A prospective study to evaluate the efficacy of isopropyl alcohol irrigations to prevent cerumen impaction.

We conducted a prospective crossover study to assess the safety and efficacy of 70% isopropyl alcohol delivered from a squeezable bottle with a specially designed tip as a weekly irrigant to reduce cerumen accumulation. Twenty patients were divided into 2 groups of 10 (20 ears in each group). The patients in group 1 instilled 70% isopropyl alcohol once a week for 2 months; this was followed by 2 months of no ear cleaning. The patients in group 2 performed the opposite routine. At each visit (0, 2, and 4 mo), cerumen accumulation was graded on a scale of 0 to 4, indicating 0, 25, 50, 75, and 100% occlusion, respectively. After the accumulation was graded, a cerumenectomy was performed. At the initial evaluation, the mean occlusion scores were 3.1 for group 1 and 3.3 for group 2-not a statistically significant difference. After the first 2 months of the study, there was a significant difference in occlusion scores between groups 1 and 2 (0.75 and 1.55, respectively; p < 0.0002). At 4 months, after the crossover, the occlusion scores were 1.15 and 0.95, respectively, not a significant difference (p = 0.38). At study's end, there were also significant differences within each group between occlusion scores obtained during the treatment and nontreatment periods (group 1: p < 0.02; group 2: p < 0.01). All patients tolerated the alcohol rinse well, and there were no cases of external otitis or other complications. We conclude that weekly irrigation with 70% isopropyl alcohol is safe and reduces the accumulation of cerumen in the external auditory canal. Routine use should decrease the number of office visits for cerumen removal and hearing aid cleaning.

Laser stapedotomy minus prosthesis: long-term follow-up.

OBJECTIVE: To evaluate long-term hearing results following laser stapedotomy minus prosthesis (laser STAMP). STUDY DESIGN: Case series with chart review. SETTING: Otologic referral center. SUBJECTS AND METHODS: From April 1995 to April 2009, 74 adult patients (77 ears; consecutive cases) underwent primary laser STAMP for otosclerosis limited to the fissula ante fenestram. Pure-tone air, bone conduction thresholds, and word discrimination scores were obtained preoperatively, 1 month postoperatively, and yearly thereafter. RESULTS: One-year minimum follow-up data were available for 43 patients (44 ears; nonconsecutive cases). The average air-bone gap (ABG) was closed from a mean of 23 dB to 6 dB at 6 weeks postoperatively. At a median of 33 (lower quartile, 20; upper quartile 46; range, 12-140) months postoperatively,the mean ABG was 7 dB, indicating little evidence of refixation. Seven of 77 patients (9%) underwent revision surgery with stapedotomy and placement of prosthesis with good results. Four patients (5%) were revised within 1 year for other problems unrelated to stapes refixation. Refixation was noted in 3 patients (4%) undergoing revision surgery. Two of these patients (3%) were revised within 1 year, and 1 patient (1%)was revised after 12 years. CONCLUSIONS: The laser STAMP is a minimally invasive procedure resulting in stable long-term hearing improvement in those patients available for long-term follow-up. Success depends on proper candidate selection of patients with accessible anatomy and minimal otosclerosis confined to the fissula ante fenestram. Advantages of this procedure include preservation of stapes anatomy and stable long-term, high-frequency hearing improvement.

The Baha system in patients with single-sided deafness and contralateral hearing loss.

OBJECTIVE: To evaluate the effectiveness of the Baha system in cases of single-sided deafness (SSD) and mild to moderate hearing loss in the better-hearing ear. STUDY DESIGN: Prospective trial. SETTING: Tertiary otologic referral center. SUBJECTS AND METHODS: Twenty-one patients with SSD and mild to moderate hearing loss in the contralateral ear implanted with the Baha system between June 2006 and March 2008 were evaluated following Baha implantation and fitting with the Divino and Intenso processors. Pure-tone air and bone conduction thresholds, sound-field testing (aided and unaided in quiet and noise) of consonant nucleus consonant words (Northwestern University Auditory Test No. 6 words), and Hearing in Noise Test sentences were obtained. Patient satisfaction questionnaires were administered pre- and post-intervention for either device. RESULTS: Patients with SSD and mild to moderate hearing loss in the contralateral ear showed a statistically significant improvement in all measures with the use of the Divino or Intenso processors compared with the unaided situation. Change in hearing, as measured in noise testing word recognition scores, revealed a statistically significant difference between the two aided conditions favoring the Intenso (P < 0.05). The Glasgow Benefit Inventory revealed that 91 percent of the patients reported improvement in their quality of life and would recommend the procedure to others. CONCLUSION: The Baha system is effective in the rehabilitation of patients with SSD and mild to moderate hearing loss in the only hearing ear. Results of the current study suggest that either the Divino or Intenso processor was successful in reestablishing hearing from the deafened side.

Intratympanic gentamicin treatment of patients with Ménière's disease with normal hearing.

OBJECTIVE: Understand the safety and outcomes of intratympanic gentamicin treatment in patients with Ménière's disease with normal hearing. STUDY DESIGN: Case series with chart review. SETTING: Tertiary referral center. SUBJECTS AND METHODS: A total of 224 patients with disabling Ménière's disease treated between May 1996 and June 2007 were grouped according to the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) 1995 Committee on Hearing and Equilibrium staging guidelines: stage 1 (<25 dB pure-tone average [PTA]); stage 2 through 4 (>25 dB PTA). Patients underwent self-treatment with intratympanic gentamicin (10 mg/mL) three times daily for one to eight weeks. Outcome measures included pre- and post-treatment speech discrimination score (SDS), PTA, electronystagmography, vertigo relief, and statistical analysis utilizing the Pearson chi(2) test. RESULTS: Twenty-two (88%) of 24 patients with stage 1 Ménière's disease showed unchanged or improved SDS. All 24 patients showed a mean PTA loss of 8 dB. Seventeen (71%) patients reported complete or improved vertigo control. One hundred sixteen (59%) of 200 patients with stage 2 through 4 Ménière's disease showed unchanged or improved SDS. All 200 patients showed a mean PTA loss of 11 dB. One hundred forty-eight (74%) patients reported complete or improved vertigo control. CONCLUSIONS: Patients with stage 1 Ménière's disease appear to have similar vertigo control with better hearing preservation than patients with advanced disease when treated with low-dose intratympanic gentamicin (10 mg/mL).

Complete round window niche occlusion for superior semicircular canal dehiscence syndrome: a minimally invasive approach.

Superior semicircular canal dehiscence (SCD) syndrome is a recognized condition associated with varying degrees of vestibular and auditory dysfunction. The authors present a case study of disabling SCD syndrome in a 37-year-old man who was successfully treated with a complete round window niche occlusion via a transcanal approach. This case represents the first report of a transcanal complete round window niche occlusion for the treatment of SCD syndrome. A brief literature review and discussion of surgical techniques follow.