Description

The only journal focused exclusively on clinical otology and neurotology, Otology & Neurotology publishes original articles relating to both clinical and basic science aspects of otology, neurotology, and skull base surgery. Under the leadership of Robert K. Jackler, MD and an international editorial board of experts from 26 countries, Otology & Neurotology publishes the most important papers from around the globe. Special features include: imaging case of the month, temporal bone pathology case of the month, a clinical forum to discuss controversial patient management issues, brief communications on emerging technologies and surgical techniques, historical articles, editorials, letters to the editor, and book reviews.

Publisher details

Lippincott, Williams & Wilkins

Publications in this journal

• Comparison of speech perception performance between Sprint/Esprit 3G and Freedom processors in children implanted with Nucleus cochlear implants

  Authors: Santarelli, Magnavita, Genovese, Arslan, Ventura Laura

  Ontology & Neurotology. 30:304-312.

• The impact of cochlear implants from the perspective of significant others of adult cochlear implant users: in reply.

  Authors: Veronica Kennedy

  Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology. 29(5):734.

• RESPONSE TO COMMENTS ON: CLINICAL SIGNIFICANCE OF VIBRATION-INDUCED NYSTAGMUS AND HEAD-SHAKING NYSTAGMUS THROUGH FOLLOW-UP EXAMINATION IN PATIENTS WITH VESTIBULAR NEURITIS.

  Authors: Hongju Park

  Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology.

• STAPEDOTOMY USING CONTINUOUS WAVE DIODE LASER (808 NM).

  Authors: Hamid Djalilian, Alice Lee

  Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology.

• Petrous Carotid Canal Dehiscence: An Anatomic and Radiographic Study.

  Authors: Matthew Hearst, Aleem Kadar, Jeffrey Keller, Daniel Choo, Myles Pensak, Ravi Samy

  Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology.

  HYPOTHESIS:: Development of the osseous petrous carotid canal is frequently incomplete. BACKGROUND:: Although dehiscence of the carotid canal has been observed in previous studies, the frequency andHYPOTHESIS:: Development of the osseous petrous carotid canal is frequently incomplete. BACKGROUND:: Although dehiscence of the carotid canal has been observed in previous studies, the frequency and extent of bony dehiscence have not been quantified. Inadvertent internal carotid artery injury occurs in 3 to 5% of skull base procedures, with an additional 1.9% of patients having carotid artery vasospasm. Documentation of the incidence of petrous apex carotid canal dehiscence is therefore warranted. METHODS:: Ninety-nine cadaveric skulls were evaluated physically and by computed tomographic scan. RESULTS:: Incidence of dorsal (endocranial) dehiscence of the petrous carotid canal was identified in 82.83% of the left side and 88.89% of the right side. Average dimensions for left dorsal dehiscence measured 10.81 mm longitudinally by 4.10 mm transversely. Dimensions for the right averaged 11.59 mm longitudinally by 4.29 mm transversely. Incidence of ventral (exocranial) dehiscence was less frequent: 37.37% on the left and 34.34% on the right. Ventral dehiscence was classified into major (absence of bone) and minor (fissure) types. Major dehiscence was observed in 8.08% and 6.06% of specimens for left and right sides, respectively; minor ventral dehiscence was present in 29.29% and 28.28% for left and right sides, respectively. CONCLUSION:: Dorsal petrous carotid canal dehiscence is more common than previously recognized. Dehiscence of the dorsal carotid canal is a frequent finding with significant implications in advanced skull base approaches to the petrous apex, clivus, and lateral sellar compartment. Ventral dehiscence is a frequent finding that will become increasingly relevant as the scope of endoscopic skull base procedures.

• Analysis of Vestibular Testing in Patients With Vestibular Schwannoma Based on the Nerve of Origin, the Localization, and the Size of the Tumor.

  Authors: Mitsuya Suzuki, Chikako Yamada, Rika Inoue, Akinori Kashio, Yuki Saito, Wakako Nakanishi

  Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology.

