https://journals.lww.com/otology-neurotology/toc/9900/00000 en-us Sat, 02 Aug 2025 02:44:41 -0500 Wolters Kluwer Health RSS Generator https://images.journals.lww.com/otology-neurotology/XLargeThumb.00129492-202508000-00000.CV.jpeg https://journals.lww.com/otology-neurotology/toc/9900/00000 https://journals.lww.com/otology-neurotology/fulltext/9900/endoscopic_anatomy_of_posterior_malleal_ligament_.847.aspx Objective The enhanced visualization provided by endoscopes has allowed for the identification of several anatomical structures that were previously unnoticed or overlooked when using a microscope. This study focused on the endoscopic anatomy of the posterior malleal ligament (PML), examining its presence, attachment sites, relationship with the chorda tympani, and its physiological function and surgical relevance. Study Design A retrospective study and theoretical analysis. Setting Tertiary referral center. Patients Thirty-seven out of 64 cases of tympanoplasty performed as initial operations at Ota General Hospital between July 2023 and June 2024 were analyzed. Intervention A detailed examination of surgical findings was conducted using a 2.7-mm endoscope with a 4K camera and recorded surgical videos to evaluate the following items: presence of a ligament or fold, attachment sites of the PML, and the anatomical relationship between the PML and the chorda tympani. Specimens of the PML were evaluated histopathologically. The effect of the stiffness of the PML on the vibration of the malleus and stapes was assessed using the finite-element method (FEM). Main Outcome Measure Variants were documented photographically and organized into tables. The change in vibration velocity at different PML stiffness levels was calculated using the FEM model. Results The PML, originating from the pretympanic spine, runs anteriorly, lateral to, and on the chorda tympani, reaching the manubrium in all cases. The thick ligament was present in 32 of 37 cases (86.5%), whereas in 5 of 37 cases (13.5%), the apparent thick ligament was absent, but a fold was present. The ligament terminated at the upper part of the manubrium (type 1: 13.5%) or branched out and terminated at both the upper part of the manubrium and the tympanic membrane (TM) (type 2: 73.0%). In cases where a thin loose connective tissue was present, it had a wider attachment to the manubrium (type 3: 13.5%). Histopathological analysis revealed the presence of dense or thinly stretched fibrous connective tissue. The FEM model demonstrated that the stiffness of the PML has a minimal effect, less than 2 dB, on the vibration of the ossicle. Conclusion Our study suggests that the PML has a suspensory role in anchoring the malleus to the pretympanic spine and does not play a significant role in sound transmission. The PML and the pretympanic spine are reliable landmarks for identifying the chorda tympani. Our findings provide fundamental evidence that cutting the PML and removing the pretympanic spine to improve surgical access can be done safely without significantly impacting auditory function.]]> Tue, 29 Jul 2025 00:00:00 GMT-05:00 00129492-990000000-00847 https://journals.lww.com/otology-neurotology/fulltext/9900/intrathecal_gadolinium_enhanced_mr_cisternography.886.aspx Objective To compare the efficacy of contrast enhanced magnetic resonance cisternography (CE-MRC), computed tomography cisternography (CTC), and single-photon emission computed tomography (SPECT-CT) radionuclide cisternography (RNC) in detection of skull base cerebrospinal fluid (CSF) leaks. Study Design Retrospective cohort study. Setting Tertiary referral center. Patients Adult patients with suspected anterior skull base (ASB) or lateral skull base (LSB) CSF leak who underwent CE-MRC, CTC, and/or SPECT-CT RNC to assess for CSF leak from 2018 to 2024. Main Outcome Measures Evidence of CSF leak on single or multiple cisternogram types. Results Fifty patients (74% female) had a mean (standard deviation) age of 50 (17) years and a median BMI of 34 (IQR, 28–42) kg/m2. Nineteen patients had a surgically or laboratory-confirmed CSF leak. Of these, 78% were spontaneous CSF leaks. There were no false-positive tests for any mode of cisternograms. CT cisternograms had a sensitivity of 53% (ASB: 86%, LSB: 33%) compared with a sensitivity of 90% (ASB: 100%, LSB: 86%) for CE-MR cisternograms and 67% (ASB: 100%, LSB: 33%) for SPECT-CT RN cisternograms. Conclusions CE-MRC appears to be more sensitive than CTC and SPECT-CT RNC in detecting skull base CSF leaks, particularly in the lateral skull base. CE-MRC should be used when appropriate in combination with high-resolution CT to assess for CSF leaks when there is a high index of suspicion with inconclusive beta-2 transferrin testing. Level of Evidence 4.]]> Fri, 25 Jul 2025 00:00:00 GMT-05:00 00129492-990000000-00886 https://journals.lww.com/otology-neurotology/fulltext/9900/impact_of_modifiable_surgical_factors_on.887.aspx Objective To determine the impact of modifiable surgical factors on ossiculoplasty outcomes after controlling for ear environment risk. Study Design Multi-institutional retrospective review. Setting Six tertiary care centers from 2011 to 2019. Patients Adults and children. Interventions Ossiculoplasty, including synthetic ossicular replacement prosthesis, autograft interposition, bone cement repair, and mobilization. Main Outcome Measure Correlation between modifiable surgical factors and pure-tone average air-bone gap (ABG) at most recent audiogram after controlling for preoperative risk using the statistically validated Ear Environment Risk (EER) score. Results A total of 1,679 cases were included with a median follow-up time of 20 months (IQR, 5–51). After controlling for EER score, malleus engagement of prosthesis yielded favorable ABG versus direct contact to tympanic membrane without malleus engagement (beta = −2.4 dB [−3.8, −1.1], p < 0.001). For total ossicular replacement prostheses (TORP), use of a footplate prosthesis yielded favorable ABG as compared with no footplate prosthesis (−3.6 dB [−6.1, −1.1], p = 0.005). For synthetic prostheses, polyethylene prostheses had a less favorable ABG compared with full titanium or titanium with hydroxyapatite prostheses (p < 0.05). In cases where the malleus was not engaged in reconstruction, amputation of the malleus head yielded worse ABG (+3.9 dB [1.2, 6.7], p = 0.005). There was no significant difference (p > 0.05) in ABG for single-stage versus multistaged approach, use of a cartilage cap over the prosthesis versus no cartilage, use of bone cement to secure a PORP to the stapes versus no cement, mastoid cavity obliteration versus no obliteration, and incudostapedial joint reconstruction with joint prosthesis/bone cement versus synthetic PORP. Conclusions With statistical correction for ear environment risk, several modifiable surgical factors are noted to impact ossiculoplasty hearing outcomes. Level of Evidence 4.]]> Fri, 25 Jul 2025 00:00:00 GMT-05:00 00129492-990000000-00887 https://journals.lww.com/otology-neurotology/fulltext/9900/anatomy_based_fitting_in_cochlear_implants_.867.aspx Objectives To investigate whether there is a difference in frequency parameters between anatomy-based fitting (ABF) using a preoperative CT scan and clinically based fitting (CBF). Study design Monocentric retrospective registry study. Setting Tertiary academic medical center. Patients 23 CI recipients between 2004 and 2021. Interventions CI. Main Outcome Measures Comparison between frequency maps: CBF versus ABF. The frequency parameters used for ABF were estimated based on preoperative CT scans and implanted electrodes. Results All electrode contact frequencies were significantly different between ABF and CBF maps. When the dataset was manually analyzed, 84% (n = 233) of the predicted electrode location frequencies were outside their allocated frequency band in the clinical fitting map. Conclusions Setting the CI filter bank frequencies based on preoperative electrode location estimates could be a useful alternative when postoperative CT or DVT imaging is not feasible or unavailable. This can serve as a good starting point when trying to reduce frequency-to-place mismatch between frequency allocations of the fitting filter bank and the tonotopy of the cochlea.]]> Thu, 24 Jul 2025 00:00:00 GMT-05:00 00129492-990000000-00867 https://journals.lww.com/otology-neurotology/fulltext/9900/modified_fisch_a_approach_for_resection_of.866.aspx No abstract available]]> Wed, 23 Jul 2025 00:00:00 GMT-05:00 00129492-990000000-00866 https://journals.lww.com/otology-neurotology/fulltext/9900/histopathological_factors_contributing_to.881.aspx Objective To analyze histopathological factors contributing to recurrent meningitis in patients with inner ear malformations (IEMs) through examination of two cases from the archives of an otopathology laboratory. Patients Two cases with documented IEMs and a history of recurrent meningitis were analyzed from archived human temporal bone specimens in July 2024. Intervention Histopathological examination and analysis of temporal bone specimens to identify anatomical defects and infection pathways. Main Outcome Measure Identifying specific anatomical defects and pathways contributing to recurrent meningitis in IEM cases. Results Case 1 demonstrated an incomplete partition type I (IP-I) malformation with a stapes footplate fistula, which provided a direct pathway for infection from the middle ear to the inner ear spaces. Case 2 revealed an incomplete partition type III (IP-III) malformation with a deficient otic capsule, presenting multiple potential routes for infection spread due to irregular erosion and minimal bone barrier between middle and inner ear spaces. Both cases resulted in fatal meningitis despite medical intervention. Conclusions Recurrent meningitis in IEMs can occur through different pathophysiological mechanisms: either through a discrete stapes footplate fistula or via a deficient otic capsule with multiple potential infection pathways. Management strategies should be tailored to the specific anatomical defect, with surgical intervention focusing on defect repair in stapes footplate fistulas and consideration of subtotal petrosectomy in cases of deficient otic capsule. Vaccination and careful selection of surgical procedures are crucial preventive measures. Level of Evidence IV.]]> Tue, 22 Jul 2025 00:00:00 GMT-05:00 00129492-990000000-00881 https://journals.lww.com/otology-neurotology/fulltext/9900/effects_of_ci_electrode_pullback_on.879.aspx Introduction The position between the cochlea implant (CI) electrode array and the neural structures is crucial for the audiological outcome in CI surgery. Using the pullback technique, an electrode position closer to the modiolus can be achieved in perimodiolar electrode arrays. An approximation to the modiolus could be demonstrated by improved electrophysiological recordings after finalizing the pullback. Methods Forty-six patients were implanted with Nucleus Slim perimodiolar electrode arrays (Cochlear Pty, Sydney). After complete insertion of the electrode, a controlled pullback by about 1.5 mm was performed in 20 subjects. Electrophysiological measurements were performed before and after the pullback. Radiological examination was performed on the first day postoperative with flat-panel tomography. Results Significant lower threshold neural response telemetry data were found between electrodes 7 and 11 after the pullback. Impedances remained unchanged during this procedure. Radiological and audiological examination revealed nonsignificant changes between both groups. Discussion In this series, a pullback of the CI electrode after full insertion showed an improved electrophysiological pattern of neural response telemetry data intraoperatively. It remains a matter for further studies to correlate those data with long-term audiological outcome data.]]