Sigmoid Sinus Diverticulum-A Unique Case of Pulsatile Tinnitus.

Sigmoid sinus diverticula are relatively rare but typically cause pulsatile tinnitus (PT) in the involved ear. Occasionally, symptoms produced by blood flowing through the diverticulum are severe enough to necessitate recontouring the sigmoid sinus. Recently, a 59-year-old female was evaluated after years of worsening unilateral PT.

Next-Day Loading of a Bone-Anchored Hearing System: Preliminary Results.

Objectives: To demonstrate the feasibility and efficacy for next-day loading of a percutaneous bone-anchored hearing device.

Study Design: Multicenter prospective cohort study.

Setting: Tertiary neurotologic referral centers.

Controversies in the Evaluation and Management of Otosclerosis.

Controversies have been associated with the etiology, diagnosis, evaluation, and management of otosclerosis since Valsalva first described stapes fixation as a cause of hearing loss. Although the exact mechanism of the bone remodeling associated with otosclerosis remains uncertain, stapedotomy has been accepted as the surgical treatment of most patients with stapedial otosclerosis. There remains a disparity of opinion, however, regarding the role of preoperative imaging, surgical technique, implant selection, and medical therapy for cochlear otosclerosis.

History of Otosclerosis and Stapes Surgery.

The current advancements in otosclerosis therapy cannot be fully appreciated without studying the history, rediscovery, and modification of a once-forgotten procedure. The evolution of stapes surgery can be best summarized into 4 noteworthy eras: the preantibiotic era (which was forgotten and then rediscovered), the fenestration era (mainstreamed by Julius Lempert), the mobilization era (led by Samuel Rosen), and the modern stapedectomy era (revived and revolutionized by John Shea). Each era is unique with its own challenges and ingenious techniques to overcome what used to be among the leading causes of deafness.

Balloon dilation of the eustachian tube for dilatory dysfunction: A randomized controlled trial.

Objectives/hypothesis: To assess balloon dilation of the Eustachian tube with Eustachian tube balloon catheter in conjunction with medical management as treatment for Eustachian tube dilatory dysfunction.

Study Design: In this prospective, multicenter, randomized, controlled trial, we assigned, in a 2:1 ratio, patients age 22 years and older with Eustachian tube dilatory dysfunction refractory to medical therapy to undergo balloon dilation of the Eustachian tube with balloon catheter in conjunction with medical management or medical management alone.

Methods: The primary endpoint was normalization of tympanogram at 6 weeks.

Next generation shape memory prosthesis (NiTiBOND) for stapedotomy: Short-term results.

Objectives/hypothesis: To review hearing results and complications for the NiTiBOND next generation shape memory prosthesis and compare them with results for the current shape memory prosthesis (SMart).

Study Design: Retrospective, multicenter chart review.

Methods: Primary laser stapedotomy was performed using either a NiTiBOND or a SMart prosthesis.

Less invasive transjugular approach with Fallopian bridge technique for facial nerve protection and hearing preservation in surgery of glomus jugulare tumors.

For the past three decades, surgery of glomus jugulare tumors (GJTs) has been characterized by extensive combined head and neck, neuro-otologic, and neurosurgical approaches. In recent years, the authors have modified the operative technique to a less invasive approach for preservation of cranial nerves while achieving satisfactory tumor resection. We evaluated and compared the clinical outcomes of our current less invasive approach with our previous more extensive procedures.

Contemporary surgical management of vestibular schwannomas: analysis of complications and lessons learned over the past decade.

Background: Despite advanced microsurgical techniques, more refined instrumentation, and expert team management, there is still a significant incidence of complications in vestibular schwannoma surgery.

Objective: To analyze complications from the microsurgical treatment of vestibular schwannoma by an expert surgical team and to propose strategies for minimizing such complications.

Methods: Surgical outcomes and complications were evaluated in a consecutive series of 410 unilateral vestibular schwannomas treated from 2000 to 2009.

