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Stapedectomy Effects on Tinnitus: Relationship of Change in Loudness to Change in Severity. - Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery
To relate poststapedectomy change in tinnitus loudness to change in tinnitus severity.Prospective, within-subjects.A single otology and neurotology subspecialty referral practice.Forty-nine subjects undergoing stapedectomy completed the study between January 2012 and October 2013. Tinnitus instruments, audiometric data, and demographic information were collected prior to and 1 and 6 months after surgery. Tinnitus loudness was assessed using an 11-point (0 = none; 5 = conversation level; 10 = jet engine) visual analog scale, and severity was measured using the validated Tinnitus Functional Index. The relationship between change in tinnitus loudness and change in tinnitus severity was evaluated using linear regression and receiver operating characteristic (ROC) analyses.A linear regression model of change in tinnitus loudness averaged for both ears on a visual analog scale (Î”VASavg) versus change in Tinnitus Functional Index score (Î”TFI) showed a strong correlation (Î”TFI = 9.35 Ã—Î”VASavg; R = 0.64; P < .001). An ROC analysis identified Î”VASavg between 1.5 and 2.0 as the optimal threshold for predicting a clinically significant change in tinnitus severity (Î”TFI â‰¥ 13), with sensitivity and specificity of approximately 0.62 and a positive predictive value (PPV) of 0.64.For poststapedectomy patients, a VAS loudness change by 1.5 to 2.0 points averaged for both ears in bilateral tinnitus or ~3 points in unilateral tinnitus has a PPV ~0.64 for a clinically significant change in tinnitus severity.Â© American Academy of Otolaryngologyâ€”Head and Neck Surgery Foundation 2015.
Development of a chemoradiation therapy toxicity staging system for oropharyngeal carcinoma. - The Laryngoscope
Develop an innovative tool to standardize representation of treatment toxicity and enable shared decision making by mapping provider-based outcome descriptions to four overall stages of toxicity from chemoradiation therapy for oropharyngeal carcinoma.Cross-sectional, provider-based questionnaire.Five short-term and five long-term treatment outcomes of cisplatin and intensity-modulated radiation therapy for oropharyngeal carcinoma were chosen by a focus group of head and neck oncologists. A pilot survey was developed in an online platform, and feedback from extramural head and neck oncologists was used to refine it for institutional review board submission and formal deployment. Respondents were surgical, radiation, and medical oncologists with experience in treating oropharyngeal carcinoma. One hundred five responses were analyzed, of which 67% were from providers with >10 years in practice and 79% were from providers who treat >15 new oropharyngeal carcinoma patients per year.A particular overall chemoradiation toxicity class is accounted for by two adjoining distress levels (>90% occurrence) for both short-term and long-term outcomes. Providers deemed mucositis and nausea, and pain and xerostomia the most distressing short-term and long-term toxicities, respectively. Providers were split as to their impression of the relative importance that patients place on short-term versus long-term outcomes when considering treatment options.A clinical tool to represent overall chemoradiation toxicity considering short-term and long-term outcomes has been developed by analyzing provider-centric responses to a realistic clinical scenario. Results from this pilot study enhance patient counseling and shared decision making, and serve as foundational information for a prospective, longitudinal patient-centric observational study.Â© 2014 The American Laryngological, Rhinological and Otological Society, Inc.
Comparative study of lens solutions' ability to remove tear constituents. - Optometry and vision science : official publication of the American Academy of Optometry
The purpose of this study was to use atomic force microscopy to compare and characterize the cleaning abilities of a hydrogen peroxide-based system (HPS) and a polyhexamethylene biguanide-containing multipurpose solution (MPS) at removing in vitro deposited tear film constituents, as well as to determine deposition patterns on various silicone hydrogel contact lenses.Silicone hydrogel materials-balafilcon A (BA), lotrafilcon B (LB), and senofilcon A (SA)-were incubated for 1 week in an artificial tear solution (ATS) containing representative lipids, proteins, and salts from the tear film. Atomic force microscopy was used to resolve each lens before and after being cleaned overnight in HPS or MPS. Atomic force microscopy was used again to resolve HPS/MPS-cleaned lenses, which were reincubated in fresh ATS for 1 week, before and after an overnight clean in their respective cleaning solution.Atomic force microscopy imaging was able to characterize lens deposits with high resolution. Lenses incubated in ATS revealed distinct differences in their deposition pattern across lens materials. The surface of BA contained about 20-nm-high deposits, whereas deposit heights up to 150 nm completely occluded the surface of SA. Lotrafilcon B lenses revealed clusters of deposits up to 90 nm. The use of either lens solution left trace amounts of tear film constituents, although components from the MPS were seen adsorbed onto the surface after cleaning. Surface roughness (Ra) measurements revealed a significant difference between ATS-incubated and HPS/MPS-cleaned SA and LB lenses (p < 0.05). Ra between first incubated and HPS/MPS-cleaned reincubated SA and LB was also significant (p < 0.05).Unique variations in ATS deposition patterns were seen between lenses with atomic force microscopy. The application of both HPS and MPS removed most visible surface deposits.