> Mon, 21 Jul 2025 00:00:00 GMT-05:00 00129492-990000000-00879 https://journals.lww.com/otology-neurotology/fulltext/9900/speech,_timbre,_and_pitch_perception_in_cochlear.880.aspx Hypothesis To determine whether chronic use of experimental computed tomography (CT)–based frequency allocations would improve cochlear implant (CI) user performance in the areas of speech and music perception, as compared to the clinical default frequency mapping provided by the CI manufacturer. Background CIs utilize default frequency maps to distribute the frequency range important for speech perception across their electrode array. Clinical default frequency maps do not address the significant frequency-place mismatch that is inherent after cochlear implantation, nor the variability between individual anatomy or array lengths. Recent research has utilized postoperative high-resolution flat-panel CT imaging to measure the precise location of electrode contacts within an individual’s cochlea, in order to generate a custom frequency map and decrease the frequency-place mismatch. Methods A cohort of 10 experienced CI users (14 CI ears) was recruited to receive CT scans and then use an experimental CT-based frequency map for 1 month. The efficacy of these maps was measured using a battery of speech and music tests. Results No change in speech or music performance between the Experimental and Clinical Maps was found at the group level, although there was large variability within the cohort. Greater benefit from the Experimental Map on speech in quiet tasks was correlated with better electrode array alignment in the apical (low frequency) region (rho14 = −0.55 to −0.72, p < 0.05). Conclusion This application of strict CT-based mapping was most beneficial for CI users with the least amount of apical-mid array frequency-place mismatch, and least beneficial for CI users with overly deep or shallow insertions. Results may be limited by long acclimation periods to clinical default frequency maps prior to CT map usage, intervention bias, and small sample size.]]> Mon, 21 Jul 2025 00:00:00 GMT-05:00 00129492-990000000-00880 https://journals.lww.com/otology-neurotology/fulltext/9900/development_and_evaluation_of_a_novel_transcanal.878.aspx Mild therapeutic hypothermia (MTH) has demonstrated neuroprotective effects in the cochlea, particularly against noise-induced and electrode insertion trauma, by reducing inflammation and oxidative stress. Prior cadaveric studies have shown that localized cochlear cooling can be achieved using a probe placed on the promontory or a surface cooling device placed on the mastoid. While the effects of MTH on the vestibular system remain unstudied, its proximity and physiological similarity to the cochlea suggest potential benefits. We aimed to develop the first noninvasive, localized MTH device for use in the clinical environment, capable of targeting both cochlear and vestibular structures without obstructing the surgical field. A custom-designed, saline-filled cooling catheter with a balloon tip was designed to be positioned in the ear canal adjacent to the tympanic membrane. Temperature measurements were recorded from the round window, oval window, and all three semicircular canals, and compared to whole-head temperature fluctuations measured via the nasopharynx in human cadaver samples. Thermistors recorded an average temperature reduction of 4–6°C during a 30-minute protocol in cadaver heads. Nasopharyngeal temperature remained stable throughout. Furthermore, a numerical model was used to evaluate the theoretical temperature reduction achieved through ear canal cooling. The computational model further validated the experimental measurements from the cochlea. In conclusion, these findings demonstrate that cochlear and vestibular hypothermia can be effectively induced using an external cooling system positioned in the ear canal, supporting the development of a more accessible and practical clinical approach to protect the inner ear during invasive procedures.]]> Thu, 17 Jul 2025 00:00:00 GMT-05:00 00129492-990000000-00878 https://journals.lww.com/otology-neurotology/fulltext/9900/single_sided_deafness_and_cochlear_implants_.876.aspx Objective This study aims to analyze the impact of single-sided deafness (SSD) on listening behavior to evaluate sound localization ability, speech-in-noise performance, and quantifying and comparing compensatory head movements in individuals with normal hearing (NH) and SSD, with and without a cochlear implant (CI). Study Design Nonrandomized, prospective, human-subject study. Setting Tertiary academic medical center. Methods NH, SSD, and SSD-CI subjects were presented with Harvard IEEE sentences at varying target azimuths in a darkened, semi-anechoic chamber in background noise while head position was monitored. Head movement (total absolute head displacement, onset delay, and response time), localization accuracy, and speech-in-noise performance were analyzed. Results SSD subjects demonstrated less accurate speech-in-noise and sound localization performance with a significant effect of hearing status and signal-to-noise ratio (SNR). Sound localization benefit with CI was limited and did not improve, with increasingly optimal SNR and speech-in-noise performance reaching the level of NH controls with more optimal SNR. Head movements varied with and without CI for total response time, whereby CI users had shortest response times. There was no difference between the SSD and SSD-CI conditions for onset delay and head displacement, despite significant differences compared with NH controls. Conclusions Speech-in-noise performance may be the most significant improvement in CI use for SSD. Although sound localization abilities are present, there may be modest clinical significance. Head movement dynamics may highlight adaptive mechanisms that, if integrated into training or device programming, may further improve speech-in-noise and localization abilities.]]> Wed, 16 Jul 2025 00:00:00 GMT-05:00 00129492-990000000-00876 https://journals.lww.com/otology-neurotology/fulltext/9900/anatomical_relationship_of_cochlear_basal_turn_and.877.aspx Objective To evaluate the anatomical factors contributing to tip fold-over (TFO) during electrode insertion in cochlear implantation (CI). Study design Retrospective study. Setting Tertiary care academic center. Patients A total of 239 ears underwent CI with Slim Modiolar Electrodes (SME) between August 2018 and December 2023. Main outcomes and measures Preoperative temporal bone CT scans were analyzed to identify differences between patients with and without TFO. The positional relationship between a horizontal line at the cochlear basal turn and the facial nerve was assessed, and the angle between this horizontal line and the lateral margin of the facial nerve was measured. Results TFO occurred in 4.2% of cases, requiring an average of 2.7 reinsertion attempts for proper placement. In the TFO group, the horizontal line at the cochlear basal turn was positioned below the facial nerve in 90% of cases, compared with only 11.3% in the non-TFO group (p < 0.001). The mean angle between the cochlear basal turn and the facial nerve was −6.7 degrees (±2.9) in the TFO group and −0.4 degrees (±2.7) in the non-TFO group (p < 0.001). Conclusion TFO is more likely to occur when the facial nerve is positioned laterally relative to the cochlear basal turn, causing the electrode sheath to prematurely contact the scala tympani floor. These findings highlight a potential anatomical risk factor for TFO, emphasizing the need for tailored surgical strategies in high-risk cases.]]> Wed, 16 Jul 2025 00:00:00 GMT-05:00 00129492-990000000-00877 https://journals.lww.com/otology-neurotology/fulltext/9900/photon_counting_ct_reveals_radiologically_occult.875.aspx No abstract available]]> Fri, 11 Jul 2025 00:00:00 GMT-05:00 00129492-990000000-00875 https://journals.lww.com/otology-neurotology/fulltext/9900/genome__and_exome_wide_identification_of.872.aspx Hypothesis To investigate the genetic susceptibility of middle ear cholesteatoma (MEC) and construct an MEC risk prediction model by integrating genetic risk with clinical factors. Background MEC represents a relatively rare disorder that is associated with high morbidity, whereas its genetic etiology remains poorly understood. Methods Using genetic data from the UK Biobank (UKB), we performed both genome-wide association study (GWAS) and exome-wide association study (ExWAS) involving 702 MEC patients and 491,503 controls. Gene-based and gene set–based association studies were then performed to identify risk genes and gene sets of MEC, respectively. In addition, logistic regression models were applied to identify clinically significant MEC-associated diseases, of which the genetic and causal relationships with MEC were further characterized using linkage disequilibrium score regression, genetic analysis incorporating pleiotropy and annotation, and Mendelian randomization. Moreover, logistic regression models were employed to construct MEC risk prediction models by integrating genetic risk with clinical factors. Results Our study identified 159 common variants across 8 genomic loci and 39 rare variants spanning 17 genomic regions that were significantly associated with MEC, with PLD1 being prioritized as the top-ranked MEC candidate target gene. Additionally, 10 different types of diseases showed significant associations with MEC, but no inconclusive genetic or causal relationship was established between them. Moreover, we successfully constructed a high-performance MEC risk prediction model with an area under the curve of 0.704, showing the potential for clinical application. Conclusions These findings advance our understanding of the genetic susceptibility of MEC and provide insights into its risk prediction, thus contributing to improved MEC prevention and management.]]> Thu, 10 Jul 2025 00:00:00 GMT-05:00 00129492-990000000-00872 https://journals.lww.com/otology-neurotology/fulltext/9900/impact_of_the_covid_19_pandemic_and_vaccination_on.873.aspx Background Bell’s palsy (BP), a sudden onset of facial paralysis, has been reported in patients with COVID-19. The relationship between COVID-19 infection and BP remains unclear, as does the impact of COVID-19 vaccination on its incidence. This study aims to assess the occurrence of BP before and after the COVID-19 pandemic and to explore any potential effects of COVID-19 vaccination on BP cases. Methods This study utilized data from the TriNetX global health research network, specifically the US Collaborative Network of 68 healthcare organizations, encompassing 99,852,106 patients with ICD codes from 2016 to 2024. BP cases were identified using ICD-10 code G51.0, while COVID-19 vaccinations and infections were identified using CPT codes and TNX Curated 9088, respectively. We conducted an incidence and prevalence analysis of BP cases annually over the 8-year period to detect trends and compared BP rates between prepandemic (2016–2020) and postpandemic (2020–2024) periods using odds ratios. Additionally, we assessed BP incidence among COVID-19 patients and performed a subgroup analysis on vaccinated individuals to evaluate the impact of vaccination on BP incidence. To reduce potential confounding, we employed propensity score matching using the greedy nearest neighbor method available in the TriNetX platform, matching patients on age, sex, race, type 2 diabetes mellitus, and vascular commodities. Statistical analyses were executed within the TriNetX platform and supplemented by online AI tools using Python. Results The analysis of BP cases from 2016 to 2024 revealed an upward trend in both incidence and prevalence. The incidence proportion rose from 48 cases per 100,000 people in 2016–2017 to 69 cases per 100,000 by 2023–2024, with a significant increase noted from 2021 onwards. Similarly, the incidence rate increased from 0.00000155 to 0.00000333 over the same period. Prevalence also showed a steady rise, from 228 to 434 cases per 100,000 people. Trend analyses confirmed these increases as statistically significant, with p-values indicating upward trends in incidence and prevalence. Comparing prepandemic (2016–2020) to postpandemic (2020–2024) periods, there was a significant rise in incidence proportions (p-value ≈ 0.0074) and prevalence rates (p-value = 0.0180). Among COVID-positive patients, the incidence proportion remained stable, while prevalence increased, indicating a higher burden compared to the general population. After propensity score matching, vaccinated individuals exhibited a significantly lower risk of BP compared to unvaccinated individuals (hazard ratio: 0.723, 95% CI: 0.618–0.84, p < 0.001). Conclusion This highlights a significant increase in the incidence and prevalence of BP during the COVID-19 pandemic years compared to prepandemic levels. While the incidence of BP among vaccinated individuals showed a gradual increase, when mitigating for confounding influences using propensity score-matched analyses, it is revealed that these rates remained significantly lower than in unvaccinated populations, indicating a potentially protective association with vaccination. Changes in lifestyle, stress, and distribution of environmental viral loads and potentials during the pandemic may have contributed to a higher susceptibility to BP in the general population.]]