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P085: Brain Metastases Mimicking Bilateral Vestibular Schwannomas
P240
Otolaryngology-Head and Neck Surgery, Vol 137, No 2S, August 2007
this procedure with specific outcome measures including patient surveys, barium swallow, and clinical swallow evaluation.
P082 Clinical Results and Technical Tips of Thyrohyoid Approach Jin-Ho Sohn, MD, PhD (presenter); Jun-Ho Park, MD; June-Sik Park, MD OBJECTIVES: Evaluate the clinical effect of the thyrohyoid procedure and introduce technical tips. METHODS: The subjects were 22 patients including 16 glottic insufficiency and 6 spasmodic dysphonia who had a previous botulinum injection history using other techniques. All patients underwent thyrohyoid vocal fold injection with either implant materials or botulinum toxin, using flexible videoendoscope under local anesthesia. Needles used were 1.5 inch and 2 inch in length with straight or bended curved shape. Stroboscopy, MPT, and GRBAS were performed to evaluate clinical results. Patients were asked on a 10-point rating scale to rate their tolerance of the procedure, voice satisfaction and comparison with other techniques. RESULTS: In glottal insufficiency, glottal gap area improved from 7.1 before the procedure to 3.2 after the procedure: MPT from 8 to 11 and GRBAS from 2.1 to 1.6. The difference of these values was found to be significant by a paired t-test. All patients successfully underwent the procedure. The mean patient tolerance score was 3.0. Bended 2-inch-length needle provided best access to a target location in the vocal fold compared to a straight or a shorter needle. All spasmodic dysphonia patients answered that the procedure produced “less discomfort” and clinical effect was “same” compared to previous injection technique. CONCLUSIONS: The thyrohyoid approach could be an excellent alternative procedure in vocal fold injection. The procedure can be easily performed and provides excellent access to any location of the vocal fold and also is readily tolerated by patients who would not be candidates for the other injection techniques.
RESULTS: The most complete family tree ever compiled with company takeovers and design categories traced. CONCLUSIONS: An understanding of the stapes prosthesis is an integral part of performing stapecdectomy surgery and the strategies used by other surgeons to overcome the difficulties encountered during surgery is important.
P084 Endoscopic Cochlear Implantation: A New Procedure Mazen Al-hajeri, FRCSI, FRCSEd, PhD (presenter) OBJECTIVES: Report and compare the results of endoscopic cochlear implantation with classical cochlear implantation surgery. METHODS: Twenty-three patients were implanted using the endoscope transcanal approach using posterior meatal groove and a 3 to 4 cm-length postauricular incision to insert and secure the implant. Tympanomeatal flap elevated and groove is drilled from the post canal wall at the bony annulus just above the exit of chorda tympani to the postrosuperior angle of the bony external meatus just below the temporal line. The groove is deepened and undermined to receive the implant active electrode. The implant is secured and the active electrode is then inserted in the cochlea and the ruminant part is pushed in the groove and covered with pieces of cartilage and soft tissue including fat and fascia. Mastoidectomy was avoided in all 23 patients. RESULTS: The endoscopic approach showed low morbidity compared to the classical approach. There was 0% facial palsy, 0% meningeal damage or csf leak, 0% flap infection since the incision is only 3 to 4 cm. There were no cases to date of rejection or ex implantation or wire extrusion. The operative time: two-and-a-half hours, approximately. The chorda tympani was preserved in all cases. Cochlea was always easily visualized and round window was seen clearly in all cases. CONCLUSIONS: Endoscopic cochlear implantation using transcanal poster-superior groove is a save procedure compared to transmastoid classical operation.
P085 P083 Phylogenetic Tree of the Stapes Prosthesis Michael H Fritsch, MD (presenter); Ilka Charlotte Naumann, MD
Brain Metastases Mimicking Bilateral Vestibular Schwannomas Arnold L Rivera, MD (presenter); Robert A Battista, MD; Arvind Kumar, MD
OBJECTIVES: 1. Understand the development of the stapes prosthesis through time. 2. Clarify the road map of company takeovers in relation to the various prostheses. METHODS: Retrospective review of literature, historical company catelogs, interviews conducted in 2006 for kinds of stapes prostheses used to treat otosclerosis since the 1800s, and the interweaving of the prosthesis manufacturers through time.
