OBJECTIVE:This research was targeted to investigate the efficacy of vestibular rehabilitation therapy (VRT) for patients with benign paroxysmal positional vertigo (BPPV) experiencing residual symptoms after repositioning, and to examine subtype-specific differences between posterior canal BPPV (pc-BPPV) and horizontal canal BPPV (hc-BPPV). METHOD:A prospective, stratified randomized controlled design was used, enrolling patients with BPPV who exhibited residual symptoms [Dizziness Handicap Inventory (DHI) ≥20 points] following repositioning between January 2024 and January 2025. Following standardized repositioning (modified Epley maneuver for pc-BPPV, Gufoni/Barbecue maneuver for hc-BPPV), patients were stratified by subtype and randomized into a VRT group and a control group. The VRT group received combined sequential VRT treatment with medication (betahistine hydrochloride+ginkgolide), incorporating traditional vestibulo-ocular reflex (VOR) adaptation training (eg, adaptive head movements) and habituation training for positional vertigo (eg, modified Brandt-Daroff training) over 28 days. The control group was given medication alone. The DHI, visual analogue scale (VAS), balance function (static closed-eye standing ≥60 s), and dynamic visual acuity (DVA, horizontal head movement) at baseline, 14 days and 28 days were evaluated. RESULTS:This study included 207 BPPV patients with residual symptoms after repositioning (110 in the control group and 97 in the VRT group). The overall efficacy of the VRT group was significantly better than that of the control group, as evidenced by lower 28-day DHI (18.00 vs. 28.00, P<0.001) and VAS (1.60±1.40 vs. 3.46±1.45, P<0.001), higher balance compliance rate (88.7% vs. 61.8%, P<0.001) and DVA improvement (3 lines vs. 1 line, P=0.001). Subgroup analysis revealed that core efficacy were generally consistent between pc-BPPV and hc-BPPV in the VRT group, but subtype-specific differences emerged: pc-BPPV demonstrated faster early vertigo relief (ΔDHI_14 d, P=0.030), while hc-BPPV showed superior DVA improvement (P=0.009). Within the control group, pc-BPPV demonstrated more pronounced early vertigo relief (ΔVAS_14 d, P<0.001) and long-term disability improvement (ΔDHI_28 d, P=0.021) during spontaneous recovery. VRT could remodel this difference, eliminating the long-term disadvantage of hc-BPPV and transforming the early advantage of pc-BPPV into rapid disability improvement. CONCLUSION:VRT significantly improves residual symptoms in BPPV after repositioning. Subtype-specific differences exist between pc-BPPV and hc-BPPV in early VRT efficacy and functional recovery dimensions, providing evidence for precision rehabilitation classification.
INTRODUCTION:Patients with medically refractory Meniére disease (MD) may present with concomitant vertigo attacks and severe-profound hearing loss (SNHL). In such cases, simultaneous labyrinthectomy/cochlear implantation (CI) is a viable treatment option. Simultaneous endolymphatic sac decompression (ESD) and CI is less well described but represents a promising alternative. This study aims to analyze outcomes after simultaneous or staged ESD/CI as compared with simultaneous labyrinthectomy/CI. MATERIALS AND METHODS:MD patients undergoing simultaneous or staged ESD/CI and simultaneous labyrinthectomy/CI were reviewed from 2 tertiary care centers. Inclusion criteria included: ≥ 2 vertigo attacks/week, supportive vestibular testing, normal MRI, SNHL meeting criteria for CI, and average sodium intake of 1200 to 1500 mg/day. Demographic data, surgical complications, audiometric outcomes, and vestibular outcomes were analyzed. RESULTS:Eighteen patients (19 ears) were included. Six patients (7 ears) underwent either simultaneous or staged ESD/CI, and 12 patients (12 ears) underwent labyrinthectomy/CI. Vertigo attacks decreased in 71.4% of ESD/CI patients and 100% of labyrinthectomy/CI patients. 6/7 ears in the ESD/CI cohort had improved AzBio sentence scores with an average improvement of 85.6% in quiet, 64.8% in +10 SNR, ( P <0.05), and 77.5% improvement in monosyllabic word scores ( P <0.05). Of the 9 patients in the labyrinthectomy/CI cohort with adequate data, 7 showed improved AzBio-Q sentence scores with an average improvement of 57.6% ( P <0.05) at the most recent follow-up. CONCLUSIONS:Simultaneous ESD/CI was safe and effective. Vestibular and hearing outcomes after this approach were comparable to those associated with labyrinthectomy/CI. ESD/CI may be associated with a lower rate of vertigo resolution than labyrinthectomy/CI. LEVEL OF EVIDENCE:Level IV, retrospective case series.