> Thu, 10 Jul 2025 00:00:00 GMT-05:00 00129492-990000000-00873 https://journals.lww.com/otology-neurotology/fulltext/9900/asymmetrical_auditory_dysfunction_as_a_potential.874.aspx Introduction Parkinson’s disease (PD) is a complex neurodegenerative disorder that often presents with unilateral motor symptoms at the onset. While motor symptoms such as tremor, bradykinesia, rigidity, and postural instability are the signs of PD, nonmotor symptoms also significantly impact the patient’s quality of life. One such nonmotor symptom is auditory dysfunction, which has been increasingly recognized as a feature of PD. Objectives Our purpose is to evaluate auditory impairment in PD patients and its asymmetry as a biomarker to differentiate PD from other neurodegenerative disorders that do not exhibit this lateralized auditory dysfunction. Subjects and Methodology Our study included 60 patients with parkinsonism “the study group”, and 40 healthy individuals “the control group.” All participants underwent three auditory tests: pure tone audiometry (PTA), auditory brainstem response (ABR), and otoacoustic emissions (OAE). Results PTA thresholds were significantly higher in the PD group, especially on the affected side. ABR absolute latencies and interpeak latencies were significantly delayed in PD, with the delays being more pronounced on the affected side. The distortion product OAEs showed a significant decrease in amplitude on the affected side compared to the nonaffected side. Furthermore, its amplitude was highly significantly reduced when compared to the control group. Conclusion The asymmetry of the audiological responses in PD patients could be a valuable nonmotor marker of PD, enhancing our understanding of its broader impact on sensory systems and aiding in more precise diagnosis and monitoring of the disease.]]> Thu, 10 Jul 2025 00:00:00 GMT-05:00 00129492-990000000-00874 https://journals.lww.com/otology-neurotology/fulltext/9900/vestibular_dysfunction_in_pediatric_patients_with.871.aspx Objective To explore the occurrence of vestibular dysfunction in pediatric patients with congenital cytomegalovirus (CMV) infection and define the characteristics of vestibular loss in this population. Study Design Retrospective study with controls. Setting Tertiary pediatric referral center. Patients Pediatric patients with hearing loss associated with congenital CMV infection and GJB2 mutation(s). Intervention(s) Balance and vestibular evaluation. Main Outcome Measure(s) Normal versus abnormal results of laboratory vestibular testing. Results A total of 50 pediatric patients with congenital CMV infection, average age = 3.4 years (ranging from 7 mo to 12 yr, SD = 2.9 yr), underwent vestibular workup, including Videonystagmography, rotary chair test, and cervical vestibular evoked myogenic potential test. Of these children with CMV infection, 35 (70%) had bilateral vestibular loss, 7 (14%) had unilateral loss, and only 8 (16%) had a normal vestibular workup. In contrast, among the 48 pediatric patients without a history of CMV infection and with hearing loss associated with GJB2 mutation(s), only 9 (19%) had bilateral vestibular loss, 2 (4%) had unilateral loss, while 37 (77%) had a normal vestibular workup. Developmental/motor delay was documented in 35 (70%) patients with congenital CMV infection and hearing loss. Conclusions Children with congenital CMV infection are at high risk for vestibular loss, which is frequently bilateral, impacting the semicircular canals and otolith organs, not just the well-known hearing loss. A comprehensive balance and vestibular workup is warranted for children with congenital CMV infection with the goal of early identification of vestibular dysfunction and earlier management.]]> Mon, 07 Jul 2025 00:00:00 GMT-05:00 00129492-990000000-00871 https://journals.lww.com/otology-neurotology/fulltext/9900/hearing_and_vestibular_outcomes_in_patients.868.aspx Objective To analyze the results of hearing, vertigo, and tinnitus after simultaneous or sequential labyrinthectomy and cochlear implant (CI) and evaluate the effectiveness of end-stage Menière's disease (MD) treatment. Study design Retrospective study. Method The medical records of 39 patients who underwent labyrinthectomy and CI ipsilaterally for intractable vertigo and hearing loss with preoperative and postoperative documents were evaluated. Auditory outcomes were assessed with pure tone and speech audiometry (word test, closed set) and compared with the preoperative audiometric evaluation. Dizziness was graded according to the Dizziness Handicap Inventory Questionnaire (DHI). Tinnitus outcomes were assessed by the Tinnitus Handicap Inventory (THI). Results Paired t tests revealed significant improvements in post-CI pure tone average (p = 0.0001), speech discrimination (p = 0.009), and tinnitus (p = 0.0001). Fifty-eight percent of patients had complete resolution of the vestibular symptoms in the operated ear, while 42% showed little or no improvement. However, over half (54.5%) of the patients with no or partial improvement were over 65 years old, as evidenced by the postoperative DHI. Patients demonstrated significant reductions in tinnitus as indicated by a significant improvement on the THI (p = 0.0001). Conclusion Patients with vertigo and profound hearing loss who have end-stage Menière's disease (MD) or secondary Menière's disease can benefit from labyrinthectomy with a cochlear implant (CI). Older individuals should be treated with caution due to the possibility of chronic instability. Cochlear implantation greatly benefits both tinnitus suppression and hearing restoration.]]> Wed, 25 Jun 2025 00:00:00 GMT-05:00 00129492-990000000-00868 https://journals.lww.com/otology-neurotology/fulltext/9900/endoscopic_versus_microscopic_tympanoplasty__a.869.aspx Objective To provide prospective evidence comparing differences in audiometric and patient-reported outcomes following endoscopic and microscopic tympanoplasty techniques. Study Design Single-blinded prospective randomized comparative trial. Setting Tertiary care center between 2022 and 2023. Patients English- and Spanish-speaking adults undergoing transcanal tympanoplasty for dry tympanic membrane perforation (without cholesteatoma or chronic ear disease). Intervention Endoscopic or microscopic tympanoplasty. Main Outcome Measures The primary outcome was air-bone gap change at 3 months. Secondary measures included speech recognition thresholds (SRT), word recognition scores (WRS), and patient-reported outcome measures (PROMs), including visual analog scale (VAS) of pain, Return to Work Self-Efficacy (RTWSE-19), and Glasgow Benefit Inventory (GBI). Results Thirty-eight adults (mean age, 39.9 yr; range, 21–74 yr) were enrolled. Fifteen received microscopy, and 16 received endoscopy. Seven were excluded from the analysis: three required a post-auricular incision, and four were lost to follow-up without postoperative audiograms. Only PROMs collected within 3 weeks postoperatively were analyzed due to high participant dropout rates beyond 3 weeks. There were no differences in any audiometric or patient-reported outcomes between treatment groups (p > 0.05). Conclusions Our findings suggest that transcanal endoscopic and microscopic approaches to tympanoplasty do not differ in postoperative audiometric outcomes or PROMs.]]> Wed, 25 Jun 2025 00:00:00 GMT-05:00 00129492-990000000-00869 https://journals.lww.com/otology-neurotology/fulltext/9900/electric_acoustic_versus_electric_only_stimulation.870.aspx Objective To determine if cochlear implant recipients who have low-frequency hearing preservation after surgery can benefit from electric-acoustic stimulation (EAS) even after a period of electric-only stimulation. Study Design Prospective, crossover controlled, clinical study. Setting Private practice single-specialty clinic. Patients Patients who are native English speakers, implanted with a 28-mm lateral wall electrode, had residual low-frequency hearing post-cochlear implantation and had at least 3 months of electric-only stimulation before enrollment. Intervention Participants were reprogrammed from electric-only stimulation to EAS-A (with electric and acoustic overlap in the preserved frequencies) for 3 months. Outcomes were measured, and then the participants were changed to EAS-B, a non-overlap program. Outcomes and the patients' map preferences were recorded. Main Outcome Measures Speech perception for each programming strategy was measured with CNC and AzBio testing. Participants subjective performance was measured with CCIQ and APHAB testing for each modality. Results Out of a total of 117 consecutive CI patients with preoperative low-frequency hearing thresholds of at least 65 db HL, 43 (36.8%) had at least one low-frequency threshold less than 65 dB allowing the use of EAS. Twelve participants with 16 implanted ears were enrolled and completed the study. Statistical analysis showed that participants performed significantly better (p < 0.05) on CNC words with EAS-A (overlap, 71.6%) versus electric (65.5%) or EAS-B (non-overlap, 68%). There was not a difference between the strategies on AzBio testing. The overall scores on CCIQ and APHAB were also not statistically significant. A chi-squared test was performed for subjects' preferred programming strategy, revealing that there was a preference of the EAS strategies over electric only (p = 0.04). Conclusions There may be an advantage to EAS over electric-only stimulation in patients with low-frequency hearing preservation after cochlear implant even after a period of electric-only stimulation.]]> Wed, 25 Jun 2025 00:00:00 GMT-05:00 00129492-990000000-00870 https://journals.lww.com/otology-neurotology/fulltext/9900/the_role_of_lengthening_temporalis_myoplasty_in.865.aspx Objective This study aims at evaluating the outcomes and patient satisfaction of the Labbé operation, a lengthening temporalis myoplasty procedure, in the treatment of longstanding complete facial paralysis. Study Design We conducted a multicenter, retrospective observational study. Setting The research analyzed 38 patients with unilateral facial paralysis treated at three Italian institutions between 2009 and 2024. Patients The study included patients with severe unilateral facial paralysis, classified as House-Brackmann grades V or VI, of various etiologies. The patients, predominantly females, had a mean age of 43 years. Intervention(s) These patients underwent surgical rehabilitation of facial nerve paralysis through the Labbé procedure, which involves transferring the temporalis muscle tendon to the labial rim while maintaining innervation through the trigeminal nerve, to restore dynamic function of the inferior part of the face. Main Outcome Measure(s) Preoperative and postoperative outcomes were assessed using the Facial Clinimetric Evaluation (FaCE) questionnaire, which measures functional and psychosocial impacts. Results The only early surgical complication recorded was bleeding (1 of 38 cases). Out of the 38 patients, 17 completed the follow-up evaluations. Postoperative results showed significant improvements in quality of life and facial function, with a mean FaCE score increase of 38.6 points. Complications and long-term sequelae were rare and exclusively related to underlying malignant pathology (and to further treatments). Conclusions In selected cases, the Labbé procedure has proven to be an effective, single-stage surgical option for addressing the aesthetic and functional deficits associated with longstanding facial paralysis. This procedure offers rapid recovery and low morbidity, making it a valuable therapeutic option for improving patient outcomes.]]> Mon, 23 Jun 2025 00:00:00 GMT-05:00 00129492-990000000-00865 https://journals.lww.com/otology-neurotology/fulltext/9900/assessing_the_role_of_nystagmus_slow_phase.859.aspx Introduction Idiopathic sudden sensorineural hearing loss (ISSNHL) exhibits a diverse range of clinical presentations and treatment responses. Currently, there are no established variables that clinicians can utilize for the purposes of patient counseling when treating ISSNHL. Materials and Methods This prospective study involved 35 patients diagnosed with ISSNHL who were treated with oral and intratympanic steroid injections. We measured the peak and average slow phase velocity (SPV) (°/sec) of nystagmus after caloric stimulation during the first session of intratympanic steroid injection (ITI), and four variables were evaluated: age, time elapsed before treatment (ET), gain, and pure tone average (PTA) posttreatment. An association between these variables was determined using Spearman’s Rho statistical analysis, followed by regression modeling. Results We found a strong significant correlation between SPV and gain and PTA posttreatment (Spearman Rho 0.000). A significant correlation between SPV and ET was also detected (Spearman Rho 0.05). The linear regression analysis indicated that for every 1° increase in SPV, there is an expected increase of 0.27 dB in gain and a decrease of 0.18 dB in PTA posttreatment. Furthermore, an SPV of 17.7 (°/sec) demonstrated a strong correlation with Siegel grade 1 posttreatment (p 0.000). Conclusions The SPV (°/sec) of nystagmus during the first ITI may serve as a valuable tool for patient counseling in the management of ISSNHL, thereby encouraging the continuation or consideration of alternative treatment options. Further studies are warranted to validate these findings.]]