  OBJECTIVES:: We aimed to analyze the factors influencing caloric response and vestibular evoked myogenic potential (VEMP) in vestibular schwannoma. SUBJECTS:: The subjects comprised 130 patients withOBJECTIVES:: We aimed to analyze the factors influencing caloric response and vestibular evoked myogenic potential (VEMP) in vestibular schwannoma. SUBJECTS:: The subjects comprised 130 patients with unilateral vestibular schwannoma pathologically diagnosed by surgery. METHOD:: Caloric response and the amplitude and latency of VEMP were measured and analyzed based on the nerve of origin, localization, and size of the tumor. The tumors were classified into 3 types based on localization: intracanalicular, intermediate, and medial; and into 4 grades based on size: 9 mm or less, 10 to 19 mm, 20 to 29 mm, and 30 mm or greater. RESULTS:: Abnormal rates of caloric response and VEMP in patients with tumors arising from the superior vestibular nerve were not significantly different from those in patients with tumors of the inferior vestibular nerve. In the intermediate and medial type-but not in the intracanalicular type-a significant difference in tumor size was observed between patients with normal caloric response and those with canal paresis as also between patients with normal VEMP and those with abnormal VEMP. In patients with tumors that maximally measured 10 to 19 mm or of the intermediate type, the p- and n-wave latencies of VEMP were significantly prolonged compared with those in the normal opposite ear. CONCLUSION:: 1) The nerve of origin of tumors cannot be predicted based on caloric response and VEMP. 2) In the intermediate and medial types, caloric response and the VEMP amplitude are significantly diminished in association with an increase in tumor size. 3) Prolonged VEMP latencies seem to be not only caused by tumor compression to the brainstem or vestibular spinal tract but also by tumor compression isolated to the inferior vestibular nerve.

• Epitympanic Osteoma.

  Authors: Petros Vlastarakos, John Xenellis, Dimitris Yiannopoulos, Athanasios Bibas

  Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology.

• Imaging of Vestibular Schwannoma With Prevalent Cystic Component: Cystic Vestibular Schwannoma.

  Authors: Francesco Dispenza, Alessandro De Stefano

  Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology.

• Cisplatin-Induced Ototoxicity: Effect of Intratympanic Dexamethasone Injections.

  Authors: Gerhard Hill, D Morest, Kourosh Parham

  Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology.

  HYPOTHESIS:: Intratympanic (IT) application of dexamethasone will reduce ototoxicity associated with systemic cisplatin therapy. BACKGROUND:: Cisplatin is a common chemotherapeutic drug oftenHYPOTHESIS:: Intratympanic (IT) application of dexamethasone will reduce ototoxicity associated with systemic cisplatin therapy. BACKGROUND:: Cisplatin is a common chemotherapeutic drug often dose-limited by ototoxicity attributed to the formation of reactive oxygen and nitrogen species damaging critical inner ear structures. Steroids have been shown to reduce formation of reactive oxygen species and thus may reduce ototoxicity. In the present pilot study, we test this hypothesis by IT administration of dexamethasone in a novel murine model of cisplatin ototoxicity. METHODS:: Click- and pure-tone-evoked auditory brainstem responses (ABRs) in young CBA/J mice were measured. The first phase consisted of a dosing study to identify the optimal cisplatin dose for ototoxicity. In the next phase, ABR thresholds were measured in cisplatin-treated mice after 5 days of IT injection of 24 mg/ml of dexamethasone in 1 ear and normal saline in the opposite ear to serve as controls. RESULTS:: Intraperitoneal injection of 14 mg/kg of cisplatin induces significant hearing loss (click-evoked ABR threshold elevation = 12 +/- 7 dB, mu +/- standard error of the mean) with acceptable mortality (20%). The ears that received IT dexamethasone in cisplatin-treated mice had minimal ABR threshold shifts with the click, 8 and 16 kHz of stimuli. There was no significant difference between IT dexamethasone and IT saline ears at 32 kHz. CONCLUSION:: IT dexamethasone protected the mouse ear against cisplatin-induced ototoxicity in a frequency-dependent manner. The present results suggest that IT dexamethasone may be a safe, simple, and effective intervention that minimizes cisplatin ototoxicity without interfering with the chemotherapeutic actions of cisplatin.

