusual etiologies of ear masses.</p><p><strong>Patients: </strong>The case was a 35-year-old female prisoner who presented with a 5 × 5.5 cm palpable exophytic mass obstructing the right EAC, accompanied by progressive hearing loss, bloody discharge, and persistent tinnitus.</p><p><strong>Interventions: </strong>Surgical excision of the infiltrating mass involving mastoidectomy and canaloplasty.</p><p><strong>Main outcome measures: </strong>Initial pathology suggested a pyogenic granuloma, but further analysis revealed a degenerating arthropod within reactive myofibroblastic and vascular changes. The patient was lost to follow-up despite a multidisciplinary treatment approach and primary surgical excision of the mass.</p><p><strong>Results: </strong>After surgical excision, the mass was confirmed as a florid reactive myofibroblastic and vascular mass enveloping a degenerating arthropod. The patient responded well to treatment without signs of infection or recurrence during follow-up.</p><p><strong>Conclusions: </strong>We report a case that emphasizes the importance of considering unusual etiologies for ear masses, especially in at-risk populations. It underscores the necessity for refined diagnostic and therapeutic strategies to manage similar clinical scenarios in the future.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":"e135-e138"},"PeriodicalIF":1.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143449741","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":"Does Topical Steroid Use Increase the Risk for Subsequent Tympanoplasty?","authors":"Lawrance Lee, Mihai A Bentan, Daniel H Coelho","doi":"10.1097/MAO.0000000000004443","DOIUrl":"10.1097/MAO.0000000000004443","url":null,"abstract":"<p><strong>Objectives: </strong>Although the current data support the notion that combination therapy of topical steroids with antibiotics is a safe, and often superior, option for suppurative otitis media when compared to topical antibiotics alone, little is known about the impact of topical steroids on tympanic membrane (TM) healing and risk of residual perforation. This study aims to describe the long-term impact the addition of topical steroids to antibiotics has on TM healing, as measured by rates of subsequent tympanoplasty.</p><p><strong>Methods: </strong>Electronic health records were queried using TriNetX Research Network to construct cohorts of adult patients with \"infected\" TM perforation (ICD-10 code H66) and \"noninfected\" TM perforation (ICD-10 code H72). Both groups were further divided based on treatment with ofloxacin or ciprofloxacin/dexamethasone (RxNorm codes). The measured outcome was whether or not the patient underwent tympanoplasty without mastoidectomy or ossicular reconstruction within 2 years following diagnosis and treatment.</p><p><strong>Results: </strong>In \"infected\" patients, the ciprofloxacin/dexamethasone cohort demonstrated a small but significantly increased risk of undergoing tympanoplasty (1.12%) compared to the ofloxacin cohort (0.76%, p < 0.05). In \"noninfected\" patients, the ciprofloxacin/dexamethasone cohort demonstrated a significantly increased risk of undergoing tympanoplasty (6.87%) compared to the ofloxacin cohort (5.67%, p < 0.05).</p><p><strong>Conclusion: </strong>In the setting of acute suppurative otitis media, there is a small but statistically significant increased risk of residual TM perforation when patients receive ciprofloxacin/dexamethasone compared to ofloxacin. However, the clinical significance of this risk must be weighed against the curative and symptomatic benefits of ciprofloxacin/dexamethasone over ofloxacin.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":"46 4","pages":"413-417"},"PeriodicalIF":1.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143616646","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}