> Wed, 18 Jun 2025 00:00:00 GMT-05:00 00129492-990000000-00859 https://journals.lww.com/otology-neurotology/fulltext/9900/carbon_dioxide__co2__laser_glomus_tympanicum.860.aspx Introduction Paragangliomas of the middle ear (glomus tympanicum, GT) are commonly encountered neoplasms of the temporal bone. GT is a benign tumor of vascular origin, arising from the neural crest cells and located on the promontory. The treatment of choice is surgical excision of the lesion. Objective Our aim was to describe the surgical and hearing outcomes in a cohort of patients with middle ear paragangliomas following resection. Methods We retrospectively reviewed the data of patients with GT who were treated with a CO2 laser from 2014 to 2021. Preoperative and postoperative audiometric outcomes, symptom evaluations, and otomicroscopic examinations were performed. The surgical approach was individualized for each patient based on tumor characteristics demonstrated on computed tomography. Three different approaches were used: (1) canal wall down, canal wall reconstruction, and mastoid obliteration (CWD, CWR, and MO) mastoidectomy; (2) canal wall up (CWU) mastoidectomy; and (3) endaural/transcanal. Results Three males and 12 females aged between 33 and 76 years (mean, 56 yr) were included. Complete removal was accomplished in all cases using a CO2 laser with no recurrence or complications during the postoperative follow-up period. CWU mastoidectomy, CWD mastoidectomy with CWR/MO, and endaural/transcanal approaches were used in 5, 3, and 7 patients, respectively. A flexible 500-micron CO2 laser fiber was employed at 3–4 watts on the continuous mode setting. Three patients underwent concurrent ossicular chain reconstruction along with CWD/CWR mastoidectomy owing to preoperative conductive hearing loss with an air-bone gap (ABG) of wider than 30 dB, resulting in postoperative ABG closure. In relation to the remaining patients, no statistically significant postoperative worsening of audiometric outcomes in Word Recognition Score, pure tone average, and speech recognition threshold were observed. The mean follow-up period was 12 months. Conclusions We found that using a flexible CO2 laser fiber and CWD mastoidectomy with canal wall reconstruction and mastoid obliteration are beneficial for managing these tumors. CO2 lasers are safe and reliable for GT resection. The advantages of this modality include complete removal, low complication and recurrence rates, and minimum morbidity.]]> Wed, 18 Jun 2025 00:00:00 GMT-05:00 00129492-990000000-00860 https://journals.lww.com/otology-neurotology/fulltext/9900/adult_aural_rehabilitation__patient_feedback.861.aspx Objective Evaluate patient feedback regarding a single institution's adult cochlear implant program experience with clinician-directed aural rehabilitation services. Study Design Retrospective survey examining the experiences and perceptions of adult cochlear implant recipients regarding aural rehabilitation. Setting Single institution, academic medical center. Patients One hundred thirty-seven adult (≥18 yrs) implant patients treated at a hospital-based cochlear implant center from 2021 to 2024. Inclusion criteria included 6 months or more of device usage time from their first surgery. Intervention(s) Clinician-directed aural rehabilitation. Main Outcome Measure(s) Patient-reported experiences and satisfaction with aural rehabilitation following cochlear implantation. Results Of 52 survey respondents, 39 (75%) received aural rehabilitation. Most participants agreed or strongly agreed that aural rehabilitation improved their overall quality of life (27, 69.2%), device satisfaction (29, 74.4%), day-to-day independence (26, 66.7%), day-to-day communication (27, 69.2%), and ability to communicate more effectively in noise (26, 66.7%). Overall quality of life and device satisfaction were higher for participants considered consistent users (p = 0.030 and p = 0.036, respectively). The number of aural rehabilitation sessions attended was unrelated to quality of life or device satisfaction. Conclusions Participation in aural rehabilitation was associated with improved patient cochlear implant satisfaction. A significant barrier to participation was a lack of awareness and understanding of aural rehabilitation and its goals. Further research is indicated to identify effective ways to improve patient awareness and best practices for aural rehabilitation, improving the quality of life for implant recipients.]]> Wed, 18 Jun 2025 00:00:00 GMT-05:00 00129492-990000000-00861 https://journals.lww.com/otology-neurotology/fulltext/9900/superior_semicircular_canal_dehiscence_in_the.862.aspx Objective To present the prevalence of concomitant superior semicircular canal dehiscence (SSCD) among patients with osteosclerosis and to compare it to the general population by using a pooled meta-analysis based upon a systematic literature review. Data Sources PubMed, Web of Science, Google Scholar, enrolled papers’ references lists. Review Methods A systematic literature review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. The database search yielded 371 articles, and 92 studies underwent full-text review. The extracted data include age, sex, computerized tomographic (CT) characteristics, and the presence of SSCD in the general population and among otosclerosis patients. Results The general population arm included 17 papers, and the otosclerosis arm included 5 papers, resulting in 8,392 and 1,169 ears, respectively. The pooled prevalence of radiologic SSCD was 4.0% (95% CI: 2.7–5.5%) in the general population and 3.2 to 4.3% (95% CI: 1.2–6.1% and 2.5–6.6%, respectively) among patients with otosclerosis (p = 0.650 and p = 0.813, respectively). The minor difference in SSCD prevalence in the general population is the result of disagreement between investigators. Conclusion The prevalence of SSCD among patients with otosclerosis is not significantly different from that of the general population. CT should therefore be considered as part of the preoperative workup for patients with otosclerosis.]]> Wed, 18 Jun 2025 00:00:00 GMT-05:00 00129492-990000000-00862 https://journals.lww.com/otology-neurotology/fulltext/9900/the_therapeutic_effects_of_systemic_corticosteroid.863.aspx Objective The aims of this study were to evaluate the otologic features and outcomes of otitis media associated with eosinophilic granulomatosis with polyangiitis (EGPA) and validate the current treatment strategies, including systemic corticosteroid (CS) and immunosuppressants for new-onset cases and therapeutic targeting of interleukin (IL)-5 for recurrent cases. Study Design Retrospective case series. Setting Tertiary referral center. Patients Patients with otitis media associated with EGPA were eligible for inclusion. Intervention Systemic CS alone or a combination of systemic CS and intravenous cyclophosphamide (IVCY) was performed as induction therapy. Maintenance therapy with oral CS and immunosuppressant, such as rituximab, methotrexate, or azathioprine, was administered. Treatment with mepolizumab was performed at the time of relapse of major organ involvement in EGPA, exacerbation of asthma, and/or recurrence of ear, nose, and throat symptoms after remission induction. Main Outcome Measures Air- and bone-conduction pure-tone thresholds, overall survival rate, EGPA relapse rate, and otitis media recurrence rate. Results Systemic CS-based induction therapy achieved remission in all patients with EGPA. In both the CS + IVCY and CS-alone groups, hearing thresholds in the remission and/or resolution phase were significantly better than those at initial presentation at all frequencies (p < 0.01). The 5-year estimated relapse rate of major organ involvement was 29.2%, and the 5-year estimated recurrence rate of otitis media was 43.6%. All cases of recurrent otitis media treated with mepolizumab achieved improvement in otologic symptoms and subsequent reduction in maintenance CS dose. However, half of ears with recurrent otitis media showed repeated secretion and cessation of middle ear discharge and required additional topical CS treatment during mepolizumab administration. Conclusions Immunosuppressive treatment affords a good response to systemic manifestations as well as otitis media associated with EGPA. Meanwhile, a significant proportion of patients experienced exacerbation of otitis media during maintenance therapy. Mepolizumab might be the treatment of choice for recurrent cases.]]> Wed, 18 Jun 2025 00:00:00 GMT-05:00 00129492-990000000-00863 https://journals.lww.com/otology-neurotology/fulltext/9900/a_case_of_calcification_discovered_within_the.864.aspx Objective To report a case of calcification discovered in the membranous labyrinth of a patient with a vestibular schwannoma after transtemporal labyrinthectomy. Study Design Clinical capsule report. Setting Tertiary academic referral center. Patient An adult male with a 3-year history of left-sided hearing loss and balance issues was confirmed by MRI to have a cystic vestibular schwannoma. Interventions Transtemporal labyrinthectomy. Main Outcome Measures Appearance of the membranous labyrinth on CT imaging and immunohistochemistry. Results A patient presented with a 3-year history of left-sided hearing loss and balance issues. MRI revealed a heterogeneously enhancing mass in the left cerebellopontine angle, consistent with a cystic vestibular schwannoma. After a transtemporal labyrinthectomy, a gross examination revealed calcification within the membranous labyrinth. Retrospective review of imaging identified a preoperative ring of calcification, confirmed with visual inspection of the removed tissue via light microscope. Immunohistochemical analysis demonstrated a reduced number of nuclei in the hypertrophied crista compared with the unaffected crista. Conclusions Calcification in the membranous labyrinth may reflect underlying inner ear pathology. Further research is warranted to establish reliable methods for detecting this calcification to enhance our understanding of inner ear disorders.]]> Wed, 18 Jun 2025 00:00:00 GMT-05:00 00129492-990000000-00864 https://journals.lww.com/otology-neurotology/fulltext/9900/position_control_of_flexible_electrodes_with.858.aspx Objective To investigate complications related to electrode design, such as incomplete insertion, electrode tip fold-over (ETFO), and scalar deviation, and to evaluate hearing outcomes with a flexible 28-mm cochlear implant electrode. Study Design Retrospective Setting Tertiary referral center Patients Postoperative computed tomographic (CT) data analysis of 36 patients with regular cochlear anatomy was performed who received a flexible 28-mm-long electrode. Interventions All patients received secondary reconstructions of flat-panel volume CT (fpVCTSECO; slice thickness: 99 μm), along with audiological testing. Radiologic analyses were performed using the otosurgical software OTOPLAN®, which included the following: (I) measurement of the cochlear parameters (A value and cochlear duct length [CDL]), (II) evaluation of insertion status and ETFO including angular insertion depth (AID), cochlear coverage, and apical electrode contact frequency; and (III) determination of the scala electrode position with the newly developed “electrode contact view,” analyzing individual electrode contact positioning within the cochlear duct. The audiological outcome with CI was tested with a monosyllabic word test at 65 dB SPL in quiet and correlated with several parameters. Main Outcome Measures Complete insertion, ETFO, scalar deviation, postoperative hearing results. Results Full electrode insertion was achieved in all patients with no observed cases of ETFO. The “electrode contact view” identified no cases of scalar deviation (34 electrodes inserted in the scala tympani and two electrodes deliberately inserted into the scala vestibuli via cochleostomy). The cochlear canal's cranial-caudal height averaged 2.3 mm at electrode contact 12 and 1.1 mm at electrode contact 1. Cochlear parameters averaged 9.3 mm for the A value and 36.9 mm for the CDL value. The AID of the most apical canal ranged from 459 to 705 degrees, with an average cochlear coverage of 81.2%. There was a significant negative correlation between cochlear size (A value and CDL) and AID. Audiological testing showed a 50% average improvement in monosyllables word scores with CI. Conclusion This case series suggests that a 28-mm flexible electrode can achieve reliable full insertion with minimal risk of scalar deviation. Despite its high flexibility, ETFO was not observed. However, cochlea size influences AID, which may impact hearing results.]]