OBJECTIVE:This study aims to evaluate endolymphatic duct radiological morphology in symptomatic and asymptomatic ears in patients with unilateral Ménière's disease. STUDY DESIGN:Retrospective. SETTING:University hospital. PATIENTS:This retrospective case-control study included 84 patients with unilateral MD. MRI scans were performed using a 3D-FLAIR protocol. MAIN OUTCOME MEASURES:The degree of cochlear and vestibular hydrops was graded using the Barath and Bernaerts scales, respectively. The morphology of the endolymphatic duct was assessed with the three-grade Attyé scale. Correlation between endolymphatic duct visibility and the degree of cochlear and vestibular hydrops were analyzed. Radiological findings were evaluated in the context of the clinical presentation and pure-tone audiometry results. RESULTS:Cochlear hydrops was present in 72 (85.7%) of symptomatic ears but only 3 (3.6%) of asymptomatic ears. Vestibular hydrops was found in 73 (86.9%) of symptomatic ears versus 9 (10.7%) of asymptomatic ears. The endolymphatic duct was not visible in 63 (75.0%) of symptomatic ears, compared to 38 (45.2%) of asymptomatic ears. A significant positive correlation was observed between the severity of EH and absence of visualization of the endolymphatic duct ( P <0.0001). Both hydrops and endolymphatic duct morphology correlated with audiological results, while only EH degree was significantly associated with vertigo frequency. CONCLUSIONS:There is a strong association between the severity of MRI-assessed EH and morphological alterations of the endolymphatic duct in MD. Advanced MRI techniques provide valuable imaging biomarkers that may improve diagnostic accuracy and help differentiate symptomatic from asymptomatic ears. These results support the potential role of endolymphatic duct assessment in the clinical management and monitoring of MD. Correlations between radiological and clinical findings confirms that endolymphatic space morphology contributes to the development of auditory and vestibular symptoms.
OBJECTIVE:To describe the clinical features of middle-aged women with isolated spontaneous episodic vestibular syndrome, focusing on vestibular, audiological, migraine-related, and climacteric symptoms. MATERIALS AND METHODS:This cross-sectional study included women aged 40 to 65 years with recurrent spontaneous vestibular symptoms and no hearing loss, evaluated at a tertiary neurotology outpatient clinic. Participants underwent a semi-structured clinical interview and completed the Dizziness Handicap Inventory (DHI), Menopause Rating Scale (MRS), and Migraine Disability Assessment (MIDAS). Clinical features were described, and associations between DHI scores, clinical features, MRS, and MIDAS were examined. RESULTS:Ninety-three patients were included. Most experienced episodes at least weekly (80.6%), typically lasting seconds to minutes (74.2%) and frequently triggered by head motion (88.2%). Episodes were commonly associated with headaches (54.8%) and emotional distress (63.4%). Frequent accompanying symptoms included tinnitus (78.5%), hyperacusis (62.4%), motion sickness (59.1%), photophobia (59.1%), neck pain (60.2%), and vasomotor symptoms (59.1%). DHI scores were significantly higher in patients with tinnitus (P=0.042). Although 19.2% did not meet diagnostic criteria for vestibular migraine (VM), 95.7% reported at least one migraine-related symptom. DHI scores correlated significantly with MRS (P=0.0007) but not with MIDAS (P=0.819). CONCLUSION:Middle-aged women with isolated episodic vestibular syndrome show a consistent pattern of brief, recurrent symptoms often accompanied by auditory, emotional, migraine-related, and vasomotor features. Tinnitus is associated with greater disability, and menopausal symptoms significantly correlate with dizziness-related handicap.