• Ototoxic Effect of Topical Ciclopirox as an Antimycotic Preparation.

  Authors: Serdar Baylancicek, Gediz Serin, Ayça Ciprut, Murat Sari, Ferda Akdaş, Alper Tutkun

  Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology.

  OBJECTIVE:: To evaluate the ototoxicity of ciclopirox-containing solution as an otologic preparation for the treatment of otomycosis. BACKGROUND:: Ciclopirox is a synthetic antimycotic agentOBJECTIVE:: To evaluate the ototoxicity of ciclopirox-containing solution as an otologic preparation for the treatment of otomycosis. BACKGROUND:: Ciclopirox is a synthetic antimycotic agent available in a variety of formulations to treat superficial fungal infections. Ciclopirox has demonstrated both fungicidal and fungistatic activity in vitro against a broad spectrum of pathogenic fungi. It also possesses a broad-spectrum antibacterial properties, anti-inflammatory, and antiedema effect. The ototoxic effect of ciclopirox-containing solutions has not been known, so the current study was designed to observe the ototoxic effect of this solution experimentally. MATERIALS AND METHODS:: Experiments were performed in 22 young male albino guinea pigs (weight, 450-550 g). The 10 animals in the experimental group received ciclopirox solution, and the control group was divided into two groups of six animals each. The first group received saline solution (negative control) and the second received gentamicin (40 mg/mL; ototoxic control). Under general anesthesia, pretreatment auditory brainstem responses (ABRs) from the right ears were obtained from the animals in all groups. The right tympanic membranes were totally perforated, and a small piece of Gelfoam was applied to the middle ear directly to the round window membrane. Ear solutions were applied through transcanal approach to the middle ear twice a day in 2 weeks. Twenty-two animals of perforated tympanic membrane were observed during a 2-week period. Posttreatment ABRs were obtained in all groups in a week after the last administration. RESULTS:: Baseline ABR results were normal in right ears of all animals tested. Animals undergoing placement of Gelfoam with either ciclopirox solution or saline in the middle ear showed no changes in the ABR threshold. The gentamicin group showed a significant change in the ABR threshold. CONCLUSION:: In the guinea pig, when applied topically to the middle ear, ciclopirox does not cause a reduction in the ABR threshold. Because its safety has not yet been confirmed in patients, caution should be observed when prescribing this agent.

• Daily Exercise Does Not Prevent Recurrence of Benign Paroxysmal Positional Vertigo.

  Authors: Janet Helminski, Imke Janssen, Timothy Hain

  Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology.

  OBJECTIVE:: The purpose of this study was to analyze if a daily routine of self-canalith repositioning procedure (CRP) will increase the time to recurrence and reduce the rate of recurrence of benignOBJECTIVE:: The purpose of this study was to analyze if a daily routine of self-canalith repositioning procedure (CRP) will increase the time to recurrence and reduce the rate of recurrence of benign paroxysmal positional vertigo (BPPV). STUDY DESIGN:: Prospective study, nonrandomized control group. SETTING:: Outpatient clinic. PATIENTS:: Thirty-nine patients diagnosed with posterior canal BPPV successfully treated with the CRP. Based on a convenience sample, 17 (44%) patients were assigned to the treatment group, whereas 22 (56%) were assigned to the no-treatment group. The number of subjects lost at the time of follow-up were 5 (29.4%) of the treatment group and 2 (9%) of the no-treatment group. INTERVENTIONS:: Patients assigned to the treatment group performed the self-CRP daily, whereas those assigned to the no-treatment group performed no exercises. Patients were followed for up to 2 years. MAIN OUTCOME MEASURES:: The main outcome measures were the rate of recurrence of BPPV and the time for BPPV to recur. RESULTS:: Of the 39 subjects, symptoms recurred in 16 (41%) of the total population, 6 (35%) of 17 of the treatment group, and 10 (46%) of 22 of the no-treatment group. There was no difference in the frequency of recurrence (Pearson chi; p = 0.522) or the time to recurrence (survival analysis; log-rank test; p = 0.242). CONCLUSION:: Our results suggest that a daily routine of the self-CRP does not affect the time to recurrence and the rate of recurrence of posterior canal-BPPV.

