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Brennan JR, Sharma R, Lindquist NR, Cass ND, Krishnapura SG, Kloosterman N, Perkins E, Bennett ML, O'Malley MR, Haynes DS, Tawfik KO. Presbycusis and Hearing Preservation in Observed Vestibular Schwannomas. Otol Neurotol 2023; 44:817-821. [PMID: 37442597 DOI: 10.1097/mao.0000000000003947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Abstract
OBJECTIVE We reviewed a cohort of patients with untreated sporadic vestibular schwannoma (VS) and examined the relationship between high-frequency hearing loss (HFHL) in the non-VS ear and long-term hearing outcomes in the VS-affected ear. We hypothesized that the progression of HFHL is associated with accelerated hearing decline in sporadic VS. STUDY DESIGN Retrospective cohort study. SETTING Tertiary center. PATIENTS We studied 102 patients with sporadic VS diagnosed from 1999 to 2015 with ≥5 years of observation (median, 6.92; interquartile range, 5.85-9.29). Sixty-six patients had AAO-HNS class A/B hearing at presentation and were included in analysis. INTERVENTIONS Audiometry, serial magnetic resonance imaging for observation of VS. MAIN OUTCOME MEASURES Four-frequency pure tone average (PTA) and word recognition scores (WRS) in the VS-affected ear. Decline in high-frequency PTA (average of thresholds at 4000, 6000, and 8,000 Hz) was defined as ≥10 dB during the study period. Decline in WRS was defined as ≥10%. RESULTS Compared with those without, patients with progressive HFHL in the non-VS ear were more likely to experience a decline in WRS in the VS ear (80% vs. 54%, p = 0.031). However, the same group showed no difference (52% vs. 41%, p = 0.40) in decline in PTA of the VS ear. CONCLUSIONS Patients with observed VS who experience progressive HFHL in the non-VS ear are more likely to experience significant declines in speech understanding in the VS-affected ear over time. Patients with a history of presbycusis may have an increased risk of losing serviceable hearing because of sporadic VS.
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Affiliation(s)
- Julia R Brennan
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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Lindquist NR, Holder JT, Patro A, Cass ND, Tawfik KO, O'Malley MR, Bennett ML, Haynes DS, Gifford RH, Perkins EL. Cochlear Implants for Single-Sided Deafness: Quality of Life, Daily Usage, and Duration of Deafness. Laryngoscope 2023; 133:2362-2370. [PMID: 36254870 DOI: 10.1002/lary.30452] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 08/22/2022] [Accepted: 09/15/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To report our experience for adults undergoing cochlear implantation (CI) for single-sided deafness (SSD). METHODS This is a retrospective case series for adults with SSD who underwent CI between January 2013 and May 2021 at our institution. CNC and AzBio speech recognition scores, Tinnitus Handicap Inventory (THI), Speech, Spatial, and Qualities of Hearing Scale (SSQ12), datalogging, and the Cochlear Implant Quality of Life (CIQOL)-10 Global measure were utilized. RESULTS Sixty-six adults underwent CI for SSD (median 51.3 years, range 20.0-74.3 years), and 57 (86.4%) remained device users at last follow-up. Compared to pre-operative performance, device users demonstrated significant improvement in speech recognition scores and achieved peak performance at six months post-activation for CNC (8.0% increased to 45.6%, p < 0.0001) and AzBio in quiet (12.2% increased to 59.5%, p < 0.0001). THI was decreased at 6 months post-implantation (58.1-14.6, p < 0.0001), with 77% of patients reporting improved or resolved tinnitus. Patients demonstrated improved SSQ12 scores as well as the disease-specific CIQOL-10 Global questionnaire. Duration of deafness was not associated with significant differences in speech recognition performance. Average daily wear time was positively associated with CNC and AzBio scores as well as post-operative CIQOL-10 scores. CONCLUSIONS Herein we present the largest cohort of adult CI recipients with SSD with data on speech recognition scores, tinnitus measures, and SSQ12. Novel insights regarding the correlation of datalogging, duration of deafness, and CI-specific quality of life (CIQOL-10) metrics are discussed. Data continue to support CI as an efficacious treatment option for SSD. LEVEL OF EVIDENCE 4 Laryngoscope, 133:2362-2370, 2023.
