Issam Saliba

Université de Montréal, Montréal, Quebec, Canada

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Publications (78)86.54 Total impact

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    ABSTRACT: To assess the utility of the paraclinical tests in patients presenting with clinical diagnosis of cervicogenic dizziness.
    07/2014;
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    ABSTRACT: Craniofacial microsomia involves structure of the first and second branchial arches. A wide range of ear anomalies, affecting external, middle and inner ear, has been described in association with this condition. We report three cases of anteverted internal auditory canal in patients presenting craniofacial microsomia. This unique internal auditory canal orientation was found on high-resolution computed tomography of the temporal bones. This internal auditory canal anomaly is yet unreported in craniofacial anomalies.
    International journal of pediatric otorhinolaryngology. 06/2014;
  • Anastasios Maniakas, Issam Saliba
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    ABSTRACT: Review the useful hearing preservation and tumor control outcomes of microsurgery (MS), stereotactic radiation (SR), conservative management (CM), and chemotherapy (ChT) for Neurofibromatosis type 2 vestibular schwannomas. Ovid MEDLINE was used to conduct a thorough search of English-language publications dating from 1948 to February 2013. Patients must have had useful hearing at diagnosis and treated with one of the 4 treatments as their primary therapy. All sporadic vestibular schwannoma cases were excluded. A total of 19 articles were reviewed. Hearing preservation was defined as unchanged or improved useful hearing. Tumor control was defined as no change in size or tumor regression for SR, CM, and ChT-treated cases, and as no recurrence for MS treated cases. Microsurgery seems to have the worse overall results, while SR has very good tumor control with poor useful hearing preservation. If a patient qualifies for CM, he is likely to show the most satisfactory results with the least treatment available. A close follow-up on ChT clinical trials and possible side-effects is warranted as preliminary short-term results are quite favorable. Additional long-term studies are required for a better understanding of this disease.
    Otology & neurotology: official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology 03/2014; · 1.44 Impact Factor
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    ABSTRACT: This study intends to identify factors that could better predict the diagnosis of perilymphatic fistula (PLF) since exploration surgery is currently the only confirmatory method. This retrospective chart review in a tertiary care center is based on all 71 available patient files operated for a suspicion of PLF between 1983 and 2012. History of predisposing factors, clinical findings and investigations were documented pre- and postoperatively. Patients were divided according to intraoperative findings into two groups: group I (fistula negative) and group II (fistula positive). In addition, group II was divided into two subgroups: patients with or without a history of stapedectomy. Both groups were demographically similar. With the exception of history of previous partial stapedectomy (p = 0.04), no statistical difference could be identified in predisposing factors and in clinical findings between the two groups. The evolution of symptoms showed an overall improvement of vestibular symptoms (91 %) and cochlear symptoms (53 %) postoperatively. Audiograms showed a significant improvement postoperatively in the pure tone audiometry and bone conduction threshold of group II while the air-bone gap and speech discrimination score did not improve. Group I did not show any significant improvement postoperatively in any audiogram parameter. This study failed to identify factors that could better predict the diagnosis of PLF. However, it shows that middle ear exploration with oval and round window obliteration is effective in PLF especially to decrease vestibular symptoms even when fistula is unidentified intraoperatively.
    Archives of Oto-Rhino-Laryngology 03/2014; · 1.29 Impact Factor
  • Musaed Alzahrani, Issam Saliba
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    ABSTRACT: We aim to compare the hyaluronic acid to fat graft myringoplasty (HAFGM) technique to a recently described modified-FGM (M-FGM) in the repair of tympanic membrane perforation (TMP). We also aim to evaluate the hearing level improvement postoperatively. We conducted a prospective study in an adult tertiary care center between 2012 and 2013. Adult patients presenting with simple TMP were operated on randomly using either HAFGM or M-FGM under local anesthesia in outpatients' settings. Success was considered when complete closure is achieved. Audiometric parameters were evaluated pre and postoperatively. Twenty-four patients were included in the study (HAFGM: 10 patients and M-FGM: 14 patients). Complete closure was achieved in 80 % in HAFGM vs 42.8 % in the M-FGM (p = 0.03). The study was abandoned due to the low success rate in first 14 patients of the M-FGM group. The pure tone audiometry was improved postoperatively in the HAFGM only. The study was aborted because of the unsatisfactory obtained results using the MFGM. It also shows the beneficial effect of hyaluronic acid application to FGM for a successful TMP repair.