OBJECTIVE:To determine whether the presence of an inner ear schwannoma (IES) is associated with earlier hearing loss, and whether this effect is independent of vestibular schwannoma size or growth in patients with NF2 -related schwannomatosis ( NF2 -SWN). STUDY DESIGN:Retrospective cohort study. SETTING:Quaternary NF2 -SWN center. PATIENTS:Three hundred seventy-three ears, including 316 with VS only and 57 with VS and IES. MAIN OUTCOME MEASURES:Primary outcomes: (1) Age at loss of normal hearing (timepoint 1; TP1); (2) Age at loss of serviceable hearing (timepoint 2; TP2). Secondary exploratory objectives: (1) VS size and growth rate at each timepoint; (2) IES size and location. RESULTS:Mean age at loss of normal hearing was 39 years in ears with VS only and 25 years in ears with VS + IES ( P = 0.00015). Mean age at loss of serviceable hearing was 42 years in ears with VS only and 29 years in ears with VS + IES ( P = 0.00020). Kaplan-Meier analyses demonstrated significantly earlier deterioration in ears with IES at both timepoints ( P < 0.0001). At TP1, logistic regression showed that although ears with IES lost normal hearing at a younger age, this association was not independent of VS size. At TP2, however, both unadjusted analyses and Firth-penalized logistic regression demonstrated that IES and smaller VS size were independently associated with earlier loss of serviceable hearing. A Cox proportional hazards model assessing progression from TP1 to TP2 further showed that IES status and VS size at TP1 were independent predictors of faster progression (adjusted hazard ratio for IES 2.79, 95% CI: 1.50-5.19). There was no significant difference in hearing outcomes between intracochlear and non-cochlear IES. CONCLUSIONS:IES is associated with earlier hearing loss, particularly with respect to loss of serviceable hearing. These findings suggest that patients with both a VS and an IES may experience hearing decline at younger ages and at smaller VS sizes than those with VS alone. This information may inform clinical decision-making and guide timing of interventions in NF2 -SWN.
OBJECTIVE:This study evaluates the feasibility and predictive value of intraoperative pure tone audiometry (PTA) during primary stapes surgery. As a secondary aim, we explored whether preoperative air conduction (AC) thresholds and air-bone gap (ABG) values may influence intraoperative and postoperative hearing outcomes. STUDY DESIGN:Retrospective case series. SETTING:"Ramazzini" Hospital, Carpi (Modena), Italy. PATIENTS AND INTERVENTIONS:Patients consecutively undergoing primary stapes surgery for otosclerosis between November 2022 and June 2023 were included. All surgeries were performed microscopically under local anesthesia. MAIN OUTCOME MEASURES:A correlation analysis was performed between intraoperative and postoperative AC PTA to evaluate the predictive value of intraoperative testing. As a secondary analysis, the potential influence of preoperative hearing status on intraoperative and postoperative outcomes was evaluated by correlating preoperative AC PTA and ABG with AC gain. Predicted AC gain was defined as the difference between intraoperative and preoperative AC PTA, whereas effective AC gain was defined as the difference between postoperative and preoperative AC PTA. RESULTS:Twenty-eight patients were included. Significant improvements in AC thresholds for single frequencies and PTA were observed both intraoperatively and postoperatively compared with preoperative values. A strong positive correlation emerged between intraoperative and postoperative AC PTA ( r = 0.76, P < 0.005), indicating the predictive value of intraoperative testing. Importantly, postoperative AC thresholds improved by an average of 0.73 dB compared with intraoperative measurements. As a secondary finding, preoperative ABG, but not preoperative AC PTA, was observed to have an association with intraoperative and postoperative outcomes. CONCLUSIONS:Intraoperatory AC PTA was shown to predict with a good approximation postoperative audiometric outcomes of primary stapedoplasty and is a simple, rapid, and cost-effective method for immediate functional assessment.
