Latest Publications

Otol Neurotol. 2016 Jun;37(5):586-92. doi: 10.1097/MAO.0000000000001003.

ABSTRACT

HYPOTHESIS: To illustrate the ability of high frequency ultrasound (HFUS) using a transducer array to demonstrate a variety of simulated clinical scenarios involving the ossicular chain.

BACKGROUND: HFUS (>20 MHz) is a relatively new area of ultrasonic imaging that provides an order of magnitude better image resolution than the conventional low-frequency systems. HFUS may be a real-time imaging system that could be used in the clinic and would complement computed tomography (CT) and magnetic resonance imaging (MRI) to enhance the decision-making process for patients with middle ear pathology.

METHODS: Using a commercially available HFUS scanner, we imaged a variety of simulated clinical scenarios to demonstrate the ability of HFUS to image middle ear pathology.

RESULTS: We were able to clearly demonstrate real-time visualization of ossicular pathology in human temporal bones, whereas there are some limitations in the current technique to be addressed before it is used in vivo.

CONCLUSION: HFUS allows excellent visualization of middle ear anatomy and pathology through an intact tympanic membrane (TM), and these experiments go some way towards giving the otologist access to high resolution, real-time imaging of the middle ear in the clinic.

PMID:26963666 | DOI:10.1097/MAO.0000000000001003

J Otolaryngol Head Neck Surg. 2016 Feb 12;45:13. doi: 10.1186/s40463-016-0126-6.

ABSTRACT

BACKGROUND: Eustachian tube dysfunction (ETD) is a common medical issue, occurring in at least 1% of the adult population. Patients suffering from ET dysfunction typically present with complaints of hearing loss or sensation of pressure or plugged ear, which can lead to impaired quality of life. Over time ETD can result in conductive hearing loss or choleastatoma formation. Effective theraputic options for ET dysfunction are few. Eustachian tube balloon dilation is a novel surgical technique being used to treat ETD. The aim of our study is to objectively measure the success of Eustachian tube balloon dilation by comparing pre and post-operative middle ear pressures using tympanometric testing.

METHODS: RA retrospective chart review was preformed on all patients who underwent balloon dilation of the Eustachian tube by authors NC or MB from 2010 to 2014. Pre and post-operative tympanograms were analyzed and categorized based on type (Type A, Type B, Type C). Success was defined by an improvement in tympanogram type: Type B or C to Type A, or Type B to type C. Pre and post-operative tympanograms were further analyzed using middle ear pressure values. Follow-up ranged from 3 to 15 months.

RESULTS: Twenty-five ears (18 patients) were included in the study. Overall 36% of ears had improvement in tympanogram type, and 32% had normalization of tympanogram post-operatively. The Jerger tympanogram type improved significantly following the procedure (p = 0.04). Patients also had statistically significant improvement in measured middle ear pressure post-operatively (P = 0.003).

CONCLUSION: The natural history of Eustachian tube dysfunction is poorly understood, and evidence for current treatments are limited. Eustachian tube balloon dilation is a safe procedure, and produces significant improvement in tympanogram values up to 15 months post-operatively. Further refinement of patient selection and standardization of technique is required to optimize the effect of this therapy. Longterm follow-up data will clarify the persistence of the effect.

PMID:26869258 | PMC:PMC4751715 | DOI:10.1186/s40463-016-0126-6

Laryngoscope. 2016 May;126(5):1207-17. doi: 10.1002/lary.25586. Epub 2015 Aug 29.

ABSTRACT

OBJECTIVES/HYPOTHESIS: To evaluate the effect of crimping techniques in stapes surgery for otosclerosis patients measured by hearing outcomes on pure-tone audiometry.

DATA SOURCES: PubMed, EMBASE, and the Cochrane Library.

METHODS: A systematic search was conducted. Studies comparing the effect of different crimping methods on pure-tone audiometric results in patients undergoing stapes surgery for otosclerosis were included. Relevance and risk of bias were assessed. Absolute risks and risk differences, means and mean differences, and 95% confidence intervals were extracted or calculated for the primary and secondary outcomes, which were air-bone gap closure to 10 dB or less, mean postoperative air-bone gap, and postoperative sensorineural hearing loss.

