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Hosoya M, Kurihara S, Koyama H, Komune N. Recent advances in Otology: Current landscape and future direction. Auris Nasus Larynx 2024; 51:605-616. [PMID: 38552424 DOI: 10.1016/j.anl.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/24/2023] [Accepted: 02/21/2024] [Indexed: 05/12/2024]
Abstract
Hearing is an essential sensation, and its deterioration leads to a significant decrease in the quality of life. Thus, great efforts have been made by otologists to preserve and recover hearing. Our knowledge regarding the field of otology has progressed with advances in technology, and otologists have sought to develop novel approaches in the field of otologic surgery to achieve higher hearing recovery or preservation rates. This requires knowledge regarding the anatomy of the temporal bone and the physiology of hearing. Basic research in the field of otology has progressed with advances in molecular biology and genetics. This review summarizes the current views and recent advances in the field of otology and otologic surgery, especially from the viewpoint of young Japanese clinician-scientists, and presents the perspectives and future directions for several topics in the field of otology. This review will aid next-generation researchers in understanding the recent advances and future challenges in the field of otology.
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Affiliation(s)
- Makoto Hosoya
- Department of Otolaryngology, Head and Neck Surgery, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Sho Kurihara
- Department of Otorhinolaryngology, The Jikei University School of Medicine, 3-25-8 Nishishimbashi Minato-ku, Tokyo, 105-8471, Japan
| | - Hajime Koyama
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, 113-8654, Japan
| | - Noritaka Komune
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, 3-1-1Maidashi Higashi-ku, Fukuoka 812-8582, Japan
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Gu F, Yang X, Wang Z, Tan X, Xue T, Chen Z, Wang Z, Chen G. Diagnostic accuracy of intraoperative brainstem auditory evoked potential for predicting hearing loss after vestibular schwannoma surgery. Front Neurol 2022; 13:1018324. [PMID: 36588877 PMCID: PMC9797509 DOI: 10.3389/fneur.2022.1018324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 11/22/2022] [Indexed: 12/23/2022] Open
Abstract
Objective This meta-analysis evaluated the diagnostic value of intraoperative brainstem auditory evoked potential (BAEP) for predicting post-operative hearing loss. Methods Research articles in MEDLINE, Embase, and Cochrane Library databases were searched and selected up to 20 January 2022, and data were extracted following a standard procedure. A diagnostic accuracy test meta-analysis was performed using a mixed-effect binary regression model. Results A total of 693 patients from 15 studies were extracted. The change in intraoperative BAEP showed high sensitivity (0.95) but low specificity (0.37), with an area under the curve of 0.83. Diagnostic accuracy of the loss of potentials showed high sensitivity (0.82) and specificity (0.79). The area under the curve was 0.88. No factor was found to account for the heterogeneity of the results according to the meta-regression and subgroup analyses (all P-values > 0.05). Conclusions Our results showed that the loss of BAEP has meaningful value for predicting hearing loss after vestibular schwannoma surgery. The change in BAEP is also important for its high sensitivity during hearing preservation surgery.