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Affiliation(s)
- Nathan R Lindquist
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jourdan T Holder
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Hearing and Speech Science, Vanderbilt Bill Wilkerson Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ankita Patro
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Nathan D Cass
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kareem O Tawfik
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Matthew R O'Malley
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Marc L Bennett
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - David S Haynes
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - René H Gifford
- Department of Hearing and Speech Science, Vanderbilt Bill Wilkerson Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Elizabeth L Perkins
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Cass ND, Lindquist NR, Patro A, Smetak MR, Perkins EL, O'Malley MR, Bennett ML, Haynes DS, Tawfik KO. Radiographic Sigmoid Sinus Wall Abnormalities and Pulsatile Tinnitus: A Case-Control Study. Otol Neurotol 2023; 44:353-359. [PMID: 36843071 DOI: 10.1097/mao.0000000000003842] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
OBJECTIVE Compare incidence of sigmoid sinus wall abnormalities (SSWAs) and other radiographic abnormalities in patients with pulsatile tinnitus (PT) versus controls. STUDY DESIGN Retrospective case-control. SETTING Tertiary referral center. PATIENTS Adults with PT and high-resolution computed tomography imaging were compared with adults undergoing cochlear implant workup including high-resolution computed tomography imaging. MAIN OUTCOME MEASURES Incidence of SSWA in PT cohort (n = 141) compared with control (n = 149, n = 298 ears). Secondary outcome measures included differences in demographics and in other radiographic abnormalities between cohorts. RESULTS Patients with PT had a higher incidence of SSWA (34% versus 9%, p < 0.001) and superior canal dehiscence (23% versus 12%, p = 0.017) than controls. Spearman product component correlations demonstrated that ipsilateral PT was weakly associated with SSWA ( r = 0.354, p < 0.001). When SSWA was present in the PT cohort (n = 48 patients, n = 59 ears), in 31 cases (64.6%), the SSWA correlated with PT laterality (e.g., left SSWA, left PT); in 12 (25.0%), SSWA partially correlated with PT laterality (e.g., bilateral SSWA, right PT); and in 5 (10.4%), the SSWA did not correlate with PT laterality (e.g., right SSWA, left PT). CONCLUSIONS For our patients with both PT and SSWA, the SSWA is likely a contributing factor in approximately 65% of cases. For a third of patients with PT and concomitant SSWA, the association between the two is either not causative or not solely causative. Surgeons counseling patients with PT and SSWA may be optimistic overall regarding sigmoid resurfacing procedures but must appreciate the possibility of treatment failure, likely because of untreated comorbid conditions.
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Affiliation(s)
| | - Nathan R Lindquist
- The Otology Group of Vanderbilt, Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ankita Patro
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Miriam R Smetak
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Elizabeth L Perkins
- The Otology Group of Vanderbilt, Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Matthew R O'Malley
- The Otology Group of Vanderbilt, Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Marc L Bennett
- The Otology Group of Vanderbilt, Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David S Haynes
- The Otology Group of Vanderbilt, Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kareem O Tawfik
- The Otology Group of Vanderbilt, Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee
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Abstract
OBJECTIVE To evaluate cochlear implant (CI) magnet-related MRI artifact shape and size, as well as imaging indications and clinical adequacy of scans. METHODS A retrospective chart review was performed for patients undergoing CI and subsequent MRI head imaging from 2014 to 2020 at a single institution. Indications and adequacy of each scan was recorded, and interpretability compared by indication. Magnet-related artifact size was determined by performing ellipsoid modeling at axial slice of greatest signal loss. Artifact radius in centimeters was calculated for 5 sequence categories, and size compared between sequences, manufacturers, and by time from implantation. RESULTS Twenty patients underwent 58 head MRI scans. Approximately 76% of MRIs (n = 44) for 70% of patients (n = 14) were performed for indications known of prior to implantation; the remainder were performed during workup of new issues. Desired structures were interpretable in 23 (52%) of known-indication MRIs and 8 (57%) of new-indication MRIs, without significant difference (P = .751). Magnet-related artifact magnitude, compared to the reference T1-weighted fast spin echo (FSE) (4.47 cm), was similar in T2 FSE (4.57 cm, P = .068) and T1 gradient echo (GRE) sequences (4.79 cm, P = .28), but significantly greater in T2 GRE (6.86, P < .0001) and DWI (7.56 cm, P < .0001) sequences. CONCLUSIONS DWI and T2 GRE sequences are less useful in MRI evaluation of CI patients. With a more favorable artifact profile, T1 FSE, T2 FSE, and T1 GRE sequences more likely yield clinically useful information. The large proportion of scans performed for known pathology represents an opportunity to optimize for magnet location preoperatively.
