SP282 – Skull base manifestations of Camurati-Engelmann disease

soft tissue canal within 5 millimeters of the tympanic membrane. Following a hearing evaluation the Lyric was placed within 5 mm of the tympanic membrane and at least 3 mm medial to the lateral rim of the posterior canal wall. Devices were replaced every 30-120 days. Ear canals were inspected at least every 120 days and observed for infection, inflammation or tympanic membrane injury. RESULTS: The Lyric was worn for 90-765 days without inflammation by 91% of users. The incidence of transient canal irritation was 9%. There were no cases of tympanic membrane injury or osteomyelitis. Patients preferred the Lyric over their prior hearing aid, when using a phone, and cosmetically, 92%, 95% and 97% of the time respectively. CONCLUSIONS: We conclude the Lyric can be safely worn in the ear canal for extended time periods, and satisfaction with the quality of hearing, cosmetic result, and phone use is extremely high. SP346 – Selenium coating of PE tubes inhibits bacterial biofilms Joehassin Cordero, MD (presenter); Ted Reid; John Marchbanks, MD; Abdul Hamood, MS, PhD; Thomas Mosley; Phat Tran; Janette Cortez; Richard Timmons, PhD OBJECTIVES: 1) To successfully coat a PE tube with organo-selenium. 2) Determine the effect of a selenium coating on the development of a staphylococcus aureus biofilm on tympanostomy tubes. METHODS: Organo-selenium compounds have the property of being able to be covalently attached to a surface and yet still retain their ability to catalyze the formation of superoxide radicals. These radicals are formed by the donation of an electron to oxygen by the selenium atom. PE tubes were treated with pulsed plasma in the presence of an organoselenium compound. The tubes were then incubated with staphylococcus aureus in nutrient broth for 24 hours to allow for the development of a mature biofilm. Tubes were then removed and examined by scanning electron microscopy. RESULTS: By scanning electron microscopy a complete mature biofilm was found on the control (uncoated) tympanostomy tubes. In contrast no biofilm was found on the selenium coated tympanostomy tubes. CONCLUSIONS: Use of a selenium coating provided an effective barrier to the formation of bacterial biofilms on a tube. SP272 – Semi-implantable hearing device and severe hearing loss Stephane Tringali, MD (presenter); Xavier Perrot, MD; Christian Dubreuil, MD; Eric Truy, MD; Paul Berger; Genevieve Lina Granade

P195 OBJECTIVES: The objective of this study is to report the audiometric outcomes of patients with severe sensorineural hearing loss and who have been fitted with an MET on one side and fitted with an optimized conventional hearing aid on the other side. METHODS: Audiometric testing was performed the day of activation (2 months post-operative) and again after 8 days, 1, 3, 6, 9, 12 and 24 months. For every check up, MET and conventional hearing devices were optimized according to the patient hearing loss. RESULTS: Mean functional gains for conventional hearing devices were 28dB [16-52dB] and were stable during the study. Mean functional gains with the MET were 35dB [2646dB] the first day of the study and were 40dB [30-52dB] after 6 months. On the IHS, statistical analysis confirms a significant difference between the first day of the study and the 6 month SRT measurements (p⫽0.006) and a similar statistical difference in the PTA (p⫽0.02). On the NIHS, statistical analysis didn’t demonstrate any PTA variation. CONCLUSIONS: For severe sensorineural hearing loss patients similar to those in this study, the MET appears to be a suitable and successful treatment option resulting in significant improvement in speech comprehension, especially after 6 months. During the 24-months follow-up of this study, the MET has been a safe and effective treatment for severe hearing loss. Additional long term studies with larger patient numbers are necessary to confirm these results. SP282 – Skull base manifestations of CamuratiEngelmann disease Matthew L Carlson, MD (presenter); Charles Beatty, MD; Colin Driscoll, MD; Michael Link, MD; Brian Neff, MD OBJECTIVES: Significance: Camurati-Engelmann Disease (CED) is a rare autosomal dominant disorder characterized by progressive symmetric diaphyseal sclerosis of the long bones and potential cranial hyperostosis. Since the first description in 1922, fewer than 200 cases have been described in the international literature. Cranial base involvement is quite variable and results from bony overgrowth leading to foraminal stenosis and neurovascular compromise. Objectives: 1) Describe presenting symptomatology. 2) Evaluation. 3) Surgical management of cranial base hyperostosis in patients with CED. METHODS: Retrospective chart review (1968-2008) at a tertiary referral center. RESULTS: In the last 40 years, 12 patients carrying the diagnosis of CED were evaluated. Of these, eight (66%) were found to have radiographic evidence of skull base thickening with concurrent cranial signs and symptoms of disease. The average onset of cranial base symptoms was 24 years (15-35 years). Sensorineural hearing loss (SNHL) was the most common finding (50%), followed by vertigo (25%), and visual