• Endolymphatic Hydrops and Blockage of the Endolymphatic Duct.

  Authors: Fred Linthicum, Aron Gortman

  Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology.

• Newborn Hearing Screening in Infants With Cleft Palates.

  Authors: Judy Chen, Anna Messner, Ginny Curtin

  Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology.

  OBJECTIVE:: The high incidence of conductive hearing loss from serous effusion in patients with cleft palate is well known. This study investigates the results and interpretation of newborn hearingOBJECTIVE:: The high incidence of conductive hearing loss from serous effusion in patients with cleft palate is well known. This study investigates the results and interpretation of newborn hearing screening in infants with cleft palates. STUDY DESIGN: Retrospective cohort review. PATIENTS:: One hundred fourteen newborns with cleft palate, with or without cleft lip, born between 1999 and 2005 and referred to a craniofacial anomalies clinic. INTERVENTION:: Tympanostomy tubes were placed in 102 newborns, and follow-up audiograms were available for 104 infants. MAIN OUTCOME MEASURES:: Hearing screening outcomes were collected. Sex, gestational period, type of screening performed, the presence of hearing loss after tube placement, and the presence of associated syndromes were noted. RESULTS:: Eighty-two (72%) of 114 of newborns with cleft palates passed their hearing screen. Of the 30 newborns who failed their hearing screen, and had tympanostomy tubes placed, 13 (43%) had persistent hearing loss after tube placement. Factors predicting persistent hearing loss include cleft palate alone, female infants, and the presence of an associated syndrome. CONCLUSION:: Newborns with cleft palate are at higher risk of failing their newborn hearing screen compared with healthy neonates. Detection of sensorineural or conductive hearing loss unrelated to middle ear effusions is more difficult in this at-risk population with cleft palate because of the high prevalence of serous otitis media.

• Role of Electrode Placement as a Contributor to Variability in Cochlear Implant Outcomes.

  Authors: Charles Finley, Timothy Holden, Laura Holden, Bruce Whiting, Richard Chole, Gail Neely, Timothy Hullar, Margaret Skinner

  Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology.

  HYPOTHESIS:: Suboptimal cochlear implant (CI) electrode array placement may reduce presentation of coded information to the central nervous system and, consequently, limit speech recognition.HYPOTHESIS:: Suboptimal cochlear implant (CI) electrode array placement may reduce presentation of coded information to the central nervous system and, consequently, limit speech recognition. BACKGROUND:: Generally, mean speech reception scores for CI recipients are similar across different CI systems, yet large outcome variation is observed among recipients implanted with the same device. These observations suggest significant recipient-dependent factors influence speech reception performance. This study examines electrode array insertion depth and scalar placement as recipient-dependent factors affecting outcome. METHODS:: Scalar location and depth of insertion of intracochlear electrodes were measured in 14 patients implanted with Advanced Bionics electrode arrays and whose word recognition scores varied broadly. Electrode position was measured using computed tomographic images of the cochlea and correlated with stable monosyllabic word recognition scores. RESULTS:: Electrode placement, primarily in terms of depth of insertion and scala tympani versus scala vestibuli location, varies widely across subjects. Lower outcome scores are associated with greater insertion depth and greater number of contacts being located in scala vestibuli. Three patterns of scalar placement are observed suggesting variability in insertion dynamics arising from surgical technique. CONCLUSION:: A significant portion of variability in word recognition scores across a broad range of performance levels of CI subjects is explained by variability in scalar location and insertion depth of the electrode array. We suggest that this variability in electrode placement can be reduced and average speech reception improved by better selection of cochleostomy sites, revised insertion approaches, and control of insertion depth during surgical placement of the array.

• Vestibular Schwannoma: Dissection of the Tumor and Arachnoidal Duplication.

  Authors: Emmanuel Lescanne, Patrick François, David Bakhos, Stéphane Velut, Alain Robier, Anita Pollak

  Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology.

