08:36 AM

dures. Abnormal vestibular testing was noted in 44 of the 225 patients (19.5%). Sixteen patients returned for repeat testing with nine resolving their abnormal caloric testing. All patients with abnormal caloric results were effectively treated with CRP. CONCLUSIONS: The modified CRP technique is an effective treatment for BPPV. Abnormal vestibular testing may have implications of horizontal canal involvement in patients with BPPV. 08:18 AM Which Tinnitus Patient Benefits from Magnetic Stimulation? Tobias Kleinjung, MD (presenter); Thomas Steffens; Tobias Murthum, MD; Berthold Langguth, MD; Goeran Hajak, MD; Juergen Strutz, MD PhD; Peter Eichhammer, MD Regensburg Germany OBJECTIVE: Chronic tinnitus is associated with hyperactivity of the central auditory system. Low frequency repetitive transcranial magnetic stimulation (rTMS) of the temporal cortex was proposed as a treatment for chronic tinnitus. First results were promising; however, there was a high interindividual variability in treatment results. The following study was performed to determine those factors that may predict a favorable outcome of rTMS treatment. METHODS: Some 47 patients with chronic tinnitus received 10 sessions of low frequency rTMS (110% motor threshold, 1 HZ, 2000 stimuli/d) to their left auditory cortex. The position of the coil was determined by a neuronavigational system according to an individual MRI dataset. Treatment outcome was assessed with a specific tinnitus questionnaire (TQ). Success after therapy was correlated to the patients’ clinical data. RESULTS: Forty percent of patients improved 5 points or more in the TQ immediately after 10 days of therapy. For this responder group the mean improvement in the TQ at day (d) 10 was 13 points, at d18 11 points, and at d90 10 points. The improvements at any time were significant. The most obvious clinical characteristic of treatment responders was a shorter duration of tinnitus complaints (less than four years) compared to nonresponders. CONCLUSIONS: A longer-lasting and more pronounced improvement of tinnitus perception after rTMS was noticed in a subgroup with a short history of complaints. This could be because the induction of neuroplastic changes by rTMS, leading to a reduction of tinnitus complaints, might be easier to achieve in patients with shorter-lasting tinnitus. 08:28 AM Otologics™ Fully Implantable Hearing System: Phase I Results Herman A Jenkins, MD (presenter); Drew M Horlbeck, MD; James S Atkins, Jr, MD; Michael E Hoffer, MD; Ben J Balough, MD; Joseph Vincent Arigo, MD; George Alexiades, MD Denver CO; Boerne TX; Kissimmee FL; San Diego CA; New York NY

P51 OBJECTIVE: Assess the safety of the Otologics Fully Implantable Hearing Device in adults patients with bilateral moderate to severe sensorineural hearing loss. METHODS: Surgical insertion of this totally implanted electromechanical transducer included atticotomy exposure of incus, securing the transducer to the mastoid bone, attaching the transducer tip to the incus via insertion into a laser-drilled hole, and postauricular implantation of the microphone/battery/electronics capsule. A repeated-measures within-subjects design assessed aided sound field thresholds and speech performances with the subject’s own, appropriately fit, walk-in hearing aid(s) and the Otologics Fully Implantable Hearing Device. RESULTS: Worldwide, as of December 28, 2005, 23 patients have been implanted with the device and 19 activated. No significant differences between preoperative and postoperative pure tone averages were noted. U.S. Phase I trial results showed 20 to 25 dB of functional gain across audiometric frequencies. Word recognition scores and patient benefit scales did not demonstrate any significant differences between preoperative walk-in-aided and postoperative implant-aided conditions. CONCLUSIONS: Preliminary results of the Phase I trial of the Otologics™ Fully Implantable Hearing Device provide evidence that this fully implantable device may be a desirable alternative to currently available hearing aids in patients with sensorineural hearing loss. 08:36 AM Improvement of Staged Tympanoplasty for Cholesteatoma Yasuyuki Hinohira, MD (presenter); Naoaki Yanagihara, MD; Kiyofumi Gyo, MD Matsuyama-shi Japan; Matsuyama Japan; Onsengun Japan OBJECTIVE: 1. Describe the team’s latest improvement of a staged canal-wall-up tympanoplasty (SCUT). 2. Show more successful outcomes of the surgery compared with previous data. METHODS: Between 1997 and 2002 the improved SCUT was applied to 69 ears of 68 advanced cholesteatoma cases. The 68 consisted of 31 males and 37 females, aged 5 to 74 years of age. The surgery is described as follows: The first stage: (1) removal of the incus and the malleus head following posterior hypotympanotomy, (2) use of otoendoscope for total removal of cholesteatoma, (3) reconstruction of scutum bony defect with bone pate, (4) a silastic sheet insertion into the tympanic cavity to avoid adhesion of the tympanic membrane, and (5) closing of the opening of the mastoid cortex bone with bone pate. RESULTS: The second stage after about a year includes (1) reformation of the reconstructed scutum after removal of residual cholesteatoma if any, (2) ossicular chain reconstruction with hydroxyapatite prosthesis, and (3) closing of the opening of the mastoid cortex with bone pate. Mastoid cavity obliteration with hydroxyapatite granules is performed if poorly aer-