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Affiliation(s)
- Feng Gu
- Department of Neurosurgery and Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Xingyu Yang
- Department of Neurosurgery and Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Zilan Wang
- Department of Neurosurgery and Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Xin Tan
- Department of Neurology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, Jiangsu, China
| | - Tao Xue
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhouqing Chen
- Department of Neurosurgery and Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China,Zhouqing Chen
| | - Zhong Wang
- Department of Neurosurgery and Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China,*Correspondence: Zhong Wang
| | - Gang Chen
- Department of Neurosurgery and Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
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Understanding the Molecular Mechanism of Vestibular Schwannoma for Hearing Preservation Surgery: Otologists’ Perspective from Bedside to Bench. Diagnostics (Basel) 2022; 12:diagnostics12051044. [PMID: 35626200 PMCID: PMC9140016 DOI: 10.3390/diagnostics12051044] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 04/19/2022] [Accepted: 04/20/2022] [Indexed: 02/04/2023] Open
Abstract
Vestibular schwannoma is a clinically benign schwannoma that arises from the vestibulocochlear nerve that causes sensorineural hearing loss. This tumor is clinically and oncologically regarded as a benign tumor as it does not metastasize or invade surrounding tissues. Despite being a benign tumor, its management is difficult and controversial due to the potential serious complications, such as irreversible sensorineural hearing loss, of current interventions. Therefore, preventing hearing loss due to the natural course of the disease and complications of surgery is a challenging issue for an otologist. Improvements have been reported recently in the treatment of vestibular schwannomas. These include advances in intraoperative monitoring systems for vestibular schwannoma surgery where the risk of hearing loss as a complication is decreased. Precise genomic analysis of the tumor would be helpful in determining the characteristics of the tumor for each patient, leading to a better hearing prognosis. These procedures are expected to help improve the treatment of vestibular schwannomas. This review summarizes recent advances in vestibular schwannoma management and treatment, especially in hearing preservation. In addition, recent advances in the understanding of the molecular mechanisms underlying vestibular schwannomas and how these advances can be applied in clinical practice are outlined and discussed, respectively. Moreover, the future directions from the bedside to the bench side are presented from the perspective of otologists.
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Kasbekar AV, Tam YC, Carlyon RP, Deeks JM, Donnelly N, Tysome J, Mannion R, Axon PR. Intraoperative Monitoring of the Cochlear Nerve during Neurofibromatosis Type-2 Vestibular Schwannoma Surgery and Description of a "Test Intracochlear Electrode". J Neurol Surg Rep 2019; 80:e1-e9. [PMID: 30723658 PMCID: PMC6361632 DOI: 10.1055/s-0038-1673649] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Accepted: 07/27/2017] [Indexed: 10/31/2022] Open
Abstract
Objectives A decision on whether to insert a cochlear implant can be made in neurofibromatosis 2 (NF2) if there is objective evidence of cochlear nerve (CN) function post vestibular schwannoma (VS) excision. We aimed to develop intraoperative CN monitoring to help in this decision. Design We describe the intraoperative monitoring of a patient with NF2 and our stimulating and recording set up. A novel test electrode is used to stimulate the CN electrically. Setting This study was set at a tertiary referral center for skull base pathology. Main outcome measure Preserved auditory brainstem responses leading to cochlear implantation. Results Electrical auditory brainstem response (EABR) waveforms will be displayed from different stages of the operation. A cochlear implant was inserted at the same sitting based on the EABR. Conclusion Electrically evoked CN monitoring can provide objective evidence of CN function after VS excision and aid in the decision-making process of hearing rehabilitation in patients who will be rendered deaf.
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Affiliation(s)
- Anand V Kasbekar
- Cambridge Skull Base Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom.,Department of Otorhinolaryngology, Head and Neck Surgery, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom.,NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, United Kingdom
| | - Yu Chuen Tam
- Emmeline Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Robert P Carlyon
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge, United Kingdom
| | - John M Deeks
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge, United Kingdom
| | - Neil Donnelly
- Cambridge Skull Base Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - James Tysome
- Cambridge Skull Base Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Richard Mannion
- Cambridge Skull Base Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Patrick R Axon
- Cambridge Skull Base Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
