Identification of target proteins involved in cochlear otosclerosis.

Hypothesis: Investigation of differential protein expression will provide clues to pathophysiology in otosclerosis.

Background: Otosclerosis is a bone remodeling disorder limited to the endochondral layer of the otic capsule within the temporal bone. Some authors have suggested an inflammatory etiology for otosclerosis resulting from persistent measles virus infection involving the otic capsule.

Conservative management of vestibular schwannoma: expectations based on the length of the observation period.

Objective: Evaluate long-term prevalence of tumor growth and need for further treatment in patients with a vestibular schwannoma treated with conservative management.

Study Design: Retrospective chart review.

Setting: Private neurotologic tertiary referral center.

Total ossiculoplasty: short- and long-term results using a titanium prosthesis with footplate shoe.

Objectives: Review experience using a titanium TORP with a footplate shoe; compare early and long-term hearing results and complications with those obtained using a TORP alone.

Study Design: Retrospective chart review.

Setting: Tertiary referral neurotologic private practice.

Round window versus cochleostomy technique in cochlear implantation: histologic findings.

Hypothesis: Cochleostomy or round window enlargement techniques for cochlear implant electrode insertion result in more abnormal tissue formation in the basal cochlea and are more apt to produce endolymphatic hydrops than round window electrode insertion.

Methods: Twelve temporal bones from implanted patients were examined under light microscopy and reconstructed with 3-dimensional reconstruction software to determine cochlear damage and volume of neo-ossification and fibrosis after electrode insertion. Amount of new tissue was compared between 3 groups of bones: insertion through the round window (RW), after enlarging the RW (RWE) and cochleostomy (Cochl).

Hearing preservation with the middle cranial fossa approach for neurofibromatosis type 2.

Objectives: To examine hearing preservation rates, facial nerve outcomes, and tumor recurrence rates in patients with neurofibromatosis Type 2 undergoing a primary middle cranial fossa approach for vestibular schwannoma removal.

Study Design: Retrospective chart review.

Setting: Private practice tertiary neurotology referral center.

Evolution in the management of facial nerve schwannoma.

Objective: To design a treatment algorithm based on experience with facial nerve schwannomas (FNS) over a 30-year period.

Study Design: Retrospective chart review.

Method: Seventy-nine patients with facial nerve schwannomas seen from 1979 through 2009 at a tertiary referral private otologic practice were categorized by treatment modality.

Vestibular neuritis.

The epidemiology, diagnostic features, differential diagnosis, and treatment of vestibular neuritis are reviewed. The authors present considerations for physical examination, imaging, and management in both the acute and chronic phases of this disease. The authors also present a dizziness questionnaire in the Appendix of this publication.

Extralabyrinthine manifestations of DFNA9.

DFNA9 is an autosomal dominant cause of non-syndromic adult-onset sensorineural hearing loss with associated variable vestibular dysfunction caused by mutations in the COCH gene. DFNA9 has previously been characterized by the presence of unique histopathologic features limited to the cochlear and vestibular labyrinth. This report describes newly discovered extralabyrinthine findings within the middle ear in DFNA9 and discusses their implications.

Endolymphatic pseudohydrops of the cochlear apex.

Objective: To demonstrate that what appears to be endolymphatic hydrops of the apical scala media is normal anatomy.

Study Design: Computer-generated three-dimensional reconstruction of the cochlear apex and tabulation of the number of cases with arched Reissner's membranes (pseudohydrops) versus flat membranes.

Setting: Temporal bone laboratory consisting of 809 documented pairs of temporal bones.

Cavitating otosclerosis: clinical, radiologic, and histopathologic correlations.

Background: Despite the high prevalence of otosclerosis and its having long been a subject of scrutiny, cavitary changes in otosclerosis are rare and not well known. Here, we describe and introduce into the literature the unusual histologic and radiologic findings of cavitation and its possible clinical relevance in patients with advanced cochlear otosclerosis.

Methods: Cases with clinical otosclerosis and presence of cavitation were selected from our temporal bone collection and correlated with premortem imaging and clinical manifestations.

Hearing results using the SMart piston prosthesis.

Objective: SMart, a newly introduced piston prosthesis for stapedotomy, is a nitinol-based, heat-activated, self-crimping prosthesis. We review our hearing results and postoperative complications using this self-crimped piston prosthesis and compare them with those obtained using stainless steel or platinum piston prostheses.

Hypothesis: Audiometric results using the SMart piston are identical to those obtained using a conventional piston prosthesis.

Jugular foramen tumors: clinical characteristics and treatment outcomes.

Objective: To describe the diagnosis, management, and treatment outcome of jugular foramen (JF) tumors.

Study Design: Retrospective chart review.

Methods: Charts of the 83 patients diagnosed with JF tumors between January 1997 and May 2008 were reviewed.

Symptomatic postsurgical traumatic neuromas.

Hypothesis: Growing nerve fibers from the stumps of amputated sensory nerves can form traumatic neuromas within inner or middle ear postsurgical fibrosis and may produce symptoms commensurate with the normal function of the nerve involved, that is, balance or pain.

Background: Microscopic traumatic neuromas have been identified in postoperative middle and inner ear fibrosis in the temporal bones of patients complaining of intractable pain or imbalance.

Methods: Postsurgical temporal bones having inner or middle ear traumatic neuromas were reviewed.

The medial wall of the jugular foramen: a temporal bone anatomic study.

Objective: To better understand the variable and complex anatomy of the jugular foramen (JF) and the relationship between the neurovascular structures in the medial wall of the jugular bulb (JB).

Study Design: A temporal bone anatomic study.

Setting: A temporal bone laboratory within a hearing research facility.

Histopathologic assessment of fibrosis and new bone formation in implanted human temporal bones using 3D reconstruction.

Objective: To evaluate new bone formation and fibrosis in implanted human temporal bones and relate that to neurosensory elements preservation.

Study Design: Human temporal bone histopathology study.

Setting: Temporal bone laboratory.

Treatment of recurrent and residual glomus jugulare tumors.

Residual and recurrent glomus jugulare tumors are rare but challenging. Treatment options include microsurgical resection, stereotactic radiotherapy, a combination of modalities, and "observation." Choice of treatment must be made on a case-by-case basis, considering patient age, health status, location and size of tumor, status of the lower cranial nerves, and, of course, patient desire.

Single vertical incision for Baha implant surgery: preliminary results.

Objectives: A single vertical skin incision with subcutaneous tissue removal is a cosmetic alternative for Baha implant placement. We aimed to determine the preliminary complication rate using a 4-cm vertical skin incision.

Study Design: Retrospective review.