Issam Saliba

Université de Montréal, Montréal, Quebec, Canada

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Publications (93)116.82 Total impact

  • Issam Saliba · Chady Dagher · Elie El-Zir · Fady G Yammine ·
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    ABSTRACT: To assess the effect of chronic middle ear effusion (CMEE) on balance and equilibrium. Prospective study controlling two groups of children. The active arm consisted of children having a unilateral or bilateral CMEE that persisted for at least 3 months. The control group consisted of children presenting with normal middle ear. Children and parents in both groups were questioned about any symptom of vertigo, dizziness, disequilibrium or child's tendency to fall. ENT exam included an assessment with pneumatic and microscopic otoscopy, evaluation of the vestibular system with the Romberg test, the Fukuda test, the head-shaking test and the Starwalk test. The study group consisted of 15 children (mean = 6.5 years, SD = 2; 10 females and 5 males). The control group consisted also of 15 children (mean = 7.2 years, SD = 1.8; 8 females and 7 males). The duration of MEE was between 3 and 12 months (mean = 8 months). Three children (20%) in the study group had a history of vertigo, imbalance, disequilibrium and/or tendency to fall. None of the children in the control group had such a history (p = 0.22); Five children in the study group had abnormal head-shaking test, Fukuda and/or Starwalk tests (33.33%). Two children in the control group had such a finding (13.33%) (p = 0.39). Romberg test was normal in all children in both groups. In the study group, one child showed positional and spontaneous nystagmus on VNG testing. Another one showed positional nystagmus. Hence, 2 children had abnormal findings on VNG (13.33%). In the control group, VNG was normal in all children (p = 0.46). Tympanometry showed a type B curve in 26 ears, a type C curve in 3 ears and type A in one ear. In the control group all patients presented a type A curve. This paper describes the first study using VNG in a population of children with CMEE. The presence of balance disturbances associated or not with hearing loss is of paramount importance to the clinician as to the indications of myringotomy with a tube intervention.
    07/2015; 11(2). DOI:10.2174/1573396311666150702105027
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    Cinzia L Marchica · Issam Saliba ·
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    ABSTRACT: To identify whether measurement of the prosthesis length is mandatory in patients requiring otosclerosis surgeries and to assess their postoperative audiometric outcomes. In addition, evaluation of prosthesis length used in revision compared to primary stapedectomy was carried out. Case series with chart review. Chart review of 393 patients undergoing primary (321) versus revision stapedectomy (72) was performed in a tertiary referral center. The indication for surgery was the presence or persistence/recurrence of an air-bone gap (ABG) greater than 20 dB. Air and bone conduction thresholds (ACT and BCT, respectively), ABG as well as pure tone averages (PTAs) were determined for all patients, and the results were compared preoperatively and postoperatively. Prosthesis length used ranged from 3.0 to 6.0 mm without differences between primary and revision groups. Of the revision surgeries, 62.5% were stapedectomies versus stapedotomies (P < 0.001). Patients showed significant decrease in speech discrimination score, with increased air and bone conduction thresholds as well as mean ABG and PTA before the revision surgeries as a first procedure failure. Prosthesis length changes occurred in 73.5% of the cases, with an average absolute change of 0.55 mm. Prosthesis length did not affect postoperative audiometric results between primary and revision groups, in all surgeries combined. When grouping stapes surgery into accurately versus inaccurately measured incus-footplate distance, significant differences were observed in prosthesis length employed (P < 0.01). Hearing outcomes were also better in the group in which an accurately measured prosthesis was chosen, as opposed to "standard-length" prosthesis. This study corroborates postoperative success rates of revision surgeries, which show smaller improvements in hearing compared to a primary intervention. Accurate intra-operative measurement of prosthesis length was correlated with better audiometric results postoperatively.
    06/2015; 8:23-31. DOI:10.4137/CMent.s27284
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    ABSTRACT: Superior canal dehiscence (SCD) is a benign condition in which a surgical treatment may be considered depending on the patients' tolerance of their symptoms. In this study, we aim to identify driving factors behind the patients' choice of a surgical management over watchful waiting. Sixty-two patients with cochlear and/or vestibular symptoms and a temporal bone high-resolution CT (HRCT) scan showing SCD were included in the study. All patients have been offered either surgical management or watchful waiting. Of these, 28 elected surgery and 34 declined it. The operated group showed more cochlear (6.6 vs. 2.4) symptoms than the non-operated group (P < 0.001) except for hypoacousis, but no significant difference (P = 0.059) was found for the number of vestibular symptoms between both groups (3.4 vs. 1.1). Footstep and eating hyperacousis were both present in 57.1% of operated vs. 3% of non-operated patients (P < 0.001). Oscillopsia with effort and with walking was found in 50% and 35.7% of operated patients, respectively, but none in the non-operated group (P < 0.001). Hearing tuning fork at malleolus and Valsalva and pneumatic speculum induced vertigo showed a statistically significant difference between the two groups (P = 0.003, P < 0.001, P = 0.010 respectively). Cervical vestibular-evoked myogenic potential (cVEMP) thresholds, air and bone conduction thresholds, and mean air-bone gap (ABG) were similar in the two populations (P > 0.05). The average dehiscence size was 4.7 mm (2.0 - 8.0 mm) and 3.8 mm (1.3 - 7.7 mm) in the operated and non-operated patients, respectively (P = 0.421). The natures of cochleovestibular signs and symptoms were shown to be key factors in patients' choice of a surgical management whereas paraclinical tests seem to be less significant in the patients' decision for a surgical treatment.
    Journal of Clinical Medicine Research 05/2015; 7(5):308-14. DOI:10.14740/jocmr2105w
  • Émilie Gosselin · Anastasios Maniakas · Issam Saliba ·