> Tue, 17 Jun 2025 00:00:00 GMT-05:00 00129492-990000000-00858 https://journals.lww.com/otology-neurotology/fulltext/9900/audiological_progression_and_treatment_outcomes_in.853.aspx Objective To describe long-term hearing outcomes and evaluate the efficacy of interventions in patients with superficial siderosis (SS) of the central nervous system (CNS). Study Design Retrospective case review. Setting Tertiary referral center. Patients Forty-six patients diagnosed with SS. Interventions Auditory examinations, including pure-tone audiometry, speech audiometry, and auditory brainstem response (ABR). Treatment modalities include surgical closure of the dural defect with postoperative iron chelator administration and cochlear implantation. Main Outcome Measure(s) Pure-tone average (PTA), maximum speech discrimination score, and interpeak latency between ABR waves I and V. Results Sensorineural hearing loss (SNHL) was observed in 39 patients (84.8%), typically presenting in the fifth to sixth decades of life, and progressed gradually. Among the patients, SNHL was bilateral in 76.9%, with 56.7% showing asymmetry. The severity ranged from minimal to profound, with high-frequency loss being the most common (63.8%). Abnormal ABRs were observed in 82.6% of the ears. Long-term follow-up (median, 39 months) revealed hearing deterioration of ≥10 dB PTA in 25.9% of the ears. The long-term hearing prognosis can be predicted based on audiological changes within the first 12 months after the initial visit. Dural defect closure with iron chelator treatment seemed to prevent hearing deterioration in seven patients. Cochlear implantation showed limited effectiveness in three patients. Conclusions SS-related hearing loss can mimic age-related hearing loss, potentially leading to misdiagnoses. Clinicians should consider SS in middle-aged to elderly patients with progressive SNHL of unknown etiology and conduct comprehensive examinations, including speech audiometry, ABR, and T2*-weighted MRI, to facilitate an early diagnosis and appropriate management.]]> Fri, 13 Jun 2025 00:00:00 GMT-05:00 00129492-990000000-00853 https://journals.lww.com/otology-neurotology/fulltext/9900/facial_nerve_amyloidosis_leading_to_unilateral.854.aspx No abstract available]]> Fri, 13 Jun 2025 00:00:00 GMT-05:00 00129492-990000000-00854 https://journals.lww.com/otology-neurotology/fulltext/9900/labyrinthine_sequestrum__otopathologic_description.855.aspx No abstract available]]> Fri, 13 Jun 2025 00:00:00 GMT-05:00 00129492-990000000-00855 https://journals.lww.com/otology-neurotology/fulltext/9900/intraoperative_esrts__feasibility_of_measurement.856.aspx Objective To assess the feasibility of intraoperative visual electrically evoked stapedial reflex threshold (eSRT) measurement using the Cochlear SmartNav 2 system, the correlation between intraoperative and postoperative eSRTs, and the correlation between eSRTs measured at 1 and 6 months post-activation. Study Design Prospective. Setting Cochlear implant (CI) program at a tertiary medical center. Patients Fourteen adult CI users. Main Outcome Measures Intraoperative eSRTs and postoperative eSRTs. Results Intraoperative eSRTs were successfully measurable on 11 of 14 participants and took approximately 3 minutes to measure. The mean intraoperative eSRT was 13.3 charge units higher than the mean 1-month post-activation eSRT (p < 0.0001). The mean difference between the intraoperative and 1-month post-activation eSRT was 17.5, 15.3, 11.1, 10.5, and 11.8 nC/phase for electrodes 1, 6, 11, 16, and 22, respectively. The combined intraoperative eSRT data for all patients and all electrodes had a standard deviation of 8.5 charge units, whereas the combined 1-month post-activation eSRT data had a standard deviation of 3.2 charge units demonstrating greater intraoperative variability. The mean difference between the 1-month and 6-month post-activation eSRT was 0.2 charge units (p > 0.999). Conclusions Intraoperative eSRT measurement is feasible and time-efficient in adult CI patients. The mean difference between the intraoperative and 1-month post-activation eSRT is similar across the array. However, intraoperative eSRTs are more variable than post-activation eSRTs, and thus, further investigation is needed to reduce this variability and create a clinically useful correction factor. Finally, postoperative eSRTs are stable over time.]]> Fri, 13 Jun 2025 00:00:00 GMT-05:00 00129492-990000000-00856 https://journals.lww.com/otology-neurotology/fulltext/9900/surgical_outcomes_of_endoscopic_transtympanic.857.aspx Objective To compare the surgical outcomes of endoscopic transtympanic myringoplasty versus endoscopic over-underlay tympanoplasty versus endoscopic overlay tympanoplasty. Study Design Retrospective chart review. Setting Tertiary referral university hospital. Patients Adult subjects with first diagnosed dry tympanic membrane perforation for at least 3 months who underwent endoscopic tympanoplasty between September 2021 and January 2024. Intervention Endoscopic transtympanic myringoplasty (ETM), endoscopic over-underlay tympanoplasty (EDT), and endoscopic overlay tympanoplasty (EVT). Main Outcome Measures The primary outcome was graft success rate at 6 months after surgery. Secondary outcomes were audiologic data including preoperative and postoperative pure-tone air average, pure-tone bone average, and air-bone gap (ABG). Results A total of 82 endoscopic tympanoplasty cases were included: 25 in ETM, 30 in EDT, and 27 in EVT. The overall graft success rate was 93.9%. The graft success rates were not different between the three groups: 92.0% in the ETM group versus 93.3% in the EDT group versus 96.3% in the EVT group (p = 0.860). Pure-tone air average improved significantly after surgery in all groups, and hearing gains for ETM, EDT and EVT were 7.9 ± 6.5, 11.3 ± 7.3, and 10.8 ± 6.2 dB, respectively, which were comparable (p = 0.141). Conclusions Favorable graft success rates and audiologic outcomes were obtained in all groups. The ETM method is more suitable for medium-sized tympanic membrane (TM) perforations because it is easier to perform and minimally invasive. For large TM perforations, we suggest the EDT or the EVT method, depending on perforation size, location, and preoperative ABG.]]> Fri, 13 Jun 2025 00:00:00 GMT-05:00 00129492-990000000-00857 https://journals.lww.com/otology-neurotology/fulltext/9900/serum_testosterone_and_dehydroepiandrosterone.845.aspx Objective This study aimed to examine the association of serum testosterone and dehydroepiandrosterone sulfate levels with hearing loss in older males. Study Design Cross-sectional study. Setting A health care center. Patients This study included 1,421 males aged 60 to 69 yrs who participated in the baseline survey of the Hitachi Health Study II. Exposure(s) Serum testosterone and DHEAS levels were measured using chemiluminescence and chemiluminescent enzyme immunoassays, respectively. Main Outcome Measure(s) Pure-tone audiometric testing was performed to identify hearing loss at 1 and 4 kHz. Results Higher serum testosterone levels were associated with lower odds of hearing loss at 4 kHz. The OR (95% CI) of hearing loss was 0.71 (0.50, 0.999) for the highest compared with that for the lowest quartile of serum testosterone. A dose-response association was also found between serum testosterone levels and hearing loss at 4 kHz (P for linearity = 0.01). No association was found between serum testosterone levels and hearing loss at 1 kHz (OR for the highest vs lowest quartiles of serum testosterone = 1.06). Serum dehydroepiandrosterone sulfate levels were not associated with hearing loss: the ORs (95% CI) for the highest compared with that for the lowest quartile were 1.01 (0.64, 1.61) and 0.81 (0.58, 1.14) for 1 and 4 kHz, respectively. Conclusion Our findings suggest that older males with higher serum testosterone levels were less likely to have high-frequency hearing loss.]]> Thu, 12 Jun 2025 00:00:00 GMT-05:00 00129492-990000000-00845 https://journals.lww.com/otology-neurotology/fulltext/9900/a_cure_for_tinnitus_after_tinnitus_retraining.846.aspx Objectives To identify the clinical features of sensorineural tinnitus patients who achieved complete symptom resolution or “cure” after tinnitus retraining therapy (TRT) and to determine significant factors that influence tinnitus resolution duration after TRT. Methods A retrospective analysis of sensorineural tinnitus patients who underwent TRT and achieved a cure between January 2017 and January 2022 was performed. Cure of tinnitus was defined as patients experiencing symptoms for less than 5 minutes of awareness per day. Clinical information, including demographics, tinnitus duration, audiometric results, and therapeutic response, was examined. Results A total of 1,027 patients who achieved a cure for tinnitus were included, with more females (65.4%, n = 672) than males (35.6%, n = 355). The median age was 57 years (range, 12–92), with most having unilateral tinnitus (73.3%, n = 753). More than half had tinnitus with hearing loss (53.3%, n = 549), and the majority was under Jastreboff's tinnitus category 2 (38.7%, n = 397). The median duration of tinnitus before consult was 12 months in range (range, 1–480), whereas the median duration before tinnitus resolution after TRT was 17 months (range, 1–96). In Jastreboff's tinnitus categories, category 4 had the longest resolution time (median, 18 months) and category 1 the shortest (median, 15 months), but the difference was not statistically significant. A moderate correlation was observed between age and tinnitus resolution duration (Spearman correlation coefficient = 0.391, p < 0.05) and between tinnitus duration before consult and tinnitus resolution duration (Spearman correlation coefficient = 0.355, p < 0.05) Conclusion TRT seems to be a promising treatment option for patients with sensorineural tinnitus. The time to achieve this cure may range from a few months to years after TRT, indicating the heterogeneity of the mechanism and therapeutic response. The younger patients and the earlier management after the onset of tinnitus seem to be good prognostic factors for a shorter tinnitus cure time after TRT.]]> Thu, 12 Jun 2025 00:00:00 GMT-05:00 00129492-990000000-00846 https://journals.lww.com/otology-neurotology/fulltext/9900/diagnosis_and_treatment_of_middle_ear_cholesterol.843.aspx Objective To evaluate the clinical features, surgical options, and prognosis of middle ear cholesterol granuloma involving the middle cranial fossa. Study Design Retrospective cohort study. Setting Tertiary referral center. Subjects and Methods Medical records of three patients with giant skull base cholesterol granuloma from 2006 to 2017 were retrospectively analyzed. The symptoms, signs, radiological features, treatment options, and prognosis were summarized. Results All patients underwent radical mastoidectomy and resection of skull base lesions by means of a retroauricular approach. Postoperative pathological diagnosis showed cholesterol granuloma. All patients were followed for more than 1 year. The symptoms were relieved, and there was no recurrence. Postoperative imaging showed that the skull base lesions were cleared and the compressed brain tissue recovered. Conclusion Patients with middle ear cholesterol granuloma involving the middle cranial fossa can be operated on by retroauricular approach. It can reduce the trauma of craniotomy and obtain good curative effect.]]