OBJECTIVES: To understand the symptoms, signs and diagnostic management of two patients with bilateral metastatic disease to the internal auditory canal. Magnetic resonance imaging (MRI) findings mimic bilateral vestibular schwannoma. In addition, a literature review of bilateral metastatic disease to the temporal bone will be performed. METHODS: Retrospective case series at a tertiary referral
Scientific Posters—Wednesday
P086 Taste Disturbance and Its Recovery after Stapes Surgery Shinya Miuchi, MD (presenter); Hirokazu Katsura, MD; Yasuo Mishiro, MD; Masafumi Sakagami, MD, PhD OBJECTIVES: Investigate how frequently taste disturbance occurs and how long it persists after stapes surgery, and to examine how much the neurotrophic factors express in the rat geniculate ganglion (GG) after injury of the chorda tympani nerve (CTN). METHODS: The subjects’ taste function was examined before surgery and at 2 weeks, 3, 6, 12, 18, and 24 months after surgery using a questionnaire and electrogustometry (EGM). The rat mRNA levels of BDNF (brain-derived neurotrophic factor) and GFR (glia-derived neurotrophic factor family receptor) were measured by RT-PCR. RESULTS: Among the cases, 15/18 (83.3%) were associated with taste disturbance and 6/18 (33.3%) with tongue numbness at 2 weeks after surgery. The symptoms ceased in 12/15 (80.0%) until 2 years after surgery. The recovery of the EGM threshold tended to be delayed as compared with that of symptoms. In the animal experiment, the amplified bands of BDNF and GFR increased at 1, 2, 4 weeks in the ipsilateral GGs after nerve injury and also increased at 1 week in the contralateral side. CONCLUSIONS: Eighty percent of the cases experienced taste disturbance after stapes surgery, and in most cases this disturbance was reversed. The animal experiment showed the role of GGs in the nerve regeneration.
P087 A Simple Bilateral Cochlear Implant Head Band Retainer David Foyt, MD (presenter); Nora Perkins, MD OBJECTIVES: The reader will be taught how to construct an inexpensive cochlear implant retainer, and fit a cochlear implant retainer on a patient. METHODS: Several pediatric cochlear implant patients were encountered who had difficulty in keeping their bilateral cochlear implants in place. A simple retaining device was created that allowed children with bilateral cochlear implants to keep the speech processors in place. RESULTS: The implant retainers were cheaply made from old earphone headbands and allowed active play with the processors on. CONCLUSIONS: Earphone headbands can successfully and inexpensively modified to create a cochlear implant retaining device for active children with bilateral cochlear implants.
P088 Comparison of Paper, Fat, and Perichondrium Myringoplasty Salim Dogru, MD (presenter); Atila Gungor, MD; I Ethem Poyrazoglu, MD; Hakan Cincik, MD; Engin C¸ekin, MD OBJECTIVES: 1. Compare the effectiveness of paper-patch, fat and perichondrium myringoplasty in the treatment of chronic tympanic membrane perforations smaller than 3 mm. 2. Ascertain the parameters that may have an influence on healing of perforations. METHODS: This study was conducted between January and September 2006. The investigation included 45 patients with chronic tympanic membrane perforations smaller than 3 mm. The patients were equally divided into three groups according to surgical procedures. Each group was divided into three subgroups, based on the size of tympanic membrane perforations [1-mm (n:5), 2-mm (n:5) and 3-mm (n:5)]. The patients underwent paperpatch, fat or perichondrium myringoplasty via transcanal approach under local anaesthesia. Healing of perforation, hearing improvement, complications and other parameters that may have had an influence on outcome were compared. Data were analyzed using SPSS 11.0 for Windows. Difference testing between groups was performed using Mann-Whitney U test. A P value ⬍ 0.05 was considered statistically significant. RESULTS: Closure rates of the perforations in the paperpatch, fat and perichondrium myringoplasty groups were 66,7%, 86,7%, 86,7%, respectively. There were no statistically significant differences in tympanic membrane closure rates between techniques with regard to size and localization of perforation (p⬎0,05). There were no statistically significant differences in mean hearing improvement rates (p⬎0,05).
SCIENTIFIC POSTERS
center. Two patients with progressive bilateral sensorineural hearing loss. Both were evaluated through lumbar puncture with cerebrospinal fluid cytology and MRI of posterior fossa. RESULTS: Two patients presented with rapidly progressive, bilateral sensorineural hearing loss. One patient also had a complete unilateral facial paralysis. MRI of the brain demonstrated enhancing lesions in each internal auditory canal. Lumbar puncture with cerebrospinal fluid (CSF) cytology was performed for both patients. CSF cytology was positive for malignant cells in the patient with facial paralysis with subsequent diagnosis made of adenocarcinoma of the colon. The patient died within two weeks of diagnosis. The other patient had a history of ductal cell carcinoma of the breast, which was believed to be metastatic to the internal auditory canals. There have been less than 30 cases reported of bilateral sensorineural hearing loss due to meningeal carcinomatosis. The majority of these 30 cases were due to adenocarcinoma. CONCLUSIONS: The differential diagnosis of patients with progressive, bilateral sensorineural hearing loss should include metastatic disease. Facial paralysis in this situation is a poor prognostic sign. CSF cytologic analysis may help to determine if lesions found on MRI are due to malignant disease.
