Effects of Varying Laser Parameters During Laser Stapedotomy on Intracochlear Pressures.

OBJECTIVE: Sensorineural hearing loss is a known complication of stapes surgery. We previously showed that laser stapedotomy can result in intracochlear pressures that are comparable to high sound pressure levels. Optimizing laser settings to those that correspond with the lowest pressure changes may mitigate risk for postoperative hearing loss. Here we quantify the effects of various laser parameters on intracochlear pressures and test the hypothesis that intracochlear pressure changes are proportional to the laser energy delivered. STUDY DESIGN: Basic and translational science. SETTING: Cadaveric dissection and basic science laboratory. METHODS: Cadaveric human heads underwent mastoidectomies. Intracochlear pressures were measured via fiber-optic pressure probes placed in scala vestibuli and tympani. Pulses of varied stimulus power and duration from a 980-nm diode laser were applied to the stapes footplate. RESULTS: Sustained high-intensity pressures were observed in the cochlea during all laser applications. Observed pressure magnitudes increased monotonically with laser energy and rose linearly for lower stimulus durations and powers, but there was increased variability for laser applications of longer duration (200-300 ms) and/or higher power (8 W). CONCLUSIONS: Results confirm that significant pressure changes occur during laser stapedotomy, which we hypothesize may cause injury. Overall energy delivered depends predictably on duration and power, but surgeons should use caution at the highest stimulus levels and longest pulse durations due to the increasing variability in intracochlear pressure under these stimulus conditions. While the risk to hearing from increased intracochlear pressures from laser stapedotomy remains unclear, these results affirm the need to optimize laser settings to avoid unintended injury.

Benign tumoral melanosis of a cervical lymph node in a child.

We present a pediatric case of benign tumoral melanosis in a cervical lymph node arising from congenital pigmented lesions of the anterior neck. This is the first reported pediatric case not associated with regressed melanoma or trauma. Tumoral melanosis is a rare phenomenon which describes a pigmented lesion like melanoma; however, histology demonstrates melanin-laden macrophages without malignant cells. In the few reported cases, tumoral melanosis has arisen in the skin or lymph node and associated with a regressed melanoma, pigmented basal cell carcinoma or mycosis fungoides. We discuss the pathology of this disease process, and the work up in a pediatric patient.

Otolaryngology in the medical school curriculum: Current trends in the United States.

OBJECTIVES/HYPOTHESIS: To identify trends in medical school otolaryngology curriculum requirements. STUDY DESIGN: Survey of United States allopathic medical schools. METHODS: A survey was sent to deans of curriculum at allopathic medical schools. We identified opportunities for medical students to learn basic concepts in otolaryngology during their undergraduate medical training. The opportunities were classified into preclinical and clinical as well as elective and mandatory rotations. RESULTS: Of the schools surveyed, 60% responded. Mean class size was 149 students. Sixty-eight percent of surveyed schools noted that 75% to 100% of their students participated in preclinical otolaryngology experiences, with 59% reporting a mandatory preclinical otolaryngology module for all students. Eighty-nine percent of schools offered otolaryngology as a clinical elective rotation, with a mean of 12 students participating yearly. Only 7% of schools required a mandatory otolaryngology clinical rotation. CONCLUSION: Our data suggest that medical students do not receive sufficient exposure to otolaryngology during medical school. Increased requirements for otolaryngology curriculum may be beneficial to all medical students, regardless of their specialty choice. LEVEL OF EVIDENCE: NA. Laryngoscope, 00:000-000, 2016 127:346-348, 2017.