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.

Side-to-end hypoglossal to facial anastomosis with transposition of the intratemporal facial nerve.

Objective: To describe results in a large series of patients using a recent variation of hypoglossal-facial nerve anastomosis (HFA) in which the intratemporal facial nerve segment is used, obviating the need for a sensory nerve "jump graft."

Study Design: Retrospective chart review.

Setting: Tertiary neurotologic referral center.

Idiopathic sudden sensorineural hearing loss: vascular or viral?

Objective: To demonstrate that sudden sensorineural hearing loss is possibly of viral origin rather than vascular.

Study Design: The histopathologic morphology in 7 temporal bones with known vascular impairment due to surgical interventions was compared with that of 11 bones with a history of idiopathic sudden sensorineural hearing loss (ISSNHL). Attention was paid to the spiral ligament, stria vascularis, organ of Corti hair cells, tectorial membrane, ganglion cell population, and degree of perilymph fibrosis and the auditory nerve.

Dietary modification as adjunct treatment in Ménière's disease: patient willingness and ability to comply.

Objective: To evaluate ease of use and compliance with dietary modification in the treatment of vertigo in patients with Ménière's disease.

Study Design: Mailed patient retrospective questionnaire and chart review.

Setting: Tertiary referral neurotologic private practice.

Evaluation of the increased use of partial resection of large vestibular schwanommas: facial nerve outcomes and recurrence/regrowth rates.

Objective: To determine whether partial tumor removal in large vestibular schwannoma improves facial nerve outcomes while maintaining a low risk of tumor regrowth/recurrence.

Study Design: Retrospective chart review and prospective database.

Setting: Tertiary neurotologic referral center.

Severe plantar hyperhidrosis: an effective surgical solution.

Severe palmoplantar hyperhidrosis both affects activities of daily living and diminishes quality of life. This study evaluated overall safety and efficacy of endoscopic lumbar sympathectomy (ELS) using a clamping method in a large series of consecutive patients. Patient data were routinely entered into a prospectively designed database.

Facing the music: pre- and postconcert assessment of hearing in teenagers.

Objective: Determine the effect of exposure to a single rock/pop concert on pure-tone hearing thresholds and outer hair cell function in teenagers.

Study Design: Repeated measures pre- and postconcert assessment of hearing.

Setting: Mobile hearing conservation test vehicle and large indoor concert venue.

A paradigm shift in salvage surgery for radiated vestibular schwannoma.

Objective: Determine whether more conservative management for surgical salvage after failed radiation leads to better facial nerve outcomes.

Study Design: "Retrospective" review using prospectively planned database.

Setting: Private practice, tertiary neurotology/neurosurgery referral center.

Allergy and its relation to Meniere's disease.

Ménière's disease (MD), which by definition is idiopathic, has been ascribed to various causes, including inhalant and food allergies. Patients with MD report higher rates of allergy history and positive skin or in vitro tests compared with a control group of patients with other otologic diseases and to the general public. Recent immunologic studies have shown higher rates of circulating immune complexes, CD4, and other immunologic components in patients with MD compared with normal controls.

Outcomes of endolymphatic shunt surgery for Ménière's disease: comparison with intratympanic gentamicin on vertigo control and hearing loss.

Objective: To compare proportions of the combined outcome of vertigo control and hearing preservation between intratympanic gentamicin injections and endolymphatic sac shunt surgery for intractable vertigo in Ménière's disease patients.

Study Design: Analysis of published data and retrospective review.

Setting: Tertiary otologic referral center.

Radiation therapy for the treatment of vestibular schwannoma: a critical evaluation of the state of the literature.

Objective: Review publications reporting radiation treatment of vestibular schwannomas (VS) and describe how data, patient characteristics, and study endpoints were reported.

Data Sources: PubMed search for English language articles on radiation treatment of VS published from January 2002 to July 2007.