P241
Otolaryngology-Head and Neck Surgery, Vol 137, No 2S, August 2007
this procedure with specific outcome measures including patient surveys, barium swallow, and clinical swallow evaluation.
P082 Clinical Results and Technical Tips of Thyrohyoid Approach Jin-Ho Sohn, MD, PhD (presenter); Jun-Ho Park, MD; June-Sik Park, MD OBJECTIVES: Evaluate the clinical effect of the thyrohyoid procedure and introduce technical tips. METHODS: The subjects were 22 patients including 16 glottic insufficiency and 6 spasmodic dysphonia who had a previous botulinum injection history using other techniques. All patients underwent thyrohyoid vocal fold injection with either implant materials or botulinum toxin, using flexible videoendoscope under local anesthesia. Needles used were 1.5 inch and 2 inch in length with straight or bended curved shape. Stroboscopy, MPT, and GRBAS were performed to evaluate clinical results. Patients were asked on a 10-point rating scale to rate their tolerance of the procedure, voice satisfaction and comparison with other techniques. RESULTS: In glottal insufficiency, glottal gap area improved from 7.1 before the procedure to 3.2 after the procedure: MPT from 8 to 11 and GRBAS from 2.1 to 1.6. The difference of these values was found to be significant by a paired t-test. All patients successfully underwent the procedure. The mean patient tolerance score was 3.0. Bended 2-inch-length needle provided best access to a target location in the vocal fold compared to a straight or a shorter needle. All spasmodic dysphonia patients answered that the procedure produced “less discomfort” and clinical effect was “same” compared to previous injection technique. CONCLUSIONS: The thyrohyoid approach could be an excellent alternative procedure in vocal fold injection. The procedure can be easily performed and provides excellent access to any location of the vocal fold and also is readily tolerated by patients who would not be candidates for the other injection techniques.
RESULTS: The most complete family tree ever compiled with company takeovers and design categories traced. CONCLUSIONS: An understanding of the stapes prosthesis is an integral part of performing stapecdectomy surgery and the strategies used by other surgeons to overcome the difficulties encountered during surgery is important.
P084 Endoscopic Cochlear Implantation: A New Procedure Mazen Al-hajeri, FRCSI, FRCSEd, PhD (presenter) OBJECTIVES: Report and compare the results of endoscopic cochlear implantation with classical cochlear implantation surgery. METHODS: Twenty-three patients were implanted using the endoscope transcanal approach using posterior meatal groove and a 3 to 4 cm-length postauricular incision to insert and secure the implant. Tympanomeatal flap elevated and groove is drilled from the post canal wall at the bony annulus just above the exit of chorda tympani to the postrosuperior angle of the bony external meatus just below the temporal line. The groove is deepened and undermined to receive the implant active electrode. The implant is secured and the active electrode is then inserted in the cochlea and the ruminant part is pushed in the groove and covered with pieces of cartilage and soft tissue including fat and fascia. Mastoidectomy was avoided in all 23 patients. RESULTS: The endoscopic approach showed low morbidity compared to the classical approach. There was 0% facial palsy, 0% meningeal damage or csf leak, 0% flap infection since the incision is only 3 to 4 cm. There were no cases to date of rejection or ex implantation or wire extrusion. The operative time: two-and-a-half hours, approximately. The chorda tympani was preserved in all cases. Cochlea was always easily visualized and round window was seen clearly in all cases. CONCLUSIONS: Endoscopic cochlear implantation using transcanal poster-superior groove is a save procedure compared to transmastoid classical operation.
P085 P083 Phylogenetic Tree of the Stapes Prosthesis Michael H Fritsch, MD (presenter); Ilka Charlotte Naumann, MD
Brain Metastases Mimicking Bilateral Vestibular Schwannomas Arnold L Rivera, MD (presenter); Robert A Battista, MD; Arvind Kumar, MD
OBJECTIVES: 1. Understand the development of the stapes prosthesis through time. 2. Clarify the road map of company takeovers in relation to the various prostheses. METHODS: Retrospective review of literature, historical company catelogs, interviews conducted in 2006 for kinds of stapes prostheses used to treat otosclerosis since the 1800s, and the interweaving of the prosthesis manufacturers through time.
