Best Practices in Facial Nerve Monitoring.

Objectives/hypothesis: Facial nerve monitoring (FNM) has evolved into a widely used adjunct for many surgical procedures along the course of the facial nerve. Even though majority opinion holds that FNM reduces the incidence of iatrogenic nerve injury, there are few if any studies yielding high-level evidence and no practice guidelines on which clinicians can rely. Instead, a review of the literature and medicolegal cases reveals significant variations in methodology, training, and clinical indications.

Laryngeal nerve monitoring.

Intraoperative neurophysiological monitoring of the vagus and recurrent laryngeal nerves is increasingly used during thyroidectomy, parathyroidectomy, skull base surgery, and cervical discectomy with fusion. Monitoring can assist in nerve localization and in reducing the incidence of neural trauma. To be effective, however, monitoring must be correctly implemented and the results interpreted based on an in-depth understanding of technique and the surgical structures at risk.

Round window reinforcement for superior semicircular canal dehiscence: a retrospective multi-center case series.

Purpose: To evaluate the outcome of round window (RW) tissue reinforcement in the management of superior semicircular canal dehiscence (SSCD).

Materials And Methods: Twenty-two patients with confirmed diagnosis of SSCD by clinical presentation, imaging, and/or testing were included in the study. Six surgeons at four institutions conducted a multicenter chart review of patients treated for symptomatic superior canal dehiscence using RW tissue reinforcement or complete RW occlusion.

Improved facial nerve outcomes using an evolving treatment method for large acoustic neuromas.

Objective: To describe a successful paradigm for the treatment of large acoustic neuromas (vestibular schwannomas).

Study Design: Retrospective case review.

Setting: Tertiary referral center.

Pitfalls in intraoperative nerve monitoring during vestibular schwannoma surgery.

Despite the widespread acceptance of intraoperative neurophysiological monitoring in skull base surgery over the last 2 decades, surgeon training in the technical and interpretive aspects of nerve monitoring has been conspicuously lacking. Inadequate fundamental knowledge of neurophysiological monitoring may lead to misinterpretations and an inability to troubleshoot system errors. Some surgeons perform both the technical and interpretive aspects of monitoring themselves while others enjoin coworkers (surgical residents, nurses, anesthetists, or a separate monitoring service) to perform the technical portion.

Acoustic neuroma neurophysiologic correlates: facial and recurrent laryngeal nerves before, during, and after surgery.

This article focuses on the facial nerve with additional comments on the recurrent laryngeal nerve as a proxy for the lower cranial nerves. Methods, advantages and disadvantages, and techniques are listed. The article addresses the anatomy of the facial nerve, discusses neurophysiologic testing, the role of electroneurography in preoperative, intraoperative, and postoperative testing, and presents 7 steps to set up for and perform facial nerve monitoring.

Otologic effects of topical mitomycin C: phase I-evaluation of ototoxicity.

Hypothesis: To determine ototoxicity of topical mitomycin C when placed in the middle ear at varying concentrations.

Background: Despite meticulous surgical technique and diligent postoperative care, some patients develop excessive scar and granulation tissue in the middle ear or mastoid cavity. Poor wound healing may result in infection, tympanic membrane perforation, or conductive hearing loss, which may necessitate further surgery.

Staged resection of large acoustic neuromas.

Objective: Surgical removal of large (>3 cm) acoustic neuromas is associated with poor long-term facial nerve function results and higher complication rates. This study analyzes whether long term facial nerve function and the incidence of neurological and vascular complications is improved by resection of large acoustic neuromas in 2 or 3 stages.

Patients And Methods: Among 660 patients who underwent surgical resection of acoustic neuromas between 1989 and 2002 by the senior author (J.

Oral dextromethorphan reduces perioperative analgesic administration in children undergoing tympanomastoid surgery.

Objective: To determine whether oral dextromethorphan (1 mg/kg) given one hour prior to surgery decreases opioid administration in the perioperative period in children undergoing tympanomastoid surgery.

Methods: This was a prospective randomized double-blinded and placebo-controlled study in which 20 male and 18 female children (age 11.5 +/- 3.

Endolymphatic sac-vein decompression for intractable Meniere's disease: long term treatment results.

Objectives: We sought to determine the long-term efficacy of endolymphatic sac-vein decompression surgery on patients with classic Meniere's disease.

Study Design And Setting: Using the 1995 American Academy of Otolaryngology-Head and Neck Surgery Committee on Hearing and Equilibrium criteria, starting stage, functional level, vertigo class, and hearing results were addressed. We studied 68 patients with classic Meniere's disease from a tertiary, private otology-neurotology practice.

Round window gentamicin absorption: an in vivo human model.

Objective/hypothesis: Using a novel human labyrinthine sampling model, in vivo gentamicin absorption through the round window can be measured.

Study Design: A prospective study.

Methods: Gentamicin was delivered either transtympanically (preoperative) or through a facial recess approach (intraoperative).

Rapid elevation of gentamicin levels in the human labyrinth following intravenous administration.

Hypothesis: Adequate quantities of labyrinthine fluid can be sampled from the human labyrinth to perform quantitative analysis of medications. A rapid elevation of intralabyrinthine gentamicin levels after intravenous administration can be measured. A model for the sampling of human inner ear fluid in this manner is described.

Over-under tympanoplasty.

Objective: Common techniques of tympanic membrane repair include underlay and overlay grafting. The over-under tympanoplasty, an innovative method for tympanic membrane repair, will be described as a reliable alternative that has advantages over traditional procedures.

Study Design: This study was a retrospective case review.

Intratympanic ciprofloxacin and the human labyrinthine sampling model.

Objective: The aim of the study was to investigate the potential absorption of intratympanic ciprofloxacin through the human round window membrane.

Study Design: A prospective study.

Methods: Ciprofloxacin was instilled into the middle ear of 10 patients undergoing acoustic tumor removal.