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Can an auditory brainstem implant make up for cochlear implant failure?
Scientific Session—Tuesday
showed a high sensitivity, it proved difficult to distinguish paragangliomas from enlarged lymph nodes using B-mode sonography. So far, two patients have undergone resection of their tumors at the Department of Otolaryngology/Head and Neck Surgery. Conclusions: The screening for paragangliomas in patients with mutations of the SDHD gene offers the chance to diagnose those tumors in an asymptomatic stage. Since the risk of surgical treatment complications increases with tumor size, early surgery results in a much better postoperative outcome. Close relatives should also be screened for mutations of the SDHD gene.
Room OCCC 109B •
Scientific Sessions: Otology/Neurotology Patrick J Antonelli MD; Colin LW Driscoll MD (moderators)
9:30
AM
Intratympanic Dexamethasone in Unilateral Meniere’s Disease: A Two-Year Prospective Trial Marco Antonio Garduno Anaya MD (presenter); Heloisa Toledo de Couthino MD; Ramon Hinojosa MD; Carlo PanePianese MD; Camilo Rios Castaneda MD Mexico City Mexico; Mexico City Mexico; Mexico City Mexico; Mexico City Mexico; Mexico City Mexico
Objectives: To quantify and evaluate the efficacy of intratympanic dexamethasone for the treatment of hearing loss, tinnitus, and vertigo, so we will be able to compare with the control group at 2 years of follow-up, in patients with unilateral Meniere’s disease. Methods: Twenty-two patients met the diagnostic criteria for definite Meniere’s disease as outlined by the American Academy of Otolaryngology–Head and Neck Surgery (AAOHNS 1995), who have persistent vertigo, hearing loss, and tinnitus despite standard medical treatment. Five consecutive daily administrations of intratympanic dexamethasone or placebo were given to the involved ear. Results: Complete relief of vertigo was maintained in 9 of 11 patients (81%) at 24 months of follow-up. In this study we are introducing the Vestibular Improvement Scale (VIS), a new form of classification that measures the improvement of the number of vertigo spells after the intratympanic therapy as a determination of the grade of control. No significant changes were observed in hearing loss or tinnitus in both groups. Conclusions: Intratympanic administration of 4 mg/mL of dexamethasone showed complete relief of vertigo in 9 of 11 patients (81%) with unilateral Meniere’s disease (Shea’s stage III), compared with 3 of 11 patients (27%) of the control group.
9:38
AM
Can an Auditory Brainstem Implant Make Up for Cochlear Implant Failure? Vittorio Colletti MD (presenter); Marco Carner MD; Francesco G Fiorino MD; Veronica Miorelli; Maurizio Guida; Luca Sacchetto MD Verona Italy; Verona Italy; Verona Italy; Verona Italy; Verona Italy; Verona Italy
Objectives: To assess whether the auditory brainstem implant (ABI) can be used as an effective rescue procedure in patients unsuccessfully treated by insertion of a cochlear implant. Methods: From 2001, 5 subjects (2 children and 3 adults) previously fitted with a cochlear implant had an ABI inserted in our ENT Department owing to their poor or non-response to the previous treatment. One child had undiagnosed bilateral cochlear nerve aplasia and the other auditory neuropathy; the three adults presented complete cochlear ossification. Using a retrosigmoid approach, the electrode array was inserted into the lateral recess of the fourth ventricle and electrode positioning was monitored by means of evoked auditory brainstem responses and neural response telemetry. Results: Hearing performance revealed that open-set sentence recognition scores (auditory-only mode) 6 months after activation of the auditory brainstem implant ranged from 0% to 100% in the three adult subjects, one of whom also achieved a speech-tracking score of 40 words per minute. No speech tracking was possible with the cochlear implant. The two children, who were both total non-responders to the cochlear implant, were able to detect sounds and words within as little as 2 months of activation of the ABI. Conclusions: The ABI may be considered an effective rehabilitative alternative when the cochlear implant is difficult, electrode insertion incomplete, or stimulation ineffective. We believe that the brainstem device is of substantial benefit and is often the only device capable of affording hearing (re)habilitation in all patients in whom the cochlea and central auditory system are anatomically or functionally disconnected.