OBJECTIVES: To understand the symptoms, signs and diagnostic management of two patients with bilateral metastatic disease to the internal auditory canal. Magnetic resonance imaging (MRI) findings mimic bilateral vestibular schwannoma. In addition, a literature review of bilateral metastatic disease to the temporal bone will be performed. METHODS: Retrospective case series at a tertiary referral
Scientific Posters—Wednesday
P086 Taste Disturbance and Its Recovery after Stapes Surgery Shinya Miuchi, MD (presenter); Hirokazu Katsura, MD; Yasuo Mishiro, MD; Masafumi Sakagami, MD, PhD OBJECTIVES: Investigate how frequently taste disturbance occurs and how long it persists after stapes surgery, and to examine how much the neurotrophic factors express in the rat geniculate ganglion (GG) after injury of the chorda tympani nerve (CTN). METHODS: The subjects’ taste function was examined before surgery and at 2 weeks, 3, 6, 12, 18, and 24 months after surgery using a questionnaire and electrogustometry (EGM). The rat mRNA levels of BDNF (brain-derived neurotrophic factor) and GFR (glia-derived neurotrophic factor family receptor) were measured by RT-PCR. RESULTS: Among the cases, 15/18 (83.3%) were associated with taste disturbance and 6/18 (33.3%) with tongue numbness at 2 weeks after surgery. The symptoms ceased in 12/15 (80.0%) until 2 years after surgery. The recovery of the EGM threshold tended to be delayed as compared with that of symptoms. In the animal experiment, the amplified bands of BDNF and GFR increased at 1, 2, 4 weeks in the ipsilateral GGs after nerve injury and also increased at 1 week in the contralateral side. CONCLUSIONS: Eighty percent of the cases experienced taste disturbance after stapes surgery, and in most cases this disturbance was reversed. The animal experiment showed the role of GGs in the nerve regeneration.
P087 A Simple Bilateral Cochlear Implant Head Band Retainer David Foyt, MD (presenter); Nora Perkins, MD OBJECTIVES: The reader will be taught how to construct an inexpensive cochlear implant retainer, and fit a cochlear implant retainer on a patient. METHODS: Several pediatric cochlear implant patients were encountered who had difficulty in keeping their bilateral cochlear implants in place. A simple retaining device was created that allowed children with bilateral cochlear implants to keep the speech processors in place. RESULTS: The implant retainers were cheaply made from old earphone headbands and allowed active play with the processors on. CONCLUSIONS: Earphone headbands can successfully and inexpensively modified to create a cochlear implant retaining device for active children with bilateral cochlear implants.
P088 Comparison of Paper, Fat, and Perichondrium Myringoplasty Salim Dogru, MD (presenter); Atila Gungor, MD; I Ethem Poyrazoglu, MD; Hakan Cincik, MD; Engin C¸ekin, MD OBJECTIVES: 1. Compare the effectiveness of paper-patch, fat and perichondrium myringoplasty in the treatment of chronic tympanic membrane perforations smaller than 3 mm. 2. Ascertain the parameters that may have an influence on healing of perforations. METHODS: This study was conducted between January and September 2006. The investigation included 45 patients with chronic tympanic membrane perforations smaller than 3 mm. The patients were equally divided into three groups according to surgical procedures. Each group was divided into three subgroups, based on the size of tympanic membrane perforations [1-mm (n:5), 2-mm (n:5) and 3-mm (n:5)]. The patients underwent paperpatch, fat or perichondrium myringoplasty via transcanal approach under local anaesthesia. Healing of perforation, hearing improvement, complications and other parameters that may have had an influence on outcome were compared. Data were analyzed using SPSS 11.0 for Windows. Difference testing between groups was performed using Mann-Whitney U test. A P value ⬍ 0.05 was considered statistically significant. RESULTS: Closure rates of the perforations in the paperpatch, fat and perichondrium myringoplasty groups were 66,7%, 86,7%, 86,7%, respectively. There were no statistically significant differences in tympanic membrane closure rates between techniques with regard to size and localization of perforation (p⬎0,05). There were no statistically significant differences in mean hearing improvement rates (p⬎0,05).
SCIENTIFIC POSTERS
center. Two patients with progressive bilateral sensorineural hearing loss. Both were evaluated through lumbar puncture with cerebrospinal fluid cytology and MRI of posterior fossa. RESULTS: Two patients presented with rapidly progressive, bilateral sensorineural hearing loss. One patient also had a complete unilateral facial paralysis. MRI of the brain demonstrated enhancing lesions in each internal auditory canal. Lumbar puncture with cerebrospinal fluid (CSF) cytology was performed for both patients. CSF cytology was positive for malignant cells in the patient with facial paralysis with subsequent diagnosis made of adenocarcinoma of the colon. The patient died within two weeks of diagnosis. The other patient had a history of ductal cell carcinoma of the breast, which was believed to be metastatic to the internal auditory canals. There have been less than 30 cases reported of bilateral sensorineural hearing loss due to meningeal carcinomatosis. The majority of these 30 cases were due to adenocarcinoma. CONCLUSIONS: The differential diagnosis of patients with progressive, bilateral sensorineural hearing loss should include metastatic disease. Facial paralysis in this situation is a poor prognostic sign. CSF cytologic analysis may help to determine if lesions found on MRI are due to malignant disease.
P241