Factors Influencing Access to Cochlear Implantation in Deaf and Hard-of-Hearing Children in Southern California.

OBJECTIVE: To determine the epidemiologic relationship of family demographics and educational resources with parental knowledge of and willingness for their children to receive cochlear implantation (CI) for deaf and hard-of-hearing (DHH) children. METHODS: A total of 213 parents of DHH children were surveyed at local schools, specialized camps, and clinics in Southern California. Data on parents were solicited, including income, insurance status, education level, hearing status, primary language, and motivations towards CI. RESULTS: Sixty-six surveys were included in the analysis. Three of these patients had already undergone CI, thus of the 63 children without CI, 59% had been presented with the option of CI by a healthcare professional and 27% were willing to have their child undergo CI. Willingness for children to undergo CI was statistically higher in families with an annual income less than $15,000 or more than $75,000 (p = 0.02), and children enrolled in specialized schools for DHH (p = 0.02). The leading reasons for unwillingness to undergo CI were risks of surgery (17%) and discouragement from others (14%). CONCLUSION: A significant gap exists between the number of CI candidates and families and willingness to undergo CI. The difference could be related to socioeconomic status and the patient's school type. This underscores the importance of parental education through the use of a multi-disciplinary team to ensure all hearing rehabilitation options are explained.

Facial nerve hemangioma: a case report.

Although hemangiomas are relatively common in the head and neck, those that originate in the facial nerve are extremely rare. These benign tumors have the potential to compress or invade the adjacent facial nerve and thereby produce facial paralysis and other associated symptoms. We present a case of facial nerve hemangioma in a 15-year-old girl that initially manifested as unilateral facial weakness. We also discuss the diagnostic imaging and management options.

A novel method to determine standardized anatomic dimensions of the osseous external auditory canal.

OBJECTIVE: To introduce a novel method for measuring the dimensions of the osseous external auditory canal (OEAC) on computed tomographic images of the temporal bone. STUDY DESIGN: Radiology case series. SETTING: Tertiary care medical center. PATIENTS: A retrospective review of high-resolution computed tomographic images of the temporal bones of 69 patients (120 ears) between the ages of 5 and 85 years (mean, 29.1 yr) was performed. MAIN OUTCOME MEASURES: Using a novel method to measure dimensions of the OEAC in the parasagittal planes, 6 defined dimensions as well as length and shape of the OEAC were studied at the annulus, midcanal, and the border of the bony cartilaginous junction. RESULTS: There was no statistically significant difference in OEAC dimensions between the male and female subjects or patients with and without a history of chronic otitis media within similar age groups. The length of the OEAC was significantly different between age groups of 5 to 12 and older than 13 years. The 6 defined dimensions were statistically different between the age groups of 5 to 8 years and older. These dimensions were not statistically different between the age groups of 9 to 12, 13 to 18, and older than 18 years. The most prevalent shape of the OEAC was conical (64%). CONCLUSION: Standardized anatomic dimensions of the OEAC provide important measurements for design of novel in-the-canal hearing aids and specialized earplugs and assist in defining average sizes for canalplasty procedures.

Temporary suppression of tinnitus by modulated sounds.

Despite high prevalence of tinnitus and its impact on quality life, there is no cure for tinnitus at present. Here, we report an effective means to temporarily suppress tinnitus by amplitude- and frequency-modulated tones. We systematically explored the interaction between subjective tinnitus and 17 external sounds in 20 chronic tinnitus sufferers. The external sounds included traditionally used unmodulated stimuli such as pure tones and white noise and dynamically modulated stimuli known to produce sustained neural synchrony in the central auditory pathway. All external sounds were presented in a random order to all subjects and at a loudness level that was just below tinnitus loudness. We found some tinnitus suppression in terms of reduced loudness by at least one of the 17 stimuli in 90% of the subjects, with the greatest suppression by amplitude-modulated tones with carrier frequencies near the tinnitus pitch for tinnitus sufferers with relatively normal loudness growth. Our results suggest that, in addition to a traditional masking approach using unmodulated pure tones and white noise, modulated sounds should be used for tinnitus suppression because they may be more effective in reducing hyperactive neural activities associated with tinnitus. The long-term effects of the modulated sounds on tinnitus and the underlying mechanisms remain to be investigated.