    Archives of Oto-Rhino-Laryngology 03/2014; · 1.29 Impact Factor
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    ABSTRACT: The purpose of this study is to evaluate hearing outcomes following partial stapedectomy according to age at the time of surgery and evaluate functional hearing at ≥10 years' follow-up, and to assess the effect of delay in surgery on overall functional hearing outcomes. Data were collected from patients operated upon for otosclerosis by a single surgeon from 1990 to 1999. Pure-tone air (PTA), pure-tone bone (PTB), air-bone gap (ABG), air-conduction at 8 kHz (AC 8), bone-conduction at 4 kHz (BC4) and speech discrimination score (SDS) were compared between patients <45 and ≥45 years old, as well as correlated with overall age preoperatively, short term (4 months) and long term (>10 years), postoperatively. Forty-five patients were included with a mean follow-up of 12.6 years. Mean preoperative ABG and AC 8 values were significantly different between the two age groups (p = 0.002; p = 0.010, respectively). No values remained significantly different between the two age groups at the long-term follow-up. ABG values correlated with age preoperatively (p = 0.001), although no correlation was seen short- and long-term postoperatively (p = 0.980; p = 0.495, respectively). Mean PTA, PTB, and ABG values showed a significant improvement in both groups preoperatively to short-term postoperatively (p < 0.001). Although mean PTA values decreased significantly from short- to long-term follow-ups in both groups (p = 0.033; p = 0.020), the improvement from the preoperative state remained significant (p < 0.001). Regardless of age at the time of surgery, long-term hearing levels will evolve similarly in patients <45 and ≥45 years old. Furthermore, no difference will be seen in hearing measurements between the two age groups at ≥10 years postoperatively. Delaying a surgery would thus not affect overall long-term hearing outcomes.
    Archives of Oto-Rhino-Laryngology 03/2014; · 1.29 Impact Factor
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    ABSTRACT: Identify independent clinical and audiometric factors to predict a positive high-resolution computed tomography (HRCT) scan for superior canal dehiscence (SCD). Retrospective chart review. Tertiary referral center. Patients presenting SCD. Audiogram, VEMP, temporal bone HRCT, and SCD symptoms and signs chart. ABG, VEMP threshold, and symptoms and signs. Approximately 106 patients with SCD symptoms were included: 62 had a positive and 44 had a negative CT scan. The positive scan group showed a higher average of cochlear symptoms than the negative CT scan group (4.3 versus 2.6) (p < 0.001), but no statistical difference for vestibular symptoms (2.2 versus 1.8) was identified. CVEMP thresholds of the positive and negative CT scan groups were of 66 and 81 dB, respectively (p < 0.001). The positive CT scan group showed higher ABGs at 250 Hz (24 versus 14 dB) and 500 Hz (17 versus 8 dB) (p = 0.008 and p = 0.008, resectively). No statistical significance was found when comparing both groups for air and bone conduction thresholds. Approximately 23% of the positive CT scan group showed a Valsalva-induced vertigo against 2.3% of the negative scan group (p = 0.003); 27% of the positive CT scan group showed speculum-induced vertigo but none of the negative scan patients (p < 0.001). Using logistic regression, we found that each 10-dB unit increase in the 250 Hz ABG is associated to an increase odd of having SCD of 51% (OR, 1.51; 95% CI, 1.10-2.08). Nature and number of cochlear symptoms, Valsalva and pneumatic speculum-induced vertigo, VEMP thresholds, and ABGs seem to correlate with a positive HRCT. The ABG at 250 Hz is the most accurate predictor of SCD.
    Otology & neurotology: official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology 02/2014; 35(2):338-43. · 1.44 Impact Factor
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    ABSTRACT: Objectives To evaluate hearing in children diagnosed with shaken baby syndrome. Methods A retrospective study, conducted in a pediatric tertiary care center between 2006 and 2012. Children diagnosed with shaken baby syndrome were included for hearing evaluation by conventional audiometry, distortion products otoacoustic emissions and auditory brainstem responses. Results Twenty-eight children were included (22 boys and 6 girls). The mean age of children at presentation was 8 months (range 1–26 months) and the mean delay before audiometric evaluation was 30 months (range 1 - 87 months). One child was diagnosed as having a moderate sensorineural hearing loss. The tympanic membrane mobility was normal (type A) for both ears in 22 children, one child had a reduced tympanic mobility in one ear, two children had a negative pressure, one child had a functional trans-tympanic tube and test was not performed in 2 patients. Conclusion This is the first study reporting hearing loss as a possible result of shaken baby syndrome. However, further studies with larger number of children would be preferable. We recommend hearing evaluation for these children to rule out hearing loss.