  INTRODUCTION:: In vestibular schwannoma (VS) surgery, the arachnoidal duplication, based on an epiarachnoidal origin of the tumor, is reputedly induced by medial growth of tumor and helpful inINTRODUCTION:: In vestibular schwannoma (VS) surgery, the arachnoidal duplication, based on an epiarachnoidal origin of the tumor, is reputedly induced by medial growth of tumor and helpful in atraumatic dissection. This study was intended to verify the epiarachnoidal origin of VS. MATERIALS AND METHODS:: We studied 49 human temporal bones (TBs) specimens. Twenty-two TBs from 18 patients with VS were selected. An additional series of 27 TBs without any tumor within the internal auditory meatus were also included. We identified the location of the meninges and the position of the transition zone inside the meatus and described the lateral extension of the subarachnoid spaces. RESULTS:: In VS specimens, psammoma bodies were seen at the fundus along the arachnoidal layer. No connective tissue or protrusion of a psammoma body was observed between the nerves and the VS. High magnification failed to demonstrate any meningeal cleavage plane between the facial or cochlear nerve and the tumor. The subarachnoid space was visible within the internal auditory meatus and extended from the porus to the fundus. In every case, the transition zone, the vestibular ganglion, or the VS was located in the subarachnoid fluid space. CONCLUSION:: We were not able to identify any layer between tumor and the intrameatal contents and did not observe any conjunctive-tissue capsule surrounding the intrameatal VS, as an epiarachnoidal tumor origin would suggest. These observations are in contradiction with the descriptions concerning the epiarachnoidal origin of VS.

• Audiologic Results of Surgery for Cholesteatoma: Short- and Long-Term Follow-Up of Influential Factors.

  Authors: Milan Stankovic

  Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology.

  OBJECTIVE:: To review the audiologic results in a cohort of patients surgically treated for cholesteatoma. STUDY DESIGN:: Retrospective review of patient records. SETTING:: Tertiary referral center.OBJECTIVE:: To review the audiologic results in a cohort of patients surgically treated for cholesteatoma. STUDY DESIGN:: Retrospective review of patient records. SETTING:: Tertiary referral center. PATIENTS:: A retrospective study of patients operated on for acquired middle ear cholesteatoma during the period 1990 to 2002 was performed. A total of 758 patients were followed during a short-term period, and 611 patients were followed during a long-term period. The patients were divided into 3 age groups: children, adolescents, and adults. The localization of cholesteatoma was classified as attic, sinus, or tensa. INTERVENTIONS:: Closed tympanoplasty was always performed as the single procedure of choice on all the children, and reoperation or conversion to open tympanoplasty was made later if needed. Adult patients were treated with single classic canal wall up, or wall down (CWD), according to the propagation of disease and condition of middle ear. MAIN OUTCOME MEASURES:: Preoperative and postoperative air-bone gap (ABG) and pure-tone average were compared after short-term and long-term follow-up. RESULTS:: Average hearing improvement (reduction of ABG) amounted 20.0 dB for short-term and deteriorated to 18.0 dB during long-term analysis for all the patients. Preoperative hearing level was significantly worse for CWD than for intact canal wall technique. The ABG closure was much better in the group with attic cholesteatoma. Both preoperative and postoperative hearing levels were worse for children than for adolescents or adults. Revision operations and bilateral cholesteatoma gave worse total postoperative hearing. The long-term results of primary operations, when recurrent cholesteatoma did not occur, were stable. Damage to auditory ossicles correlated well with total preoperative and postoperative results. The most hearing improvement was verified for the frequencies between 500 and 3,000 Hz, and there was no sensorineural hearing loss. CONCLUSION:: The audiologic results of cholesteatoma surgery are preserved during long-term follow-up. We found that recurrent cholesteatoma was associated with diminished postoperative hearing. Poorer preoperative hearing level, CWD tympanoplasty, younger age, bilateral cholesteatoma, and ossicular damage, as well as revision surgery, were associated with reduced gains in hearing with surgical management. Surgical experience was important for ICW technique and for advanced damage of auditory ossicles. Recurrent cholesteatoma resulted in significantly worse hearing results for each analyzed parameter.