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Affiliation(s)
- Nathan D Cass
- The Otology Group of Vanderbilt, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - John D Ross
- Department of Radiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Matthew R O'Malley
- The Otology Group of Vanderbilt, Vanderbilt University Medical Center, Nashville, TN, USA
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Freeman MH, Cass ND, Berndt DM, Kloosterman N, Poulos EA, Perkins EL, O'Malley MR, Tawfik KO, Bennett ML, Aulino JM, Haynes DS. Association of Postoperative Sigmoid Sinus Occlusion and Cerebrospinal Fluid Leak in Translabyrinthine Surgery. Otolaryngol Head Neck Surg 2023; 168:435-442. [PMID: 35671137 DOI: 10.1177/01945998221102817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 04/28/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To characterize the incidence of sigmoid sinus occlusion (SSO) following translabyrinthine (TL) surgery for posterior fossa tumor resection and determine the association with cerebrospinal fluid (CSF) leak. STUDY DESIGN Retrospective case series. SETTING Tertiary referral center. METHODS Patients undergoing TL surgery for vestibular schwannoma from 2012 to 2020 were included. Demographic data, medical history, preoperative tumor length and volume, and postoperative complications including CSF leak were recorded. Neuroradiology review of postoperative magnetic resonance imaging was used to determine the presence or absence of flow through the sigmoid sinus. RESULTS Of 205 patients undergoing TL, 21 (10.2%) experienced CSF leak postoperatively. Overall 56 (27%) demonstrated SSO on immediate postoperative magnetic resonance imaging. CSF leaks were more likely in those with SSO (19.6%) than those without SSO (6.7%; odds ratio, 3.54 [95% CI, 1.25-10.17]). Tumor volume and body mass index were not significantly associated with CSF leak. In total, 105 (51%) patients had some degree of sigmoid sinus thrombosis, but nonocclusive thrombosis was not associated with CSF leak. CONCLUSION SSO after TL approaches is common and appears to be significantly associated with postoperative CSF leak development. Minimizing manipulation of the sigmoid sinus during TL surgery and compression after surgery may have a role in preventing CSF leak.
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Affiliation(s)
- Michael H Freeman
- The Otology Group, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Nathan D Cass
- The Otology Group, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - David M Berndt
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Eric A Poulos
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Elizabeth L Perkins
- The Otology Group, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Matthew R O'Malley
- The Otology Group, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kareem O Tawfik
- The Otology Group, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Marc L Bennett
- The Otology Group, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Joseph M Aulino
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - David S Haynes
- The Otology Group, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Smetak MR, Fernando SJ, O'Malley MR, Bennett ML, Haynes DS, Wootten CT, Virgin FW, Dwyer RT, Dawant BM, Noble JH, Labadie RF. Electrode array positioning after cochlear reimplantation from single manufacturer. Cochlear Implants Int 2023. [PMID: 37489512 PMCID: PMC10372339 DOI: 10.1080/14670100.2023.2179756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
OBJECTIVE To investigate whether revision surgery with the same device results in a change in three key indicators of electrode positioning: scalar location, mean modiolar distance (M¯), and angular insertion depth (AID). METHODS Retrospective analysis of a cochlear implant database at a university-based tertiary medical center. Intra-operative CT scans were obtained after initial and revision implantation. Electrode array (EA) position was calculated using auto-segmentation techniques. Initial and revision scalar location, M¯, and AID were compared. RESULTS Mean change in M¯ for all ears was -0.07 mm (SD 0.24 mm; P = 0.16). The mean change in AID for all ears was -5° (SD 67°; P = 0.72). Three initial implantations with pre-curved EAs resulted in a translocation from Scala Tympani (ST) to Scala Vestibuli (SV). Two remained translocated after revision, while one was corrected when revised with a straight EA. An additional five translocations occurred after revision. CONCLUSIONS In this study examining revision cochlear implantation from a single manufacturer, we demonstrated no significant change in key indicators of EA positioning, even when revising with a different style of electrode. However, the revision EA is not necessarily confined by the initial trajectory and there may be an increased risk of translocation.