    International journal of pediatric otorhinolaryngology 01/2014; · 0.85 Impact Factor
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    ABSTRACT: The objective of this study is to describe the superior canal dehiscence syndrome (SCDS) and its vestibule-cochlear manifestations, while analyzing dehiscence size, audiogram and vestibular-evoked myogenic potential (VEMP) changes following dehiscence obliteration. We conducted a prospective study in a tertiary referral center. All Patients diagnosed and surgically treated for SCDS were operated through a middle fossa craniotomy (MFC). Clinical and radiological data were collected. The main outcome measures were Air-bone gaps, Pure-tone average (PTA), speech discrimination scores (SDS) and VEMP thresholds and were correlated to dehiscence size. 28 patients were included in this study with a mean dehiscence size of 4.68 mm. Phonophobia and imbalance were the most debilitating cochlear and vestibular symptoms, respectively. At 2 months postoperatively, low-frequency air-bone gaps showed a statistically significant improvement (p < 0.001). SDS and PTA did not show any statistically significant changes 2 months postoperatively (p = 0.282 and p = 0.295, respectively). VEMP threshold differences between operated and contralateral ears were statistically significant preoperatively (p < 0.001) and non-significant 2 months postoperatively (p = 0.173). Dehiscence size only showed a statistically significant correlation with preoperative total cochlear symptoms, while remaining insignificant with all other variables measured. Air-bone gaps, VEMP and computerized tomography remain essential tools in diagnosing and following SCDS. Dehiscence size is an independent factor in the analysis of SCDS, with cochlear symptomatology being associated to dehiscence sizes. Finally, it is shown that overall symptomatology, audiometric results and VEMP thresholds return to normal values post-obliteration, confirming the continuing success of the MFC approach for SCDS obliteration.
    Archives of Oto-Rhino-Laryngology 10/2013; · 1.29 Impact Factor
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    ABSTRACT: Objective: To investigate the effect of hyaluronic acid(HA) associated to fat graft on growth factors expression during the healing process of tympanic membrane(TM) perforations in guinea pigs using the hyaluronic acid fat graft Myringoplasty(HAFGM) technique. Study Design: Prospective randomized animal study. Methods: Thirty guinea pigs were divided equally into 3 groups: Group I(control group), group II(fat graft Myringoplasty technique) and group III(HAFGM technique). TMs were perforated on day 1, then sampled on days 0, 3, 8 and 21 and tested for the expression of: Epidermal growth factor(EGF), Insulin-like growth factor(IGF), Tumor necrosis factor α(TNF α), vascular endothelial growth factor(VEGF) and Keratinocyte growth factor(KGF). Five perforated TMs were taken at day 0 from group I to serve as a reference level. Results: Group III showed an increased expression of all tested growth factors except for KGF. EGF was highest in the early healing process; then IGF peaked at day 8 with statistically significant increase compared to groups I and II. TNF α in group III was significantly higher than group I throughout the study with a peak level at day 21. VEGF was significantly higher in group III compared to group I at days 3 and 21. Neovascularization and scarless TM closure was obtained in group III while spontaneous closure was associated with thin layered and scarred TM in group I. Conclusion: HA association to fat graft in perforated TM increases the expression of the endogenous growth factors suggesting that such association is advantageous for healing.