Femtosecond laser ablation of the stapes.

A femtosecond laser, normally used for LASIK eye surgery, is used to perforate cadaveric human stapes. The thermal side effects of bone ablation are measured with a thermocouple in an inner ear model and are found to be within acceptable limits for inner ear surgery. Stress and acoustic events, recorded with piezoelectric film and a microphone, respectively, are found to be negligible. Optical microscopy, scanning electron microscopy, and optical coherence tomography are used to confirm the precision of the ablation craters and lack of damage to the surrounding tissue. Ablation is compared to that from an Er:YAG laser, the current laser of choice for stapedotomy, and is found to be superior. Ultra-short-pulsed lasers offer a precise and efficient ablation of the stapes, with minimal thermal and negligible mechanical and acoustic damage. They are, therefore, ideal for stapedotomy operations.

Skull base osteomyelitis: the effect of comorbid disease on hospitalization.

OBJECTIVES/HYPOTHESIS: Skull base osteomyelitis is a rare disease that has a high morbidity and mortality rate if diagnosis and treatment are delayed. Our objective was to perform a more detailed analysis of skull base osteomyelitis in the inpatient population. We also provide a more comprehensive evaluation of comorbid disease and severity of illness in this population and describe their effects on the duration and cost of hospital stay. STUDY DESIGN: Review of the California Hospital Discharge Database between the years 1990 and 2000. METHODS: Information evaluated included age, race, insurance, charges and length of hospital stay, comorbid disease, severity of illness, and disposition. Data were analyzed using analysis of variance and linear regression analysis. RESULTS: The overall incidence of skull base osteomyelitis ranged from 57 to 95 cases annually (median 75.5). Whites (69.3%) were more likely to present with the disease than Native Americans (13.2%), African Americans (6.5%), or Asians (2.9%). The majority of patients diagnosed with skull base osteomyelitis had Medicare or public assistance (62%) compared with those with Preferred Provider Organization or Health Maintenance Organization insurance (27%). Increased length of hospital stay and increased charges incurred during hospitalization were significantly associated (P < .05) with aplastic anemia, renal disease, arteriosclerosis, facial nerve dysfunction, and diabetes. Severity of illness and the presence of one or more comorbid conditions also significantly affected the duration and charges incurred during hospital stay (P < .05). CONCLUSIONS: The presence of concurrent illness with skull base osteomyelitis significantly affects the duration of hospital stay and the charges incurred during hospitalization.

Porencephalic cyst: a review of the literature and management of a rare cause of cerebrospinal fluid otorrhea.

OBJECTIVE: To discuss the first reported case of spontaneous cerebrospinal fluid (CSF) otorrhea caused by a massive CSF-containing porencephalic cyst. STUDY DESIGN: A case report and review of the literature (MEDLINE 1962-2005). SETTING: A tertiary neurotologic referral center. PATIENT: A 65-year-old woman with congenital hemiplegia presented with left-sided spontaneous CSF otorrhea of 4-month duration. An audiogram revealed a mixed hearing loss. High-resolution computed tomography revealed a thinning of the tegmen and epitympanum without an obvious defect. Magnetic resonance imaging revealed a massive porencephalic cyst essentially replacing the entire left cerebral hemisphere. INTERVENTION: A transmastoid approach with three-layered closure was used to successfully repair the sieve-like defects that were discovered in her tegmen. RESULTS: The patient remains free of drainage, and the conductive hearing loss has resolved. CONCLUSION: Spontaneous CSF otorrhea caused by a porencephalic cyst is an uncommon cause of conductive hearing loss that has never been reported before. Only a few cases of traumatic CSF otorrhea/rhinorrhea associated with a porencephalic cyst have been reported. A high level of suspicion, a beta2-transferrin assay, and appropriate radiographic imaging are required for diagnosis in adults without a history of trauma, meningitis, chronic ear disease, or previous ear surgery.