9:46
AM
Image-Guided Otologic Surgery Robert F Labadie MD PhD (presenter); David S Haynes MD; Michael Fenlon PhD; Robert L Galloway Jr PhD; J Michael Fitzpatrick PhD Nashville TN; Nashville TN; London United Kingdom; Nashville TN; Nashville TN
Objectives: Application of image-guided surgery to otology has been limited by the need for submillimeter accuracy via a fiducial system that is easily useable (noninvasive and nonobstructive). Our goal was to overcome these limitations
TUESDAY
P136
Otolaryngology– Head and Neck Surgery August 2003
showed a high sensitivity, it proved difficult to distinguish paragangliomas from enlarged lymph nodes using B-mode sonography. So far, two patients have undergone resection of their tumors at the Department of Otolaryngology/Head and Neck Surgery. Conclusions: The screening for paragangliomas in patients with mutations of the SDHD gene offers the chance to diagnose those tumors in an asymptomatic stage. Since the risk of surgical treatment complications increases with tumor size, early surgery results in a much better postoperative outcome. Close relatives should also be screened for mutations of the SDHD gene.
Room OCCC 109B •
Scientific Sessions: Otology/Neurotology Patrick J Antonelli MD; Colin LW Driscoll MD (moderators)
9:30
AM
Intratympanic Dexamethasone in Unilateral Meniere’s Disease: A Two-Year Prospective Trial Marco Antonio Garduno Anaya MD (presenter); Heloisa Toledo de Couthino MD; Ramon Hinojosa MD; Carlo PanePianese MD; Camilo Rios Castaneda MD Mexico City Mexico; Mexico City Mexico; Mexico City Mexico; Mexico City Mexico; Mexico City Mexico
Objectives: To quantify and evaluate the efficacy of intratympanic dexamethasone for the treatment of hearing loss, tinnitus, and vertigo, so we will be able to compare with the control group at 2 years of follow-up, in patients with unilateral Meniere’s disease. Methods: Twenty-two patients met the diagnostic criteria for definite Meniere’s disease as outlined by the American Academy of Otolaryngology–Head and Neck Surgery (AAOHNS 1995), who have persistent vertigo, hearing loss, and tinnitus despite standard medical treatment. Five consecutive daily administrations of intratympanic dexamethasone or placebo were given to the involved ear. Results: Complete relief of vertigo was maintained in 9 of 11 patients (81%) at 24 months of follow-up. In this study we are introducing the Vestibular Improvement Scale (VIS), a new form of classification that measures the improvement of the number of vertigo spells after the intratympanic therapy as a determination of the grade of control. No significant changes were observed in hearing loss or tinnitus in both groups. Conclusions: Intratympanic administration of 4 mg/mL of dexamethasone showed complete relief of vertigo in 9 of 11 patients (81%) with unilateral Meniere’s disease (Shea’s stage III), compared with 3 of 11 patients (27%) of the control group.
9:38
AM
Can an Auditory Brainstem Implant Make Up for Cochlear Implant Failure? Vittorio Colletti MD (presenter); Marco Carner MD; Francesco G Fiorino MD; Veronica Miorelli; Maurizio Guida; Luca Sacchetto MD Verona Italy; Verona Italy; Verona Italy; Verona Italy; Verona Italy; Verona Italy
Objectives: To assess whether the auditory brainstem implant (ABI) can be used as an effective rescue procedure in patients unsuccessfully treated by insertion of a cochlear implant. Methods: From 2001, 5 subjects (2 children and 3 adults) previously fitted with a cochlear implant had an ABI inserted in our ENT Department owing to their poor or non-response to the previous treatment. One child had undiagnosed bilateral cochlear nerve aplasia and the other auditory neuropathy; the three adults presented complete cochlear ossification. Using a retrosigmoid approach, the electrode array was inserted into the lateral recess of the fourth ventricle and electrode positioning was monitored by means of evoked auditory brainstem responses and neural response telemetry. Results: Hearing performance revealed that open-set sentence recognition scores (auditory-only mode) 6 months after activation of the auditory brainstem implant ranged from 0% to 100% in the three adult subjects, one of whom also achieved a speech-tracking score of 40 words per minute. No speech tracking was possible with the cochlear implant. The two children, who were both total non-responders to the cochlear implant, were able to detect sounds and words within as little as 2 months of activation of the ABI. Conclusions: The ABI may be considered an effective rehabilitative alternative when the cochlear implant is difficult, electrode insertion incomplete, or stimulation ineffective. We believe that the brainstem device is of substantial benefit and is often the only device capable of affording hearing (re)habilitation in all patients in whom the cochlea and central auditory system are anatomically or functionally disconnected.
9:46
AM
Image-Guided Otologic Surgery Robert F Labadie MD PhD (presenter); David S Haynes MD; Michael Fenlon PhD; Robert L Galloway Jr PhD; J Michael Fitzpatrick PhD Nashville TN; Nashville TN; London United Kingdom; Nashville TN; Nashville TN
Objectives: Application of image-guided surgery to otology has been limited by the need for submillimeter accuracy via a fiducial system that is easily useable (noninvasive and nonobstructive). Our goal was to overcome these limitations
TUESDAY
P136
Otolaryngology– Head and Neck Surgery August 2003