Clinical Evaluation of the Patient with Otosclerosis.

Otosclerosis is a disorder presenting most commonly with unilateral conductive hearing loss. It can present as a mixed hearing loss also. Evaluation for otosclerosis relies on a specific history and physical examination, including tuning fork assessment and audiometric testing.

Multicenter US Clinical Trial With an Electric-Acoustic Stimulation (EAS) System in Adults: Final Outcomes.

Objective: To demonstrate the safety and effectiveness of the MED-EL Electric-Acoustic Stimulation (EAS) System, for adults with residual low-frequency hearing and severe-to-profound hearing loss in the mid to high frequencies.

Study Design: Prospective, repeated measures.

Setting: Multicenter, hospital.

Modification of Osseointegrated Device Parameters to Improve Speech in Noise and Localization Ability: Clinical Recommendations.

Objective: To determine how best to modify osseointegrated (OI) devices or environmental settings to maximize hearing performance.

Study Design: Prospective cohort study.

Setting: Tertiary referral center.

Outcomes review of modern hearing preservation technique in cochlear implant.

Introduction: Preservation of residual hearing in cochlear implantation is a main concern for patients and otologists. New electrode arrays as well as development of minimally invasive technique have allowed the expansion of indication criteria for cochlear implantation. The loss of residual low-frequency hearing is thought to be the result of many factors.

Cochlear implant placement: round window approach.

The indications for cochlear implantation continue to extend to patients with increased levels of residual hearing. Single-sided deafness and tinnitus are currently under various clinical trials as even further expansion of the application of cochlear implant device and programming technology is underway. This video details a round window and hearing preservation approach for cochlear implant placement, and incorporates the most recent advances in surgical technique.

Assessing candidacy for bilateral cochlear implants: a survey of practices in the United States and Canada.

Objectives: There are currently no agreed-upon criteria to establish candidacy for bilateral cochlear implants (CIs). This study categorized practice patterns for establishing bilateral CI candidacy.

Methods: A postal survey was sent to all practices performing CIs in the United States and Canada.

Preventing complications in pediatric cochlear implantation.

Purpose Of Review: This review addresses four key areas of controversy in the prevention of common complications of pediatric cochlear implant surgery: reducing meningitis risk, managing acute otitis media (AOM) in the cochlear implant population, assessing the optimum age for implanting a child to take advantage of the critical periods of language acquisition, and managing the social risk in defining ethical issues still surrounding cochlear implant in children.

Recent Findings: Improved surgical techniques and the replacement of Prenvar-7 with Prenvar-13 significantly reduce the risk of cochlear implant related meningitis. AOM within 2 months of cochlear implant placement requires aggressive management to reduce the risk of complication.

International classification of reliability for implanted cochlear implant receiver stimulators.

Objective: To design an international standard to be used when reporting reliability of the implanted components of cochlear implant systems to appropriate governmental authorities, cochlear implant (CI) centers, and for journal editors in evaluating manuscripts involving cochlear implant reliability.

Study Design: The International Consensus Group for Cochlear Implant Reliability Reporting was assembled to unify ongoing efforts in the United States, Europe, Asia, and Australia to create a consistent and comprehensive classification system for the implanted components of CI systems across manufacturers.

Setting: All members of the consensus group are from tertiary referral cochlear implant centers.

Facial Nerve Grading System 2.0.

Objective: To present an updated version of the original Facial Nerve Grading Scale (FNGS), commonly referred to as the House-Brackmann scale.

Study Design: Controlled trial of grading systems using a series of 21 videos of individuals with varying degrees of facial paralysis.

Results: The intraobserver and interobserver agreement was high among the original and revised scales.

Guiding patients through the choices for treating vestibular schwannomas: balancing options and ensuring informed consent. 2007.

Counseling patients who are diagnosed with vestibular schwannomas, formerly known as acoustic neuromas, can be challenging. The health care provider has the responsibility to explain, in understandable language, to the patient or legal representative the proposed treatment options, risks and complications associated with each form of treatment, and alternatives to treatment, including no therapy. Patients should be encouraged to gather information before making a treatment decision.

Scedosporium apiospermum otomycosis.