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Lourenço B, Madero B, Tringali S, Dubernard X, Khalil T, Chays A, Bazin A, Mom T, Avan P. Non-invasive intraoperative monitoring of cochlear function by cochlear microphonics during cerebellopontine-angle surgery. Eur Arch Otorhinolaryngol 2017; 275:59-69. [PMID: 29080147 DOI: 10.1007/s00405-017-4780-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 10/12/2017] [Indexed: 11/28/2022]
Abstract
In vestibular-schwannoma (VS) surgery, hearing-preservation rate remains low. Besides damage to the cochlear nerve, intraoperative cochlear ischemia is a potential cause of hearing loss. Here, we used non-invasive cochlear microphonic (CM) recordings to detect the cochlear vascular events of VS surgery. Continuous intraoperative CM monitoring, in response to 80-95 dB SPL, 1-kHz tone-bursts, was performed in two samples of patients undergoing retrosigmoid cerebellopontine-angle surgery: one for VS (n = 31) and one for vestibular neurectomy or vasculo-neural conflict causing intractable trigeminal neuralgia, harmless to hearing (n = 19, control group). Preoperative and postoperative hearings were compared as a function of intraoperative CM changes and their chronology. Monitoring was possible throughout except for a few tens of seconds when drilling or suction noises occurred. Four patterns of CM time course were identified, eventless, fluctuating, abrupt or progressive decrease. Only the VS group displayed the last two patterns, mainly during internal-auditory-canal drilling and the ensuing tumor dissection, always with postoperative loss of hearing as an end result. Conversely, eventless and fluctuating CM patterns could be associated with postoperative hearing loss when the cochlear nerve had been reportedly damaged, an event that CM is not meant to detect. Cochlear ischemia is a frequent event in VS surgery that leads to deafness. The findings that CM decrease raised no false alarm, and that CM fluctuations, insignificant in control cases, were easily spotted, suggest that CM intraoperative monitoring is a sensitive tool that could profitably guide VS surgery.
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Affiliation(s)
- Blandine Lourenço
- INSERM, Laboratory of Neurosensory Biophysics, Université Clermont Auvergne, 63000, Clermont-Ferrand, France.,Department of Otolaryngology Head Neck Surgery, University Hospital, Clermont-Ferrand, France.,Centre Jean Perrin, Clermont-Ferrand, France
| | - Béatriz Madero
- INSERM, Laboratory of Neurosensory Biophysics, Université Clermont Auvergne, 63000, Clermont-Ferrand, France.,Department of Otolaryngology Head Neck Surgery, University Hospital, Reims, France.,Centre Jean Perrin, Clermont-Ferrand, France
| | - Stéphane Tringali
- Department of Otolaryngology Head Neck Surgery, University Hospital, Lyon, France
| | - Xavier Dubernard
- Department of Otolaryngology Head Neck Surgery, University Hospital, Reims, France
| | - Toufic Khalil
- Department of Neurosurgery, University Hospital, Clermont-Ferrand, France
| | - André Chays
- Department of Otolaryngology Head Neck Surgery, University Hospital, Reims, France
| | - Arnaud Bazin
- Department of Neurosurgery, University Hospital, Reims, France
| | - Thierry Mom
- INSERM, Laboratory of Neurosensory Biophysics, Université Clermont Auvergne, 63000, Clermont-Ferrand, France.,Department of Otolaryngology Head Neck Surgery, University Hospital, Clermont-Ferrand, France
| | - Paul Avan
- INSERM, Laboratory of Neurosensory Biophysics, Université Clermont Auvergne, 63000, Clermont-Ferrand, France. .,Centre Jean Perrin, Clermont-Ferrand, France.
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Hummel M, Perez J, Hagen R, Gelbrich G, Ernestus RI, Matthies C. Auditory Monitoring in Vestibular Schwannoma Surgery: Intraoperative Development and Outcome. World Neurosurg 2016; 96:444-453. [PMID: 27647030 DOI: 10.1016/j.wneu.2016.09.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 09/03/2016] [Accepted: 09/06/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The auditory brainstem response (ABR) may be a predictor of postoperative cochlear nerve function. In this study, the course of intraoperative ABR monitoring was analyzed to find predictive markers for postoperative hearing function. PATIENTS AND METHODS From 2010 to 2012, 46 patients who had had vestibular schwannoma surgery were investigated by intraoperative ABR monitoring. The type of ABR development was identified: type A, improved or stable ABR; type B, fluctuating or deteriorated ABR; and type C, slow or sudden ABR loss. Hearing function was correlated with ABR monitoring. RESULTS The different types of ABR development showed a strong correlation with postoperative hearing (P < 0.001). ABR quality after 60% tumor removal was independently significant for hearing outcome. Possible interpretations are: 1) Independent of positive factors at the start of surgery at the final phase of tumor resection, what mattered for hearing outcome was the ABR quality (P < 0.001). 2) Dependence on ABR quality in the last phase might be a result of what the cochlear nerve has endured during resection. 3) The importance of ABR quality in the last phase might be because the tumor capsule is dissected from the nerves in that final phase. ANALYSIS of critical actions with incidence of ABR impairment showed that dissection in the internal auditory canal and drilling were most critical. CONCLUSIONS Intraoperative ABR development is a predictive factor for postoperative hearing outcome. Deterioration should be avoided, because ABR improvement as a result of good status at the beginning of surgery could not be assumed.