RESULTS: Twenty-two studies with moderate or high risk of bias were included for data extraction. Air-bone gap closure to 10 dB or less was assessed in 17 studies and mean postoperative air-bone gap in 20 studies. The hearing outcomes did not consistently favor one crimping method. However, the differences that were statistically significant were consistently in favor of heat crimping over manual and no crimping (difference in air-bone gap closure to 10 dB or less ranged between 22% and 42% in these studies and difference in mean postoperative air-bone gap between 2.8 dB and 7.4 dB) and in favor of manual crimping over no crimping (30% difference in air-bone gap closure to 10 dB or less and difference in mean postoperative air-bone gap between 2.6 dB and 6.0 dB).

CONCLUSION: Moderate to high risk of bias and inconsistent results characterize the current evidence. Laryngoscope, 126:1207-1217, 2016.

PMID:26333166 | DOI:10.1002/lary.25586

Ann Otol Rhinol Laryngol. 2015 Dec;124(12):925-30. doi: 10.1177/0003489415592000. Epub 2015 Jun 16.

ABSTRACT

OBJECTIVE: The benefits of bone-anchored hearing devices (BAHD) in children with unilateral aural atresia are controversial. We sought to determine whether there is parental decisional conflict surrounding elective placement of BAHD for this indication.

METHODS: Caregivers of pediatric patients with unilateral aural atresia and normal contralateral ear undergoing percutaneous BAHD consultation were enrolled. All consultations were carried out by one pediatric otolaryngologist in a consistent manner. After consultation, the participants completed a demographics form and the Decisional Conflict Scale (DCS) questionnaire.

RESULTS: Twenty-three caregivers of 15 male (65.2%) and 8 female (34.8%) children (mean age 5.65 years) participated. The overall median DCS score was 15.63 (standard error = 4.21). Significant decisional conflict (DCS score ≥ 25) was found in 10 participants (43.5%). The median DCS score in the group choosing surgery was 5.47, and it was 23.44 in those who did not choose surgery (Mann-Whitney U = 39, Z = -1.391, P = .164). The median DCS score for mothers and fathers was 25 and 3.91, respectively.

CONCLUSION: Many parents experienced significant decisional conflict when considering percutaneous BAHD surgery in children with unilateral aural atresia in our study population. Future research should explore the impact of decisional conflict on health outcomes.

PMID:26082472 | DOI:10.1177/0003489415592000

IEEE Trans Biomed Circuits Syst. 2016 Apr;10(2):404-11. doi: 10.1109/TBCAS.2015.2421823. Epub 2015 Jun 1.

ABSTRACT

Ultrasonic power transfer using piezoelectric devices is a promising wireless power transfer technology for biomedical implants. However, for sub-dermal implants where the separation between the transmitter and receiver is on the order of several acoustic wavelengths, the ultrasonic power transfer efficiency (PTE) is highly sensitive to the distance between the transmitter and receiver. This sensitivity can cause large swings in efficiency and presents a serious limitation on battery life and overall performance. A practical ultrasonic transcutaneous energy transfer (UTET) system design must accommodate different implant depths and unpredictable acoustic changes caused by tissue growth, hydration, ambient temperature, and movement. This paper describes a method used to compensate for acoustic separation distance by varying the transmit (Tx) frequency in a UTET system. In a benchtop UTET system we experimentally show that without compensation, power transfer efficiency can range from 9% to 25% as a 5 mm porcine tissue sample is manipulated to simulate in situ implant conditions. Using an active frequency compensation method, we show that the power transfer efficiency can be kept uniformly high, ranging from 20% to 27%. The frequency compensation strategy we propose is low-power, non-invasive, and uses only transmit-side measurements, making it suitable for active implanted medical device applications.

PMID:26054073 | DOI:10.1109/TBCAS.2015.2421823

J Biomed Opt. 2015 May;20(5):56008. doi: 10.1117/1.JBO.20.5.056008.