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Affiliation(s)
- Miriam R. Smetak
- Department of Otolaryngology – Head and Neck Surgery, Vanderbilt University Medical Center, 1215 21st Avenue South, Nashville, TN 37232, USA
| | - Shanik J. Fernando
- Department of Otolaryngology – Head and Neck Surgery, Vanderbilt University Medical Center, 1215 21st Avenue South, Nashville, TN 37232, USA
| | - Matthew R. O'Malley
- Department of Otolaryngology – Head and Neck Surgery, Vanderbilt University Medical Center, 1215 21st Avenue South, Nashville, TN 37232, USA
| | - Marc L. Bennett
- Department of Otolaryngology – Head and Neck Surgery, Vanderbilt University Medical Center, 1215 21st Avenue South, Nashville, TN 37232, USA
| | - David S. Haynes
- Department of Otolaryngology – Head and Neck Surgery, Vanderbilt University Medical Center, 1215 21st Avenue South, Nashville, TN 37232, USA
| | - Christopher T. Wootten
- Department of Otolaryngology – Head and Neck Surgery, Vanderbilt University Medical Center, 1215 21st Avenue South, Nashville, TN 37232, USA
| | - Frank W. Virgin
- Department of Otolaryngology – Head and Neck Surgery, Vanderbilt University Medical Center, 1215 21st Avenue South, Nashville, TN 37232, USA
| | - Robert T. Dwyer
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, 1215 21st Avenue South, Nashville, TN 37232, USA
| | - Benoit M. Dawant
- Department of Electrical Engineering & Computer Science, Vanderbilt University, 2201 West End Avenue, Nashville, TN 37235, USA
| | - Jack H. Noble
- Department of Electrical Engineering & Computer Science, Vanderbilt University, 2201 West End Avenue, Nashville, TN 37235, USA
| | - Robert F. Labadie
- Department of Otolaryngology – Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge 135 Rutledge Avenue, MSC 550, Charleston, SC 29425, USA
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Freeman MH, Perkins EL, Tawfik KO, O'Malley MR, Labadie RF, Haynes DS, Bennett ML. Facial Paralysis in Skull Base Osteomyelitis - Comparison of Surgical and Nonsurgical Management. Laryngoscope 2023; 133:179-183. [PMID: 35546515 DOI: 10.1002/lary.30161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/18/2022] [Accepted: 04/25/2022] [Indexed: 02/02/2023]
Abstract
TITLE Facial Paralysis in Skull Base Osteomyelitis - Comparison of Surgical and Nonsurgical Management. OBJECTIVE To compare outcomes of surgical and nonsurgical management in cases of facial paresis secondary to skull base osteomyelitis. METHODS A 14 patients presenting with skull base osteomyelitis complicated by facial nerve paresis at a single tertiary referral center from 2009 to 2019 were retrospectively reviewed. Patients were treated with medical therapy with or without surgical intervention, consisting of mastoidectomy and debridement with or without facial nerve decompression. House-Brackmann (HB) Grade was the main outcome measure. RESULTS A 14 patients (average age 68 years, range 58-82 years, 71% male) were analyzed, with 5 undergoing facial nerve decompression (36%), 5 undergoing mastoidectomy without facial nerve decompression (36%), and 4 undergoing medical management alone (28%). Of the 4 patients who underwent medical therapy alone, none experienced significant improvement in facial function. Of the 5 patients who underwent facial nerve decompression, 3 patients experienced improved facial function. Of the 5 patients who underwent mastoidectomy without decompression, 4 experienced improved facial function. There was no clear link between the severity of infection and the severity of facial paresis. When comparing HB score changes before and after treatment across groups, there was no statistically significant difference seen (p = 0.47). CONCLUSIONS Mastoidectomy and debridement with or without facial nerve decompression may improve facial nerve outcomes when compared to isolated medical management, although differences were not of statistical significance. The best facial nerve recoveries occurred in patients undergoing surgery within 14 days of the onset of paralysis. LEVEL OF EVIDENCE 4 - Case Series Laryngoscope, 133:179-183, 2023.