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Affiliation(s)
- Maria Hummel
- Department of Neurosurgery, University Hospital Würzburg, Würzburg, Germany.
| | - Jose Perez
- Department of Neurosurgery, University Hospital Würzburg, Würzburg, Germany
| | - Rudolf Hagen
- Department of Otolaryngology, University Hospital Würzburg, Würzburg, Germany
| | - Götz Gelbrich
- Institute for Clinical Epidemiology and Biometry, Julius-Maximilians University Würzburg, Würzburg, Germany
| | - Ralf-Ingo Ernestus
- Department of Neurosurgery, University Hospital Würzburg, Würzburg, Germany
| | - Cordula Matthies
- Department of Neurosurgery, University Hospital Würzburg, Würzburg, Germany
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When Does Hearing Loss Occur in Vestibular Schwannoma Surgery? Importance of Auditory Brainstem Response Changes in Early Postoperative Phase. World Neurosurg 2016; 95:91-98. [PMID: 27495840 DOI: 10.1016/j.wneu.2016.07.085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 07/22/2016] [Accepted: 07/23/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Some patients suffer postoperative hearing loss even when the intraoperative auditory brainstem response (ABR) is preserved during vestibular schwannomas surgery. This study was conducted to evaluate whether there are dynamic changes of the ABR after surgery. PATIENTS AND METHODS In a prospective study from 2010-2012, 46 patients (24 female and 22 male) with vestibular schwannomas were investigated by intraoperative and postoperative ABR monitoring. Development of ABR quality during and after surgery (Class 1 normal, Class 5 complete loss) was correlated to auditory outcome. RESULTS At the end of surgery, 17 patients had an ABR Class 1-4 and 29 had Class 5. Four hours after surgery, 9 of 23 (39%) patients showed an ABR quality change, and 24 hours after surgery, 15 of 30 (50%) had undergone ABR quality changes. Four different types of postoperative ABR courses could be distinguished-Course 1: stable with reproducible ABR, Course 2: unstable with reproducible ABR, Course 3: unstable with ABR loss, and Course 4: stable with ABR loss. These courses correlated highly significantly with the intraoperative development (P < 0.001) and with hearing outcome (P = 0.003). CONCLUSION The study identifies ongoing changes of ABR quality and hearing function after the end of vestibular schwannoma surgery. Therefore it seems worthwhile to continue ABR monitoring in the postoperative phase in order to identify patients who are at risk of a secondary hearing deterioration and start therapeutic interventions in a timely manner.
