mixed hearing loss: our experience with FIMOS

mellitus causes cochlear microangiopathy and subsequently degeneration of cochlear lateral walls and OHCs. SP311 – Cochlear implantation with cochlear nerve deficiency Joe Walter Kutz, Jr., MD (presenter); Peter Roland, MD; Brandon Isaacson, MD; Kenneth Lee, MD, PhD; Timothy Booth, MD; Melissa Sweeney, MS, CCC/SLP OBJECTIVES: 1) Understand the limitations of cochlear implantation in children with a deficient cochlear nerve. 2) Realize the importance of adopting new technology for this group of children. METHODS: A retrospective case review was performed to identify children that underwent cochlear implantation with cochlear nerve deficiency. The cochlear nerve was evaluated by high-resolution T2-weighted fast-spin echo MR in the sagittal, coronal, and oblique planes. A deficient cochlear nerve was defined as a cochlear nerve that is smaller in diameter when compared with the adjacent nerves in the internal auditory canal. The cochlear nerve was considered absent if there was no radiographic evidence of a cochlear nerve. Post-operative performance was measured to determine benefit after cochlear implantation. RESULTS: Six children were identified that underwent cochlear implantation in an ear without radiographic evidence of a cochlear nerve. The mean age was 6.3 (1-13 years). One child developed pattern perception. The other children failed to demonstrate clear evidence of pattern perception or sound awareness. Two children (ages 1 and 5) underwent cochlear implantation with a deficient cochlear nerve. Both patients developed limited open set speech. CONCLUSIONS: Cochlear nerve absence as determined by MR portends a poor prognosis for cochlear implant performance. However, children with cochlear nerve deficiency may gain limited open-set speech perception. The potential availability of alternative technology in the United States, such as the auditory brainstem implant, should be strongly considered to provide this group of patients with a viable option for hearing habilitation. SP330 – Cochlear schwannomas Brandon Isaacson, MD (presenter); Peter Roland, MD; Walter Kutz, MD OBJECTIVES: To understand the presentation, imaging characteristics and management of cochlear schwannomas. METHODS: Retrospective chart review from 1995 to 2008 was undertaken at a tertiary care academic medical center. Six subjects with isolated intracochlear schwannomas were identified. Treatment included observation with serial imaging and/or excision via a transotic approach.

P183 RESULTS: All six patients presented with sensorineural hearing loss. One patient developed vertigo, which was unresponsive to medical management. This patient underwent a transotic removal of her tumor with resolution of her balance disturbance. CONCLUSIONS: Intracochlear schwannomas are rare neoplasms that present with sensorineural hearing loss. All of the patients in this series presented with or eventually lost all hearing. One subject developed severe imbalance and vertigo, which resolved after transotic removal of her tumor. SP279 – Comparison of caloric test with galvanic test in dizziness Seog Kyun Mun, MD (presenter) OBJECTIVES: The purpose of this study is to characterize various responses by comparing eye movements, which is induced by galvanic vestibular stimulation (GVS), in normal subjects and patients with peripheral vestibulopathy. Another purpose of this study is to estimate the clinical significance of GVS tests in patients with results of caloric test. METHODS: Thirty normal subjects and 17 patients with peripheral vestibulopathy were selected on the basis of medical history and neurological examination. Binaural electric current was applied to each subject’s and patient’s mastoid. And then by carrying out GVS, galvanic stimulating nystagmus (GSN), post-galvanic stimulating nystagmus (PGSN), and spontaneous nystagmus were evaluated in all of them using a 3D videoelectronystagmography technique. Canal paresis and directional preponderance were measured in patients by alternative binaural bithermal caloric test. RESULTS: In patients with peripheral vestibulopathy, when the negative electrode was attached to the intact side, increased GSN was always directed toward the negative electrode but decreased PGSN was directed toward the negative electrode. When the negative electrode was attached to the lesion side, decreased GSN was directed toward the positive electrode but increased PGSN was directed toward the positive electrode. There was a correlation between canal paresis and response degree of GVS (p⬍0.05). CONCLUSIONS: The response to GVS in patients with peripheral vestibulopathy differed from that in normal subjects, which suggests that GVS could be useful for estimating vestibular function. Because response degree of GVS was proportionate to canal paresis, it is thought to be another useful method for assessing vestibular functions. SP304 – Conductive/mixed hearing loss: our experience with FIMOS Maurizio Levorato, MD (presenter); Victoria Rivero de Jesus, MD; Luis Garcia-Ibanez, MD; Emilio Garcia-Ibanez, MD OBJECTIVES: 1) To determine the safety of Otologics MET fully implantable ossicular stimulator (FIMOS) implanted with