ABSTRACT

Noninvasive middle ear imaging using optical coherence tomography (OCT) presents some unique challenges for real-time, clinical use in humans. We present results from a two-dimensional/three-dimensional OCT system built to assess the imaging requirements of clinical middle ear imaging, and the technical challenges associated with them. These include the need to work at a low numerical aperture, the deleterious effects of transtympanic imaging on image quality at the ossicles, sensitivity requirements for clinical fidelity of images at real-time rates, and the high dynamic-range requirements of the ear. We validated the system by imaging cadaveric specimens with simulated disorders to show the clinical applicability of the images. We also provide additional insight into the likely role of OCT in clinical otology.

PMID:26000794 | DOI:10.1117/1.JBO.20.5.056008

Otol Neurotol. 2015 Jun;36(5):819-25. doi: 10.1097/MAO.0000000000000762.

ABSTRACT

INTRODUCTION: This study compared wireless Contralateral Routing of Signals (CROS) hearing aid and bone-anchored hearing device (BAHD) in patients with single-sided deafness.

METHODS: Eight adults with single-sided deafness previously implanted with a BAHD were given a 2-week trial with a CROS hearing aid and tested in unaided and aided conditions. Both devices were compared on head shadow effect reduction, speech perception measures in quiet and in noise, self-assessment questionnaires, and daily diaries.

RESULTS: Both the CROS and BAHD significantly reduced the head shadow effect. QuickSIN scores were significantly better with noise presented to the poorer ear, as compared to the better ear, for the unaided condition, the BAHD, and the CROS. Scores showed no significant differences between the CROS and BAHD with noise presented to the better ear, but scores with the CROS were significantly poorer than in the unaided condition with noise presented to the poorer ear. There were no significant differences between BAHD and CROS for the ratings on the Bern Benefit in Single-Sided Deafness and Speech Spatial Qualities questionnaires. Both devices were worn an average of 10 hours per day. Four participants preferred the CROS for sound quality; three preferred the BAHD for comfort.

CONCLUSION: Comparisons of CROS and BAHD need to be re-evaluated as both technologies have evolved. In our pilot study, both devices seem comparable, with the CROS avoiding the risks of surgery, and we recommend a trial of CROS in our center for first line treatment of single-sided deafness.

PMID:25853611 | DOI:10.1097/MAO.0000000000000762

Hear Res. 2015 Aug;326:1-7. doi: 10.1016/j.heares.2015.03.009. Epub 2015 Mar 27.

ABSTRACT

Imaging techniques currently used in the clinic to inspect ears in patients are generally limited to views terminating at the tympanic membrane (TM) surface. For imaging past the TM, methods such as computed tomography are typically used, but in addition to disadvantages such as being costly, time consuming, and causing radiation exposure, these often do not provide sufficient resolution of the middle ear structures of interest. This study presents an investigation into the capability of high frequency ultrasound to image the middle ear with high resolution in real-time, as well as measure vibrations of TM and middle ear structures in response to sound stimuli. In unfixed cadaver ears, the TM, ossicles, and ossicular support tissues were all readily identifiable, with capabilities demonstrated for real-time imaging and video capture, and vibrometry of middle ear structures. Based on these results, we conclude that high frequency ultrasonography is a relatively simple and minimally invasive technology with great potential to provide clinicians with new tools for diagnosing and monitoring middle ear pathologies.

PMID:25818516 | DOI:10.1016/j.heares.2015.03.009

Am J Otolaryngol. 2015 Jul-Aug;36(4):526-34. doi: 10.1016/j.amjoto.2015.02.016. Epub 2015 Mar 3.

ABSTRACT

OBJECTIVE: To compare hearing preservation between stereotactic radiotherapy (SRT) and conservative treatment of patients with unilateral vestibular schwannoma.

DATA SOURCES: Retrospective case series comparing hearing outcomes of patients with a unilateral vestibular schwannoma managed conservatively or with stereotactic radiotherapy in a tertiary care academic centre.