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Affiliation(s)
- Michael H Freeman
- The Otology Group, Department of Otolaryngology, Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Elizabeth L Perkins
- The Otology Group, Department of Otolaryngology, Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kareem O Tawfik
- The Otology Group, Department of Otolaryngology, Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Matthew R O'Malley
- The Otology Group, Department of Otolaryngology, Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Robert F Labadie
- Department of Otolaryngology, Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - David S Haynes
- The Otology Group, Department of Otolaryngology, Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Marc L Bennett
- The Otology Group, Department of Otolaryngology, Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Patro A, Totten DJ, Sherry AD, Manzoor NF, Cass ND, Tawfik K, Bennett ML, O'Malley MR, Haynes DS, Perkins EL. Outcomes of Initial Observation Versus Upfront Microsurgical Resection for Small to Medium-sized Vestibular Schwannomas. Otol Neurotol 2021; 42:1408-1413. [PMID: 34149031 DOI: 10.1097/mao.0000000000003243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess postoperative outcomes and predictive factors of patients observed prior to microsurgery and those undergoing upfront resection for small and medium-sized VS. STUDY DESIGN Retrospective cohort. SETTING Tertiary referral center. PATIENTS VS patients who had microsurgery from 2003 to 2018 for tumors up to 2.5 cm. MAIN OUTCOME MEASURES Postoperative outcomes including facial nerve function and interventions, complications, extent of resection, and salvage therapy. RESULTS Of 220 patients, 120 were initially observed, and 100 pursued upfront microsurgery. There was no significant association between initial observation and upfront microsurgery for postoperative facial nerve function at 2 to 3 weeks (p = 0.18) or 12 months (p = 0.5), facial nerve intervention (p = 0.5), major/minor complications (p = 0.48/0.63), recurrence (p = 0.8), subtotal resection (p = 0.6), or salvage therapy (p = 0.9). Time from initial consultation to surgery did not significantly impact outcomes. Intrameatal tumors were more likely to be observed (odds ratios [OR] 2.93; 95% CI 1.53-5.63; p = 0.001). Patients with larger tumor volume (OR 0.52; 95% CI 0.37-0.72; p < 0.0001), brainstem compression (OR 0.28; 95% CI 0.09-0.91; p = 0.03), or higher PTA were less likely to undergo observation (OR 0.99; 95% CI 0.97-0.997; p = 0.02). On multivariable analysis, predictive factors for observation were smaller tumor volume (OR 0.53; 95% CI 0.38-0.75; p < 0.001), lower PTA (OR 0.99; 95% CI 0.98-0.999; p = 0.04), and diabetes (OR 2.54; 95% CI 0.95-6.83; p = 0.06). CONCLUSIONS Patients with worse hearing, larger tumor volume, and brainstem compression were more likely to pursue upfront microsurgery. A watchful waiting period does not appear to worsen outcomes and can be considered for patients with better hearing and smaller tumors without brainstem compression.
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Affiliation(s)
- Ankita Patro
- Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center
| | | | | | - Nauman F Manzoor
- Department of Otolaryngology - Head and Neck Surgery, University Hospitals, ENT Institute, Case Western Reserve University, Cleveland, Ohio
| | - Nathan D Cass
- Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center
| | - Kareem Tawfik
- Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center
| | - Marc L Bennett
- Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center
| | - Matthew R O'Malley
- Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center
| | - David S Haynes
- Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center
| | - Elizabeth L Perkins
- Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center
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Longino ES, Manzoor NF, Cass ND, Tawfik KO, Bennett ML, O'Malley MR, Haynes DS, Perkins EL. Cochlear Implantation Outcomes in Observed Vestibular Schwannoma: A Preliminary Report. Otolaryngol Head Neck Surg 2021; 167:149-154. [PMID: 34546801 DOI: 10.1177/01945998211045903] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Over the last decade there has been a trend toward observation for small nongrowing vestibular schwannoma (VS). Even without tumor growth, patients commonly experience ipsilateral hearing decline, and hearing rehabilitation remains challenging. This study analyzes hearing and speech performance outcomes after cochlear implantation (CI) in observed VS. STUDY DESIGN Retrospective review. SETTING Tertiary referral center. METHODS Chart review was used to include patients with observed VS who had undergone ipsilateral CI, pre- and postimplantation audiometry, and speech performance. Tumor size pre- and postimplantation was measured with volumetric analysis. RESULTS Seven patients with ipsilateral VS and CI were identified. Preimplantation tumor volume was 0.11 to 1.02 cm3. Five subjects were implanted with a straight electrode and two with a perimodiolar electrode. The average preimplant pure tone average was 91.3 dB (range, 80-117 dB) and 61.2 dB (range, 12-118 dB) for the implanted and nonimplanted ears, respectively. In all subjects with at least 1 year of listening experience (n = 6), consonant-nucleus-consonant word scores improved at 6 months and 1 year in the CI-alone and bimodal listening conditions. AzBio scores in quiet also improved at 6 months and 1 year. Of subjects with serial pre- and postoperative magnetic resonance imaging, volumetric analysis demonstrated no tumor growth. CONCLUSION Our results demonstrate that CI is a successful option for subjects with small nongrowing VS. All subjects had improved performance postimplantation. VS may continue to be observed with serial magnetic resonance imaging given increasing conditionality among CI manufacturers and ability to assess cerebellopontine angle extension despite implant artifact.
