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Pimecrolimus in the Treatment of Pruritic Ears
Scientific Session—Monday
for expression of hair cell markers and the relative competence of cells in different regions of the cochlea was determined. Results: Math-1 efficiently induced formation of ectopic hair cells in the inner sulcus, but much less efficiently in the sensory region and outer sulcus. Other HLH genes were ineffective. LIM HD proteins with a similar developmental expression pattern to Math-1 also failed to induce a hair cell phenotype. Conclusion: Ectopic Math-1 efficiently induces ectopic hair cells in a restricted region of the postnatal cochlea. Further manipulation of gene expression may be necessary to generate fully differentiated hair cells in other regions of the cochlea. It remains to be seen if these cells become appropriately innervated and functional. Funding: AAOHNS/AOS Herbert Silverstein Award, NIDCDK08DC006437-02
11:06
AM
Hyaluronate Gel Stapedotomy Simon I Angeli, MD (presenter) Miami FL
Objectives: To evaluate hearing results and postoperative vertigo after stapedotomy with application of sodium hyaluronate gel to the oval window niche during fenestration of the footplate. Methods: Study Design: Retrospective case-control study comparing 27 consecutive hyaluronate gel (HG) stapedotomies and 32 stapedotomies without HG by the same surgeon. Setting: Academic tertiary referral center. Outcome Measure: Preoperative and postoperative audiometric data, postoperative vertigo and nystagmus. Results: Ninety three percent (25/27) of HG stapedotomies had a postoperative average air-bone gap of less than 10dB at six months. Postoperative hearing results were not statistically different for the two groups. There were no cases of postoperative sensorineural hearing loss greater than 10dB (average bone conduction threshold for 0.5, 1, 2 and 4 kHz). Temporary vertigo or nystagmus had a shorter duration in the HG group when compared to the control group. There were no cases of persistent vertigo or nystagmus at the four to six week follow-up visit. Conclusion: Sodium hyaluronate gel stapedotomy is safe, effective and results in less early postoperative vertigo when compared to the standard technique of stapedotomy. The application of sodium hyaluronate gel to the oval window niche to prevent blood from entering or perilymph from escaping the vestibule during fenestration of the stapes footplate may contribute to a quicker recovery in outpatient otosclerosis surgery.
11:14
AM
Pimecrolimus in the Treatment of Pruritic Ears Hamid R Djalilian, MD (presenter); Omeed Memar, MD,PhD Los Angeles CA; Chicago IL
Objectives: To understand the role and efficacy of topical pimecrolimus in the treatment of refractory pruritis of the external auditory canals (EACs). Methods: Retrospective chart review of 36 patients with pruritic EACs who had failed conventional therapy with topical and systemic medications were treated with topical pimecrolimus 1% for a period of three months was carried out. Baseline and follow-up evaluation of the degree of pruritis, degree of cerumen production of the EAC, among other variables was performed. Results: Of the 36 patients who were treated with topical pimecrolimus for their pruritic EACs, 34 patients had resolution of their symptoms. There was evidence of return of cerumen production in 86% of patients. Conclusion: Topical pimecrolimus appears to be efficacious in the treatment of pruritic ears for chronic use without side effects. Pimecrolimus is a medication in a new class of topical anti-inflammatory medications with minimal side-effects that is effective in treating pruritic EACs. 11:26
AM
Improvement after Surgical Treatment for Vertigo: Characteristics and Time Course Karen Borne Teufert, MD (presenter); Antonio De la Cruz, MD; Karen I. Berliner, PhD Los Angeles CA; Los Angeles CA; Marina Del Rey CA
Objectives: To review our surgical experience with the treatment of vertigo, determine relative frequency of procedure type for 3638 procedures performed over a 30-year period, and assess characteristics and timing of postsurgical symptom improvement for each procedure type. Methods: At total of 3638 surgical procedures for treatment of vertigo were performed since 1974, including transmastoid labyrinthectomy with and without vestibular neurectomy (VN), transcanal labyrinthectomy, retrolabyrinthine, retrosigmoid and middle cranial fossa VN, and endolymphatic sac shunt. Most patients (84%) had Meniere’s disease. Frequency and relative prevalence of procedure was determined by decade and diagnosis. A questionnaire sent to a random sample of 75 patients for each major procedure type performed in recent years assessed frequency, severity and amount of disability for both vertigo and unsteadiness before and after surgery, and the postoperative time course of improvements. Results: 12% of procedures were VN (retrolabyrinthine, retrosigmoid and middle cranial fossa), 11% were labyrinthectomies with and without VN, and 75% were endolym-