A comprehensive analysis of hearing preservation after radiosurgery for vestibular schwannoma: clinical article. - Journal of neurosurgery
Gamma Knife surgery (GKS) has evolved into a practical alternative to open microsurgical resection in the treatment of patients with vestibular schwannoma (VS). Hearing preservation rates in GKS series suggest very favorable outcomes without the possible acute morbidity associated with open microsurgery. To mitigate institutional and practitioner bias, the authors performed an analytical review of the published literature on the GKS treatment of vestibular schwannoma patients. Their aim was to objectively characterize the prognostic factors that contribute to hearing preservation after GKS, as well as methodically summarize the reported literature describing hearing preservation after GKS for VS.A comprehensive search of the English-language literature revealed a total of 254 published studies reporting assessable and quantifiable outcome data obtained in patients who underwent radiosurgery for VSs. Inclusion criteria for articles were 4-fold: 1) hearing preservation rates reported specifically for VS; 2) hearing status reported using the American Association of Otolaryngology-Head and Neck Surgery (AAO-HNS) or Gardner-Robertson classification; 3) documentation of initial tumor size; and 4) GKS was the only radiosurgical modality in the treatment. In the analysis only patients with AAO-HNS Class A or B or Gardner-Robertson Grade I or II status at the last follow-up visit were defined as having preserved hearing. Hearing preservation and outcome data were then aggregated and analyzed based on the radiation dose, tumor volume, and patient age.The 45 articles that met the authors' inclusion criteria represented 4234 patients in whom an overall hearing preservation rate was 51%, irrespective of radiation dose, patient age, or tumor volume. Practitioners who delivered an average â‰¤ 13-Gy dose of radiation reported a higher hearing preservation rate (60.5% at â‰¤ 13 Gy vs 50.4% at > 13 Gy; p = 0.0005). Patients with smaller tumors (average tumor volume â‰¤ 1.5 cm3) had a hearing preservation rate (62%) comparable with patients harboring larger tumors (61%) (p = 0.8968). Age was not a significant prognostic factor for hearing preservation rates as in older patients there was a trend toward improved hearing preservation rates (56% at < 65 years vs 71% at â‰¥ 65 years of age; p < 0.1134). The average overall follow-up in the studies reviewed was 44.4 Â± 32 months (median 35 months).These data provide a methodical overview of the literature regarding hearing preservation with GKS for VS and a less biased assessment of outcomes than single-institution studies. This objective analysis provides insight into advising patients of hearing preservation rates for GKS treatment of VSs that have been reported, as aggregated in the published literature. Analysis of the data suggests that an overall hearing preservation rate of ~ 51% can be expected approaching 3-4 years after radiosurgical treatment, and the analysis reveals that patients treated with â‰¤ 13 Gy were more likely to have preserved hearing than patients receiving larger doses of radiation. Furthermore, larger tumors and older patients do not appear to be at any increased risk for hearing loss after GKS for VS than younger patients or patients with smaller tumors.
Transcanal blind sac closure of the external auditory canal after skull base surgery to treat CSF leak: technique and results. - Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology
To report outcomes of a novel transcanal blind sac closure technique of the external auditory canal (EAC) with obliteration of the Eustachian tube orifice to treat CSF leaks after skull base surgery.Clinical capsule report.University hospital.Ten patients who have undergone a transcanal blind sac closure of the EAC after skull base surgery to treat CSF leak between 2004 and 2012.Transcanal blind sac closure of the EAC.Resolution rate of postoperative CSF leak, time to final resolution of CSF leak, and complications.The CSF leak resolution rate, with subsequent conservative management in some cases, is approximately 80%. One case of postsurgical pseudomeningocele was identified.Transcanal blind sac closure of the EAC with obliteration of the Eustachian tube orifice provides a rapid and safe method to treat CSF leak after skull base surgery, without the need to reenter the original surgical wound or mastoid cavity.
Facial neuroma masquerading as acoustic neuroma. - Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
Facial nerve neuromas are rare benign tumors that may be initially misdiagnosed as acoustic neuromas when situated near the auditory apparatus. We describe a patient with a large cystic tumor with associated trigeminal, facial, audiovestibular, and brainstem dysfunction, which was suspicious for acoustic neuroma on preoperative neuroimaging. Intraoperative investigation revealed a facial nerve neuroma located in the cerebellopontine angle and internal acoustic canal. Gross total resection of the tumor via retrosigmoid craniotomy was curative. Transection of the facial nerve necessitated facial reanimation 4 months later via hypoglossal-facial cross-anastomosis. Clinicians should recognize the natural history, diagnostic approach, and management of this unusual and mimetic lesion.Copyright Â© 2014 Elsevier Ltd. All rights reserved.