• Ramsay Hunt Syndrome: A Histopathologic Observation of a Facial Sequelae.

  Authors: Rodrigo de Mendonca Vaz, Fred Linthicum

  Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology.

• Endoscopic Vascular Decompression.

  Authors: Gregory Artz, Frank Hux, Michael Larouere, Dennis Bojrab, Seilesh Babu, Daniel Pieper

  Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology.

  OBJECTIVE:: This article describes the technique and reports the results of endoscopic vascular decompression (EVD) in patients with trigeminal neuralgia (TGN), hemifacial spasm (HFS), andOBJECTIVE:: This article describes the technique and reports the results of endoscopic vascular decompression (EVD) in patients with trigeminal neuralgia (TGN), hemifacial spasm (HFS), and cochleovestibular nerve compressive syndrome. STUDY DESIGN:: Retrospective case review. SUBJECTS AND METHODS:: This study evaluates the outcome and length of stay (LOS) of 20 patients who underwent EVD for vascular compressive disorders from 2005 to 2007. It also evaluates LOS in 41 patients who underwent traditional microvascular decompression (MVD) by the same surgeons from 1999 to 2004. RESULTS:: Eighty-six percent (12 of 14) patients had resolution of their TGN, and 80% (4 of 5) had resolution of their HFS. There were no major complications. The EVD patients had an average LOS of 2.36 days as compared with 4.36 days for the MVD patient group (p < 0.001). CONCLUSION:: Endoscopic vascular decompression for patients with vascular compressive syndromes such as TGN and HFS is a safe and equally effective procedure when compared with the traditional and widely successful MVD surgery, with the added benefit of less morbidity and shorter hospital stays.

• RESPONSE TO "LACK OF DIAGNOSTIC VALUE OF HIGH-PASS NOISE MASKING OF AUDITORY BRAINSTEM RESPONSES IN MENIERE'S DISEASE BY CLAUDIA F. J. DE VALCK, GERD M. E. CLAES, FLORIS L. WUYTS, AND PAUL H. VAN DE HEYNING. OTOLOGY & NEUROTOLOGY 2007;28:700-7"

  Authors: Manuel Don, Betty Kwong, Chiemi Tanaka

  Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology.

• Analysis of Hepatitis B Virus in the Cerumen and Otorrhea of Chronic HBV-Infected Patients: Is There a Hepatitis B Virus Infectivity?

  Authors: Eui-Kyung Goh, Bong-Hyung Son, Soo-Keun Kong, Kyong-Myong Chon, Kyu-Sup Cho

  Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology.

  HYPOTHESIS:: The object of this study was to find out whether cerumen and otorrhea have any infectivity in the transmission of hepatitis B virus (HBV). BACKGROUND:: The HBV infection is a worldwideHYPOTHESIS:: The object of this study was to find out whether cerumen and otorrhea have any infectivity in the transmission of hepatitis B virus (HBV). BACKGROUND:: The HBV infection is a worldwide health problem. It can be transmitted by infected blood or other body fluids through percutaneous or permucosal exposure. Recently, there have been some reports where cerumen can be a potential source of HBV transmission. METHODS:: This study was performed on 30 chronic hepatitis B patients who tested positive in hepatitis B surface antigen (HBs Ag). Thirty cerumen and 5 otorrhea samples were analyzed. The cerumen and the serum were examined for (HBs Ag) and hepatitis B e antigen (HBe Ag) by using enzyme immunoassay systems. As for HBV DNA detection, quantitative polymerase chain reaction was performed on the serum, cerumen, and otorrhea. RESULTS:: Hepatitis B virus DNA was detected in the 20 samples of cerumen (66.7%) and all 5 otorrhea (100%) from 30 patients. The mean values of HBV DNA in cerumen and otorrhea were significantly lower than serum. Hepatitis B virus DNA and HBs Ag were detected with significantly higher rates in the cerumen of patients who are serum HBe Ag positive than negative. However, positive HBe Ag, which implies that it is associated with the increased risk of disease progression and infectivity, was not detected in any of cerumen samples. CONCLUSION:: The cerumen and otorrhea of chronic hepatitis B patients have a low risk of infectivity.

