Size as a Risk Factor for Growth in Conservatively Managed Vestibular Schwannomas: The Birmingham Experience.

This article discusses conservatively managed tumors, whether larger tumors at presentation are more likely to grow, and whether position at presentation corresponds with growth. A review is presented of more than 900 patients managed at Queen Elizabeth Hospital, Birmingham, between 1997 and 2012. Tumors were arbitrarily divided into 3 groups: intracanalicular (IC), and extracanalicular (EC) tumors measuring 1 to 10 mm or 11 to 20 mm at the cerebellopontine angle. This series shows that larger EC tumors grow faster than IC tumors and that EC tumors overall at presentation are more likely to grow than IC tumors.

High Frequency Ex Vivo Ultrasound Imaging of the Middle Ear to Show Simulated Ossicular Pathology.

HYPOTHESIS: To illustrate the ability of high frequency ultrasound (HFUS) using a transducer array to demonstrate a variety of simulated clinical scenarios involving the ossicular chain. BACKGROUND: HFUS (>20 MHz) is a relatively new area of ultrasonic imaging that provides an order of magnitude better image resolution than the conventional low-frequency systems. HFUS may be a real-time imaging system that could be used in the clinic and would complement computed tomography (CT) and magnetic resonance imaging (MRI) to enhance the decision-making process for patients with middle ear pathology. METHODS: Using a commercially available HFUS scanner, we imaged a variety of simulated clinical scenarios to demonstrate the ability of HFUS to image middle ear pathology. RESULTS: We were able to clearly demonstrate real-time visualization of ossicular pathology in human temporal bones, whereas there are some limitations in the current technique to be addressed before it is used in vivo. CONCLUSION: HFUS allows excellent visualization of middle ear anatomy and pathology through an intact tympanic membrane (TM), and these experiments go some way towards giving the otologist access to high resolution, real-time imaging of the middle ear in the clinic.

Real-time imaging of in-vitro human middle ear using high frequency ultrasound.

Imaging techniques currently used in the clinic to inspect ears in patients are generally limited to views terminating at the tympanic membrane (TM) surface. For imaging past the TM, methods such as computed tomography are typically used, but in addition to disadvantages such as being costly, time consuming, and causing radiation exposure, these often do not provide sufficient resolution of the middle ear structures of interest. This study presents an investigation into the capability of high frequency ultrasound to image the middle ear with high resolution in real-time, as well as measure vibrations of TM and middle ear structures in response to sound stimuli. In unfixed cadaver ears, the TM, ossicles, and ossicular support tissues were all readily identifiable, with capabilities demonstrated for real-time imaging and video capture, and vibrometry of middle ear structures. Based on these results, we conclude that high frequency ultrasonography is a relatively simple and minimally invasive technology with great potential to provide clinicians with new tools for diagnosing and monitoring middle ear pathologies.

Preoperative headband assessment for semi-implantable bone conduction hearing devices in conductive hearing loss: is it useful or misleading?

OBJECTIVE: To establish whether preoperative assessment using a conventional, percutaneous bone conducting implant (pBCI) processor on a headband accurately represents postoperative performance of a semi-implantable BCI (siBCI). STUDY DESIGN: Retrospective case series. SETTING: Tertiary otology unit. PATIENTS: Five patients with chronic otitis media (implanted unilaterally) and one with bilateral congenital ossicular fixation (implanted bilaterally). INTERVENTION(S): Semi-implantable bone conduction hearing implant. MAIN OUTCOME MEASURE(S): Functional hearing gain; preoperative (headband) versus postoperative (aided) speech discrimination; unaided bone conduction (BC) versus postoperative (aided) soundfield threshold. RESULTS: Significant functional gain was seen at all frequencies (one-tailed t test p G 0.01; n = 7). There was a 50 dB improvement in median speech reception threshold (SRT) from 70 dB unaided to 20 dB aided. Compared to the preoperative BC, aided siBCI thresholds were worse at 0.5 kHz, but at frequencies from 1 to 6 kHz, the siBCI closely matched the bone curve ( p G 0.01). The siBCI performed better than both pBCI processors on a headband at 3 to 4 kHz, except 1 kHz ( p G 0.01). CONCLUSIONS: BC thresholds may be a better indicator of implant performance than headband assessment. Candidacy assessment for siBCI implantation that relies on headband testing with pBCI processors should be interpreted with caution because the headband may under-represent the implanted device. This seems to be especially true at 3 kHz and above and may make it difficult for surgeons to conduct accurate informed consent discussions with patients about the realistic anticipated outcomes and benefits of the procedure.

Vocalization-induced stapedius contraction.

OBJECTIVE: To present a case of a patient with visible stapedius contraction on vocalization and to discuss the related literature. PATIENTS: A 51 year-old woman with a Type III myringostapediopexy due to chronic suppurative otitis media and an incidental finding of voice-induced movement of the stapes head. INTERVENTIONS: Otoendoscopy, pure tone and impedance audiometry, and modified stapedius reflex decay. MAIN OUTCOME MEASURE: Stapes head movement on otoendoscopy. RESULTS: Stapes head movement was seen endoscopically on vocalization but not on tympanometric measures. CONCLUSION: Visible stapedius contraction with vocalization is an uncommon phenomenon. Our understanding of the nonauditory pathways to stapedius is limited and requires further research.

Prognostic biomarkers of survival in oropharyngeal squamous cell carcinoma: systematic review and meta-analysis.

BACKGROUND: Human papillomavirus (HPV) positivity improves prognosis in patients with oropharyngeal squamous cell carcinoma (OPSCC). Combining HPV status with other biomarkers may improve its prognostic power. METHODS: The approach was a literature search for longitudinal studies of biomarkers in OPSCC, with systematic review and meta-analysis. RESULTS: In all, 3130 articles were identified; 32 satisfied the inclusion and exclusion criteria. On meta-analysis, there was a significant overall survival (OS) benefit for patients with HPV positive and p16 positive tumors. There was some evidence of improved OS of OPSCC patients with raised bcl2; amplification of 11q3 and loss of 16q genes; and low c-met, ki67, IMD, PLK, FHIT, nuclear surviving, or nuclear cyclin D1. However, none of these was suitable for meta-analysis. CONCLUSION: Survival from OPSCC is associated with several biomarkers, which constitute potential targets for research into improving the prognostic power of HPV in OPSCC. Larger trials are needed, with standardization of cut-points and adherence to consensus reporting guidelines.