Tinnitus modulation by stapedectomy. - Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology
To assess change in tinnitus severity after stapedectomy using the validated Tinnitus Functional Index (TFI) at 1 and 6 months in 2 cohorts of subjects with otosclerosis with different preoperative (TFIpre) distress levels.Prospective within-subjects repeated measures.Twenty-six subjects completed the study between January 2012 and April 2013. Demographic information, preoperative and postoperative audiometric data at 1 month, and TFI scores measured preoperatively within 1 month of stapedectomy and postoperatively at 1 and 6 months were captured and analyzed.Stapedectomy has its largest effect on tinnitus severity reduction within the first month of surgery. Cohort A (TFIpre > 15, n = 16) Î”TFI mean and median values were âˆ¼20 for the intervals preoperatively to 1 month and preoperatively to 6 months (p values < 0.01) and dropped to âˆ¼0 for the interval between 1 and 6 months postoperatively. Cohort B (TFIpre < 15, n = 10) Î”TFI mean and median values were âˆ¼0 for all time intervals (all pairwise comparison p values > 0.05).Stapedectomy in patients with otosclerosis with more than a small problem with tinnitus (TFIpre > 15) will reduce severity by at least 1 clinical category in âˆ¼85% of cases within 6 months of surgery. The majority of patients will experience stable tinnitus suppression within the first postoperative month. In patients with no tinnitus or less than a small problem with tinnitus (TFIpre < 15), stapedectomy carries a 10% risk of transient worsening of tinnitus at 1 month, which resolves by the sixth postoperative month.
Willingness-to-accept Gamma knife radiosurgery for tinnitus among career San Francisco firefighters. - Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology
Measure willingness-to-accept novel Gamma knife (GK) radiosurgery of the caudate nucleus to treat tinnitus among career firefighters who are at higher risk of hearing loss because of occupational noise exposure.Cross-sectional survey.A Web-based 80-item survey was distributed to 800 San Francisco firefighters and satisfactorily completed by 101 respondents. Demographic and work-related characteristics including occupational noise exposure, hearing handicap using the Hearing Handicap Inventory for Adults (HHIA), and tinnitus severity using the tinnitus functional index (TFI) were assessed. Willingness-to-accept GK radiosurgery for tinnitus was profiled using a 7-point scale for 6 decremental levels of expected tinnitus improvement.Respondents were a majority male (82%) and Caucasian (56%). Nearly all (95%) reported significant daily or weekly occupational noise exposure. Mean HHIA (16.3) and mean TFI (14.6) were mild. At the 100% (complete) tinnitus improvement level, more than 60% of respondents were "likely" willing-to-accept Gamma knife radiosurgery. At the 75% tinnitus improvement level, 43% of respondents were "likely" willing-to-accept GK radiosurgery. Below the 75% tinnitus improvement level, willingness-to-accept dropped off steeply.Gamma knife radiosurgery to area LC, a locus of the caudate nucleus, for tinnitus would be of interest to a large population with moderate or lower tinnitus distress. Should this innovative intervention be considered in the future, a rigorous clinical trial will be necessary to establish safety and efficacy.
Primary auditory cortical responses to electrical stimulation of the thalamus. - Journal of neurophysiology
Cochlear implant electrical stimulation of the auditory system to rehabilitate deafness has been remarkably successful. Its deployment requires both an intact auditory nerve and a suitably patent cochlear lumen. When disease renders prerequisite conditions impassable, such as in neurofibromatosis type II and cochlear obliterans, alternative treatment targets are considered. Electrical stimulation of the cochlear nucleus and midbrain in humans has delivered encouraging clinical outcomes, buttressing the promise of central auditory prostheses to mitigate deafness in those who are not candidates for cochlear implantation. In this study we explored another possible implant target: the auditory thalamus. In anesthetized cats, we first presented pure tones to determine frequency preferences of thalamic and cortical sites. We then electrically stimulated tonotopically organized thalamic sites while recording from primary auditory cortical sites using a multichannel recording probe. Cathode-leading biphasic thalamic stimulation thresholds that evoked cortical responses were much lower than published accounts of cochlear and midbrain stimulation. Cortical activation dynamic ranges were similar to those reported for cochlear stimulation, but they were narrower than those found through midbrain stimulation. Our results imply that thalamic stimulation can activate auditory cortex at low electrical current levels and suggest an auditory thalamic implant may be a viable central auditory prosthesis.
A stroke of silence: tinnitus suppression following placement of a deep brain stimulation electrode with infarction in area LC. - Journal of neurosurgery
The authors report on a case of tinnitus suppression following deep brain stimulation (DBS) for Parkinson disease. A perioperative focal vascular injury to area LC, a locus of the caudate at the junction of the head and body of the caudate nucleus, is believed to be the neuroanatomical correlate. A 56-year-old woman underwent surgery for implantation of a DBS lead in the subthalamic nucleus to treat medically refractory motor symptoms. She had comorbid tinnitus localized to both ears. The lead trajectory was adjacent to area LC. Shortly after surgery, she reported tinnitus suppression in both ears. Postoperative MRI showed focal hyperintensity of area LC on T2-weighted images. At 18 months, tinnitus localized to the ipsilateral ear remained completely silenced, and tinnitus localized to the contralateral ear was substantially suppressed due to left area LC injury. To the authors' knowledge, this is the first report of a discrete injury to area LC that resulted in bilateral tinnitus suppression. Clinicians treating patients with DBS may wish to include auditory phantom assessment as part of the neurological evaluation.
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