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Affiliation(s)
- Elizabeth S Longino
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Nauman F Manzoor
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Nathan D Cass
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kareem O Tawfik
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Marc L Bennett
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Matthew R O'Malley
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - David S Haynes
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Elizabeth L Perkins
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Totten DJ, Smetak MR, Manzoor NF, Perkins EL, Cass ND, Hatton K, Santapuram P, O'Malley MR, Haynes DS, Bennett ML, Rivas A. Endoscope-Assisted Superior Semicircular Canal Dehiscence Repair: Single Institution Outcomes. Ann Otol Rhinol Laryngol 2021; 131:743-748. [PMID: 34459286 DOI: 10.1177/00034894211041223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To compare outcomes of endoscope-assisted middle cranial fossa MCF) repair of superior semicircular canal dehiscence (SSCD) compared to microscopic MCF repair. STUDY DESIGN Retrospective cohort. SETTING Tertiary medical center neurotology practice. METHODS Retrospective chart review and cohort study of patients who underwent surgical repair of SSCD via MCF approach from 2010 to 2019 at our institution. Patients were categorized according to use of endoscope intraoperatively. Pre- and post-operative symptom number was calculated from 8 patient-reported symptoms. Pre- and post-operative changes in symptom number were assessed using paired t-tests. Single-predictor binary logistic regression was used to compare final reported symptoms between cohorts. Linear regression was performed to assess air-bone gap (ABG) changes postoperatively between cohorts. RESULTS Forty-six patients received surgical management for SSCD. Of these, 27 (59%) were male and 19 (41%) were female. Bilateral SSCD was present in 14 cases (29%), of which 3 underwent surgical management bilaterally, for a total of 49 surgical ears. Surgery was performed on the right ear in 19 cases (39%) and on the left in 30 cases (61%). Forty ears (82%) underwent microscopic repair while 9 (18%) underwent endoscope-assisted repair. Microscopic and endoscope-assisted MCF repair both demonstrated significantly improved symptom number postoperatively (P < .001 for each). There was no significant difference in change in ABG between the 2 cohorts. On average, patient-reported symptoms and audiometrically-tested hearing improved postoperatively in both groups. CONCLUSION While endoscopic-assisted MCF repair has the potential to provide better visualization of medial and downslope defects, repair via this technique yields similar results and is equivalent to MCF repair utilizing the microscope alone.
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Affiliation(s)
| | | | | | | | - Nathan D Cass
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kelsey Hatton
- Vanderbilt University Medical Center, Nashville, TN, USA
| | | | | | - David S Haynes
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Marc L Bennett
- Vanderbilt University Medical Center, Nashville, TN, USA
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Manzoor NF, Yancey KL, Aulino JM, Sherry AD, Khattab MH, Cmelak A, Morrel WG, Haynes DS, Bennett ML, O'Malley MR, Netterville J, Wanna G, Rivas A. Contemporary Management of Jugular Paragangliomas With Neural Preservation. Otolaryngol Head Neck Surg 2020; 164:391-398. [PMID: 32660391 DOI: 10.1177/0194599820938660] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Management of jugular paragangliomas (PGL) has evolved toward subtotal resection (STR). The purpose of this study is to analyze neural preservation and adjuvant treatment for long-term local control. STUDY DESIGN Retrospective chart review. SETTINGS Tertiary neurotology practice. SUBJECTS AND METHODS Adults undergoing surgical treatment of jugular PGL between 2006 and 2019. Patients, disease, and treatment variables were collected retrospectively. Single predictor logistic regression was used to ascertain predictors of regrowth or need for salvage radiation. RESULTS A total of 41 patients (median age, 47 years; 76% female) were identified. Most patients presented with advanced-stage disease (Glasscock-Jackson stage III-IV = 76%). Subtotal resection (STR) was performed in 32 (78%) patients. Extended STR (type 1) was the most commonly performed conservative procedure (n = 19, 59%). Postoperative new low cranial neuropathy (LCN) involving CN X and XII was rare (n = 3 and n = 1, respectively). Seventeen patients (41%) underwent postsurgical therapy for tumor regrowth or recurrence, including 15 patients who underwent adjuvant (n = 4) or salvage (n = 11) radiation. Overall tumor control of 94.7% was achieved at a mean follow-up of 35 months. All patients treated with combined modality treatment had local control at last follow-up. Logistic regression identified no single predictor for postsurgical radiation treatment or salvage-free survival. CONCLUSION Management of jugular PGL with a conservative approach is safe and effective with a low rate of new LCN deficit. Active surveillance of residual tumor with salvage radiation for growth results in excellent long-term tumor control.