OBJECTIVE:Prior cross-sectional analysis suggests an association between conductive hearing loss (CHL) and depression. However, little is known about the potential impact of specific CHL pathologies on mood disorders. We investigate if there is an association between 3 potentially correctable causes of CHL (otosclerosis, cholesteatoma, and tympanic membrane perforation) and depressive disorders in a national cohort. STUDY DESIGN:Cross-sectional epidemiologic study. SETTING:National Institutes of Health All of Us Research Program. PATIENTS:Participants 18 years or older (n=363,302). Exposures were CHL pathologies defined by ICD-10 code: otosclerosis (H80.X), cholesteatoma (H71.X), and tympanic membrane perforation (H72.X). MAIN OUTCOME MEASURES:Outcomes were depressive disorders defined by ICD-10 code: major depressive disorder (MDD; F32-33) and dysthymia (F34.1). Multivariable regression, adjusting for potential confounders (age, sex, race, ethnicity, education, and smoking history), assessed the odds of depression in subjects with and without specific CHL pathologies. RESULTS:The median age (interquartile range, range) was 57 years [41 to 69, 18 to 122]; 62% identified as female. Controlling for covariates, the odds of MDD were 1.5 times (95% CI: 1.2-1.9; P <0.001) higher for those with otosclerosis compared with those without; no association was seen with dysthymia. The odds of MDD and dysthymia were 1.8 times (1.5 to 2.3; P <0.001) and 2.2 times (1.2 to 3.6; P =0.004) higher, respectively, for those with cholesteatoma, and 2.4 times (2.2 to 2.6; P <0.001) and 2.8 times (2.2 to 3.5; P <0.001) higher, respectively, for those with tympanic membrane perforation. CONCLUSIONS:In the All of Us dataset, all CHL pathologies were associated with MDD and most with dysthymia. This adds evidence that sensory deprivation from a purely peripheral process may impact mood.
OBJECTIVE:To present the initial clinical experience with tympano-stapedotomy using the new semisynthetic TORP (NSSTORP) in patients with stapes otosclerosis associated with malleus fixation and in stapedotomy revision with unusable incus, as a less invasive alternative to malleo-stapedotomy. METHODS:Between June 2024 and June 2025, 6 patients (5 females, one male; mean age, 42.1 y) underwent tympano-stapedotomy at 2 tertiary referral centers: 3 primary cases with stapes otosclerosis and malleus fixation (Avellino) and 3 revision cases with incus necrosis (Siena). All procedures were performed under local anesthesia using a surgical microscope, and a 6.5-mm-long NSSTORP was implanted in every case. Pre- and postoperative audiometric evaluation included air conduction, bone conduction, and air-bone gap (ABG) at 0.5, 1, 2, and 3 kHz. The main outcome measure was postoperative ABG ≤20 dB. Follow-up ranged from 3 to 10 months (mean, 7.2 mo). RESULTS:No patient experienced worsening of bone conduction, dizziness, or tinnitus. The pure-tone average improved from a preoperative mean of 48.9 dB (SD = 6.9) to a postoperative mean of 32.1 dB (SD = 8.4), for a mean hearing gain of 16.8 dB (SD = 4.5). The mean ABG decreased from 25.5 dB (SD = 3.8) to 11.4 dB (SD = 3.5), representing a mean improvement of 14.1 dB (SD = 3.0). A postoperative ABG of less than 20 dB was achieved in 100% of the cases. CONCLUSION:Tympano-stapedotomy with the NSSTORP avoids the technically demanding steps of malleo-stapedotomy and eliminates vestibular penetration.