We present a case of Scedosporium apiospermum otomycosis in an immunocompetent 62-year-old woman presumably inoculated as a child in Vietnam. She had life-long recurrent symptoms of chronic otomastoiditis and otorrhea. The organism was identified in an unexpected wound infection after a modified radical mastoidectomy done for chronic otitis media.

Guiding patients through the choices for treating vestibular schwannomas: balancing options and ensuring informed consent.

Counseling patients who are diagnosed with vestibular schwannomas, formerly known as acoustic neuromas, can be challenging. The health care provider has the responsibility to explain, in understandable language, to the patient or legal representative the proposed treatment options, risks and complications associated with each form of treatment, and alternatives to treatment, including no therapy. Patients should be encouraged to gather information before making a treatment decision.

Intracranial pressure concerns in lateral skull base surgery.

This article serves as a concise review of cerebrospinal fluid metabolism and intracranial pressure regulation for otolaryngologists and lateral skull base surgeons. It examines the methodologies for maintaining cerebrospinal fluid homeostasis by preventing and treating acute elevations of intracranial pressure encountered during lateral skull base surgery.

Panel discussion IV: cochlear implant candidacy, elderly and residual hearing.

Cochlear implant technology continues to advance, placing new challenges on physicians, audiologists, speech-language pathologists, and deaf educators to properly determine cochlear implant candidacy. This panel addressed the topics of new technology applied to elderly and to very young children. Six panelists were selected to represent varied regions of the world, prompting interesting discussion and interaction with the audience.

Standardization of reliability reporting for cochlear implants: an interim report.

Objective: To propose a standard definition of "out of specification" for cochlear implants and a paradigm for inclusion of category C of the ISO standard 5841-2:2000 for reporting in cumulative survival statistics.

Hypothesis: A standard definition of "out of specification" and consistent reporting by manufacturers of cochlear implants will create a fair and consistent representation of cumulative survival. This will allow discernment of differences between manufacturers for reliability and for detection of trends in reliability between model types from the same manufacturer.

Management of cerebrospinal fluid leakage from cochleostomy during cochlear implant surgery.

Objectives: The objectives of this retrospective review were to determine the incidence of cerebrospinal fluid (CSF) otorrhea from the cochleostomy during cochlear implant surgery, to recognize patients at risk, and to determine the appropriate preoperative, postoperative and intraoperative management.

Methods: A chart review from two cochlear implant centers was performed to determine the incidence of CSF otorrhea, patients at risk, and appropriate management.

Results: The incidence of CSF gusher is low, encountered in approximately 1% of patients undergoing cochlear implant surgery, and is seen in equal incidence in children and adults in our series.

Implantable middle ear hearing devices: current state of technology and market challenges.

Purpose Of Review: This review of implantable middle ear hearing devices is relevant to hearing professionals and otolaryngologists as an update of technological developments and the status of performance of current devices used in the United States. The 9th International Conference on Cochlear Implants and related Sciences was conducted 14-17 June in Vienna, Austria. Middle ear implantable devices were considered a 'hot topic', as two fully implantable devices are nearing European CE and FDA approval.

Diagnosis and management of aggressive, acquired cholesteatoma with skull base and calvarial involvement: a report of 3 cases.

A prospective case review of 3 patients treated at a tertiary referral center from 1997 to 2002 are presented. Three men, age 30 to 68 (mean, 45) years, were treated for acquired cholesteatoma with skull base invasion. Two patients had no prior otological surgery, and 1 was detected after 4 prior mastoid procedures.

Counseling patients on surgical options for treating acoustic neuroma.

The selection of surgical approach for the removal of AN is a complex one, depending on factors related to specific tumor anatomy, patient characteristics, and the familiarity and skill level of the skull base team.Overall, the literature supports that surgical outcomes are acceptable in regard to tumor removal, patient safety, and complication rates. The inconsistent reporting methods in the current literature make it difficult to assess logically the rates for hearing preservation, facial nerve outcome, and complications as controlled for tumor size and other preoperative patient characteristics.

Basic principles of cerebrospinal fluid metabolism and intracranial pressure homeostasis.

Significant progress has been made in understanding the production,circulation, and absorption of CSF. In part because of autoregulation, rapid changes in arterial pressure produce parallel but significantly dampened changes in CSF pressure. Chronic arterial hypertension rarely affects ICP,but changes in venous pressure are transmitted directly into the CSF, taking precedence over arterial effects.