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Affiliation(s)
- Nauman F Manzoor
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kristen L Yancey
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Joseph M Aulino
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Alexander D Sherry
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Mohamed H Khattab
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Anthony Cmelak
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - William G Morrel
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - David S Haynes
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Marc L Bennett
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Matthew R O'Malley
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - James Netterville
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - George Wanna
- Department of Otolaryngology, New York Eye and Ear Infirmary, New York, New York, USA
| | - Alejandro Rivas
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Yawn RJ, Dedmon MM, Xie D, Thompson RC, O'Malley MR, Bennett ML, Rivas A, Haynes DS. Delayed Facial Nerve Paralysis after Vestibular Schwannoma Resection. J Neurol Surg B Skull Base 2018; 80:283-286. [PMID: 31143572 DOI: 10.1055/s-0038-1669941] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 07/17/2018] [Indexed: 10/28/2022] Open
Abstract
Objective To describe the incidence and clinical course of patients who develop delayed facial nerve paralysis (DFNP) after surgical resection of vestibular schwannoma. Setting Tertiary skull base center. Methods Retrospective chart review. Results Two hundred and forty six consecutive patients, who underwent surgical resection for vestibular schwannoma at a single center between 2010 and 2015, were analyzed. Of these patients, 22 (8.9%) developed DFNP, defined here as deterioration of function by at least 2 House-Brackmann (HB) grades within 30 days in patients with immediate postoperative HB ≤ 3. The mean age of DFNP patients was 47.2 years (range: 17-67) and 16 (73%) were female. The mean tumor size in greatest dimension was 2.1 cm (range: 0.7-3.5 cm). At the conclusion of each case, the facial nerve stimulated at the brainstem. Mean immediate postoperative facial nerve function was HB 1.8 (range: 1-3). Average facial nerve function at the 3-week-postoperative visit was 4.4 (range: 2-6). In 1-year, 8 patients (36%) recovered HB 1 function, 10 patients (46%) recovered to HB 2, and 2 patients (9%) were HB 3. The remaining 2 patients did not recover function and were HB 6 at last follow-up. Initial postoperative facial nerve function (HB 1 or HB 2) was associated with improved recovery to normal (HB 1) function ( p = 0.018). Conclusion A majority of patients that develop delayed paralysis will recover excellent facial nerve function. Patients should be counseled; however, a small percentage of patients will not recover function long-term, despite having a previously functioning and anatomically intact nerve.
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Affiliation(s)
- Robert J Yawn
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Matthew M Dedmon
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Deborah Xie
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Reid C Thompson
- Department of Neurologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Matthew R O'Malley
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Marc L Bennett
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Alejandro Rivas
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - David S Haynes
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, United States
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Abstract
Sudden sensorineural hearing loss is a medical emergency in search of an appropriate treatment. Almost all aspects of this disease process are disputed in the literature. The natural course of the disease process has not been well defined, although spontaneous recovery in a percentage of patients appears well accepted. Little scientific data exist to develop an evidence-based treatment protocol. The more common elements of treatment in the United States include oral steroid therapy, transtympanic steroid therapy, and potentially oral antiviral therapy. Other therapies are used with great frequency, and their potential should not be discounted.