BACKGROUND:Hearing loss (HL) and chronic kidney disease (CKD) are both significant components of the global health burden. We explored the phenotypic association between CKD and HL, along with the underlying genetic drivers, through studies ranging from clinical cohorts to genetic analyses. METHODS:First, we utilized data from the China Health and Retirement Longitudinal Study (CHARLS) and assessed the relationship between CKD and hearing loss using Cox proportional hazards models. Subsequently, we used genome-wide genetic aggregation data to investigate the genetic drivers underlying CKD and HL. RESULTS:In the cohort study, 7084 individuals were included, of whom 1509 participants (21.3%) experienced hearing loss. Cox regression analysis showed that CKD was associated with an increased risk of hearing loss (HR=1.541, 95% CI=1.317-1.804). In genetic analysis, CKD was positively genetically correlated with HL (rg=0.155, P <0.05). Multi-trait analysis of GWAS (MTAG) and cross-phenotype association analysis (CPASSOC) from the genome-wide association study identified 2 significant pleiotropic SNPs (rs12149832 and rs2044993) for both CKD and HL. Transcriptome-wide association study (TWAS) identified shared tissue-specific expression-trait associations, but Mendelian randomization did not reveal causal relationships (OR=1.035, 95% CI=0.973-1.101). CONCLUSIONS:Our cohort study confirms the clinical association between CKD and HL. Genetic analysis reveals a shared genetic link between the 2 conditions and potential underlying genetic drivers. These findings may provide effective strategies for preventing and managing hearing loss in clinical CKD patients.
Objectives: To examine whether interaural angular insertion depth (AID) mismatch affects horizontal sound localization accuracy (SLA) in adolescents with bilateral cochlear implants (BiCI) since early childhood. Study design: Cross-sectional study. Setting: University hospital. Patients: Twenty subjects with mean age of 16.9 years (range: 12.8 to 21.6 y) and 14.7 years (9.6 to 19.6 y) of BiCI experience. Methods/Main outcome measures: On the basis of three-dimensional modeling of photon-counting detector-computed tomography images of the inner ears, interaural AID mismatch of the most apical electrodes was estimated. SLA was objectively measured using 4 stimuli providing various spatial cues, quantified by an Error Index (EI). The effect of interaural AID mismatch on the EI was studied using linear regression analyses, and by comparing the EI between a matched and a mismatched group stratified on a mismatch criterion of 75 degrees. Results: The median interaural AID absolute difference was 45.5 degrees (range: 4 to 256 degrees). Across sounds, no linear relationship between interaural AID mismatch and EI existed. No effect of group (matched vs. mismatched) on the EI existed. A significant effect of stimulus ( P <0.001) and an interaction between stimulus and group ( P <0.02) was found, with performance differences between stimuli for the mismatched but not the matched group. Conclusions: Individuals who have been listening through BiCI since early childhood show large variability in AID mismatch between the ears. Horizontal SLA seems unrelated to this mismatch. For large mismatches, the spatial cues present in a sound seem to affect localization accuracy.
OBJECTIVE:Quantify mastoid soft-tissue thickness on temporal bone computed tomography (CT) and evaluate associations with body mass index (BMI), age, and sex. STUDY DESIGN:Retrospective cross-sectional study. SETTING:Tertiary referral center. PATIENTS:Adults with temporal bone CT and a recorded BMI within 12 months. MAIN OUTCOME MEASURES:Mean mastoid soft-tissue thickness measured at 6 sites (3 per ear) on multiplanar reconstructions. RESULTS:One hundred forty-seven CT scans (mean age: 57.4±22.0 y; 46.3% male; mean BMI: 30.2±9.9 kg/m 2 ). The mean mastoid thickness was 9.7±4.1 mm (range: 3.4 to 27.0 mm). BMI was associated with greater mastoid thickness (adjusted β =0.30 mm per kg/m 2 , 95% CI: 0.25-0.34; P <0.001). Male sex was associated with thicker tissue (adjusted difference: 1.37 mm, 95% CI: 0.46-2.27; P =0.003), whereas age was not independently associated. Interaural means were highly correlated ( r =0.89), with a negligible paired difference. Interrater ICC for mean mastoid thickness was 0.995 (n=59). CONCLUSIONS:Mastoid soft-tissue thickness varies widely and increases predictably with BMI. BMI may serve as an accessible clinical proxy for the soft-tissue envelope at bone conduction coupling sites, with potential implications for the interpretation of bone conduction audiometry and the planning of skin-drive and magnet-retained bone conduction hearing devices.