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Hummel M, Krausgrill C, Perez J, Hagen R, Ernestus RI, Matthies C. Management of vestibular schwannoma: A pilot case series with postoperative ABR monitoring. Clin Neurol Neurosurg 2016; 143:139-43. [PMID: 26943723 DOI: 10.1016/j.clineuro.2016.02.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 02/18/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Auditory brainstem response (ABR) monitoring is regularly used in surgery of vestibular schwannoma to achieve hearing preservation. Despite ABR preservation at the end of surgery, there are cases with postoperative deafness. To date it is unclear whether these are false positive ABR data or cases of secondary hearing loss. In this pilot study, we focused on the early postoperative phase and possible ABR changes in this period. PATIENT AND METHOD In a prospective study from March 2008 to April 2009, eleven patients (5 female and 6 male) with vestibular schwannoma and preoperative residual hearing were investigated by repeated postoperative ABR investigation at seven dates during the first week. ABR results, hearing function and tumor extension were categorized according to Hannover classification system. The postoperative developments of the first week after surgery are described. RESULTS Hearing preservation was achieved in 55% (6 of 11) of the patients. In the early postoperative phase, three patients with an ABR loss at the end of surgery showed some kind of recovery. In one case, a permanent recovery could be reproduced and developed step by step during the early postoperative phase. Three patients showed a postoperative deterioration resulting in a complete ABR loss. In one of these cases, it was probably a technical problem, but in the two other cases it was a real impairment. In 8 of 11 ABR, quality changed considerably during the early postoperative phase. CONCLUSION This pilot study identifies considerable change of ABR formation occurring in a considerable proportion of patients early after vestibular schwannoma resection. Obviously, in some patients, the endoperative state of the ABR is not the final state. Some patients show a postoperative improvement and some a deterioration towards a complete loss of all ABR components. Whether secondary hearing loss could be presented by early detection, will be a matter of further studies.
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Affiliation(s)
- Maria Hummel
- Department of Neurosurgery, University Hospital Würzburg, Josef-Schneider-Straße 11, 97080 Würzburg, Germany.
| | - Christin Krausgrill
- B.A.D. Gesundheitsvorsorge und Sicherheitstechnik GmbH, Eifelweg 8-10, 63069 Offenbach, Germany
| | - Jose Perez
- Department of Neurosurgery, University Hospital Würzburg, Josef-Schneider-Straße 11, 97080 Würzburg, Germany
| | - Rudolf Hagen
- Department of Otolaryngology, University Hospital Würzburg, Josef-Schneider-Straße 11, 97080 Würzburg, Germany
| | - Ralf-Ingo Ernestus
- Department of Neurosurgery, University Hospital Würzburg, Josef-Schneider-Straße 11, 97080 Würzburg, Germany
| | - Cordula Matthies
- Department of Neurosurgery, University Hospital Würzburg, Josef-Schneider-Straße 11, 97080 Würzburg, Germany
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Intraoperative neuromonitoring for superior semicircular canal dehiscence and hearing outcomes. Otol Neurotol 2015; 36:139-45. [PMID: 25333320 DOI: 10.1097/mao.0000000000000642] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Recent findings in patients with superior semicircular canal dehiscence (SCD) have shown an elevated ratio of summating potential (SP) to action potential (AP), as measured by electrocochleography (ECochG). Changes in this ratio can be seen during surgical intervention. The objective of this study was to evaluate the utility of intraoperative ECochG and auditory brainstem response (ABR) as predictive tools for postoperative hearing outcomes after surgical plugging via middle cranial fossa approach for SCD syndrome (SCDS). METHODS This was a review of 34 cases (33 patients) in which reproducible intraoperative ECochG recordings were obtained during surgery. Diagnosis of SCDS was based on history, physical examination, vestibular function testing, and computed tomography imaging. Simultaneous intraoperative ECochG and ABR were performed. Pure-tone audiometry was performed preoperatively and at least 1 month postoperatively, and air-bone gap (ABG) was calculated. Changes in SP/AP ratio, SP amplitude, and ABR wave I latency were compared with changes in pure-tone average and ABG before and after surgery. RESULTS Median SP/AP ratio of affected ears was 0.62 (interquartile range [IQR], 0.45-0.74) and decreased immediately after surgical plugging of the affected canal to 0.42 (IQR, 0.29-0.52; p < 0.01). Contralateral SP/AP ratio before plugging was 0.33 (IQR, 0.25-0.42) and remained unchanged at the conclusion of surgery (0.30; IQR, 0.25-0.35; p = 0.32). Intraoperative changes in ABR wave I latency and SP amplitude did not predict changes in pure-tone average or ABG after surgery (p > 0.05). CONCLUSION This study confirmed the presence of an elevated SP/AP ratio in ears with SCDS. The SP/AP ratio commonly decreases during plugging. However, an intraoperative decrease in SP/AP does not appear to be sensitive to either the beneficial decrease in ABGs or the mild high-frequency sensory loss that can occur in patients undergoing surgical plugging of the superior semicircular canal. Future work will determine the value of intraoperative ECochG in predicting changes in vestibular function.
