Odontoma of the middle ear: case report with 25-year follow-up

We report the 25-year follow-up on the first reported case of odontoma in the middle ear. Diagnosis of odontoma had been made on the basis of radiography films that showed a middle ear mass with multiple toothlike areas of radiopacity. No clinical intervention was recommended. At 25-year follow-up, audiometry showed progressive mixed hearing loss on the affected side and mild ipsilateral sensorineural hearing loss. Computed tomography better characterized the discrete mass, which was shaped similar to a dental crown. To avoid jeopardizing cochlear and facial nerve function, no surgical intervention was pursued, and we recommended use of a BiCROS (bilateral contralateral routing of signal) hearing aid.

An analysis of the Adour-Swanson and House-Brackmann grading systems for facial nerve recovery

Lack of uniformity in reporting facial nerve recovery in patients with facial nerve paralysis has been a major disadvantage in comparing treatment modalities. To remove subjectivity from the analysis, we devised a facial paralysis recovery profile as a system for measuring facial motion. This profile has been used since 1968 at Kaiser Permanente Medical Center, Oakland, California. The House facial paralysis grading system was introduced in 1983 for clinical use and was modified by Brackmann in 1985. This latter system has since been accepted by the American Academy of Otolaryngology-Head and Neck Surgery in the United States as the standard used in reporting results. In a prospective study of 54 patients, we tested multiple parameters that affect accurate reporting. We tested reliability and accuracy of facial measurements by using 30 control subjects and 3 independent examiners. We used Pearson correlation coefficients to statistically analyze results. To compare our system with the House-Brackmann grading system, we measured facial motions of 24 patients randomly selected from our data bank. All had incomplete returns of facial function and facial defects associated with faulty regeneration of a partially denervated facial nerve. Our overall results show defects in the House-Brackmann system which should be addressed. We offer the Adour-Swanson grading system as a reliable, easy-to-use, suitable alternative to the House-Brackmann system.

Hilger facial nerve stimulator: a 25-year update

Percutaneous nerve excitability testing using the Hilger facial nerve stimulator was introduced about 25 years ago. The test is reliable, easy to use, and inexpensive; it continues to be the most frequently used method for predicting prognosis of facial nerve disorders. Between 1966 and 1974, we recorded 10,243 nerve excitability tests on 865 patients with a mean of 3.29 tests for each peripheral branch and 3.43 for the trunk. Using a multiple regression model, we determined the effect on nerve stimulation values of age, sex, race, diabetes, hypertension, partial or complete clinical paralysis, diagnosis of herpes zoster, year of testing, and eventual facial paralysis recovery profile. We discuss statistical reliability, provide a table of interpretive results, and offer "tips and traps" invaluable to the practitioner. A prospective study of 25 patients with residual facial paralysis was evaluated by two separate otolaryngologists to determine intertester reliability.