Study Selection: Studies presenting outcomes were selected, yielding 56 articles (58 studies) in journals of neurosurgery (30), oncology (18), otolaryngology (6), and other (2).

Recent experience with the neuromonics tinnitus treatment.

This study examines the outcomes of patients undergoing the Neuromonics tinnitus treatment protocol at a single, tertiary referral center over a 2-year period. A retrospective review of patient records was performed with the objective of collecting demographic and au-diological information and identifying changes in score on an established tinnitus questionnaire (Tinnitus Reaction Questionnaire [TRQ]) after treatment. Forty-seven patients initiated reatment with the Neuromonics device during the study period.

Evidence-based review of the nonsurgical management of hyperhidrosis.

The most common nonsurgical modern treatments for hyperhidrosis include topical treatments such as aluminum chloride, iontophoresis (usually with tap water), oral medications such as anticholinergics, and BTX-A. Topical treatments should always be first-line therapy. For those who fail such treatment, iontophoresis is typically recommended for those with palmar or plantar hyperhidrosis, whereas BTX is often considered as first- or second-line therapy in severe axillary hyperhidrosis.

Persistent dizziness after surgical treatment of vertigo: an exploratory study of prognostic factors.

Objective: Persistent vertigo and imbalance can occur after surgery for vertigo regardless of surgical approach. This study explored for factors affecting outcome of vertigo surgery.

Study Design: Patient survey and chart review.

Allergy and Ménière's disease.

Ménière's disease (MD), which by definition is idiopathic, has been ascribed to various causes, including both inhalant and food allergies. Patients with MD report higher rates of allergy history and positive skin or in vitro tests compared to a control group of patients with other otologic diseases and to the general public. Recent immunologic studies have shown higher rates of circulating immune complexes, CD4, and other immunologic components in patients with MD compared to normal controls.

Transmastoid labyrinthectomy versus translabyrinthine vestibular nerve section: does cutting the vestibular nerve make a difference in outcome?

Objective: Analyze differences in outcomes between labyrinthectomy with and without vestibular nerve section, including characteristics of symptoms and time course for improvement.

Study Design: Patient survey.

Setting: Tertiary referral neurotologic private practice.

Surgical treatment for vertigo: patient survey of vertigo, imbalance, and time course for recovery.

Objectives: To assess surgical treatment of vertigo by patient ratings of postoperative vertigo, imbalance, and timing of symptom improvement.

Methods: A total of 3637 surgeries for vertigo were performed since 1974. Questionnaires sent to a random sample of patients operated since 1994 were completed by 28 endolymphatic sac shunt (ES), 54 vestibular nerve section (VNS), and 14 labyrinthectomy patients.

Meniere's disease: prevalence of contralateral ear involvement.

Objective: Determine the prevalence and time interval for conversion from unilateral to bilateral involvement in Meniere's disease and cochlear hydrops.

Study Design And Setting: Retrospective chart review in a tertiary otologic referral center.

Patients: 232 patients diagnosed with Meniere's Disease (n=186) or cochlear hydrops (n=46) between 1959 and 2001, who visited the clinic over a five-year period between 1997-2001 and have at least 2 audiograms more than 12 months apart.

Surgical salvage after failed irradiation for vestibular schwannoma.

Objectives/hypothesis: Compare vestibular schwannoma (VS) surgical outcome between patients with prior irradiation and those not previously treated.

Study Design: Retrospective review with matched control group.

Methods: Review of tumor adherence to the facial nerve, facial nerve grade, and complications in 38 patients with radiotherapy as a primary procedure before VS surgical removal and a matched random sample of 38 patients with primary surgery.

Allergy and the contemporary otologist.

Allergy may affect the outer, the middle, or the inner ear. Although the otologic manifestations of allergy are not by themselves diagnostic, the history, including family history and associated symptoms in other target organs, will often help lead to the correct diagnosis and institution of therapy. Patients with significant and chronic symptoms, including those with labyrinthine symptoms of allergy, respond well to specific immunotherapy or dietary elimination.