> Wed, 11 Jun 2025 00:00:00 GMT-05:00 00129492-990000000-00843 https://journals.lww.com/otology-neurotology/fulltext/9900/association_between_cochlear_implants_and_dementia.844.aspx Objective This study aims to investigate whether restoring hearing through a cochlear implant (CI) influences the risk of dementia development, using data obtained from the South Korea's National Health Information Database. Study Design A longitudinal follow-up study. Setting Data from the Korean National Health Insurance Service. Patients and Intervention This study examines the association between CIs and dementia in patients with severe-to-profound hearing loss. Data were collected from January 2010 to December 2020. All eligible patients were confirmed to have no previous diagnosis of dementia at the time of their hearing loss diagnosis. A total of 356,850 patients 50 years and older were included, with 2,447 having had Cis implanted and 354,403 who had not. Main Outcome Measures Patients who had CIs were compared with those who did not, focusing on the newly diagnosed dementia. Results Among the CI recipients, 274 (11.2%) were newly diagnosed with dementia, compared with 61,939 (17.5%) among the nonrecipients. This difference was statistically significant (p < 0.001). For patients 70 years and older, a similar level of significance was observed. The interval between the diagnosis of the hearing loss and the subsequent development of dementia was significantly associated with the use of CIs (587.7 versus 1886.9 d, p < 0.001). Conclusions The study elucidated the association between CIs and reduced dementia in patients with severe-to-profound hearing loss using nationwide data in South Korea. CIs are beneficial in preventing dementia, even in patients older than 70 years.]]> Wed, 11 Jun 2025 00:00:00 GMT-05:00 00129492-990000000-00844 https://journals.lww.com/otology-neurotology/fulltext/9900/consistent_visualization_of_the_round_window_niche.841.aspx Objective To assess whether the ultrahigh-resolution (UHR) mode of photon-counting detector (PCD) CT can consistently visualize the round window niche veil (RWNV) in human ex vivo specimens. Samples This ex vivo study was conducted on nine human cadaveric temporal bones (four male and five female body donors) with an average age of 72 years (range of 56–83 yr). Intervention Imaging with a dual-source PCD-CT scanner in ultrahigh-resolution (UHR) mode. Main Outcome Measures Two blinded, independent board-certified radiologists reviewed CT images in axial and coronal reformations to determine the presence and extent of an RWNV (complete or partial). The performance of the PCD-CT was evaluated by comparing the readings of the radiologists to inspection of the dissected specimens with a surgical endoscope and microscope. Results The UHR mode of PCD-CT provided consistent visualization of the RWNVs. Five out of six RWNVs were accurately identified, and all three specimens without RWNVs were correctly recognized. All complete RWNVs were correctly identified. The readers missed one partial RWNV due to its close proximity and minimal fluid next to the round window membrane. The visualization of the RWNV was superior in the coronal plane compared with the axial plane. Conclusions This study is the first to demonstrate that the UHR mode of PCD-CT enables a consistent visualization of the RWNV in ex vivo specimens. The promising results of the current study support verification of the results in prospective patient studies.]]> Mon, 09 Jun 2025 00:00:00 GMT-05:00 00129492-990000000-00841 https://journals.lww.com/otology-neurotology/fulltext/9900/prognostic_factors_for_facial_nerve_outcome_after.842.aspx Introduction This study aimed to evaluate facial nerve (FN) impairment in patients undergoing three vestibular schwannoma (VS) surgical techniques and identify variables influencing FN function. Materials and Methods A retrospective multicentric analysis was conducted on patients treated between 2010 and 2022 using retrosigmoid (RS), translabyrinthine (TL), or transcanal transpromontorial surgery (TTS). All participants had normal preoperative FN function and no previous radiotherapy. FN function was evaluated immediately, 6, 12, and 24 months post-surgery using the HB scale. Results Among 234 patients, the median FN grade was HB III immediately post-surgery, improving to HB II at 6, 12, and 24 months. Transient FN palsy occurred in 48%, whereas permanent palsy affected 39%. Higher Koos grades were significantly associated with worse FN outcomes. Older age correlated with poorer recovery at 6, 12, and 24 months (p = 0.03, 0.009, 0.02). In Koos II cases, TL yielded better FN function than RS at 48 hours and 12 months (p = 0.03). Among Koos III patients, FN preservation rates were significantly higher with TL versus RS at all time points (p = 0.003, 0.003, 0.001, 0.004). TTS demonstrated superior FN preservation compared with RS at 12 and 24 months (p = 0.007, 0.001). Multivariate analysis revealed younger age, lower Koos, TL, and TTS as predictors of better FN outcomes. Discussion Younger age, lower Koos grades, and the TL and TTS approaches are significantly linked to improved FN function after VS surgery.]]> Mon, 09 Jun 2025 00:00:00 GMT-05:00 00129492-990000000-00842 https://journals.lww.com/otology-neurotology/fulltext/9900/integrating_expression_quantitative_trait_loci_and.840.aspx Background The investigation of druggable target genes through large-scale expression quantitative trait loci (eQTL) and genome-wide association study (GWAS) data has demonstrated promise across various diseases. This approach has yet to be explored in the context of tinnitus. Methods We obtained cis-eQTL data for 3,453 druggable genes from eQTLGen. Tinnitus phenotype derived from the UK Biobank was used as the discovery cohort. A large-scale Mendelian randomization (MR) analysis was conducted to investigate the inferred causal relationships between the 3,453 druggable genes and tinnitus. Replication analyses were conducted using tinnitus phenotypes from FinnGen. We further conducted colocalization analysis to identify actionable drug targets for tinnitus. Besides, MR analysis was used to explore the association of the identified genes with hearing loss and inflammation. Results Genetic predictions indicated that the expression of NEU1 (β = 0.137, 95% CI = 0.112 to 0.162, p = 2.21 × 10−26), APOM (β = 0.139, 95% CI = 0.112 to 0.166, p = 1.23 × 10−24), and TUBB (β = −0.043, 95% CI = −0.062 to −0.024, p = 5.46 × 10−6) was causally associated with tinnitus. Our replication analysis in FinnGen yielded consistent results. There is a strong colocalization association between the three genes and tinnitus (PPH4 > 0.8). No evidence indicated these three genes were associated with hearing loss. Network MR suggested that IL-17C and CCL20 mediates effects of APOM on tinnitus, and IL-17C accounts for effects of NEU1 on tinnitus. Conclusions Our findings investigated the potential pathological mechanisms and therapeutic targets of tinnitus, providing novel strategies for future clinical trials.]]> Fri, 06 Jun 2025 00:00:00 GMT-05:00 00129492-990000000-00840 https://journals.lww.com/otology-neurotology/fulltext/9900/histopathology_of_opioid_induced_sensorineural.835.aspx No abstract available]]> Tue, 03 Jun 2025 00:00:00 GMT-05:00 00129492-990000000-00835 https://journals.lww.com/otology-neurotology/fulltext/9900/systematic_review_of_the_impact_of_magnetic.836.aspx Objective Review the properties, safety, and artifacts of current cochlear implants (CI) with freely rotatable magnets during MRI scans. Databases Reviewed PubMed, Cochrane, and Web of Science; last accessed September 2023. Methods The study was BSMH IRB exempted. MESH term “magnetic resonance imaging” and phrases of “Med-el Synchrony,” “Cochlear Nucleus Profile Plus,” “Advanced Bionics HiRes Ultra 3D,” “rotatable magnet cochlear,” “rotatable magnet,” “diametric magnet,” “diametric magnet cochlear implant,” and “MRI-safe cochlear implant” using “AND” function. Non-English, non-human, non-implanted CI, and cadaveric studies were excluded. Methodological quality was assessed using the Mixed Methods Appraisal Tool, and quality of the evidence was evaluated using the GRADE criteria. Results The review included 18 studies. Fifteen assessed pain as a complication, with two reporting its occurrence: two cases for Synchrony and one for Ultra 3D. Demagnetization did not occur in the 12 studies that reported on it. One magnet displacement was noted with the Ultra 3D implant out of the 16 reporting studies. Artifacts were reported by 11 studies, with most scans retaining most to limited diagnostic usability. One Synchrony device required explantation due to artifact, and one was explanted before MRI. Conclusion Of the CI models reviewed with diametric magnets, Med-El Synchrony may enable MRI usage with fewer safety concerns when following the manufacturer's recommendations. However, clinical reports of freely rotatable CI safety during MRI scans are sparse and contain incomplete data. MRI artifacts from CI still pose concerns for image quality but can be minimized with appropriate implant location and scanning protocols.]]> Tue, 03 Jun 2025 00:00:00 GMT-05:00 00129492-990000000-00836 https://journals.lww.com/otology-neurotology/fulltext/9900/impact_of_vestibular_schwannoma_management_on.837.aspx Objectives To compare electrical stimulation and speech perception in vestibular schwannoma (VS) patients across treatment modalities and standard cochlear implant (CI) patients. Study Design Retrospective review. Setting Tertiary academic center. Patients Sixty-seven CI ears consisting of 23 standard CI controls and 44 VS patients with ipsilateral CI. VS patients were separated by treatment modality: 24 microsurgical resection, 15 radiation therapy, and 5 observation. Eleven VS patients with CI did not receive auditory sensation from electrical stimulation. Interventions VS microsurgical resection, radiation therapy, and observation. Main Outcome Measures Threshold (T-levels), comfort (C-levels), consonant-nucleus-consonant (CNC) word score, and AzBio sentence recognition scores. Results Patients who underwent microsurgical resection required significantly higher (p < 0.001) T-levels and C-levels compared with the standard CI group. Stimulation levels in the VS radiation therapy and observation groups were higher but not significantly different compared with standard CI controls. Overall rate of CI nonstimulation across all VS patients was 25%: 38% for microsurgery and 13% for radiation. Average CNC score for microsurgery group was 18% compared with 44% for radiation, 55% for observation, and 68.5% for standard CI controls. CNC word and AzBio scores were significantly lower (p < 0.001) for the microsurgery group compared with standard CI group. Conclusions Resection may negatively affect auditory nerve function, leading to higher stimulation levels, increased risk of nonstimulation, and poorer postoperative CI speech outcomes compared with observation or radiosurgery. When medically appropriate, nonsurgical VS management may be used to allow for optimization of CI programming and postoperative hearing outcomes.]]> Tue, 03 Jun 2025 00:00:00 GMT-05:00 00129492-990000000-00837 https://journals.lww.com/otology-neurotology/fulltext/9900/blastomycosis_of_the_temporal_bone_with.838.aspx No abstract available]]> Tue, 03 Jun 2025 00:00:00 GMT-05:00 00129492-990000000-00838 https://journals.lww.com/otology-neurotology/fulltext/9900/perspectives_on_minimum_neurotology_fellowship.839.aspx Objective Compare the Accreditation Council for Graduate Medical Education (ACGME) Neurotology Minimum Number case requirements for graduating neurotology fellows with what American Neurotology Society (ANS) members believe to be the number of cases needed to achieve competency and other clinically relevant benchmarks. Methods An anonymous Internet-based ratio scale survey of current ANS members to assess 1) respondents' demographic and practice characteristics (e.g., years in practice, practice environment); 2) self-reflection estimates regarding fellowship case numbers needed to achieve surgical competency and case numbers post-training needed to achieve key benchmarks (current case duration, outcomes comparable to the literature); and 3) opinions on what minimum case numbers should be for conventional lateral skull base approaches. Results A total of 143 ANS members (24% response rate) completed the survey, representing both academic and private practice neurotology and a broad range of years in practice. To achieve competency, respondents reported needing approximately 20 translabyrinthine approaches, 15 retrosigmoid approaches, 18 middle cranial fossa (MCF) approaches for tumors, and 13 MCF approaches for non-neoplastic indications each. Most (85%) respondents believed the translabyrinthine approach should be assigned a minimum case number requirement. A substantial proportion of respondents (21–31%) reported rarely or never using the MCF approach for vestibular schwannoma resection. Conclusion For any single lateral skull base approach, ANS members' responses fell within the ACGME's current 25-case minimum. Cumulatively, however, for competency in multiple conventional approaches coming out of fellowship, these data may suggest that more cases are necessary. Additionally, making a specific requirement for translabyrinthine approach should be considered.]]