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Hearing preservation after acoustic neuroma resection
Otolaryngology Head and Neck Surgery Volume 113 Number 2
Scientific Sessions- - Tuesday
P 151
Poster 7 3
Poster 75
Neonatal Hearing Screening With Otoscopy, Auditory Brain Stem Response, and Otoacoustic Emissions
Revision Stapes Surgery With Argon Laser: Is it Effective and Safe?
KAREN JO DOYLE, MD, PHD (presenter), BARBARA BURGGRAAFF, MD, SHARON FUJIKAWA, PHD, JU KIM, MD, and CAROL MAcARTHUR, MD, Orange, Calif.
RICHARD J. WIET, MD, FACS (presenter), PAUL LEMBERG, MD, and DOUGLAS KUBEK, DO, Hinsdale and Chicago, II1.,and Birmingham, Mich.
A study was performed to investigate the relationship between external and middle ear factors and hearing screening results by auditory brain stem response (ABR) and evoked otoacoustic emissions (EOAE). The ears of 200 well newborns ages 5 hours to 48 hours underwent screening by ABR and EOAE, followed by otoscopic examination. The pass rates for ABR and EOAE were 88.5% and 79%, respectively. On otoscopic examination, 13% (53 or 400) ears had occluding vernix obscuring the view of the tympanic membrane, Cleaning of vernix was attempted in ears that failed ABR or EOAE. Seventeen ears that failed ABR were cleaned, and 12 (71%) of them passed repeat ABR. Thirtythree ears that failed EOAE were cleaned, and 22 (67%) of them passed repeat emissions testing. Cleaning vernix increased the pass rates for ABR and EOAE to 91.5% and 84%. Decreased tympanic membrane mobility was found in 9% of ears that could be evaluated otoscopically. Increased failure rates for both ABR and EOAE were found in infant ears with decreased tympanic membrane mobility, but significant testing could not be performed because of inadequate sample size. Prevalence of occluding external canal vernix and middle ear effusion as a function of increasing infant age were studied. Implications for newborn hearing screening are discussed.
Two study groups who were referred for revision surgery were analyzed using techniques with laser (n = 19) and without laser (n = 14). All patients underwent one prior procedure. The follow-up was beyond 6 months to an average of 4 years. Improvement in hearing was 64% in the nonlaser group and 74% in the laser group. In the nonlaser group the air-bone gap was closed to within 10 dB in 29% of patients and to within 20 dB in 57%. The laser group was closed to within 10 dB in 58% of patients and to within 20 dB in 79% of patients. In the nonlaser group, 17% of patients had a postoperative speech discrimination score (SDS) that decreased by more than 8%. In the laser group, there we~e no patients whose postoperative SDS decreased by more than 8%. Argon laser appears to be effective and safe when used judiciously.
Poster 74
Hearing Preservation After Acoustic Neuroma Resection CRAIG S. HECHT, MD (presenter), R/CHARD J. W/EL MD, FACS, and CATHLEEN A. O'CONNOR, MS, CCC-A, Hinsdale, III.
The results of surgery for hearing preservation in 56 patients diagnosed with acoustic schwannornas from 1981 to 1994 were reviewed. Thirty-five percent of the patients who underwent a retr0sigmoid approach (14 of 40) and 38% of the patients who were approached via the middle fossa (6 of 16) had heating preservation. The average size of the tumors found in the group with successful preservation was 1.4 cm for the retrosigmoid approach and 0.8 cm for the middle fossa approach. This study analyzes the postoperative heating changes and will attempt to provide criteria that defines successful hearing preservation. In addition, the use of direct e~ghth nerve monitoring as a prognostic indicator will be introduced and discussed.
Poster 76
Independent Otolaryngologists' Outcomes Survey of External Otitis Using Confidential Self Assessment of Quality STEVEN F. ISENBERG,MD, FACS (presenter), Indianapolis, Ind.
Independent otolaryngologists formed a multi-state organization to obtain outcomes data about the treatment of external otitis. Using the unique methodology of Confidential Self Assessment of Quality, each physician supervised the completion of a three-part outcome study including an initial patient questionnaire, an initial examination, and a follow-up visit. The data presented and the methodology of Confidential Self Assessment is discussed. The use of a nationwide organization of independent community physicians to gather clinical outcomes data to improve efficiency is presented.
Poster 77
The Effect of Nitric Oxide on Compound Action Potential Thresholds in the Cochlea C. G. DEAN DAIS, MSIV (presenter), JIRI PRAZMA, MD, PHD, STEVENS. BALL, MSIV, VINCENT CARRASCO, MD, and HAROLD C. PILLSBURYtit, MD, Chapel Hill, N,C.
The purpose of this study was to evaluate the effect nitric oxide (NO) has on hearing and to describe how these actions are mediated. In a gerbil model, cochlear action potential (CAP) thresholds were tested after cochlear perfusion of control and test solutions. Hearing thresholds were obtained before and after the drilling of perfusion holes and after each perfusion. The scala tympani was perfused from the first turn to the apex of the cochlea. There were four study groups in this experiment. The first control group was
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Scientific Sessions- - Tuesday
P 151
Poster 7 3
Poster 75
Neonatal Hearing Screening With Otoscopy, Auditory Brain Stem Response, and Otoacoustic Emissions
Revision Stapes Surgery With Argon Laser: Is it Effective and Safe?