• The Effects of Superior Semicircular Canal Dehiscence on the Labyrinth: Does Size Matter?

  Authors: Gunesh Rajan, Matthew Leaper, Leigh Goggin, Marcus Atlas, Rudolf Boeddinghaus, Robert Eikelboom

  Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology.

  BACKGROUND:: Superior semicircular canal dehiscence (SSCD) is characterized by lack of bony covering of the superior semicircular canal in the inner ear, resulting in a third mobile window withBACKGROUND:: Superior semicircular canal dehiscence (SSCD) is characterized by lack of bony covering of the superior semicircular canal in the inner ear, resulting in a third mobile window with altered functioning of the superior semicircular canal. Vertigo in association with sound and pressure changes often occurs. This study examines the relationship between dehiscence size and frequency of sound-induced vertigo. METHOD:: Retrospective review of 22 patients with SSCD, noting the auditory frequency producing the maximal electronystagmographic response. RESULTS:: The study found a correlation between dehiscence size and stimulator frequency of r = 0.856, p < 0.001. The larger the dehiscence, the lower the frequency of stimuli required to provoke a vestibular response. CONCLUSION:: The relationship found between the superior canal dehiscence size and the stimulator frequency has clinical implications in the diagnosis and management of patients with SSCD.

• Tight Stapes Prosthesis Fixation Leads to Better Functional Results in Otosclerosis Surgery.

  Authors: Alexander Huber, Dorothe Veraguth, Stephan Schmid, Thomas Roth, Albrecht Eiber

  Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology.

  HYPOTHESIS:: Tight fixation of stapes prostheses yields better functional results because sound transmission from the incus to the prosthesis is improved. BACKGROUND:: The optimal prosthesis to useHYPOTHESIS:: Tight fixation of stapes prostheses yields better functional results because sound transmission from the incus to the prosthesis is improved. BACKGROUND:: The optimal prosthesis to use for otosclerosis surgery is still a matter of debate. It has been proposed that using prostheses made of Nitinol, a shape-memory metal, produces better functional results with less variability and reduced risk for middle and inner ear damage. This is thought to be because heat activation rather than manual crimping of the prosthesis loop forms a tighter fixation. METHODS:: Functional results of two groups were compared 1 year after surgery. In one group were 75 cases of stapedotomy performed using Nitinol prostheses. Results were analyzed prospectively and compared with 75 retrospectively analyzed matched controls with conventional stapes prostheses. Crimping quality was measured in 23 patients by intraoperative laser Doppler interferometry (LDI). Causality was assessed by correlating results of intraoperative LDI and postoperative pure-tone thresholds. RESULTS:: Nitinol and conventional prostheses yielded postoperative air-bone gaps (ABGs) of 8.0 and 11.6 dB with 71 and 43% ABG closure within 10 dB, respectively. Intraoperatively, sound transmission was improved by 2.5 dB with the Nitinol prostheses as compared with conventional prostheses. These differences were statistically significant. Intraoperative fixation quality was positively correlated to functional outcome, but results were not statistically significant. CONCLUSION:: Tight fixation, as provided by Nitinol prostheses leads to improved functional results because of better sound transmission properties at the incus-prosthesis interface. The improvement in ABG closure is in the range of 3 dB pure-tone average and more pronounced at higher frequencies. Nitinol prostheses provide an effective treatment option in otosclerosis surgery.

• Implanting Common Cavity Malformations Using Intraoperative Fluoroscopy.

  Authors: Daniel Coelho, Susan Waltzman, J Thomas Roland

  Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology.