> Tue, 03 Jun 2025 00:00:00 GMT-05:00 00129492-990000000-00839 https://journals.lww.com/otology-neurotology/fulltext/9900/challenges_in_achieving_a_definitive_diagnosis_of.824.aspx Objective Squamous cell carcinoma (SCC) of the external auditory canal has a favorable prognosis when complete resection with negative margins is achieved. Early diagnosis and timely referral to specialized centers are crucial. However, definitive diagnosis is often delayed due to challenges in timely referral and the need for multiple biopsies. This study aims to examine the diagnostic trajectory of SCC of the external auditory canal, focusing on the number of biopsies required and the process leading to definitive diagnosis. Study Design Retrospective case review and descriptive study. Setting Tertiary referral center. Patients We conducted a retrospective case review at a tertiary referral center, analyzing 56 cases of SCC of the external auditory canal treated between January 2015 and February 2024. Intervention(s) Medical records were retrospectively reviewed. Main Outcome measure(s) The course of events leading up to their visit of our hospital, the number of biopsies performed to be diagnosed, and the histopathological findings. Results The time from initial presentation to referral ranged from 1 to 785 days (mean: 170.6 d; median: 130 d). A definitive diagnosis was achieved with the first biopsy in 35 cases (62.5%), whereas 21 cases (37.5%) required multiple biopsies. Only 21.4% of the cases were definitively diagnosed at the initial presenting facility, whereas 32.1% were diagnosed at our hospital. More than 90% of the tumors were well-differentiated or well-to moderately/poorly differentiated SCC. The number of biopsies required to confirm a definitive diagnosis was significantly associated with longer delays in hospital referral (correlation coefficient: 0.3122, p = 0.0192). Two cases of the hyperkeratotic SCC were presented as representative cases in which a definitive diagnosis was challenging. Conclusion Early diagnosis of SCC of the external auditory canal relies on thorough biopsy evaluation. Given the tumor's tendency for high differentiation, obtaining biopsy samples with clear malignant features is critical for making an accurate and timely definitive diagnosis.]]> Mon, 02 Jun 2025 00:00:00 GMT-05:00 00129492-990000000-00824 https://journals.lww.com/otology-neurotology/fulltext/9900/response_to_letter_to_editor_for__morphometric.825.aspx No abstract available]]> Mon, 02 Jun 2025 00:00:00 GMT-05:00 00129492-990000000-00825 https://journals.lww.com/otology-neurotology/fulltext/9900/validation_of_a_3d_printed_multimaterial.828.aspx Background Simulation is an interesting tool to improve the learning curve of total endoscopic ear surgery (TEES), but hard 3D-printed temporal bones, and cadaveric or animal models have their limits. The objective of this study was to establish face, content, and construct validity for a new 3D-printed multimaterial transcanal tympanoplasty simulator. Methods Temporal bone hard and soft tissues were segmented from an anonymized CT scan and 3D-printed using Polyjet multimaterial technology. Otolaryngology residents and TEES experts performed posterior perforation myringoplasty procedures on the simulator to assess face, content, and construct validity based on Likert scales. Residents also compared the model to cadaveric subjects. Results Twelve residents and six experts gave overall 6.3/7 ± 1.4 and 6.0/7 ± 0.6 face validity scores (p = 0.06) and overall 6.3/7 ± 0.8 and 6.0/7 ± 0.6 content validity scores (p = 0.35), respectively. They indicated that the simulator should be incorporated into surgical training (6.5/7 ± 0.7 versus 5.5/7 ± 1.5; p = 0.17) and that it would be useful as a surgical competency evaluation tool (5.5/7 ± 0.8 versus 5.7/7 ± 1.4; p = 0.74). Overall satisfaction was similar to cadaveric subjects (3.7/7 ± 1.2). Construct validity, based on myringoplasty assessment scores for three experts, three fellows, and six residents, was 47.3/50 ± 0.6 versus 36.3/50 ± 3.2 versus 26.5/50 ± 5.3, respectively (p = 0.009). Conclusion The multimaterial tympanoplasty simulator met acceptable face, content, and construct validity scores. This opens a new field for simulation training in otology, moving on from temporal bone drilling to transcanal procedures including TEES.]]> Mon, 02 Jun 2025 00:00:00 GMT-05:00 00129492-990000000-00828 https://journals.lww.com/otology-neurotology/fulltext/9900/imaging_case_of_the_month__differentiating.829.aspx No abstract available]]> Mon, 02 Jun 2025 00:00:00 GMT-05:00 00129492-990000000-00829 https://journals.lww.com/otology-neurotology/fulltext/9900/behavioral_feedback_during_cochlear_implant_array.830.aspx Objective To describe the potential applications of awake cochlear implantation (CI). Patients Adult patients with sensorineural hearing loss who qualify for CI. Interventions CI under local anesthesia, without any form of systemic analgesia or anesthesia. Main Outcome Measures Acoustic hearing preservation, subjective patient report of cochlear implant pitch matching, and subjective patient report of cochlear implant sound quality. Results Four illustrative cases are presented, highlighting the potential uses of CI performed under local anesthesia for optimizing outcomes in hearing preservation, implant pitch matching, and implant sound quality. Conclusions CI under local anesthesia allows surgeons to use real-time patient feedback during electrode array insertion to minimize intracochlear trauma, particularly in cases where hearing preservation is a goal of CI, and to potentially improve implant performance by optimizing pitch matching and sound quality.]]> Mon, 02 Jun 2025 00:00:00 GMT-05:00 00129492-990000000-00830 https://journals.lww.com/otology-neurotology/fulltext/9900/cochlear_nerve_atrophy_in_postlingual_ansd_.831.aspx Objective To evaluate cochlear nerve (CN) atrophy in postlingual auditory neuropathy spectrum disorder (post-ANSD) versus simple sensorineural hearing loss (sSNHL) and its implications for cochlear implantation (CI). Design A retrospective study of 61 CI recipients (15 post-ANSD, 46 sSNHL) assessed CN size through imaging, analyzed auditory performance, and compared outcomes based on etiology, age, and molecular subtypes. Results Post-ANSD exhibited more severe CN atrophy despite better pure tone averages than sSNHL. Postsynaptic post-ANSD showed significantly greater CN atrophy than presynaptic cases and sSNHL. Although CN atrophy was pronounced, it did not predict poor CI outcomes within the observed thresholds. Speech scores improved markedly post-CI, with no correlation to CN size. Conclusion CN atrophy severity is etiology-dependent and most pronounced in postsynaptic post-ANSD. Severe atrophy could serve as a diagnostic marker of postsynaptic post-ANSD without auditory test clues. Early CI is recommended for optimal outcomes, emphasizing timely intervention in post-ANSD patients.]]> Mon, 02 Jun 2025 00:00:00 GMT-05:00 00129492-990000000-00831 https://journals.lww.com/otology-neurotology/fulltext/9900/initial_surgeon_experiences_with_a.832.aspx Objective To assess integration of a single-use robotic-assisted cochlear implant (RA-CI) electrode array insertion system into surgical workflows, identify potential challenges, and inform best practices. Study Design Survey. Setting Survey data from 16 surgeons across 10 US hospitals. Patients CI candidates 12 years and older with radiographically normal cochleae. Intervention CI surgery with single-use RA-CI insertion system during electrode array insertion. Main Outcome Measures Number of RA-CI to achieve proficiency, estimated additional time for RA-CI, and best practices to successfully incorporate the RA insertion system into CI surgery. Results A total of 121 RA-CI cases were performed. All surgeons completed the survey. Most surgeons (62.5%) reported they would feel comfortable using the device within five cases. Eight (50%) reported use of the RA system added 5 to 10 minutes to the case, and seven (44%) reported an added 10–15 minutes. Providing adequate incision size to secure the unit base superior to the temporal line and maximizing exposure of the facial recess were the most recommended best practices. Additional recommendations included pulling the receiver/stimulator forward within the pocket to facilitate a full electrode array insertion and considering drive head placement and mastoidectomy size to maximize overall visibility during electrode array insertion. Conclusions Proficiency with an RA electrode array insertion system during CI surgery can be achieved with minor adjustments to the surgical approach, within relatively few use cases (generally <5) and with minimal time addition (between 5 and 15 min). Training to specific best practices is important before initial clinical use.]]> Mon, 02 Jun 2025 00:00:00 GMT-05:00 00129492-990000000-00832 https://journals.lww.com/otology-neurotology/fulltext/9900/development_and_first_evaluation_of_a_spatial.833.aspx Purpose Cochlear implants (CIs) allow single-sided deafness (SSD) patients to regain hearing on both sides. However, current rehabilitation programs primarily focus on speech perception, leaving a significant gap in spatial hearing abilities compared with normal-hearing individuals. In this study, we developed and evaluated a novel method for training spatial hearing abilities in SSD CI users. Methods Twelve SSD CI patients underwent a 4-week training program. Twice a week, subjects completed training sessions of approximately 30 minutes, each involving 50 stimuli presented by 7 loudspeakers arranged from −90 to +90 degrees in the horizontal plane. Spatial hearing was evaluated before and after training using the root mean square error (RMSE), the mean absolute error (MAE), and the bias of source location angles, and by the Speech, Spatial and Quality of Hearing Scale (SSQ) questionnaire. Results Localization abilities assessed by MAE and by RMSE were better with CI than without (p < 0.001), but further significantly improved after spatial auditory training (both p < 0.05), especially for signals presented from the frontal direction. Furthermore, subjective spatial hearing abilities measured by the SSQ also improved after training (p < 0.01). Subjects with a larger pretraining bias showed a greater reduction in bias after training. Conclusion A 4-week lasting spatial auditory training led to significant improvements both in subjective and in objective spatial hearing outcomes in adult SSD CI subjects. Therefore, the inclusion of such training programs in the postoperative rehabilitation setting of SSD CI patients and its evaluation in larger studies is a worthwhile next step.]]> Mon, 02 Jun 2025 00:00:00 GMT-05:00 00129492-990000000-00833 https://journals.lww.com/otology-neurotology/fulltext/9900/progression_of_peripheral_vestibular_system.823.aspx Hypothesis Untreated otitis media (OM) may associate with progressive histopathological changes in the peripheral vestibular system structures in the chinchilla model. Background Previous studies have suggested a link between OM and vestibular pathology. However, the mechanisms underlying this relationship are not well understood. Objectives To evaluate the progression of peripheral vestibular pathology in chinchilla temporal bones with OM. Methods Chinchilla temporal bones, both control and Streptococcus pneumoniae–inoculated, were obtained from the Paparella Otopathology & Ear Pathogenesis Laboratory and evaluated at 3, 7, 14, 21, and 28 days. Peripheral vestibular pathology was assessed by evaluating organ-specific cell densities in the sensory epithelia and quantifying vestibular ganglion cells for potential pathologies. Results Compared with controls, S. pneumoniae–inoculated specimens exhibited significantly lower densities of type I and II cells starting from 7 days postinoculation. The exceptions were in the utricle for both cell types and the posterior semicircular canals for type II cells, where the decrease first became noticeable on day 14 (p < 0.05). Loss of transitional cell and dark cells was initially identified in the 14-day and 21-day groups, respectively. The density of vestibular ganglion cells were decreased only in the 28-day group. Conclusion Our results revealed progressive loss of peripheral vestibular cells and ganglion neurons in cases with persistent OM, which closely aligns with the findings from human otopathology studies. This supports the chinchilla as a reliable model for vestibular pathology research.]]