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Otolaryngology-Head and Neck Surgery, Vol 135, No 2S, August 2006
findings allow us to suggest including prenatal ultrasonographic studies of those regions. This would allow us early diagnosis and treatment with the inherent benefits to the newborn. P118 Contralateral Hearing Loss after Acoustic Neuroma Surgery Meredith E. Adams, MD (presenter); Ana H Kim, MD; H Alexander Arts, MD; Steven A Telian, MD Ann Arbor MI OBJECTIVES: To present a case series of contralateral ear hearing loss after acoustic neuroma surgery. METHODS: Retrospective review of patients undergoing acoustic neuroma surgery from 1992 to 2004 in a tertiary referral medical center. Changes in the mean pure tone average of greater than 20 dB or speech discrimination score of 15% from their preoperative audiogram were considered a significant hearing loss. RESULTS: Four patients developed significant hearing loss in the contralateral ear after surgery. One patient developed sudden acute sensorineural hearing loss (SNHL) on post-op day 12. Two patients developed acute SNHL at 5 and 9 years postsurgery along with symptoms suggestive of endolymphatic hydrops. The fourth patient developed SNHL 3 months after surgery that was preceded by a complex post-op course of CSF leakage, bacterial meningitis, and subdural hematoma while on IV heparin for DVT. All patients were treated with oral steroids. Hearing improved to pre-op or near pre-op levels in three patients within days to a few weeks after the initial hearing loss. CONCLUSIONS: Contralateral hearing loss after acoustic neuroma surgery is rare, but a devastating complication for the patient. Although several pathophysiologic mechanisms have been proposed such as compromised vascular supply or auditory nerve function resulting from brainstem shift and edema, intracochlear fluid disturbance caused by CSF release, immunological reactions, and drill-induced acoustic trauma, a clear etiology is rarely confirmed as in this patient series. P119 New Instruments for Intraoperative Facial Nerve Monitoring Shingo Murakami, MD (presenter); Nobuhiro Watanabe, MD; Mariko Takahashi, MD; Koji Yamano; Shinichi Ezaki, MD Nagoya Japan; Kona City Japan OBJECTIVES: Intraoperative facial nerve monitoring has been requisite for acoustic neuroma surgery. Now, the monitoring is widely adopting for middle ear surgery and cochlear implantation. Although several kinds of stimulus instrument have been developed, most of them are used after exposing the internal auditory canal (IAC) and facial nerve. To prevent
iatrogenic facial palsy in otologic surgery, real-time stimulation using a power drill is mandatory. Here, stimulus suction tubes for intraoperative facial nerve monitoring were made because the suction tube was used in cooperation with a power drill during mastoidectomy, posterior tympanotomy, and IAC opening. METHODS: The Frazier’s suction tubes are insulated up to their functional edge by Teflon coating. They consist of seven different sizes of diameter ranging from 1.5 to 3.4 mm. Newly designed stimulus dissectors for small acoustic neuroma surgery were also made. These instruments can be connected with a NIM-Pulse or NIM-Response integrity monitor. Simultaneous stimulation by suction tube and dissector is possible because NIM-Pulse and NIM-Response have two electric output channels. RESULTS: The stimulus suction tube and dissectors were used for 21 patients with acoustic neuroma, 12 with middle ear cholesteatoma and 10 with cochlear implantation. For all patients, stimulus suction tube and dissectors worked well, and were helpful to identify the facial nerve and to dissect the tumor. CONCLUSIONS: Stimulus suction tube and dissector might be useful for resident training of middle ear surgery and cochlear implantation. They are also useful for revision cases of chronic otitis media, congenital atresia, and acoustic neuroma surgery for the experienced surgeon. P120 Otological Problems in Turner’s Syndrome: 30 Years’ Review Rafael Luis Boemo, MD (presenter); Felix Pumarola-Segura, MD; Marc Pellicer, MD; Elisabet Genestar, MD; Susana Lareo-Copa, MD; Enrique Perello-Scherdel, MD Barcelona Spain OBJECTIVES: Ear and hearing disorders are common problems among girls and women with Turner syndrome. During infancy and childhood the girls often suffer from repeated attacks of acute otitis media and later in life the women frequently complain of a rapid onset of social hearing problems due to sensorineural hearing impairment. This study involved the assessment of the otologic and audiologic characteristics of a group of patients with Turner syndrome who were diagnosed with this disease between the years 1964 and 1994. METHODS: All patients were called, by the permission of the ethics comittee of our hospital, to answer questions concernig otologic and related problems and to submit to an audiometric and otomicrocopic examination afterward. RESULTS: Otologic disease is an important characteristic in Turner syndrome. The majority of patients (62%) complain of chronic or recurrent middle ear disease and an important portion of the patients presented hearing deficits during audiometric examinations (31%). CONCLUSIONS: Careful follow-up during early childhhood of children with Turner syndrome is necessary to detect oto-