POSTERS

Program Poster Presentations

P196

Otolaryngology-Head and Neck Surgery, Vol 141, No 3S1, September 2009

disturbances (17%); less commonly facial nerve weakness (8%) and brainstem compression (8%) occurred. Four patients underwent a total of six decompression surgeries for aggressive disease and one additionally received cochlear implantation for profound bilateral SNHL. CONCLUSIONS: CED should be included in the differential diagnosis for patients with radiographic evidence of skull base thickening and synchronous cranial neuropathies (most commonly cochleovestibulopathy). In mild forms of disease, patients should be followed with serial examination, audiometric testing, and radiography. Those with more symptomatic skull base involvement benefit from wide decompression of involved neurovascular structures. SP327 – Subgaleal hematoma following cochlear implantation Mike Sheu (presenter); Daniel Zeitler, MD OBJECTIVES: 1) Present a unique case of a post-operative subgaleal hematoma following cochlear implantation. 2) Review of the literature regarding the management of post-operative hematoma in cochlear. METHODS: Case report and literature review. RESULTS: A 7-year-old girl with underwent left CI. On POD 3, she was noted to have increased swelling of the nasal dorsum and ipsilateral periorbital region that progressed over the following two days to involve her left forehead and temporoparietal skull. On POD 6, the patient was re-admitted with objective fevers and worsening edema over her left forehead and scalp without involvement of the post-auricular wound. Imaging revealed a large hematoma in the subgaleal space. The patient was started on antibiotics and taken to the operating room for hematoma evacuation. The patient discharged on hospital day three with no further complications. CONCLUSIONS: Subgaleal hematoma is typically associated with vacuum assisted birth and head trauma. This is the first reported case in the English literature of a subgaleal hematoma following CI, likely the result of unidentified bleeding from a branch of the superficial temporal artery beneath the temporoparietal fascia. A thorough review of the relevant anatomy can help the CI surgeon understand the etiology of a post-operative subgaleal hematoma, and assist in the management of this complication. SP297 – Surgical treatment of labyrinthine fistula caused by cholesteatoma Shan-Kai Yin, MD (presenter); Hai-Bo Shi, MD; Zheng-Nong Chen, MD; Akira Miyoshi, MD OBJECTIVES: To investigate the safety and efficacy of semicircular canal occlusion for surgical treatment of labyrinthine fistula caused by cholesteatoma. METHODS: Twenty-two patients with labyrinthine fistula,

who were treated surgically, were enrolled in the study. All patients were treated by completely removing the cholesteatoma matrix followed by semicircular canal occlusion. RESULTS: With a follow up of at least six months, there was no recurrent cholesteatoma in all patients. Vertigo disappeared in all the patients. Most patients presented no hearing detriment, and four of them demonstrated hearing improvement. No patient presented with surgery related deafness. CONCLUSIONS: Semicircular canal occlusion after completely removing cholesteatoma matrix for treatment of labyrinthine fistula is a safe and effective approach. SP284 – Tai Chi as a form of vestibular rehabilitation Paul S Lee, MD (presenter) OBJECTIVES: Evaluate the utility of Tai Chi in managing patients with vestibular symptoms who have failed conventional vestibular therapy. METHODS: This study aims to evaluate the utility of Tai Chi in managing patients with vestibular symptoms who have failed conventional vestibular therapy. We conducted a questionnaire study from April 2008 to March 2009 at an outpatient rehabilitation program utilizing the activities-specific balance confidence scale and dynamic gait index survey prior to therapy and at the conclusion of an eight-week course. Independent variables included compliance and medical co-morbidity. Mean improvement in ABC score was 7.3611.3 (p⬍ 0.05). Mean DGI score improved post intervention by 3.182. RESULTS: Total of 21 patients (18 females, three males) completed the study to date. Participants report subjective improvements in their vestibular symptoms, reflected by a mean improvement in their ABC score by 7.3611.3 (p⬍ 0.05). Mean DGI score also improved post Tai Chi intervention by 3.182 3.093 (p⬍0.05). Overall mean indices on ABC (N⫽21) and DGI (N⫽11) show statistically significant improvement after undergoing Tai Chi rehabilitation. CONCLUSIONS: Our study show benefits of using Tai Chi as an alternative form of vestibular rehabilitation in patients with vestibular symptoms based on both subjective and objective assessments. This may be based on the technique of Tai Chi promoting coordination through relaxation rather than muscular SP289 – Ten-year prognosis of low-frequency hearing loss Naoki Oishi, MD (presenter); Kaoru Ogawa, MD, PhD; Yasuhiro Inoue; Hideyuki Saito; Sho Kanzaki, MD, PhD OBJECTIVES: Investigate the clinical course of low-frequency hearing loss (LFHL), typically regarded as an effect of endolymphatic hydrops and postulated as a precursor of Me´-