POSTERS

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P184

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

no convencional technique (footplate, stape, and round window). 2) To evaluate the effectiveness and functional outcomes in severe to moderate conductive/mixed hearing loss. METHODS: Study design: retrospective clinical evaluation. Period: July 2007 to September 2008. Condition studied: middle-ear FIMOS implantation in conductive/mixed hearing loss. Subjects: six patients, all adults, with moderate to severe conductive/mixed hearing loss. Setting: tertiary referral private institution. Interventions: middle-ear implantation of FIMOS in six patients: two stape, two footplate, and two round window. Activation of the implant two months after surgery. Tonal and vocal audiometry pre and post surgery. Specific satisfaction test developed by Otologics administered three months after activation. Statistical Method: descriptive statistical method. RESULTS: Post-operative hearing threshold with FIMOS not activated almost unchanged if compared with the pre-operative hearing threshold. Mean functional gain for all frequencies analyzed (250, 500, 750, 1,000, 1,500, 2,000, 3,000, 4,000, 6,000, 8,000Hz) is 33.5dBHL (min 22.5, max 40.5, DS 6.5). Satisfation test: four patients very satisfied, one patient satisfied, one patient not yet tested. Complications: one patient reimplanted for implant failure after direct trauma to the device. CONCLUSIONS: In our experience FIMOS seems to be a promising alternative in severe to moderate conductive/mixed hearing loss rehabilitation (not easy to realize with conventional hearing aids). The degree of satisfation has been very high. One patient had to be reimplanted for implant failure after direct trauma to the device, but functional outcomes did not change after second surgery. No life threatening complications occurred. SP313 – Congenital cholesteatoma of the eustachian tube Thomas Stewart, MD (presenter); Helen Xu OBJECTIVES: 1) Learn about an unusual presentation of congenital cholesteatoma. 2) Be able to discuss the appropriate work-up and treatment for atypical congenital cholesteatoma. Middle-ear cholesteatoma is described as either acquired or congenital. The latter is traditionally defined as a white pearly mass sitting behind an intact tympanic membrane with no history of ear infection. The objective is to report a rare presentation of congenital cholesteatoma presenting with chronic middle-ear infection and a eustachian tube mass. Further objectives include a literature review and discussion about the role of imaging studies for early diagnosis and management. METHODS: A 6-month-old female presented with chronic right otorrhea that did not respond to antibiotic treatment. Middle-ear exploration and subsequent pathology revealed cholesteatoma. Extirpation was successfully performed; subsequently the available literature was thoroughly examined. RESULTS: Imaging and surgical exploration revealed cholestea-

toma in an enlarged eustachian tube. The cholesteatoma extended into the anterior mesotympanum with granulation tissue in the middle ear and mastoid. Chronic pressure from cholesteatoma expansion turned the eustachian tube into a large cavity approximately double size of the middle-ear space. Complete removal of cholesteatoma from the eustachian tube was confirmed by retrograde fiberoptic endoscopy from the nasopharynx. CONCLUSIONS: Congenital cholesteatoma is an expansile and destructive lesion. This case was unusual not only in the location of the cholesteatoma but also in respect to the unusual presentation as chronic middle-ear infection, secondary to eustachian tube obstruction. Early recognition and surgical therapy is important for improved outcome. SP295 – Cyanoacrylate glue in tympanoplasty: A case presentation Alaa Ali Abou-Bieh, MB, BCh, MSc (ORL), MD (ORL), DO-HNS (RCS Eng) (presenter); Khaled Al-Abdulhadi, FRCS, ABOI-O OBJECTIVES: To present a case included the use of tissue glue composed of N-butil-2-cyanoacrylate during type 1 tympanoplasty and its impact on the surgical and functional results of the procedure. In addition, to recognize any local or systematic side effects from the use of this material locally in the ear during the surgery. A review of the published literature about the usage of the tissue adhesives in tympanoplasty to investigate its history, advantages, disadvantages and safety, would be performed. METHODS: A case with a dry central tympanic membrane perforation was operated upon with type 1 tympanoplasty using autogenous temporalis fascia graft and the glue to fix the graft to flaps and surroundings, with follow-up for six months post-operatively. The main outcome measure was a healed and intact tympanic membrane. The hearing results were obtained following the 1995 guidelines described by the American Academy of Otolaryngology Head and Neck Surgery Committee on Hearing and Equilibrium for evaluation of results of treatment of conductive hearing loss. RESULTS: A healed intact tympanic membrane without lateralization or anterior blunting and with near normal membrane translucency was achieved. The post-operative air-bone gap was less than 10dB. No significant complications were recorded. CONCLUSIONS: The tissue glue composed of N-butil-2cyanoacrylate was used safely during type 1 tympanoplasty with successful closure of the perforation. SP277 – Depression and anxiety influence vestibular rehabilitation Fumiyuki Goto, MD (presenter); Naokazu Takahashi; Motohiro Arai OBJECTIVES: In 1996, we developed an in-hospital vestib-