Otolaryngology-Head and Neck Surgery, Vol 135, No 2S, August 2006
findings allow us to suggest including prenatal ultrasonographic studies of those regions. This would allow us early diagnosis and treatment with the inherent benefits to the newborn. P118 Contralateral Hearing Loss after Acoustic Neuroma Surgery Meredith E. Adams, MD (presenter); Ana H Kim, MD; H Alexander Arts, MD; Steven A Telian, MD Ann Arbor MI OBJECTIVES: To present a case series of contralateral ear hearing loss after acoustic neuroma surgery. METHODS: Retrospective review of patients undergoing acoustic neuroma surgery from 1992 to 2004 in a tertiary referral medical center. Changes in the mean pure tone average of greater than 20 dB or speech discrimination score of 15% from their preoperative audiogram were considered a significant hearing loss. RESULTS: Four patients developed significant hearing loss in the contralateral ear after surgery. One patient developed sudden acute sensorineural hearing loss (SNHL) on post-op day 12. Two patients developed acute SNHL at 5 and 9 years postsurgery along with symptoms suggestive of endolymphatic hydrops. The fourth patient developed SNHL 3 months after surgery that was preceded by a complex post-op course of CSF leakage, bacterial meningitis, and subdural hematoma while on IV heparin for DVT. All patients were treated with oral steroids. Hearing improved to pre-op or near pre-op levels in three patients within days to a few weeks after the initial hearing loss. CONCLUSIONS: Contralateral hearing loss after acoustic neuroma surgery is rare, but a devastating complication for the patient. Although several pathophysiologic mechanisms have been proposed such as compromised vascular supply or auditory nerve function resulting from brainstem shift and edema, intracochlear fluid disturbance caused by CSF release, immunological reactions, and drill-induced acoustic trauma, a clear etiology is rarely confirmed as in this patient series. P119 New Instruments for Intraoperative Facial Nerve Monitoring Shingo Murakami, MD (presenter); Nobuhiro Watanabe, MD; Mariko Takahashi, MD; Koji Yamano; Shinichi Ezaki, MD Nagoya Japan; Kona City Japan OBJECTIVES: Intraoperative facial nerve monitoring has been requisite for acoustic neuroma surgery. Now, the monitoring is widely adopting for middle ear surgery and cochlear implantation. Although several kinds of stimulus instrument have been developed, most of them are used after exposing the internal auditory canal (IAC) and facial nerve. To prevent
iatrogenic facial palsy in otologic surgery, real-time stimulation using a power drill is mandatory. Here, stimulus suction tubes for intraoperative facial nerve monitoring were made because the suction tube was used in cooperation with a power drill during mastoidectomy, posterior tympanotomy, and IAC opening. METHODS: The Frazier’s suction tubes are insulated up to their functional edge by Teflon coating. They consist of seven different sizes of diameter ranging from 1.5 to 3.4 mm. Newly designed stimulus dissectors for small acoustic neuroma surgery were also made. These instruments can be connected with a NIM-Pulse or NIM-Response integrity monitor. Simultaneous stimulation by suction tube and dissector is possible because NIM-Pulse and NIM-Response have two electric output channels. RESULTS: The stimulus suction tube and dissectors were used for 21 patients with acoustic neuroma, 12 with middle ear cholesteatoma and 10 with cochlear implantation. For all patients, stimulus suction tube and dissectors worked well, and were helpful to identify the facial nerve and to dissect the tumor. CONCLUSIONS: Stimulus suction tube and dissector might be useful for resident training of middle ear surgery and cochlear implantation. They are also useful for revision cases of chronic otitis media, congenital atresia, and acoustic neuroma surgery for the experienced surgeon. P120 Otological Problems in Turner’s Syndrome: 30 Years’ Review Rafael Luis Boemo, MD (presenter); Felix Pumarola-Segura, MD; Marc Pellicer, MD; Elisabet Genestar, MD; Susana Lareo-Copa, MD; Enrique Perello-Scherdel, MD Barcelona Spain OBJECTIVES: Ear and hearing disorders are common problems among girls and women with Turner syndrome. During infancy and childhood the girls often suffer from repeated attacks of acute otitis media and later in life the women frequently complain of a rapid onset of social hearing problems due to sensorineural hearing impairment. This study involved the assessment of the otologic and audiologic characteristics of a group of patients with Turner syndrome who were diagnosed with this disease between the years 1964 and 1994. METHODS: All patients were called, by the permission of the ethics comittee of our hospital, to answer questions concernig otologic and related problems and to submit to an audiometric and otomicrocopic examination afterward. RESULTS: Otologic disease is an important characteristic in Turner syndrome. The majority of patients (62%) complain of chronic or recurrent middle ear disease and an important portion of the patients presented hearing deficits during audiometric examinations (31%). CONCLUSIONS: Careful follow-up during early childhhood of children with Turner syndrome is necessary to detect oto-