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Effects of the intensity of masking noise on ear canal recorded low-frequency cochlear microphonic waveforms in normal hearing subjects. Hear Res 2014; 313:9-17. [DOI: 10.1016/j.heares.2014.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Revised: 04/09/2014] [Accepted: 04/15/2014] [Indexed: 11/20/2022]
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You YP, Zhang JX, Lu AL, Liu N. Vestibular schwannoma surgical treatment. CNS Neurosci Ther 2013; 19:289-93. [PMID: 23462373 DOI: 10.1111/cns.12080] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2012] [Revised: 01/14/2013] [Accepted: 02/03/2013] [Indexed: 11/30/2022] Open
Abstract
Neurosurgical intervention remains the main step in the effective management of vestibular schwannomas. Extensive studies on vestibular schwannoma treatment have placed emphasis on preserving quality of life and neurological functions, particularly of the facial and vestibulocochlear nerves. Facial nerve preservation and hearing preservation have been achieved by significant advances in skull base microsurgical techniques and intraoperative neuromonitoring. Diffusion tensor imaging is a powerful and accurate method for preoperatively identifying the facial nerve in relation to vestibular schwannomas. Endoscopy offers excellent illumination of the anatomical structures and provides panoramic vision inside the surgical area. In this report, we focused on facial nerve and vestibulocochlear nerve preservation and analyzed the major techniques used for identifying the nerve-tumor relationship.
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Affiliation(s)
- Yong-Ping You
- Department of Neurosurgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Zhang M. Effects of Stimulus Intensity on Low-Frequency Toneburst Cochlear Microphonic Waveforms. Audiol Res 2013; 3:e3. [PMID: 26557341 PMCID: PMC4627126 DOI: 10.4081/audiores.2013.e3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Revised: 10/03/2012] [Accepted: 10/31/2012] [Indexed: 11/23/2022] Open
Abstract
This study investigates changes in amplitude and delays in low-frequency toneburst cochlear microphonic (CM) waveforms recorded at the ear canal in response to different stimulus intensities. Ten volunteers aged 20-30 were recruited. Low-frequency CM waveforms at 500 Hz in response to a 14-ms toneburst were recorded from an ear canal electrode using electrocochleography techniques. The data was statistically analyzed in order to confirm whether the differences were significant in the effects of stimulus intensity on the amplitudes and delays of the low-frequency CM waveforms. Electromagnetic interference artifacts can jeopardize CM measurements but such artifacts can be avoided. The CM waveforms can be recorded at the ear canal in response to a toneburst which is longer than that used in ABR measurements. The CM waveforms thus recorded are robust, and the amplitude of CM waveforms is intensity-dependent. In contrast, the delay of CM waveforms is intensity-independent, which is different from neural responses as their delay or latency is intensity-dependent. These findings may be useful for development of the application of CM measurement as a supplementary approach to otoacoustic emission (OAE) measurement in the clinic which is severely affected by background acoustic noise. The development of the application in the assessment of low-frequency cochlear function may become possible if a further series of studies can verify the feasibility, but it is not meant to be a substitute for audiometry or OAE measurements. The measurement of detection threshold of CM waveform responses using growth function approach may become possible in the clinic. The intensity-independent nature of CMs with regards to delay measurements may also become an impacting factor for differential diagnoses and for designing new research studies.
