Abstract Objective This study aimed to describe the microscopic over-under cartilage tympanoplasty technique, provide hearing results and detail clinically significant complications. Method This was a retrospective case series chart review study of over-under cartilage tympanoplasty procedures performed by the senior author between January 2015 and January 2019 at three tertiary care centres. Cases were excluded for previous or intra-operative cholesteatoma, if a mastoidectomy was performed during the procedure or if ossiculoplasty was performed. Hearing results and complications were obtained. Results Sixty-eight tympanoplasty procedures met the inclusion criteria. The median age was 13 years (range, 3–71 years). The mean improvement in pure tone average was 6 dB (95 per cent confidence interval 4–9 dB; p < 0.0001). The overall perforation closure rate was 97 per cent ( n = 66). Revision surgery was recommended for a total of 6 cases (9 per cent) including 2 post-operative perforations, 1 case of middle-ear cholesteatoma and 3 cases of external auditory canal scarring. Conclusion Over-under cartilage tympanoplasty is effective at improving clinically meaningful hearing with a low rate of post-operative complications.
Objective Tophaceous lesions of the middle ear from calcium pyrophosphate deposition disease (CPPD, or pseudogout) and gout are infrequently reported. Recognizing its characteristic findings will allow clinicians to accurately narrow the differential diagnosis of bony-appearing middle ear lesions and improve management. Patients Two consecutive cases of tophaceous middle ear lesions presenting to a tertiary care center between January 2021 and December 2021. Neither with previous rheumatologic history. Interventions Surgical excision of tophaceous middle ear lesions. Main Outcome Measure Improvements in facial weakness and conductive hearing loss. Results The first case was a 66-year-old gentleman with progressive conductive loss, ipsilateral progressive facial weakness over years, and an opaque, irregular-appearing tympanic membrane anterior to the malleus found to have CPPD on surgical pathology, with immediate postoperative improvement of facial function. The second was a 75-year-old gentleman with progressive conductive loss and similar appearing tympanic membrane as case 1, previously diagnosed with tympanosclerosis, found to have gout on surgical pathology. In both cases, the CT showed a heterogenous, bony-appearing lesion in the middle ear, and both tophaceous lesions were a of gritty, chalky consistency intraoperatively. Conclusion Tophaceous lesions of the middle ear are rare but have similar findings. Notably, the tympanic membrane can appear opaque and irregular, and the CT demonstrates a radiopaque, heterogeneous appearance. Facial weakness is an unusual finding. Specimens of suspected tophi must be sent to pathology without formalin for accurate diagnosis.
Ubiquitous throughout the literature and during patient counseling, vestibular schwannoma is often quoted to affect about 1 per 100,000 people. Yet, reports from distinct international populations suggest that the incidence is likely much higher. The objective of the current work was to systematically characterize the global incidence of sporadic vestibular schwannoma.Scopus, Embase, and PubMed.Population-based studies reporting incidence rates of sporadic vestibular schwannoma between January 2010 and August 2020 were searched with language restrictions requiring reports to be published in Chinese, English, German, Italian, or Spanish. The protocol was registered with PROSPERO (CRD42021228208) prior to commencement of data collection. PRISMA guidelines for transparent reporting of systematic reviews were followed.Among 424 citations, 6 publications covering 4 distinct populations from Denmark, the Netherlands, Taiwan, and the United States met inclusion criteria. Most recent incidence rates of among all ages ranged between 3.0 and 5.2 per 100,000 person-years. Highest incidence rates were reported among patients aged ≥70 years, peaking at 20.6 per 100,000 person-years. One study from the United States reported the incidence of asymptomatic, incidentally diagnosed tumors at a rate of 1.3 per 100,000 person-years from 2012 to 2016.Recent international incidence rates of sporadic vestibular schwannoma exceed the commonly quoted "1 per 100,000" figure by up to 5-fold among all ages and by up to 20-fold among age groups at highest risk. Based on modern incidence rates, the lifetime prevalence of developing sporadic vestibular schwannoma likely exceeds 1 per 500 persons.
To determine whether central findings from vestibular tests predict abnormal findings on magnetic resonance imaging.This study was a retrospective case series at a tertiary referral centre. The main outcome measure of this diagnostic intervention study was the positive predictive value of central vestibular findings in relation to magnetic resonance imaging abnormalities.Central vestibular findings had a 50.9 per cent positive predictive value for magnetic resonance imaging abnormalities across all age groups although they varied according to age group. Optokinetic nystagmus (p < 0.05) and abnormal findings on videonystagmography tests (p < 0.05) were the main predictors of magnetic resonance imaging abnormalities. White matter lesions constituted the bulk of the central lesions on magnetic resonance imaging followed by cortical and cerebellar atrophy.Central vestibular findings had a 50.9 per cent positive predictive value for magnetic resonance imaging abnormalities across all age groups. Magnetic resonance imaging is medically justified to further evaluate patients with central findings on vestibular studies. Therefore, it is reasonable to request magnetic resonance imaging in these patients.