  OBJECTIVE:: To describe a safe and effective technique for the implantation of common cavity cochleae. STUDY DESIGN:: Retrospective case review. SETTING:: Tertiary referral center. PATIENTS:: FifteenOBJECTIVE:: To describe a safe and effective technique for the implantation of common cavity cochleae. STUDY DESIGN:: Retrospective case review. SETTING:: Tertiary referral center. PATIENTS:: Fifteen cochleae in 9 adults and children with common cavity deformities implanted with and without the use of intraoperative fluoroscopy. INTERVENTION(S):: Fluoroscopically assisted cochlear implantation. MAIN OUTCOME MEASURE(S):: Rates of extracochlear placement, bending, kinking, intrameatal placement, and complications were analyzed. Numbers of electrodes inserted, number of active electrodes, and speech performance were compared between the 2 groups. RESULTS:: Half of the nonfluoroscopy group had suboptimal placement of their electrode arrays. This group also had a higher rate of complications, lower numbers of electrodes implanted, and lower number of active electrodes at follow-up. Results of speech perception testing suggest that fluoroscopically assisted implantation of the common cavity results in improved performance. CONCLUSION:: Intraoperative fluoroscopy is an easy, safe, and effective technique that results in improved outcomes for cochlear implant patients with common cavity deformities.

• The Influence of Age and Vestibular Disorders on Gaze Stabilization: A Pilot Study.

  Authors: Miranda Pritcher, Susan Whitney, Gregory Marchetti, Joseph Furman

  Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology.

  OBJECTIVE:: The purpose of this study was to identify the sensitivity and specificity of a computerized gaze stabilization test (GST), to analyze if age affects vestibulo-ocular reflex function, andOBJECTIVE:: The purpose of this study was to identify the sensitivity and specificity of a computerized gaze stabilization test (GST), to analyze if age affects vestibulo-ocular reflex function, and to assess differences of vestibulo-ocular reflex function between patients and control subjects. STUDY DESIGN:: Descriptive, cross sectional. SETTING:: Tertiary medical center. PATIENTS:: Fifty-seven subjects, including 20 young controls (20-40 yr), 21 elderly controls (60-80 yr), and 16 patients with vestibular disease (20-80 yr), were included. MAIN OUTCOME MEASURES:: Sensitivity and specificity characteristics of the GST, which records visual acuity during active head movement. RESULTS:: Identification of subjects with vestibular disease was maximized at an average downward velocity of less than 61 degrees per second and a likelihood ratio of 4.4 (sensitivity, 44%; specificity, 90%). Patients demonstrated significantly slower GST downward speeds than the control-young subjects. There were no differences in GST head velocities in either the pitch or yaw planes between young and older control subjects. CONCLUSION:: There were no differences in GST maximum velocities in healthy young and older adults. The GST maximum velocity differentiated between young control subjects and patients with vestibular disorders in the pitch plane.

• The Effect of the Meniett Device in Patients With Ménière's Disease: Long-Term Results.

  Authors: John Dornhoffer, Deanne King

  Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology.

  OBJECTIVE:: To review our long-term experience with the Meniett device in patients who failed medical management to analyze its efficacy in controlling vertigo and its impact on the functional levelOBJECTIVE:: To review our long-term experience with the Meniett device in patients who failed medical management to analyze its efficacy in controlling vertigo and its impact on the functional level of the patient. STUDY DESIGN:: Retrospective case review with long-term follow-up of patients receiving the Meniett device at our institution between May 2002 and April 2005. SETTING:: Tertiary referral center. PATIENTS:: Patients who failed medical therapy for Ménière's disease and opted to receive the Meniett over chemical labyrinthectomy, surgical labyrinthectomy, endolymphatic shunt surgery, or vestibular nerve section. INTERVENTION:: The Meniett is a small, portable, low-pressure pulse generator meant to be self-administered, requiring 5-minute sessions 3 times a day. MAIN OUTCOME MEASURE:: Patient's current perception of usefulness of Meniett device for controlling vertigo and current level of Meniett treatment. RESULTS:: Of 14 patients meeting the study criteria, 12 were able to be contacted, giving an average follow-up of 4 years. Three patients (25%) showed no benefit; 9 patients (75%) did respond to the Meniett and thought it had reduced the frequency and severity of their vertigo attacks. Seven patients (58%) continued to use the device on a daily basis; the other 2 patients (17%) went into remission 2 and 3 years after initiating treatment. CONCLUSION:: The Meniett device is a minimally invasive, nondestructive treatment that may be used to provide longer-term reduction of vestibular symptoms in patients with Ménière's disease.

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