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Affiliation(s)
- Ming Zhang
- Department of Speech Pathology and Audiology, University of Alberta - Faculty of Rehabilitation Medicine; Department of Audiology, Alberta Health Services - Glenrose Rehabilitation Hospital; Department of Surgery - Otolaryngology, University of Alberta - Faculty of Medicine and Dentistry , Edmonton, Canada
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Neurophysiologic Intraoperative Monitoring of the Vestibulocochlear Nerve. J Clin Neurophysiol 2011; 28:566-81. [DOI: 10.1097/wnp.0b013e31823da494] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Abstract
INTRODUCTION Advances in molecular biology and in the basic understanding of the mechanisms associated with sensorineural hearing loss and other diseases of the inner ear are paving the way towards new approaches for treatments for millions of patients. However, the cochlea is a particularly challenging target for drug therapy, and new technologies will be required to provide safe and efficacious delivery of these compounds. Emerging delivery systems based on microfluidic technologies are showing promise as a means for direct intracochlear delivery. Ultimately, these systems may serve as a means for extended delivery of regenerative compounds to restore hearing in patients suffering from a host of auditory diseases. AREAS COVERED Recent progress in the development of drug delivery systems capable of direct intracochlear delivery is reviewed, including passive systems such as osmotic pumps, active microfluidic devices and systems combined with currently available devices such as cochlear implants. The aim of this article is to provide a concise review of intracochlear drug delivery systems currently under development and ultimately capable of being combined with emerging therapeutic compounds for the treatment of inner ear diseases. EXPERT OPINION Safe and efficacious treatment of auditory diseases will require the development of microscale delivery devices, capable of extended operation and direct application to the inner ear. These advances will require miniaturization and integration of multiple functions, including drug storage, delivery, power management and sensing, ultimately enabling closed-loop control and timed-sequence delivery devices for treatment of these diseases.
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Affiliation(s)
- Jeffrey T Borenstein
- Biomedical Engineering Center, Draper Laboratory, Cambridge, MA 02139, United States.
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Theodosopoulos PV, Pensak ML. Contemporary management of acoustic neuromas. Laryngoscope 2011; 121:1133-7. [DOI: 10.1002/lary.21799] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Revised: 01/20/2011] [Accepted: 01/26/2011] [Indexed: 11/05/2022]
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Charalampakis S, Koutsimpelas D, Gouveris H, Mann W. Post-operative complications after removal of sporadic vestibular schwannoma via retrosigmoid-suboccipital approach: current diagnosis and management. Eur Arch Otorhinolaryngol 2011; 268:653-60. [DOI: 10.1007/s00405-010-1480-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Accepted: 12/23/2010] [Indexed: 10/18/2022]
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Zhang M. Using concha electrodes to measure cochlear microphonic waveforms and auditory brainstem responses. Trends Amplif 2010; 14:211-7. [PMID: 21131635 DOI: 10.1177/1084713810388811] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
During electrocochleography, that is, ECochG or ECoG, a recording electrode can be placed in the ear canal lateral to the tympanic membrane. We designed a concha electrode to record both sinusoidal waveforms of cochlear microphonics (CMs) and auditory brainstem responses (ABRs). The amplitudes of CM waveforms and Wave I or compound action potentials (CAPs) recorded at the concha were greater than those recorded at the mastoid but slightly lower than those recorded at the ear canal. Wave V amplitudes recorded at the concha were greater than those recorded at the ear canal but lower than those recorded at the mastoid. There was not a significant difference between the amplitudes recorded at the concha and at the ear canal. For CM and Wave I or CAP, the latency recorded at the concha was longer than at the canal but shorter than at the mastoid; for Wave V, the reverse was true. However, these differences were not statistically significant and may be due to the distance to response generators. Aside from the advantages that the regular ECoG has over otoacoustic emission (OAE) testing, the concha electrode was also easier and safer to place and may be suitable for children, newborn screening, participants with canal conditions, and remote clinics which could have concerns with the availability and cost of a canal electrode. Using concha electrodes, we also experienced fewer postauricular artifacts than when using a mastoid electrode.
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Affiliation(s)
- Ming Zhang
- University of Alberta, Faculty of Rehabilitation Medicine, Edmonton, AB, Canada.
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