Endolymphatic duct blockage surgery vs. intratympanic steroids for treatment of refractory Ménière's disease.

PURPOSE: To compare the effectiveness of the Endolymphatic duct blockage (EDB) and intratympanic methylprednisolone(ITMP) injection to control refractory Ménière's disease(MD) symptoms and evaluate their impact on hearing level. STUDY DESIGN: Retrospective study in a tertiary care center. METHODS: 36 received ITMP injection and 52 EDB. Mean outcome measures at 24 months included vertigo control, tinnitus, aural fullness and hearing level: pure-tone average (PTA), bone conduction average(BCA) and speech discrimination score(SDS). RESULTS: At 24 months postoperatively, 90.4% of the EDB group had complete control of vertigo and 43.4% of the ITMP group (p = 0.001). There was no significant difference in tinnitus or aural fullness control (p = 0.34 and p 0.21 respectively). In each group, the drop in tinnitus and aural fullness frequency at 24 months were significant for EDB (p = 0.03; p < 0.001 respectively) and for ITMP group in tinnitus (p = 0.03) but not aural fullness (p = 0.063). At 24 months, PTA, BCA and SDS were significantly worst in the ITMP group when compared to preoperative levels (p = 0.038, p = 0.027, p = 0.016). PTA in the EDB group was stable with no difference compared to ITMP group (p = 0.48). BCA and SDS in the EDB group were stable and better than the ITMP group (p = 0.032; p = 0.036). In each group, vestibular paresis was not significantly different before (p = 0.06) and after treatment (p = 0.68). CONCLUSION: EDB is more effective than the ITMP for controlling the vertigo symptoms of Ménière's disease and in preserving hearing function. It is a novel surgical technique with promising results for a complete treatment of Ménière's disease. ITMP decreases the frequency and the severity of the symptoms but only control vertigo in 27.8% of cases.

Public and patients' perceptions of facial reanimation using lengthening temporalis myoplasty.

OBJECTIVES: To answer the clinical research questions: "Among facial paralysis patients (FPPs), did lengthening temporalis myoplasty (LTM) improve public's perceptions, patients' perceptions, as well as objective oral measurements of post-operative outcomes?" METHODS: To answer the research questions, we designed and implemented a hybrid cross-sectional and retrospective cohort study enrolling a cohort of laypersons and FPPs treated at a tertiary care center from 2011 to 2020. The primary predictor variables were LTM in FPPs (before/after) and medical background on medical care (FPPs/laypersons). The main outcome variable was post-operative outcomes (from a public's perspective, FPPs' perspective, and with objective measurements). Descriptive and univariate statistics were computed as appropriate, and P ≤ 0.05 was considered statistically significant. RESULTS: The sample consisted of 203 lay volunteers and 15 FPPs. After LTM, public perception voted the significant improvements in disfigured, important to repair, bothersome, severity (DIBS) score, and facial attractiveness. Patients' perspective was also significantly improved for global severity, oral function, and facial movement. Objective measurements of deviation at the oral commissure and the smile angle also significantly improved after LTM. CONCLUSION: Despite no control groups (i.e., other techniques to be compared) in this study, our study results suggest that LTM can be used to improve public's perception, patient's perception, and objective oral measurement of post-operative outcomes in FPPs. Because different questionnaires were used, it is unknown whether public and patient's perceptions are compatible.

Analysis of the Acoustic Transcranial Bone Conduction.

OBJECTIVES: (1) To analyze the preferential pathways of sound transmission and sound waves travelling properties in the skull and (2) to identify the location(s) on the skull where bone conduction to the cochlea is optimal. STUDY DESIGN: Basic research Methods: Nine cadaveric heads were placed in an anechoic chamber and equipped with six Bone Anchored Hearing Aids (BAHA™) implants (Cochlear™, Sydney, NSW, Australia) and fifteen accelerometers. A laser velocimeter was used to measure cochlear response by placing a reflector on the round window. Different frequency sweeps were applied to each implant, and measurements were recorded simultaneously by the laser velocimeter and accelerometers. RESULTS: Low-frequency sound waves mostly travel the frontal transmission pathways, and there is no clear predominant pattern for the high frequencies. The mean inter-aural time lag is 0.1 ms. Optimal sound transmission to the cochlea occurs between 1000 and 2500 Hz with a contralateral 5 to 10 dB attenuation. The implant location does not influence mean transmission to the cochlea. CONCLUSION: There is a pattern of transmission for low frequencies through a frontal pathway but none for high frequencies. We were also able to demonstrate that the localization of the BAHA™ implant on the skull had no significant impact on the sound transmission, either ipsi or contralaterally.