    The Laryngoscope 10/2013; · 1.98 Impact Factor
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    ABSTRACT: Objective: to assess the hearing status of trisomy 21 patients by analyzing electrophysiological and radiological findings of any correlation between hearing impairment and major or minor inner ear malformations. Study Design: Prospective radiological and electrophysiological study. Methods: A group of 34 ears of Down syndrome subjects and a 20 ears of volunteering age and sex matched control group of 10 normal patients were studied electrophysiologically by means of otoacoustic emissions and auditory brain stem response. Temporal bone CT Scans were carried out in both groups; radiological findings were compared. Inner ear structures measurements were applied attempting to disclose subtle bony labyrinthine anomalies. The findings from both groups were statistically analyzed employing t-test. Results: The rate of sensorineural hearing loss (SNHL) in Down syndrome group was 41%. Temporal bone CT Scan showed no ossicular malformation in all Down syndrome cases. Major inner ear abnormalities were disclosed in 5.8%; they corresponded to 2 cases of lateral semicircular canal dysplasia detected on CT images by visual inspection. The application of various inner ear structures measurements increased the overall detection rate of common inner ear malformations to 47%. A statistically significant correlation was found between hearing level and vestibule length (p=0.009) and internal auditory canal length (p=0.028). Vestibular aqueduct width is correlated to different otic abnormalities. Conclusions: SNHL is mainly secondary to the underestimated subtle inner ear malformations that are adequately demonstrated by adopting standardized inner ear structures measurements on petrous bone imaging. Vestibular height and IAC length are correlated to SNHL.
    The Laryngoscope 09/2013; · 1.98 Impact Factor
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    Musaed Alzahrani, Issam Saliba
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    ABSTRACT: Our objectives were to review all reported staging systems of tympanic membrane (TM) retraction pockets (RP) and to report their reliability and utility to our daily clinical practice in terms of follow-up and decision making in the management of RP. We aim to propose a new management algorithm of TMRPs. We conducted a thorough research on Ovid Medline, Pubmed and Cochrane databases for English and French languages studies published between 1963 and 2012 on the retraction pocket. Studies were excluded if it were a short comments, photo clinical cases, experimental studies or round table articles. Cholesteatoma was not included in keywords, since it is considered as an advanced pathological entity with different staging and management approaches. We included 60 of 756 articles that met our inclusion criteria. Sadé and Berco proposed the first staging system of RP in 1976, while the last one was described by Borgstein et al. in 2007. From 1976 to 2007, 12 different staging systems have been described for tympanic membrane retractions. There are three broad categories of TMRPs: localized retractions of the pars tensa, generalized retractions of the pars tensa (atelectasis) and retraction of the pars flaccida. Most of the described staging systems are useful for following up the evolution of retractions over time. However, no consensus was found concerning the decision making in its management. In conclusion, proper management of TMRPs requires a reproducible, easily applicable staging system with low inter- and intra-observer variability. We propose a management algorithm that considers the functional handicap of the patient rather than the topographic description of the TM.
    Archives of Oto-Rhino-Laryngology 07/2013; · 1.29 Impact Factor
  • Nathalie Gabra, Issam Saliba
    Otolaryngology Head and Neck Surgery 07/2013; 149(1):175-6. · 1.73 Impact Factor
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    Otology & neurotology: official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology 05/2013; · 1.44 Impact Factor
  • Nathalie Gabra, Issam Saliba
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    ABSTRACT: Objectives To compare the efficacy of intratympanic injections of methylprednisolone (ITMP) and intratympanic injections of gentamicin (ITG) to control the symptoms of Ménière's disease and to evaluate their effect on hearing level.Study DesignA historical cohort study.SettingTertiary referral center.Subjects and Methods Eighty-nine patients affected by Ménière's disease were included in this study, of whom 47 were treated with ITG and 42 were treated with ITMP. Two periods of follow-up were considered: 0 to 6 months and 6 to 12 months after the intratympanic injections (ITI). Mean outcome measurements consisted of control of vertigo attacks, tinnitus, and aural fullness; pure-tone average (PTA); and speech discrimination score (SDS).ResultsThe 2 groups had the same number of vertigo spells per month before ITI (P = .883). Six to 12 months after ITI, 82.9% of the ITG group and 48.1% of the ITMP group achieved complete control of vertigo (P = .004). There was better control of tinnitus and aural fullness with ITG than with ITMP (P ≤ .002). The 2 groups had a statistically significant difference in hearing level before ITI (P ≤ .001). This difference was no longer present 6 to 12 months after ITI (P > .05).Conclusion Intratympanic injections of gentamicin are more efficient than ITMP in controlling the symptoms of Ménière's disease. The 2 groups ended up without a difference in hearing level after ITI. According to these findings, administrating ITMP to control Ménière's disease seems to be less beneficial than ITG.