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Affiliation(s)
- Matthew R O'Malley
- The Otology Group Vanderbilt, 300 20th Ave N., Suite 502, Nashville, TN 37203-2115, USA
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Sanchez GB, Kaylie DM, O'Malley MR, Labadie RF, Jackson CG, Haynes DS. Chemical meningitis following cerebellopontine angle tumor surgery. Otolaryngol Head Neck Surg 2008; 138:368-73. [PMID: 18312887 DOI: 10.1016/j.otohns.2007.10.038] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2007] [Revised: 10/29/2007] [Accepted: 10/31/2007] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Postoperative chemical meningitis mimics bacterial meningitis, complicating the diagnosis until results of cerebrospinal fluid (CSF) cultures can be obtained. We analyzed clinical and laboratory data from a series of 1146 patients to identify findings that could exclude bacterial meningitis. SUBJECTS AND METHODS We reviewed the charts of patients who developed meningitis after cerebellopontine angle surgery. Lumbar puncture data from asymptomatic postoperative patients were our control. STUDY DESIGN Clinical symptoms, CSF profiles, and serum white blood cell (WBC) counts were compared between patients with chemical meningitis, bacterial meningitis, and asymptomatic patients. RESULTS The incidence of meningitis in our series of 1146 patients was 4.54 percent; 0.87 percent was culture-proven bacterial meningitis. The patients with bacterial meningitis had significantly higher CSF and serum WBC counts, and lower CSF glucose. The major difference between asymptomatic patients and those with chemical meningitis was the significantly lower ratio of CSF WBCs to red blood cells (RBCs) in asymptomatic patients. CONCLUSION Patients with mild CSF leukocytosis and normal CSF glucose without high serum WBC counts or focal neurological deficits may be treated for chemical meningitis.
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Affiliation(s)
- Gabriela B Sanchez
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
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O'Malley MR, Kaylie DM, Van Himbergen DJ, Bennett ML, Jackson CG. Chronic Ear Surgery in Patients With Syndromes and Multiple Congenital Malformations. Laryngoscope 2007; 117:1993-8. [PMID: 17909451 DOI: 10.1097/mlg.0b013e318135449e] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES/HYPOTHESIS The propensity for the development of chronic ear disease in patients with certain congenital syndromes is well described. Little is known about the efficacy of surgery in the management of such patients. This paper will review an institutional experience with the surgical management of chronic ear disease in patients with congenital syndromes or multiple major malformations associated with high rates of ear disease. STUDY DESIGN Retrospective chart review. METHODS Charts were reviewed to identify patients diagnosed with either a congenital syndrome or multiple major malformations with a known association with the development of chronic ear disease who underwent ear surgery for chronic ear disease (excluding tympanostomy tube placement). Syndromes encountered, surgeries performed, operative outcomes, complications, and the efficacy of ossicular chain reconstruction is reported. RESULTS Forty-three patients with 14 different syndromes or malformations were identified. These patients underwent 66 surgical procedures on 56 ears. Seventy-nine percent of patients had undergone an ear procedure prior to presentation. Disease eradication was achieved in 64% of ears with a single procedure, and 89% of ears were controlled with two surgeries or less. Thirty-two percent of surgeries involved a canal wall down procedure, a rate similar to that seen for all patients in our practice over the past decade. When used, ossicular chain reconstruction significantly reduced the air-bone gap, resulting in hearing improvement. Results for patients with Down syndrome, Turner syndrome, and conotruncal cardiac abnormalities are discussed. Only minor complications were encountered. CONCLUSIONS Syndromic patients and those with a major congenital malformation may present with significant chronic ear disease. Appropriate surgical management can yield successful eradication of disease with low complication rates.
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Affiliation(s)
- Matthew R O'Malley
- Vanderbilt University Medical Center, Department of Otolaryngology, Division of Neurotology, The Otology Group, Nashville, TN 37203, USA.
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Abstract
OBJECTIVE The objective of this study was to investigate retrograde fluorescent axonal labeling of motor nerves as an aid to surgical dissection in otolaryngology-head and neck surgery. METHODS Cholera toxin B subunit conjugated to a fluorescent dye was injected into the facial musculature of New Zealand white rabbits. At variable time points after injection, the facial nerves were harvested and analyzed for fluorescence in the peripheral axon. RESULTS All injected animals demonstrated axonal fluorescence. No animal demonstrated facial weakness. Fluorescence was detected a maximum of 20 mm from the distal end of the nerve. Time periods greater than 48 hours did not substantially increase transport distance. CONCLUSIONS Cholera toxin B subunit fluorescent conjugates, when administered intramuscularly, reliably label the distal portion of the facial nerve. In vivo labeling of a motor nerve may have significant potential for identifying a nerve in surgery. This work represents a preliminary investigation into the adaptation of in vivo fluorescence techniques as an aid to surgical dissection. Further research to refine this technique should be supported.
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Affiliation(s)
- Matthew R O'Malley
- Vanderbilt University Department of Hearing and Speech Sciences, Nashville, Tennessee, USA.
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