We report a case of hearing rehabilitation following combined cochlear implantation and ossiculoplasty. A 71-year-old patient visited the clinic for right-sided mixed hearing loss. We targeted neural and conductive components, performing two different operations simultaneously. At two months post-operative, the patient showed satisfactory results with respect to hearing threshold and speech comprehension. Our experience suggests that careful evaluation of patients and consideration of the diverse array of available treatment strategies can be used to provide personalized rehabilitation with maximal effectiveness. To the best of our knowledge, this is the first report to take such an integrated approach to treat hearing impairment and is thus likely to have clinical importance for otologists.

A cholesterol granuloma is the most common primary lesion of the petrous apex, and accounts for 40% of the pathologies that arise in this region. The primary treatment for symptomatic lesions is by surgery to decompress and drain or to completely remove the lesion. Here we describe the use of infralabyrinthine approach to access a lesion through the temporal bone and completely remove it with the assistance of a 0-degree endoscope. A 43-year-old man visited our clinic for diplopia. Magnetic resonance imaging revealed a 2.3-cm cholesterol granuloma located in the left petrous apex that caused deviation of the left abducens nerve. The tumor was completely removed using the endoscopic-assisted infralabyrinthine approach; the patient is currently being followed up, and there is no evidence of disease recurrence. This case report describes the successful completion of a petrous apex cholesterol granuloma that preserved the cochlear and vestibular systems.
Abducens Nerve ; Adult ; Cholesterol* ; Diplopia ; Endoscopes ; Granuloma* ; Humans ; Magnetic Resonance Imaging ; Pathology ; Recurrence ; Temporal Bone

Unilateral presentation of vestibular schwannoma with concurrent chronic middle ear disease or cholesteatoma is rare. We report a series of patients with ipsilateral chronic middle ear disease and vestibular schwannoma, which were simultaneously removed via the enlarged translabyrinthine approach. All tumors were near-totally removed, and middle ear disease was completely excised; there were no major postoperative complications such as cerebrospinal fluid leakage, cholesteatoma recurrence, or meningitis. If hearing preservation of the affected ear is not necessary, simultaneous surgical removal of both pathologies is more convenient than staged treatment. The enlarged translabyrinthine approach can achieve complete treatment with one corridor.

Chemical labyrinthectomy may be performed in patients with Meniere’s disease who have intractable vertigo that does not respond to drug. By using aminoglycosides, the surgical procedure ablates vestibular type 1 hair cells. However, the risk of hearing loss remains a main concern for clinicians because gentamicin ablates cochlear hair cells as well as vestibular hair cells. To deal with the concern for hearing loss, dexamethasone can be combined with gentamicin during chemical labyrinthectomy. Herein, we show that chemical labyrinthectomy using gentamicin combined with dexamethasone preserve hearing at high-frequency compared to the conventional method.

Objectives: . The aim of study is to find conditions that aggravate auditory deprivation in patients with symmetric hearing loss after unilateral digital, non-linear hearing aid (HA). Methods: . In the retrospective case-comparison study, we assessed 47 patients with symmetric sensorineural hearing loss (SNHL), wearing unilateral conventional HAs. Audiological outcomes were assessed >1 year after HA fitting (mean duration, 31.0 months). Pure-tone audiometry in HA-aided and HA-unaided conditions was performed over time. Word recognition score (WRS) was evaluated at the most comfortable listening level. Results: . The initial pure tone average of four frequency thresholds at 500, 1,000, 2,000, and 4,000 Hz (PTA4) did not show a difference of >5 dB HL between HA-aided and HA-unaided ears. WRS progressively decreased for both HA-aided and HA-unaided ears although the extent of decrease was significantly greater for HA-unaided (7.6%) than for HA-aided ears (5.1%, P<0.05). Notably, auditory deprivation in HA-unaided ears was significantly greater in patients with an initial PTA4 ≥53 dB HL (P<0.001). Conclusion . Bilateral HAs are strongly recommended, particularly for patients with moderate to severe SNHL to prevent auditory deprivation in the contralateral ear.

Objectives: . The first purpose of this study was to investigate the difference in the frequency of involvement of the superior vestibular nerve (SVN) and inferior vestibular nerve (IVN) territories in general vestibular disorders, and to identify which IVN territory was more commonly involved in patients with IVN lesions. The second purpose was to investigate the correlation of the degree of each saccular and posterior semicircular canal (PSCC) dysfunction, as represented by the parameters of cervical vestibular evoked myogenic potential (cVEMP) and video head impulse test (vHIT), in patients with pathology of the IVN territory. Methods: . In total, 346 patients with dizziness who underwent the caloric test, cVEMP, and vHIT were enrolled. Canal weakness in the caloric test, interaural amplitude difference (IAD) of cVEMP, and vestibulo-ocular reflex gain of the vestibulo-ocular reflex gain of the posterior semicircular canal (p-VOR) in vHIT were analyzed. Results: . Among the enrolled patients, 15.6% had total vestibular nerve dysfunction, 14.5% had solely SVN dysfunction, and 29.5% had solely IVN dysfunction. Isolated saccular pathology was most common in patients with IVN pathology, followed by those with total IVN dysfunction and PSCC dysfunction. IAD and p-VOR were statistically well correlated, and the correlation was strongest in patients with both pathologic IAD and pathologic p-VOR (n=23, r=0.944), followed by patients with normal IAD and pathologic p-VOR (n=27, r=0.762) and patients with pathologic IAD and normal p-VOR (n=106, r=0.339). Conclusion . Abnormal results were more common in vestibular tests investigating the IVN than in vestibular tests investigating the SVN in patients with general vestibular disorders. Isolated saccular pathology was more frequent than PSCC or combined pathology in patients with IVN dysfunction. Patients with abnormal p-VOR in vHIT had a higher probability of having both saccular and PSCC pathologies than patients with an abnormal IAD. This study describes the characteristics of vestibular-system subregions and provides guidance for clinically interpreting the combination of cVEMP and vHIT results.

Objectives: . To compare the surgical outcomes of externally monitored and conventional buried flaps with the goal of determining the usefulness of external monitoring of buried flaps. Methods: . In this case-control study with propensity score matching, 30 patients were evenly divided into externally monitored buried flap and conventional buried flap groups. The total operative time for free flap reconstruction, the flap survival rate, the length of hospital stay, the initial time of a reliable visual assessment, complications, the final diet achieved, and the duration until diet initiation were compared between the groups. Results: . The mean operative time for reconstruction was 115 minutes (interquartile range, 85–150 minutes) and 142 minutes (interquartile range, 95–180 minutes) in the externally monitored and conventional groups, respectively (P= 0.245). The median length of hospital stay was 24 days (interquartile range, 18–30 days) and 27 days (interquartile range, 20–41 days) in the externally monitored and conventional groups, respectively (P=0.298). The median duration until diet initiation was 15 days (interquartile range, 15–21 days) and 18 days (interquartile range, 15–34 days) in the externally monitored and conventional groups, respectively (P=0.466). The final diet, initial time of a reliable visual assessment, and complications were comparable between the groups, but the external skin paddle provided an excellent visual assessment immediately postoperatively in all cases. Conclusion . The outcomes were comparable between the groups, indicating that externalization of the cutaneous component of a buried flap may be a straightforward and useful technique for monitoring a buried anterolateral thigh free flap in laryngopharyngeal reconstructions. The salvage and false-positive rates of compromised flaps should be compared in large subject groups in future studies to prove that the use of an external skin paddle improves flap monitoring.