PATIENTS: Tumor database patients with American Academy of Otolaryngology Head and Neck Surgery Class A or B hearing at the onset of study. Stereotactic radiotherapy patients were predominantly those who failed conservative management.

INTERVENTIONS: Audiometric pure tone averages and speech discrimination scores as well as patient demographics, tumor location, size and growth were extracted.

MAIN OUTCOME MEASURES: Hearing outcome measures were: 1) Hearing Preservation, i.e. no drop from Class A/B to Class C/D hearing, 2) Hearing Survival of Class A/B hearing in months, 3) Audiometric Pure Tone Averages, Difference between post-treatment and pre-treatment, and 4) Speech Discrimination Score Difference (pre-treatment-post treatment). Survival analysis and non-parametric tests were used for hearing outcome measures, with multiple covariates tested.

RESULTS: Overall, serviceable hearing preservation among the 123 patients was 51%. The median hearing survival time was 46 months (mean 59 months). The Pure Tone averages and Speech Discrimination score differences were 16 dB and 82% respectively over a median follow-up time of 43 months. No significant difference was found between the conservative and SRT groups in any hearing outcome. Class A patients showed far better hearing survival than Class B patients.

CONCLUSIONS: No significant difference was demonstrated as to measures of hearing outcomes between stereotactic radiotherapy and conservative management. Excellent existing hearing appears to be the best predictor of long term hearing survival in the cohort studied.

PMID:25771841 | DOI:10.1016/j.amjoto.2015.02.016

Otol Neurotol. 2015 Feb;36(2):e36-41. doi: 10.1097/MAO.0000000000000696.

ABSTRACT

OBJECTIVE: The primary objective is to assess the validity of nasal-noise masking audiometry (NNMA) as a clinical diagnostic tool in our patient population.

STUDY DESIGN: Retrospective case review.

SETTING: Tertiary ambulatory referral center.

PATIENTS: Patients with patulous Eustachian tube (PET) were identified from referrals to our Eustachian tube disorders clinic primarily with symptoms including autophony, aural fullness, and hearing their own breathing. The healthy subjects had no history of ear disease.

INTERVENTION: NNMA was measured in 20 ears of 10 healthy subjects as well as in 42 ears of 21 patients with suspected PET.

MAIN OUTCOME MEASURE: NNMA mean auditory thresholds were measured at frequencies ranging from 250 to 8,000 Hz.

RESULTS: When stratified as definitive or probable PET based on observed tympanic membrane movement with breathing, both Definitive and Probable PET groups had significantly higher NNMA mean auditory thresholds compared to Normal ears at 250 Hz (p = 0.001, p = 0.003), 1,000 Hz (p = 0.019, p = 0.001), and 6,000 Hz (p = 0.4, p = 0.001). When stratified based on symptoms on the day of testing, both Symptomatic Ears and Non-Symptomatic Ears had significantly higher mean auditory thresholds compared to Normal ears at 250 Hz (p = 0.001, p = 0.015) and at 1,000 Hz (p = 0.002, p = 0.004).

CONCLUSION: Our results demonstrate a larger masking effect in patients with PET compared to normal subjects in the low-frequency region. In clinical practice, the relatively small effect and the wide variability of results between patients have made this test be of little value clinically in our patient population.

PMID:25522198 | DOI:10.1097/MAO.0000000000000696

J Med Case Rep. 2014 Sep 18;8:310. doi: 10.1186/1752-1947-8-310.

ABSTRACT

INTRODUCTION: Facial nerve weakness is most commonly due to Bell's palsy or cerebrovascular accidents. Rarely, middle ear tumor presents with facial nerve dysfunction.

CASE PRESENTATION: We report a very unusual case of middle ear osteoma in a 49-year-old Caucasian woman causing progressive facial nerve deficit. A subtle middle ear lesion was observed on otoscopy and computed tomographic images demonstrated an osseous middle ear tumor. Complete surgical excision resulted in the partial recovery of facial nerve function.