MONDAY

Scientific Sessions—Monday

P52

Otolaryngology-Head and Neck Surgery, Vol 135, No 2S, August 2006

ated. Over three years after the second-stage operation, the microscopic otoscopy revealed no recurrence. A shallow pocket in 4 cases and a deep pocket with no debris in 2 cases were seen. CONCLUSIONS: This incidence of postoperative pocket (6/ 69: 8.7%) is statistically smaller than the team’s previous data (41/134: 30.6%, p⬍0.05) in 1993. The conclusion is that the latest improvement of a SCUT is appropriate for prevention of cholesteatoma recurrence at the moment. 08:44 AM TYPE III Cartilage Shield Tympanoplasty: Hearing Results Efthymios Kyrodimos, MD (presenter); Daniel Santos, MD; Aristides Sismanis, MD Richmond VA OBJECTIVE: To report the hearing results following type III cartilage shield tympanoplasty. METHODS: Study Design: Retrospective chart review at a tertiary referral center. RESULTS: Conchal cartilage, shaped as a shield, was used to replace the entire tympanic membrane and reconstruct the ossicular chain in patients with absent incus and diminished space between stapes superstructure and alleolar manubrium. Graft take was evaluated in follow-up examination and hearing results were determined by comparing preoperative and postoperative pure tone and speech audiometry. Between January 1998 and June 2005, 52 patients (15 children and 37 adults) were treated. The mean age of these patients was 32.4 years (range 7-72 years). The mean follow up was 16 months (range 6 –36 months). In 29 patients (55.7%) the procedure was primary and in 23 (44.2%) revision. Twenty-five (48%) were for total tympanic membrane perforation, 18 (34.6%) for cholesteatoma, and 9 (17.3%) for atelectatic tympanic membranes. Graft take was successful in all patients. The average pre-op air-bone gap (ABG) was 31.35dB ⫹/⫺12.79 dB and the post-op was 20.13 dB ⫹/⫺10.43dB (p⬍0.0001), for an average improvement of 11.22 dB (p⬍0.0001). A postoperative ABG of 25 dB or less was achieved in 41 (78.8%) patients. Speech discrimination scores remained unchanged postoperatively. No complications were identified. CONCLUSIONS: Type III cartilage shield tympanoplasty is an effective technique for hearing improvement in selected patients with chronic otitis media. The results of this procedure are similar to those obtained with partial ossicular replacement prosthesis. 08:54 AM Importance of Correct Classification of Acute Hearing Loss Oswaldo Laercio Mendonc¸a Cruz, MD (presenter); Norma de Oliveira Penido, MD PhD; Alessandra Zanoni, MD; Hugo Valter Lisboa Ramos, Sr, MD Sao Paulo Brazil

OBJECTIVE: To evaluate patients with acute sensorineural hearing loss (ASNHL) in a search for a possible etiology and adequate classification. METHODS: Clinical prospective study. Some 136 consecutive cases of ASNHL entered this study and underwent physical examination, audiologic testing, and magnetic resonance imaging. Three different groups of patients were recognized: 60 cases with idiopathic ASNHL, 31 cases with an identified etiology, and 45 patients with a comorbidity not related to ANSHL. Audiometric tests performed after initial treatment, in a follow-up from 3 to 6 months, were analyzed to compare short-term evolution. RESULTS: Of the cases with idiopathic ASNHL, 44% achieved normalization of auditory thresholds and 26% partial recovery of hearing. ASNHL with an assumed etiology showed 12.5% normalization and 37.5% partial hearing recovery. The main etiologies in this group were diabetes (61%), hydrops (19%), and acoustic neuroma (10%). Patients with ASNHL in the presence of comorbidity achieved 13.04% of hearing normalization and 39.14% partial recovery. The main associated clinical condition in this group was high blood pressure (67%). CONCLUSIONS: ASNHL is not synonymous with idiopathic hearing loss or sudden deafness. It is proposed that at least three groups of ASNHL must be recognized: idiopathic or sudden deafness, ASNHL with an established etiology, and ASNHL in the presence of comorbidities. This is important for initial adequate management of these cases; different etiology requires different approaches. 09:02 AM Evolution of Idiopathic Sudden Deafness Norma de Oliveira Penido, MD PhD (presenter); Alessandra Zanoni, MD; Hugo Walter L. Ramos, MD; Oswaldo Laercio Mendonc¸a Cruz, MD Sao Paulo Brazil OBJECTIVE: Prospective study to analyze if the intensity of initial hearing loss has any influence on hearing recovery in idiopathic acute sensorineural hearing loss. METHODS: Sixty patients (one with bilateral involvement) with sudden deafness (SD) were evaluated. The intensity of the initial hearing involvement, treatment. and hearing recovery were analyzed by pre- and post-treatment auditory tests. RESULTS: Regarding initial threshold shift intensity: Three (4.92%) patients presented mild hearing loss; 29 (47.54%), the majority of patients in this sample, showed moderate hearing loss; 14 (22.95%) presented severe hearing loss; 10 (16.39%) had profound hearing loss; and 5 (8.20%) total deafness. Corticosteroids associated with pentoxifylline were used in 72.22% of the cases. Corticosteroid alone was employed in 20.37% cases and other forms of treatments in 7.41%. Overall, 44% presented normalization of their auditory thresholds and 26% had some improvement in their hearing tests. Total recovery was achieved in all patients with initial mild hearing