KAREN JO DOYLE, MD, PHD (presenter), BARBARA BURGGRAAFF, MD, SHARON FUJIKAWA, PHD, JU KIM, MD, and CAROL MAcARTHUR, MD, Orange, Calif.
RICHARD J. WIET, MD, FACS (presenter), PAUL LEMBERG, MD, and DOUGLAS KUBEK, DO, Hinsdale and Chicago, II1.,and Birmingham, Mich.
A study was performed to investigate the relationship between external and middle ear factors and hearing screening results by auditory brain stem response (ABR) and evoked otoacoustic emissions (EOAE). The ears of 200 well newborns ages 5 hours to 48 hours underwent screening by ABR and EOAE, followed by otoscopic examination. The pass rates for ABR and EOAE were 88.5% and 79%, respectively. On otoscopic examination, 13% (53 or 400) ears had occluding vernix obscuring the view of the tympanic membrane, Cleaning of vernix was attempted in ears that failed ABR or EOAE. Seventeen ears that failed ABR were cleaned, and 12 (71%) of them passed repeat ABR. Thirtythree ears that failed EOAE were cleaned, and 22 (67%) of them passed repeat emissions testing. Cleaning vernix increased the pass rates for ABR and EOAE to 91.5% and 84%. Decreased tympanic membrane mobility was found in 9% of ears that could be evaluated otoscopically. Increased failure rates for both ABR and EOAE were found in infant ears with decreased tympanic membrane mobility, but significant testing could not be performed because of inadequate sample size. Prevalence of occluding external canal vernix and middle ear effusion as a function of increasing infant age were studied. Implications for newborn hearing screening are discussed.
Two study groups who were referred for revision surgery were analyzed using techniques with laser (n = 19) and without laser (n = 14). All patients underwent one prior procedure. The follow-up was beyond 6 months to an average of 4 years. Improvement in hearing was 64% in the nonlaser group and 74% in the laser group. In the nonlaser group the air-bone gap was closed to within 10 dB in 29% of patients and to within 20 dB in 57%. The laser group was closed to within 10 dB in 58% of patients and to within 20 dB in 79% of patients. In the nonlaser group, 17% of patients had a postoperative speech discrimination score (SDS) that decreased by more than 8%. In the laser group, there we~e no patients whose postoperative SDS decreased by more than 8%. Argon laser appears to be effective and safe when used judiciously.
Poster 74
Hearing Preservation After Acoustic Neuroma Resection CRAIG S. HECHT, MD (presenter), R/CHARD J. W/EL MD, FACS, and CATHLEEN A. O'CONNOR, MS, CCC-A, Hinsdale, III.
The results of surgery for hearing preservation in 56 patients diagnosed with acoustic schwannornas from 1981 to 1994 were reviewed. Thirty-five percent of the patients who underwent a retr0sigmoid approach (14 of 40) and 38% of the patients who were approached via the middle fossa (6 of 16) had heating preservation. The average size of the tumors found in the group with successful preservation was 1.4 cm for the retrosigmoid approach and 0.8 cm for the middle fossa approach. This study analyzes the postoperative heating changes and will attempt to provide criteria that defines successful hearing preservation. In addition, the use of direct e~ghth nerve monitoring as a prognostic indicator will be introduced and discussed.
Poster 76
Independent Otolaryngologists' Outcomes Survey of External Otitis Using Confidential Self Assessment of Quality STEVEN F. ISENBERG,MD, FACS (presenter), Indianapolis, Ind.
Independent otolaryngologists formed a multi-state organization to obtain outcomes data about the treatment of external otitis. Using the unique methodology of Confidential Self Assessment of Quality, each physician supervised the completion of a three-part outcome study including an initial patient questionnaire, an initial examination, and a follow-up visit. The data presented and the methodology of Confidential Self Assessment is discussed. The use of a nationwide organization of independent community physicians to gather clinical outcomes data to improve efficiency is presented.
Poster 77
The Effect of Nitric Oxide on Compound Action Potential Thresholds in the Cochlea C. G. DEAN DAIS, MSIV (presenter), JIRI PRAZMA, MD, PHD, STEVENS. BALL, MSIV, VINCENT CARRASCO, MD, and HAROLD C. PILLSBURYtit, MD, Chapel Hill, N,C.
The purpose of this study was to evaluate the effect nitric oxide (NO) has on hearing and to describe how these actions are mediated. In a gerbil model, cochlear action potential (CAP) thresholds were tested after cochlear perfusion of control and test solutions. Hearing thresholds were obtained before and after the drilling of perfusion holes and after each perfusion. The scala tympani was perfused from the first turn to the apex of the cochlea. There were four study groups in this experiment. The first control group was
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