    Otolaryngology Head and Neck Surgery 01/2013; · 1.73 Impact Factor
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    ABSTRACT: Malignant peripheral nerve sheath tumors (MPNSTs) are rare entities and MPNSTs of intracranial nerves are even more sporadic. MPNSTs present diagnosis and treatment challenges since there are no defined diagnosis criteria and no established therapeutic strategies. We reviewed literature for MPNST-related articles. We found 45 relevant studies in which 60 cases were described. We identified 60 cases of intracranial nerve MPNSTs. The age ranged from 3 to 75 years old. Male to female ratio was 1.5:1. The most involved cranial nerves (CNs) were CN VIII (60%), CN V (27%), and CN VII (10%). Most of the MPNSTs reported (47%) arose sporadically, 40% arose from a schwannoma, 8% arose from a neurofibroma, and 6% arose from an unspecified nerve tumor. Twenty patients had a history of radiation exposure, four patients had neurofibromatosis type 1 (NF1), four patients had neurofibromatosis type 2 (NF2), and NF2 was suspected in two other patients. Twenty-two patients were treated with radiotherapy and presented a higher survival rate. Seventy-two percent of patients died of their disease while 28% of patients survived. One-year survival rate was 33%. Forty-five percent of tumors recurred and 19% of patients had metastases. MPNSTs involving CNs are very rare. Diagnosis is made in regards to the histological and pathological findings. Imaging may help orient the diagnosis. A preexisting knowledge of the clinical situation is more likely to lead to a correct diagnosis. The mainstay of treatment is radical surgical resection with adjuvant radiotherapy. Since these tumors are associated with a poor prognosis, a close follow-up is mandatory.
    OncoTargets and Therapy 01/2013; 6:459-70. · 2.07 Impact Factor
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    ABSTRACT: A 48-year-old woman presented with unilateral hearing loss and tinnitus for three years associated with middle ear effusion. Previous treatments, including antibiotics, corticoids, and transtympanic tube, were ineffective. Otomicroscopy showed a greyish retrotympanic mass associated with middle ear effusion. High resolution CT scan of the mastoid was in favor of chronic oto-mastoiditis without any evidence of tegmen dehiscence. Surgical exploration revealed a polypoid greyish mass filling the tympanic cavity. Histological examination postoperatively revealed a meningothelial meningioma. Postoperative magnetic resonance imaging (MRI) was obtained and showed a large skull base meningioma, extending from the clivus anteriorly to the porus acusticus posteriorly with middle ear invasion. After discussion with the multidisciplinary tumor board, it was managed by stereotactic radiotherapy due to the high surgical associated neurovascular risks. In conclusion, middle ear meningioma, although still a rare presentation, should be suspected in the presence of atypical chronic OME.
    Case Reports in Medicine 01/2013; 2013:396805.
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    ABSTRACT: OBJECTIVES To compare hyaluronic acid fat graft myringoplasty (HAFGM) with fat graft myringoplasty (FGM) on grade I tympanic membrane perforations (TMPs) (<25% of the tympanic membrane surface) and to assess 12-month postoperative hearing outcomes in a pediatric population. DESIGN Prospective study. SETTING Tertiary care pediatric center. PATIENTS Ninety-two children with a TMP were included in the study and were operated on using either the HAFGM (n = 50) or FGM (n = 42) technique. Age at surgery ranged from 4 to 17 years (mean age, 11.52 years). INTERVENTIONS Hyaluronic acid fat graft myringoplasty is a new technique for TMP repair in a pediatric population and is performed using local anesthesia at the outpatient office. MAIN OUTCOME MEASURES Postoperative status of the tympanic membrane, hearing improvement, and incidence of complications. RESULTS Successful closure of the tympanic membrane was achieved in 90% of the HAFGM group and in 57.1% of the FGM group (P = .004). The mean (SD) postoperative air-bone gap in the HAFGM (6.86 [8.52] dB) group was significantly lower than in the FGM (18.32 [13.44] dB) group (P < .002). The mean postoperative follow-up time was 31.5 and 34.7 months for HAFGM and FGM groups, respectively. No difference was observed between children 10 years or younger and children older than 10 years. In the 2 groups, no postoperative complications were observed. The location of the perforation was not found to be a factor indicative of failure. CONCLUSIONS The success rate of HAFGM is superior to that of FGM alone. Hyaluronic acid fat graft myringoplasty can be performed as an office-based procedure using local anesthesia and requires no hospitalization. Because of its substantial advantages, HAFGM could be considered as the first choice for the reconstruction of a dry TMP in the pediatric population.
