Efficacy of Intratympanic Gentamicin in Menière's Disease With and Without Migraine.

OBJECTIVE: To compare the efficacy of intratympanic gentamicin injection (ITG) on vertigo control, drop attacks, and functional level in Menière's disease patients with and without a history of migraine. PATIENTS: Menière's disease patients (patients with migraine and age- and sex-matched control patients without migraine) treated from 2002 to 2012 who failed medical management and received ITG, with a minimum 2-year follow up. INTERVENTION: ITG. MAIN OUTCOME MEASURES: Vertigo control, drop attack prevalence, and change in functional level. RESULTS: Twenty-eight Menière's disease patients were included in this study (14 with migraine and 14 matched patients without migraine). There were three men and 11 women in each groups, with a mean age of 53 ±â€Š8.9 years. Baseline characteristics (Menière's stage, vertigo frequency, drop attack prevalence, and functional level) before ITG were not significantly different between the two groups. Two years after ITG, 71% of Menière's disease with migraine patients and 78% of Menière's disease without migraine patients had class A, B, or C vertigo control (p > 0.999). Change in prevalence of drop attacks (43-7% versus 50-0%, respectively) was also similar (p > 0.999). However, significantly fewer vertigo control class A, B, and C migraine patients achieved functional level 1 or 2 (40%) compared with non-migraine patients (91%) (p = 0.007). CONCLUSIONS: Although ITG appears equally effective in treating vertigo and drop attacks in Menière's disease with and without migraine, patients with migraine derive significantly less benefit in terms of functional improvement.

Contemporary changes with the use of facial nerve monitoring in chronic ear surgery.

OBJECTIVE: There is a growing trend for the routine use of the facial nerve monitor (FNM) in chronic ear surgery. We aimed to examine current patterns in the use of FNMs in chronic ear surgery. STUDY DESIGN: Descriptive design (survey). SETTING: Academic health center. METHODS: A 10-question survey was designed to identify level of training, scope of practice, specific otologic surgeries where monitoring was most used, and the opinion of respondents regarding the use of FNMs as standard of care for chronic and/or middle ear surgery. A randomized list of 2000 board-certified members of the American Academy of Otolaryngology-Head and Neck Surgery was generated. One thousand subjects received a mailed survey with a self-addressed return envelope and 1000 subjects received an emailed survey through Surveymonkey.com. RESULTS: There were 359 (36%) surveys returned by mail and 258 (26%) surveys returned electronically. Forty-three percent of respondents were in private practice, and 31% were fellowship trained in otology/neurotology. Sixty-five percent used a FNM in their training and 95% had regular access to a FNM. Revision mastoid surgery, cholesteatoma, canal wall down mastoidectomy, and facial recess approach were the settings where a FNM was most used. Forty-nine percent of respondents felt that a FNM should be used as the standard of care in chronic ear surgery; this represents an increase from 32% in a similar study done approximately 10 years ago. CONCLUSION: There is a growing trend for routine facial nerve monitoring in the setting of chronic ear surgery.

Multi-channel cochlear implant histopathology: are fewer spiral ganglion cells really related to better clinical performance?

CONCLUSION: Our findings show that all cochlear implanted temporal bones had a varied degree of trauma and inflammatory reaction from cochlear implantation. No definitive relationship was observed from our limited number of specimens between residual spiral ganglion cells (SGCs) in implanted temporal bones and clinical speech performance. OBJECTIVES: We hypothesize that there is a relationship between residual SGCs in cochlear implanted temporal bones and clinical speech performance. Our aim was to examine the histopathology of multi-channel cochlear implant temporal bones and to evaluate the relationship of residual SGC counts to clinical hearing performance. METHODS: Temporal bones from four cochlear implant patients were examined histologically. Comparisons were made between implanted and nonimplanted temporal bones. Clinical performance data were obtained from patient charts. RESULTS: There were varying amounts of inflammation in the basal turn of the cochleae in all four implanted temporal bones. Trauma to the facial nerve at the facial recess was noticed in one case. Surviving dendrites varied from 5% to 30% among four cases, with no relationship to clinical performance. The speech recognition scores, measured with Central Institute of the Deaf (CID) sentence score, varied among patients from 4% to 89%, while the patient with the highest SGCs had the best clinical outcome.

Delayed facial nerve palsy after endolymphatic sac surgery.

Data on delayed facial nerve palsy (DFNP) following endolymphatic sac enhancement surgery are limited. We conducted a retrospective chart review to determine the incidence, possible predisposing factors, treatment, and prognosis of DFNP in such cases. We reviewed the records of 779 patients who had undergone endolymphatic sac surgery for intractable Ménière disease from January 1997 through December 2007 at a tertiary care otologic referral center. We found 5 cases (0.64%) of postoperative DFNP. The length of time between surgery and the onset of DFNP ranged from 7 to 20 days (mean: 11). Paralysis was incomplete in all 5 patients. Four of these patients had an abnormal mastoid bone anatomy, as the sigmoid sinus was either anteriorly or anteromedially displaced. The 5 patients had been treated with a steroid, either with or without an antiviral, and all 5 experienced a complete recovery of facial nerve function within 8 weeks of the onset of their paralysis. It is difficult to delineate the exact etiology of DFNP following endolymphatic sac surgery, but we speculate that factors such as physical injury to the nerve and/or a viral reactivation might have played a role. Also, the unusual mastoid bone anatomy seen in 4 of these patients might have been responsible, as well.