CONCLUSIONS: Facial nerve dysfunction is rarely caused by middle ear tumors. The weakness is typically due to a compressive effect on the middle ear portion of the facial nerve. Early recognition is crucial since removal of these lesions may lead to the recuperation of facial nerve function.

PMID:25236378 | PMC:PMC4170216 | DOI:10.1186/1752-1947-8-310

Otol Neurotol. 2014 Aug;35(7):1201-6. doi: 10.1097/MAO.0000000000000320.

ABSTRACT

OBJECTIVE: Patulous eustachian tube (PET) can have a significant negative impact on a patient's quality of life. Previous work has demonstrated that temporarily mass loading and stiffening the tympanic membrane significantly reduces these symptoms. This study examined KTP laser myringoplasty (LM) and cartilage tympanoplasty (CT) as a means to manipulate the tympanic membrane to alleviate PET symptoms.

STUDY DESIGN: Retrospective case review.

SETTING: Academic tertiary care referral hospital.

PATIENTS: Patients (n = 20) were identified from the senior authors' (M.B.) specialty eustachian tube disorders clinic. Patients met previously established diagnostic criteria for PET. All patients had a clinically apparent flaccid segment of the eardrum and had symptom improvement after simple mass loading of their eardrum in the clinic.

INTERVENTIONS: Patients in this study received either KTP LM (10 patients, 15 ears) or CT (10 patients, 11 ears) to treat their flaccid eardrum segment in an attempt to alleviate PET symptoms.

MAIN OUTCOME MEASURES: Preoperative and postoperative questionnaire scores and tympanometry measurements were compared.

RESULTS: Patients undergoing CT for PET had a significant reduction in their symptoms of autophony (p ≤ 0.001), conducted breath sounds (p = 0.001), and aural fullness (p = 0.009). KTP LM did not significantly reduce symptoms.

CONCLUSION: Cartilage tympanoplasty provides a safe and accessible surgical option for the treatment of PET and significantly reduces the symptoms of autophony, conducted breath sounds, and aural fullness. Further studies are needed to investigate whether addressing PET symptoms simultaneously from both the tympanic membrane and the eustachian tube orifice can improve patient symptoms even further.

PMID:25111423 | DOI:10.1097/MAO.0000000000000320

Otol Neurotol. 2015 Feb;36(2):382-5. doi: 10.1097/MAO.0000000000000447.

ABSTRACT

OBJECTIVE: To present a case of a patient with visible stapedius contraction on vocalization and to discuss the related literature.

PATIENTS: A 51 year-old woman with a Type III myringostapediopexy due to chronic suppurative otitis media and an incidental finding of voice-induced movement of the stapes head.

INTERVENTIONS: Otoendoscopy, pure tone and impedance audiometry, and modified stapedius reflex decay.

MAIN OUTCOME MEASURE: Stapes head movement on otoendoscopy.

RESULTS: Stapes head movement was seen endoscopically on vocalization but not on tympanometric measures.

CONCLUSION: Visible stapedius contraction with vocalization is an uncommon phenomenon. Our understanding of the nonauditory pathways to stapedius is limited and requires further research.

PMID:24892365 | DOI:10.1097/MAO.0000000000000447

Am J Otolaryngol. 2014 Sep-Oct;35(5):678-82. doi: 10.1016/j.amjoto.2014.04.006. Epub 2014 May 2.

ABSTRACT

Atrial fibrillation (A-fib) is the most common cardiac arrhythmia which is associated with an increased risk of mortality secondary to stroke and coronary artery disease. Intravenous glucocorticoid therapy (such as dexamethasone and hydrocortisone) is frequently used peri-operatively in patients undergoing cardiac surgery to prevent A-fib. Dexamethasone is also frequently used in patients with single or bilateral vestibular schwannomas (VS), to reduce tumor swelling both before and after radiation treatment. We describe a case of A-fib in a 50 year-old female patient with neurofibromatosis type 2 (NF-2), who was prescribed dexamethasone for post-radiation tumor edema.

PMID:24888793 | DOI:10.1016/j.amjoto.2014.04.006