    Archives of otolaryngology--head & neck surgery 10/2012; 138(10):950-5. · 1.92 Impact Factor
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    ABSTRACT: OBJECTIVES: BAHA implantation surgery in a pediatric population is usually done in two-stage surgeries. This study aims to evaluate the safety and possible superiority of the one-stage over the two-stage BAHA implantation and which one would be the best standard of care for our pediatric patients. METHODS: A retrospective chart review of 55 patients operated in our tertiary care institutions between 2005 and 2010 was conducted. The actual tendency in our institutions, applied at the time of the study, is to perform a one-stage surgery for all operated patients (pediatric and adult), except for patients undergoing translabyrinthine surgeries for cerebellopontine tumor excision. These patients indeed had a two-stage insertion. 26 patients underwent one-stage surgery (group I) while 29 patients had a two-stage (group II) BAHA insertion. A period of 4 months was allowed for osseointegration before BAHA processor fitting. As for the safety assessment of the one-stage surgery, we compared both groups regarding the incidence and severity (minor, moderate and major) of encountered complications, as well as the operating time and follow-up. The operating time of the two-stage surgery includes the time of the first and of the second stage. RESULTS: The mean age at surgery was 8.5 years old for the group I and 50 years old for the group II patients. There was no difference in the incidence of minor (p=0.12), moderate (p=0.41) nor severe (p=0.68) complications between groups I and II. Two cases of traumatic extrusion were noted in the group I. Furthermore, the one-stage BAHA implantation requests a significantly lower operating time (mean: 54 [32-100] min) than the two-stage surgery (mean: 79 [63-148] min) (p=0.012). All pediatric cases of BAHA insertion were performed in a one day surgery. The mean postoperative follow-up was 114 and 96 weeks for groups I and II respectively (p=0.058). CONCLUSIONS: One-stage BAHA insertion surgery in the pediatric population is a reliable, safe and efficient therapeutic option that allows a good result in a significantly lower operating time compared to the two-stage insertion and is achieved in a one day surgery. It could therefore be considered as a standard of care for pediatric patients.
    International journal of pediatric otorhinolaryngology 09/2012; · 0.85 Impact Factor
  • Anastasios Maniakas, Issam Saliba
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    ABSTRACT: OBJECTIVE: To compare the long-term outcome of hearing and tumor outcome of small vestibular schwannomas treated with stereotactic radiation and microsurgery. DATA SOURCES: A thorough search for English-language publications and "in process" articles dating from 1948 to December 2011 was conducted using Ovid MEDLINE. STUDY SELECTION: The principal criteria were patients having had microsurgery or radiation therapy as their sole treatment, with a follow-up of at least 5 years, and a useful hearing level at diagnosis. DATA EXTRACTION: Sixteen studies met our criteria. Hearing preservation outcome (worse or preserved) and tumor outcome (failure, control) data, as well as all other significant observations, were collected from the articles. Stereotactic radiation was the only radiation therapy analyzed. DATA SYNTHESIS: The Pearson χ test was our primary statistical analysis. CONCLUSION: Stereotactic radiation showed significantly better long-term hearing preservation outcome rates than microsurgery (p < 0.001). However, long-term tumor outcome was not significantly different in stereotactic radiation as compared with microsurgery (p = 0.122). Although stereotactic radiation demonstrates a more favorable long-term hearing preservation outcome as compared with microsurgery, additional studies are required to provide the medical field with a better understanding of vestibular schwannoma treatment.
    Otology & neurotology: official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology 09/2012; · 1.44 Impact Factor

Publication Stats

203 Citations
86.54 Total Impact Points

Institutions

  • 2006–2014
    • Université de Montréal
      • School of Speech Pathology and Audiology
      Montréal, Quebec, Canada
  • 2008–2013
    • Centre hospitalier de l'Université de Montréal (CHUM)
      Montréal, Quebec, Canada
  • 2011
    • CHU Sainte-Justine
      Montréal, Quebec, Canada
  • 2009
    • Hotel Dieu Hospital
      Kingston, Ontario, Canada