Latest Publications

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