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.

Hearing preservation in patients with vestibular schwannoma treated with Gamma Knife surgery.

Object: Hearing loss after Gamma Knife surgery (GKS) in patients with vestibular schwannoma has been associated with radiation dose to the cochlea. The purpose of this study was to evaluate serviceable hearing preservation in patients with VS who were treated with GKS and to determine if serviceable hearing loss can be correlated with the dose to the cochlea.

Methods: Forty patients with vestibular schwannoma with serviceable hearing were treated using GKS with a median marginal dose of 12.

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.

Longitudinal assessment of quality of life and audiometric test outcomes in vestibular schwannoma patients treated with gamma knife surgery.

Objective: To prospectively assess the quality of life (QOL) and hearing acuity in vestibular schwannoma (VS) patients after gamma knife surgery (GKS).

Patients: Fifty-nine VS patients.

Intervention: GKS.

Successful treatment of glomus jugulare tumours with gamma knife radiosurgery: clinical and physical aspects of management and review of the literature.

Purpose: To demonstrate the feasibility of treatment and early outcomes for patients treated with gamma knife radiosurgery (GKR), with or without surgical resection, for glomus jugulare tumours.

Methods: Between January 2007 and November 2008, 10 patients with glomus jugulare tumours were treated with GKR. Eight had prior surgical resection, seven subtotal resection and one total resection.

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.

Ambulatory tympanomastoid surgery in children: factors affecting hospital admission.

Objective: To identify clinical factors associated with postoperative nausea and vomiting (PONV) and failure to discharge from the hospital on the day of surgery in children undergoing tympanomastoid surgery.

Design: Records of 144 children undergoing 152 tympanomastoid surgical procedures from July 1, 2001, through June 30, 2002, were retrospectively reviewed and the data analyzed.

Setting: A tertiary care university-affiliated hospital.

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.

Smoking and tympanoplasty: implications for prognosis and the Middle Ear Risk Index (MERI).

Objectives/hypothesis: The objectives of this study are to review the effects of smoking on preoperative middle ear disease severity, long-term surgical outcome, type and extent of surgery required, the need for ossicular chain reconstruction, and the long-term hearing results.

Study Design: A retrospective chart review.

Materials And Methods: The charts of 74 smokers and non-smokers who underwent over-under tympanoplasty were reviewed.

Implications of sound levels generated by otologic devices.

Objective: Exposure to loud noise can result in sensorineural hearing loss. In otology, a wide variety of devices are used that have significant noise output, both to the operator and the patient. This study quantifies and compares the sound pressure levels (SPL) of a variety of otologic instruments.

Tympanic membrane Patcher: a new device to close tympanic membrane perforations in an office setting.

Objective: To assess a new device intended to cover tympanic membrane (TM) perforations in an office setting.

Study Design: Not all patients with TM perforations require or choose tympanoplasty surgery. Alternatives to surgery (e.

Tympanic membrane perforation repair using AlloDerm.

Background: Some patients lack quality autologous tissue for tympanic membrane (TM) grafting. AlloDerm (LifeCell Corp, The Woodlands, TX) is a preserved allograft that has been effective in nonotologic applications.

Objective: The goal of this study was to investigate AlloDerm in the repair of chronic TM perforations.

Octylcyanoacrylate: a new medical-grade adhesive for otologic surgery.

Hypothesis: The adhesive octylcyanoacrylate is not associated with significant inner ear toxicity in a guinea pig model.

Background: Many cyanoacrylate adhesives have been investigated for use in otologic surgery, but variable ototoxicity has been reported. Octylcyanoacrylate is a medical-grade adhesive with many properties that make it ideal for use in the ear.

Ossicular chain reconstruction using a new tissue adhesive.

Hypothesis: A new medical-grade cyanoacrylate tissue adhesive will improve the results of ossicular chain reconstruction in a rat model.

Background: An ideal tissue adhesive has long been awaited by otologists. Studies examining the older cyanoacrylates have demonstrated variable efficacy and toxicity.