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    ABSTRACT: The objective of this review is to compare the symptomatological evolution following conservative management (CM) or microsurgery (MS) in patients with intralabyrinthine schwannomas (ILS). A thorough systematic review of the English and French literature from 1948 to February 2014 was performed using Ovid Medline. An ancestor search was also completed. The major inclusion criterion consisted of a diagnosis of ILS with magnetic resonance imaging. Patients with a classic vestibular schwannoma, cases of incidentaloma during surgery or an autopsy were the main exclusion criteria. Thirty-one studies met our selective criteria. Descriptive data were collected from the articles. Clinical outcomes regarding the hearing loss, tinnitus, vertigo, dizziness and aural fullness were stated as improved, unchanged or worse at the last follow-up. All data were then separated into two different groups according to the management option: CM and MS. The data were analyzed using a Pearson χ (2) test and Fisher's exact test. This meta-analysis suggests that MS has a statistically significant favorable outcome regarding symptom relief compared to CM in patients with ILS suffering from tinnitus, vertigo and dizziness. Hearing level was not compared between treatment groups, as MS leads to anacusis. An indicative bias was the main limitation of this study, as patients suffering from intractable vertigo with moderate-to-severe hearing loss were referred to MS. Therefore, in the presence of a serviceable hearing, we suggest that CM should be the treatment of choice.
    Archiv für Klinische und Experimentelle Ohren- Nasen- und Kehlkopfheilkunde 02/2015; DOI:10.1007/s00405-015-3548-2 · 1.55 Impact Factor
  • S Belhassen · I Saliba ·
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    ABSTRACT: Objective: To determine the efficacy of intratympanic methylprednisolone injections for treating sudden sensorineural hearing loss. Method: A retrospective chart review was performed to identify patients suffering from sudden sensorineural hearing loss with no recovery after oral steroids. Patients were given up to three intratympanic methylprednisolone injections at one-week intervals. They were classified according to their functional hearing class, remission was monitored and potential factors affecting prognosis were analysed. Results: Intratympanic injections provide effective salvage therapy for sudden sensorineural hearing loss (p = 0.039). Changes in pure tone average and speech discrimination score were analysed following intratympanic methylprednisolone injections. The pure tone average reached a plateau after the second injection; however, the speech discrimination score improved until after the third injection. Hearing improvement after intratympanic injections mainly occurred at low frequencies. The interval between symptoms appearing and intratympanic injections starting was not significantly associated with remission (p = 0.680). Conclusion: A delay between symptom onset and the first intratympanic methylprednisolone injection does not seem to affect prognosis.
    The Journal of Laryngology & Otology 11/2014; 128(12):1-6. DOI:10.1017/S0022215114002710 · 0.67 Impact Factor
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    ABSTRACT: To compare the effectiveness of the endolymphatic duct blockage (EDB) and the endolymphatic sac decompression (ESD) to control Ménière's disease symptoms and to evaluate their effect on hearing level. Prospective nonblinded randomized study. Tertiary medical center. Fifty-seven patients affected by a refractory Ménière's disease were included out of which 22 underwent an ESD and 35 underwent an EDB. Five periods of follow-up were considered: 0 to 1 week, 1 week to 6 months, 6 to 12 months, 12 to 18 months, and 18 to 24 months. Mean outcome measurements consisted of vertigo control, tinnitus, aural fullness, instability, and hearing level. Hearing level was evaluated using pure-tone average (PTA) and speech discrimination score (SDS). There was no significant difference between the 2 groups in the number of vertigo spells per months preoperatively (P = .153). Twenty-four months postoperatively, 96.5% of the EDB group had achieved a complete control of vertigo spells against 37.5% of the ESD group with a statistically significant difference (P = .002). There was a better control of tinnitus and aural fullness with EDB (P = .021 and P = .014, respectively). There was no statistically significant difference in hearing level preoperatively (P = .976) and 24 months postoperatively (P = .287) between the 2 groups. Hearing level was preserved in each group with no significant difference between the preoperative and the postoperative levels (P > .05). EDB is more effective than the traditional ESD in controlling the symptoms of Ménière's disease. It is a novel surgical technique with promising results for a complete treatment of Ménière's disease. There are no significant complications or adverse effect. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2014.
    Otolaryngology Head and Neck Surgery 11/2014; 152(1). DOI:10.1177/0194599814555840 · 2.02 Impact Factor
  • M Alzahrani · P Tabet · I Saliba ·
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    ABSTRACT: Pediatric hearing loss limits the child ability to develop effective auditory and speech capabilities. Early rehabilitation of hearing loss results in higher levels of linguistic, academic and social skills. The etiology of hearing loss can be classified according to its nature as sensorineural hearing loss (SNHL), Conductive hearing loss (CHL) or Mixed hearing loss (MHL). Congenital hearing loss could be genetic or non genetic (acquired), syndromic or non-syndromic. Syndromic SNHL is relatively easy to diagnose because of the associated findings. In this review article, we aim to highlight the most common causes of pediatric hearing loss, their character and presentation and to review the diagnostic and therapeutic approaches of a deaf child. We report four algorithms of diagnosis and management of congenital hearing loss. Diagnosis of hearing loss starts at the neonatal period through the neonatal hearing screening programs. Establishment of hearing loss in neonatal period is either done by the Otoacoustic emissions or the Automated auditory brainstem responses. It is important to have a detailed and comprehensive history when assessing a child with SNHL. We should look for any prenatal, perinatal and postnatal events. Health care providers including pediatricians, geneticist and otolaryngologists should be aware of the most common causes for proper detection and early rehabilitation of those patients. The implementation of national newborn hearing screening programs has improved the management of affected children by rehabilitating them at early stages to allow for normal speech development.
    Minerva Pediatrica 10/2014; 67(1). · 0.43 Impact Factor
  • I. Saliba · É. Gosselin · A. Maniakas ·