MONDAY
P66
Otolaryngology– Head and Neck Surgery August 2005
for expression of hair cell markers and the relative competence of cells in different regions of the cochlea was determined. Results: Math-1 efficiently induced formation of ectopic hair cells in the inner sulcus, but much less efficiently in the sensory region and outer sulcus. Other HLH genes were ineffective. LIM HD proteins with a similar developmental expression pattern to Math-1 also failed to induce a hair cell phenotype. Conclusion: Ectopic Math-1 efficiently induces ectopic hair cells in a restricted region of the postnatal cochlea. Further manipulation of gene expression may be necessary to generate fully differentiated hair cells in other regions of the cochlea. It remains to be seen if these cells become appropriately innervated and functional. Funding: AAOHNS/AOS Herbert Silverstein Award, NIDCDK08DC006437-02
11:06
AM
Hyaluronate Gel Stapedotomy Simon I Angeli, MD (presenter) Miami FL
Objectives: To evaluate hearing results and postoperative vertigo after stapedotomy with application of sodium hyaluronate gel to the oval window niche during fenestration of the footplate. Methods: Study Design: Retrospective case-control study comparing 27 consecutive hyaluronate gel (HG) stapedotomies and 32 stapedotomies without HG by the same surgeon. Setting: Academic tertiary referral center. Outcome Measure: Preoperative and postoperative audiometric data, postoperative vertigo and nystagmus. Results: Ninety three percent (25/27) of HG stapedotomies had a postoperative average air-bone gap of less than 10dB at six months. Postoperative hearing results were not statistically different for the two groups. There were no cases of postoperative sensorineural hearing loss greater than 10dB (average bone conduction threshold for 0.5, 1, 2 and 4 kHz). Temporary vertigo or nystagmus had a shorter duration in the HG group when compared to the control group. There were no cases of persistent vertigo or nystagmus at the four to six week follow-up visit. Conclusion: Sodium hyaluronate gel stapedotomy is safe, effective and results in less early postoperative vertigo when compared to the standard technique of stapedotomy. The application of sodium hyaluronate gel to the oval window niche to prevent blood from entering or perilymph from escaping the vestibule during fenestration of the stapes footplate may contribute to a quicker recovery in outpatient otosclerosis surgery.
11:14
AM
Pimecrolimus in the Treatment of Pruritic Ears Hamid R Djalilian, MD (presenter); Omeed Memar, MD,PhD Los Angeles CA; Chicago IL
Objectives: To understand the role and efficacy of topical pimecrolimus in the treatment of refractory pruritis of the external auditory canals (EACs). Methods: Retrospective chart review of 36 patients with pruritic EACs who had failed conventional therapy with topical and systemic medications were treated with topical pimecrolimus 1% for a period of three months was carried out. Baseline and follow-up evaluation of the degree of pruritis, degree of cerumen production of the EAC, among other variables was performed. Results: Of the 36 patients who were treated with topical pimecrolimus for their pruritic EACs, 34 patients had resolution of their symptoms. There was evidence of return of cerumen production in 86% of patients. Conclusion: Topical pimecrolimus appears to be efficacious in the treatment of pruritic ears for chronic use without side effects. Pimecrolimus is a medication in a new class of topical anti-inflammatory medications with minimal side-effects that is effective in treating pruritic EACs. 11:26
AM
Improvement after Surgical Treatment for Vertigo: Characteristics and Time Course Karen Borne Teufert, MD (presenter); Antonio De la Cruz, MD; Karen I. Berliner, PhD Los Angeles CA; Los Angeles CA; Marina Del Rey CA
Objectives: To review our surgical experience with the treatment of vertigo, determine relative frequency of procedure type for 3638 procedures performed over a 30-year period, and assess characteristics and timing of postsurgical symptom improvement for each procedure type. Methods: At total of 3638 surgical procedures for treatment of vertigo were performed since 1974, including transmastoid labyrinthectomy with and without vestibular neurectomy (VN), transcanal labyrinthectomy, retrolabyrinthine, retrosigmoid and middle cranial fossa VN, and endolymphatic sac shunt. Most patients (84%) had Meniere’s disease. Frequency and relative prevalence of procedure was determined by decade and diagnosis. A questionnaire sent to a random sample of 75 patients for each major procedure type performed in recent years assessed frequency, severity and amount of disability for both vertigo and unsteadiness before and after surgery, and the postoperative time course of improvements. Results: 12% of procedures were VN (retrolabyrinthine, retrosigmoid and middle cranial fossa), 11% were labyrinthectomies with and without VN, and 75% were endolym-
MONDAY
P66
Otolaryngology– Head and Neck Surgery August 2005