Critical assessment of operative approaches for hearing preservation in small acoustic neuroma surgery: retrosigmoid vs middle fossa approach.

Background: For hearing preservation in acoustic neuroma (AN) surgery, the middle fossa (MF) or retrosigmoid (RS) approach can be used. Recent literature advocates the use of the MF approach, especially for small ANs.

Objective: To present our critical analysis of operative results comparing these 2 approaches.

Remote programming of cochlear implants: a telecommunications model.

Objective: Evaluate the effectiveness of remote programming for cochlear implants.

Study Design: Retrospective review of the cochlear implant performance for patients who had undergone mapping and programming of their cochlear implant via remote connection through the Internet.

Methods: Postoperative Hearing in Noise Test and Consonant/Nucleus/Consonant word scores for 7 patients who had undergone remote mapping and programming of their cochlear implant were compared with the mean scores of 7 patients who had been programmed by the same audiologist over a 12-month period.

Hearing preservation in surgery for large vestibular schwannomas.

Object: Hearing preservation remains a challenging problem in vestibular schwannoma (VS) surgery. The ability to preserve hearing in patients with large tumors is subject to particular difficulty. In this study, the authors focus on hearing preservation in patients harboring large VSs.

External auditory canal closure: an alternative management for the refractory chronically draining ear.

Objective: To discuss the surgical technique and evaluate the effectiveness of external auditory canal (EAC) closure in patients with refractory chronically draining ears.

Study Design And Setting: A retrospective case review of seven patients who underwent EAC closure for chronically draining ears at a private tertiary otologic referral center between 2001 and 2004. Three patients underwent concomitant placement of a BAHA implant, and one patient underwent cochlear implantation during a second-stage procedure.

Injectable form of cross-linked hyaluronan is effective for middle ear wound healing.

Objectives: Two studies were designed to investigate a hyaluronan (HA) gel for middle ear (ME) wound healing.

Methods: We used a guinea pig model of ME wound healing. In a long-term study, we performed a comparison of hearing and ME inflammation in 3 groups.

Reversible canal wall down mastoidectomy for acquired cholesteatomas: preliminary results.

Objectives: The educational objectives were to discuss a new technique to manage acquired cholesteatomas and to compare this with standard approaches used for cholesteatoma removal. The study objective was to determine the feasibility of using a new approach, the reversible canal wall down approach, in conjunction with bone cement to remove acquired cholesteatomas and, potentially, preserve the ossicular chain.

Study Design: Retrospective review of five patients who underwent resection of their acquired cholesteatomas using a technique that maximizes exposure, yet preserves the posterior canal wall and, potentially, the ossicular chain.

Preliminary ossiculoplasty results using the Kurz titanium prostheses.

Objective: Limitations in biocompatibility and hearing improvement with ossicular chain reconstruction prostheses are addressed with new, lightweight titanium prostheses designed to maximize visualization of the capitulum and footplate regions. The effectiveness of these new prostheses is being tested in a prospective multicenter study.

Study Design: Prospective case series.

Intracanalicular meningioma mimicking vestibular schwannoma.

Three cases of intracanalicular meningioma mimicking vestibular schwannoma are presented. In each case, a contrast-enhancing mass filling the internal auditory canal was identified on MR images and was originally diagnosed as a vestibular schwannoma. Although it is difficult to differentiate definitively between these lesions preoperatively, imaging findings inconsistent with a diagnosis of vestibular schwannoma can be identified.

Hearing preservation in acoustic neuroma surgery: importance of adhesion between the cochlear nerve and the tumor.

Object: To evaluate the possible prognostic factors for hearing preservation, the authors retrospectively reviewed the results of 30 consecutive acoustic neuroma operations in which hearing preservation was attempted, in a total series of 63 acoustic neuromas.

Methods: Intracanalicular tumors or those that extended less than 3 mm outside the porus acusticus (10 cases) were resected via the middle fossa approach. The retrosigmoid approach was used for tumors exceeding the limits for the middle fossa approach (20 cases).