Intracochlear schwannomas confined to the otic capsule.

OBJECTIVE: To determine the natural history and management for patients with intracochlear schwannomas. STUDY DESIGN: Retrospective case series of intracochlear schwannomas confined to the otic capsule. SETTING: Tertiary referral center. PATIENTS: Ten patients were found to have schwannomas limited to the cochlea from 1998 to 2009. INTERVENTIONS: All subjects underwent at least 1 magnetic resonance imaging (MRI) study and had at least 1 audiogram. Two patients underwent a transotic excision for intractable symptoms. MAIN OUTCOME MEASURES: Presenting symptoms, initial and follow-up MRI findings, audiometric testing results, and need for surgical intervention were recorded for each subject. RESULTS: Hearing loss was present in all 10 patients at their initial presentation. Tinnitus was present in 50% of patients, and vertigo was present in 30% of patients. No patient presented with aural fullness or facial weakness. The pattern of hearing loss seemed to correlate with the location of the lesion within the cochlea. Of the 9 patients that had follow-up MRIs, 3 patients showed tumor growth. Two of the 10 patients underwent surgical excision for intractable vertigo that resulted in resolution of symptoms. CONCLUSION: Hearing loss is the most common finding in patients with intracochlear schwannomas, followed by tinnitus and vertigo. If the patient does not have symptoms of intractable vertigo, observation with serial MRI scans is indicated. Surgical excision should be reserved for patients with intractable vertigo or with significant tumor growth.

Biofilm presence in humans with chronic suppurative otitis media.

OBJECTIVE: To study the presence of biofilm formation in humans with chronic suppurative otitis media (CSOM). STUDY DESIGN: Cross-sectional study. SETTING: Tertiary academic hospital. SUBJECTS AND METHODS: Patients undergoing middle ear surgery between July 2006 and March 2008. Tissue samples were obtained from 25 patients, of which 20 specimens were successfully processed for this study. The remaining samples were not analyzed due to sample damage or loss during preparation. Of the 20 specimens studied, 10 were harvested as the experimental group from patients with CSOM and the other 10 harvested as controls from patients undergoing otologic surgery for acoustic neuroma, cochlear implant, or routine tympanoplasty. Ages ranged from 26 to 74 years (mean 45 yrs). Male-to-female ratio was 2:3. Scanning electron microscopy and confocal laser scanning microscopy were used to identify the presence of biofilms. Live-dead staining was used to assess whether bacteria present were viable. The outcome measured was the presence of adherent biofilms on middle ear mucosa. RESULTS: Biofilms were present in six of 10 samples (60%) from the CSOM group, but only in one of 10 control samples (10%). Comparative analysis revealed a statistically significant difference (P < 0.05) in the presence of biofilms in specimens from the CSOM group versus the control group. CONCLUSION: Biofilms were statistically more common in patients with CSOM compared with control patients.