> Thu, 29 May 2025 00:00:00 GMT-05:00 00129492-990000000-00823 https://journals.lww.com/otology-neurotology/fulltext/9900/teamwork_is_not_just_dreamwork__an_intentional,.820.aspx Contemporary healthcare delivery requires the optimal application of cooperative, collaborative teamwork in order to address the complex needs of patients. Failure to communicate and work effectively as teams has been cited as a leading driver for poorer clinical outcomes and patient satisfaction. Yet, hierarchical models persist, including within hearing implant programs, where interdisciplinary coordination is imperative. Other industries and healthcare specialties have successfully analyzed and adopted best practices for the development of effective teams. These practices include identifying ideal team members, optimizing team dynamics, and nurturing a team-oriented culture. This article highlights the key considerations for creating and maintaining effective teams in hearing implant programs.]]> Fri, 23 May 2025 00:00:00 GMT-05:00 00129492-990000000-00820 https://journals.lww.com/otology-neurotology/fulltext/9900/relationship_between_chronicity_and_severity_of.817.aspx Objectives Growing evidence suggests a potential link between tinnitus and sleep-related disturbances. This study aimed to explore this association in a large-scale population-based data. Study Design Cross-sectional study. Setting The 6,951 subjects with data on demographics, sleep patterns, sleep-related symptoms, and otologic assessments were selected from the eighth and ninth Korea National Health and Nutrition Examination Surveys (2019, 2020, and 2022), a database representing the general population. Main Outcomes Measures Subjects were classified into tinnitus and nontinnitus groups, with the tinnitus group subdivided by chronicity (acute/chronic) and severity (mild/severe), and their association with sleep issues was analyzed. Results The chronic tinnitus group had shorter sleep durations (weekdays, p < 0.001; weekends, p < 0.001) and higher proportions of sleep deprivation (weekdays, p = 0.001; weekends, p < 0.001), fatigue (p < 0.001), and witnessed obstructive sleep apnea (p = 0.026) compared to the nontinnitus group. They also exhibited shorter sleep duration (p = 0.027) and more sleep deprivation (p = 0.025) on weekends than the acute tinnitus group. The severe tinnitus group showed shorter sleep durations (weekdays, p = 0.004; weekends, p < 0.001), more sleep deprivation (weekdays, p = 0.025; weekends, p = 0.001), and higher levels of fatigue (p = 0.001) compared to the nontinnitus group, as well as more fatigue than the mild tinnitus group (p = 0.001). Conclusion The chronicity and severity of tinnitus were significantly associated with sleep problems. Chronic and severe tinnitus are strongly associated with sleep disturbances, emphasizing the need for targeted management.]]> Thu, 22 May 2025 00:00:00 GMT-05:00 00129492-990000000-00817 https://journals.lww.com/otology-neurotology/fulltext/9900/a_new_type_of_third_window_lesion__vestibular.818.aspx No abstract available]]> Thu, 22 May 2025 00:00:00 GMT-05:00 00129492-990000000-00818 https://journals.lww.com/otology-neurotology/fulltext/9900/association_of_tonotopic_mismatch_with_the_speech.813.aspx Objective Review the relationship of tonotopic mismatch with the speech recognition of cochlear implant (CI) users with unilateral hearing loss (UHL; also known as single-sided deafness). Patients Twenty-seven adults (≥18 yr of age) with late-onset UHL. Intervention Cochlear implantation. Main Outcome Measures Speech recognition was assessed at 6 months post-activation with consonant-nucleus-consonant (CNC) words in the CI alone condition (contralateral ear masked). In the combined condition (CI plus the normal-hearing ear), masked speech recognition was assessed using AzBio sentences in a 10-talker masker (0-dB signal-to-noise ratio) in three target-to-masker configurations. Tonotopic mismatch was calculated as the semitone deviation between the center filter frequency and the cochlear place frequency of the most apical electrode contact. Results There was a significant, negative association between tonotopic mismatch and CNC scores (r27= −0.43, p = 0.013) and masked speech recognition when the target was from the front and the masker was presented toward the normal-hearing ear (r27= −0.36, p = 0.033). Conclusions The speech recognition of adult CI users with UHL in the CI alone and bilateral listening conditions may be significantly influenced by tonotopic mismatches. These findings support the need for prospective investigation of methods to reduce or eliminate tonotopic mismatches (e.g., implantation of electrode arrays that approximate cochlear place and/or individualized mapping of filter frequencies) for CI users with UHL.]]> Thu, 15 May 2025 00:00:00 GMT-05:00 00129492-990000000-00813 https://journals.lww.com/otology-neurotology/fulltext/9900/reply_to_the_commentary_on__effect_of_non_ablative.739.aspx No abstract available]]> Wed, 19 Feb 2025 00:00:00 GMT-06:00 00129492-990000000-00739 https://journals.lww.com/otology-neurotology/fulltext/9900/the_predictive_value_of_preoperative_measurements.628.aspx Objective The current study aims to investigate whether objective measurements of the cochlear nerve (CN), derived from preoperative MRI images, correlate with postoperative speech perception in CI patients. Study Design Retrospective cohort study. Setting University Medical Center, tertiary academic referral center. Patients Patients undergoing a cochlear implant surgery including MED-EL (Synchrony 2, FLEX electrode series; MED-EL, Innsbruck, Austria) Cochlear (slim straight electrodes; Cochlear Ltd., Sydney, Australia), Advanced Bionics (HiRes Ultra 3D CI, HiFocus SlimJ electrodes; Sonova, Zürich, Switzerland), and Oticon (Neuro Zti EVO; Oticon A/S, Smørum, Denmark) between 2020 and 2023. Intervention Preoperative MRI images were utilized to measure the volume of the modiolus (VM), the cross-sectional areas of the CN (ACN), and for normalization, the area of the facial nerve (AFN) and the area of the internal ear canal (AIEC). Postoperative speech perceptions were assessed through word recognition scores (WRS) at several stages following the first fitting (FF) of the CI processor: immediately after FF, 1 month, 3 months, and 6 months after FF. Main Outcome Measures Sixty-eight patients were enrolled in this study. A statistically significant positive correlation between the ratio between ACN and AFN (ACN/AFN) and WRSFF was identified (R = 0.36, p < 0.003). However, this correlation disappeared in subsequent follow-up tests. Moreover, upon grouping patients based on their degree of asymmetrical hearing loss, it was observed that the correlation was primarily driven by patients with moderate to severe asymmetrical hearing loss (AHLm) on the contralateral side (R = 0.62, p = 0.0003). Conclusion The present results suggest that assessing the size of the CN through MRI has limited predictive utility for postoperative speech perceptions during CI consultations. This limitation seems to be particularly relevant for AHLm patients and is confined to the initial activation period.]]> Fri, 06 Sep 2024 00:00:00 GMT-05:00 00129492-990000000-00628 https://journals.lww.com/otology-neurotology/fulltext/9900/long_term_follow_up_after_translabyrinthine_iac.631.aspx Objective To evaluate the long-term hearing outcome after translabyrinthine resection of tumors within the internal auditory canal (IAC) with simultaneous cochlear implantation (CI). Study Design Prospective study. Setting Tertiary referral center. Patients Thirty-seven patients with tumors of the IAC undergoing translabyrinthine tumor surgery as a first-line therapy. Intervention(s) Intraoperatively, electrically evoked auditory brainstem response audiometry (eABR) was performed in all patients to assess cochlear nerve (CN) integrity. In case of preserved CN function after tumor removal, CI was subsequently performed. Postoperatively, patients were regularly followed up to evaluate pure-tone hearing as well as speech recognition with a monosyllabic word comprehension test. Main Outcome Measure(s) Postoperative hearing thresholds and word recognition scores. Results Of 37 included patients, 22 (59.46%) had positive eABR responses after tumor removal. Twenty-one of these underwent simultaneous CI directly after tumor surgery and were followed-up for 24.24 ± 19.83 months after surgery. Hearing of these patients significantly improved from 73.87 ± 21.40 dB preoperatively to a mean pure-tone average of 41.56 ± 18.87 dB 1 year (p = 0.0008) and 34.58 ± 2.92 dB 3 years after surgery (p = 0.0157). Speech recognition significantly recovered from 13.33 ± 25.41% to 58.93 ± 27.61% 1 year (p = 0.0012) and 51.67 ± 28.58% 3 years postoperatively (p = 0.0164). Conclusions Regardless of tumor histopathology, CI is an effective option to restore patients' hearing after translabyrinthine tumor surgery. After CI, patients hearing can be restored over a long-term period of a minimum of 3 years post-surgery. Furthermore, eABR proves to be a practical tool to evaluate CN function and screen for patients eligible for CI.]]> Fri, 06 Sep 2024 00:00:00 GMT-05:00 00129492-990000000-00631 https://journals.lww.com/otology-neurotology/fulltext/9900/influence_of_anatomy_based_fitting_in_cochlear.609.aspx Objectives The aim is to investigate the influence of the anatomy-based fitting (ABF) in cochlear implants (CI) on the perception of specific musical features. Design The Montreal Battery of Evaluation of Amusia (MBEA) test battery was performed with a collective of 16 CI users with and without an anatomy-based fitting and 9 normal hearing subjects. The insertion angles of the intracochlear electrode arrays were calculated using Otoplan® (MED-EL, Innsbruck, Austria) software. Results CI users with an anatomy-based fitting achieve better results in the MBEA in all categories, especially in rhythm, meter, and memory. There is no effect of insertion depth alone on the ability to perceive musical features, even after anatomy-based fitting. Conclusions The results of the CI users in comparison to normal hearing people confirm previous studies. Apart from better speech understanding in CI users, which has been demonstrated in other studies, the anatomy-based fitting also contributes to a better perception of musical features. Currently, there are no comparable studies on this relationship. Investigations with further parameters with the help of the MBEA are pending. Significance Our results show that anatomy-based fitting of cochlear implants significantly improves the perception of specific musical attributes and thus leads to an increased enjoyment of music.]]> Mon, 12 Aug 2024 00:00:00 GMT-05:00 00129492-990000000-00609 https://journals.lww.com/otology-neurotology/fulltext/9900/systematic_overestimation_of_the_angular_insertion.596.aspx Objective By estimating the length of the cochlear duct, commercial software algorithms intend to support CI teams by the selection of the suitable electrode array length prior to cochlear implant (CI) surgery. In the present study center, predominantly 31.5 mm flexible electrode arrays are used for patients with radiologically regular cochleae. Routinely performed postoperative Stenvers x-ray detects complete insertion in all cases. The aim of this study was to test the accuracy of the commercial software algorithm in predicting the angular insertion depths for this specific CI group with deeply inserted electrodes. Study Design Retrospective cohort study. Setting University medical center, tertiary academic referral center. Patients Patients undergoing a cochlear implant surgery MED-EL FLEXsoft electrode array (Synchrony2, MED-EL, Innsbruck, Austria) between January 2019 and December 2022. Intervention Preoperative CT images for 72 CI ears with 31.5 mm flexible electrode arrays were examined using OTOPLAN, and the maximum insertion depth (maxAID) was estimated. Postoperatively, the actual maxAID was determined through Stenvers x-ray images. Main Outcome Measures The preoperatively estimated maxAID demonstrated a correlation with the postoperatively measured maxAID (R = 0.45, p < 0.001) but deviated by 44.8° ± 8.4°. There is a systematic overestimation by OTOPLAN of the insertion depths for estimated values exceeding 720°. To address this, an optimal offset of 2.4 mm is identified when considering this parameter in estimating maxAID for depths exceeding 720°. Conclusion OTOPLAN predicts AID outcomes in CI patients but may deviate in small cochleae (CDL < 35 mm).]]> Fri, 02 Aug 2024 00:00:00 GMT-05:00 00129492-990000000-00596