Abstract Objective This study aims to describe the prevalence of unilateral, asymmetric, and bilateral tinnitus by severity of tinnitus across hearing sensitivity within the Noise Outcomes In Service members Epidemiology (NOISE) Study cohort. Study Design A cross‐sectional study. Setting Multi‐institutional tertiary referral centers. Methods Behavioral audiometric testing, tinnitus history, and tinnitus severity were described cross‐sectionally. Tinnitus severity was assessed by the Tinnitus Functional Index (TFI). The WHO Disability Assessment Schedule (WHODAS) 2.0 was used to capture functional deficits. Results Tinnitus prevalence within the NOISE cohort was 46% (644/1387). Among those with tinnitus, the mean age was 36.1 years (standard deviation = 9.7), and 86% (553/644) were male, reflecting the predominantly male composition of the overall study population. The majority (85%) had normal hearing, and the remaining (15%) had mild‐to‐moderate sensorineural hearing loss. Bilateral tinnitus was the most prevalent (54%), followed by asymmetric (35%) and unilateral (11%). Severe tinnitus was reported in 24%, moderate in 38%, and no/mild in 38%. Compared to those with normal hearing, subjects with mild‐to‐moderate hearing loss had a higher prevalence of tinnitus (odds ratio (OR) = 2.4, 95% confidence interval [CI]: 1.6‐3.7), higher TFI scores (mean difference = 14.1, 95% CI: 9.4‐18.7), and a higher proportion reporting severe versus mild tinnitus (OR = 3.7, 95% CI: 2.0‐6.9). In individuals with mild‐to‐moderate hearing loss, the highest TFI and WHODAS scores were associated with bilateral tinnitus (49.0 and 28.2, respectively). Conclusion Tinnitus is prevalent in people with military service history, both in those with and without sensorineural hearing loss. However, tinnitus had a greater impact on daily functioning among those with sensorineural hearing loss.
Objective: Evaluate and compare the Dizziness Handicap Inventory with Activities-specific Balance Confidence scores shortly after vestibular schwannoma excision. Study Design: Retrospective database review. Setting: Tertiary care center. Patients: Adults undergoing vestibular schwannoma excision between January 2015 and December 2019. Intervention: Diagnostic, therapeutic, and rehabilitative. Main Outcome Measures: Postoperative change in Dizziness Handicap Inventory scores and Activities-specific Balance Confidence scores 2 to 3 weeks after surgical intervention in relation to preoperative vestibular testing. Results: A total of 49 patients met inclusion criteria. The average change in the Dizziness Handicap Inventory was 6 ( p = 0.07, 95% CI 0–13). This was weakly correlated to preoperative caloric testing values ( r = −0.31, p = 0.03), but not cervical vestibular evoked myogenic potentials (cVEMP) values ( r = −0.17, p = 0.23). The average change in Activities-specific Balance Confidence was −10% ( p = 0.007, 95% CI −3 to −17%). This change was moderately correlated with preoperative caloric values ( r = 0.42, p = 0.006), but it was not correlated with cVEMP ( r = 0.07, p = 0.66). Conclusions: In vestibular schwannoma patients, factors other than preoperative vestibular function likely affect postoperative Dizziness Handicap Inventory and Activities-specific Balance Confidence scores. The change in Activities-specific Balance Confidence was slightly more consistent with expected physiological vestibular loss, and it represents another tool in a multidisciplinary vestibular evaluation of the postoperative patient.
Objectives Assesses whether preoperative functional testing can distinguish vestibular schwannomas from facial nerve schwannomas medial to the labyrinthine segment. Study Design Retrospective cohort. Methods Retrospectively review surgically managed intracranial facial and vestibular schwannomas between January 2015 and December 2019 at two tertiary care centers. Patients with neurofibromatosis 2 and surgery for recurrence were excluded. Preoperative functional testing to include House‐Brackmann scores, electroneuronography (ENoG), cervical vestibular evoked myogenic potentials (cVEMP), caloric testing, acoustic brainstem responses (ABRs), acoustic reflexes, and audiograms was compared between the two groups of schwannomas. Results Twelve facial and 128 vestibular schwannomas met inclusion criteria. In only one case was a facial schwannoma diagnosed preoperatively from imaging. No statistically significant difference was found in preoperative House‐Brackmann scores, ENoG, cVEMP, caloric testing, ABRs, or acoustic reflexes. Pure tone average was worse in the vestibular schwannoma group (63 dB [95% CI: 58–68 dB] vs. 46 dB [95% CI: 34–58 dB], P = .01), and the difference was more apparent in the lower frequencies. Word recognition score was better in the facial schwannoma group (66% [95% CI: 45–86%] vs. 41% [95% CI: 34–47%], P = .02). Conclusion Specialized preoperative functional evaluation of the nerves of the internal auditory canal cannot reliably predict the presence of an intracranial facial schwannoma. Hearing is better in facial schwannomas, particularly in the lower frequencies. This should raise the index of suspicion for an intracranial facial schwannoma, especially in candidates for hearing preservation vestibular schwannoma surgery. Level of Evidence 3 Laryngoscope , 131:2098–2105, 2021
The aim of this study was to determine the diagnostic yield of expedited magnetic resonance imaging (MRI) in patients presenting to the Emergency Department (ED) with isolated vertigo without neurologic deficits.