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    ABSTRACT: Objective: To assess the utility of the paraclinical tests in patients presenting with clinical diagnosis of cervicogenic dizziness. Study Design: Case controlled. Setting: Otolaryngology clinic of a tertiary referral hospital center. Patients: Twenty-five subjects with cervicogenic dizziness and 25 subjects with benign paroxysmal positional vertigo. Main Outcome Measures: Symptoms description, Dizziness Handicap Inventory–short form (DHI), Trait anxiety score, cervical joint position error, the smooth pursuit neck torsion and cervical torsion tests on videonystagmography, and standing balance test (timed 10-meter walk with head turns). Results: The results showed differences in reported symptoms, in mean cervical joint position error (p = 0.001), and cervical torsion test (p = 0.001) between the two groups. There was no between-group difference for DHI scores (p = 0.137), trait anxiety scores (p = 0.240), and walking test: time (p = 0.797), steps (p = 0.963). The Youden index is 0.60 for the predictive value of the cervical joint position error, and the smooth pursuit and the cervical torsion tests. Conclusion: This study showed differences in sensorimotor disturbances between the two groups, particularly in the control of head and eye movements and cervical proprioception. Patients with cervicogenic dizziness were more likely to (1) have a sensation of drunkenness and lightheadedness, (2) have pain induced during the physical examination of the upper cervical vertebrae, (3) have an elevated joint position error of 4.5 degrees during the cervical relocation test, and (4) exhibit more than 2 degrees per second nystagmus during the cervical rotation test. The walking test was not able to differentiate the two groups.
    Ontology & Neurotology 07/2014; 35(10). DOI:10.1097/MAO.0000000000000506 · 1.79 Impact Factor
  • Bénédicte L'Heureux-Lebeau · Issam Saliba ·
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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; 78(9). DOI:10.1016/j.ijporl.2014.06.004 · 1.19 Impact Factor
  • Issam Saliba · Musaed Alzahrani · Tang Zhu · Chemtob Sylvain ·
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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 06/2014; 124(6). DOI:10.1002/lary.24468 · 2.14 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 05/2014; 78(5). DOI:10.1016/j.ijporl.2014.02.018 · 1.19 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 04/2014; 124(4). DOI:10.1002/lary.24375 · 2.14 Impact Factor
  • 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; 35(5). DOI:10.1097/MAO.0000000000000272 · 1.79 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; 272(8). DOI:10.1007/s00405-014-3007-5 · 1.55 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; 272(8). DOI:10.1007/s00405-014-2982-x · 1.55 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; 272(7). DOI:10.1007/s00405-014-2958-x · 1.55 Impact Factor
  • Lina Zahra Benamira · Musaed Alzahrani · Issam Saliba ·
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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. DOI:10.1097/MAO.0000000000000230 · 1.79 Impact Factor
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    Musaed Alzahrani · Louis Gaboury · Issam Saliba ·
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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 12/2013; 2013(6):396805. DOI:10.1155/2013/396805
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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; 271(11). DOI:10.1007/s00405-013-2711-x · 1.55 Impact Factor

Publication Stats

459 Citations
116.82 Total Impact Points


  • 2005-2015
    • Université de Montréal
      • School of Speech Pathology and Audiology
      Montréal, Quebec, Canada
  • 2010-2014
    • Hôpital Notre-Dame
      Montréal, Quebec, Canada
  • 2008-2014
    • Centre hospitalier de l'Université de Montréal (CHUM)
      Montréal, Quebec, Canada
  • 2010-2013
    • CHU Sainte-Justine
      Montréal, Quebec, Canada
  • 2009
    • Hotel Dieu Hospital
      Kingston, Ontario, Canada