OBJECTIVE:To evaluate the feasibility of detecting stapedius reflex (SR) through direct middle ear pressure monitoring during contralateral acoustic stimulation. STUDY DESIGN:Prospective, observational, single-centre feasibility study. SETTING:Tertiary referral centre; intraoperative setting during tympanotomy procedures. PATIENTS:Eleven adult patients (≥18 y) with unilateral sudden sensorineural hearing loss undergoing transtympanic dexamethasone instillation, with an elicitable SR through contralateral stimulation, were included in this study. Patients with SR thresholds >100 dB HL were excluded. INTERVENTION S:A pressure transducer was inserted intraoperatively into the middle ear. A tympanometer device on the contralateral side apply acoustic stimulation and monitored the SR on that side. Stimulation was ECG-synchronized, and filtering was applied to the pressure signal to enhance detection. MAIN OUTCOME MEASURES:Detection of SR-related pressure changes using the pressure transducer, compared with tympanometry-based detection. RESULTS:Out of 32 stimulus combinations, 24 elicited confirmed stapedius reflexes, while 8 did not. Among the 24 reflex-positive cases, the pressure-based method correctly identified reflex-related pressure changes in 20 instances, yielding a detection accuracy of 83.3% for confirmed reflexes. In the remaining 4 reflex-positive cases, the system failed to detect a response. In all 8 cases where no reflex was elicited, the system also did not detect any pressure changes, indicating no false positives. CONCLUSIONS:Middle ear pressure monitoring is a feasible method for detecting SR. This approach demonstrates feasibility under intraoperative conditions and may, with further development and validation, support future objective reflex assessment in cochlear implant users.
Introduction: Hearing rehabilitation aims to enhance or restore auditory perception, which is critical for oral language development and to mitigate the cognitive and psychosocial impacts of hearing loss. Although air-conduction hearing aids represent the standard approach, they may be unsuitable for conductive or mixed hearing loss, particularly in cases of ear malformations or chronic otitis media. In such cases, bone-conduction implants, available since the 1980s, offer an alternative by bypassing the outer and middle ear. These implants, passive or active transcutaneous, percutaneous, and middle ear, differ in surgical approach, coupling to the sound processor, and sound-transmission mechanisms. Objective: To evaluate and compare the audiological performance and speech recognition in individuals with conductive and mixed hearing loss implanted with different hearing implants. Materials and methods: A retrospective, comparative longitudinal study analyzed audiological outcomes in 101 individuals implanted with 5 implant types. Free-field pure-tone audiometry and speech recognition were analyzed unaided, at activation, and at 3-month follow-up. Results: All implants yielded improvements compared with the unaided condition. Aided free-field thresholds showed mean gains of 15.59 to 39.41 dB at activation and 20.00 to 39.71 dB at follow-up. Speech recognition also improved, with mean gains in silence of 19.95 to 31.99 dB at activation and 25.07 to 35.15 dB at follow-up, and in noise of 1.97 to 6.95 dB at activation and 2.16 to 7.56 dB at follow-up. Additional advantages were observed for Baha-p and Ponto. Conclusions: All implants provided benefits in audibility and speech perception. However, percutaneous implants, Baha-p and Ponto, offered superior overall performance compared with other implants.
OBJECTIVE:To determine the rate of spontaneous recovery in sudden sensorineural hearing loss (SSNHL) within 1 week of onset and evaluate the effect of corticosteroid treatment in patients without early recovery. STUDY DESIGN:Prospective, non-randomized comparative study. SETTING:Tertiary academic medical center. PATIENTS:Patients with SSNHL who presented within 3 days of onset between September 2023 and December 2024. INTERVENTION:Patients were observed for 1 week from the onset, followed by corticosteroid therapy only in insufficient early recovery group. MAIN OUTCOME MEASURES:Pure-tone average (PTA), word recognition score (WRS), and hearing gain. RESULTS:Among 41 patients who completed the 3-month follow-up, 13 (31.7%) showed complete or partial recovery after 1 week and were classified into the observation group. The remaining 28 patients (68.3%) received corticosteroid therapy. At the end of the observation, the observation group showed significantly better PTA (17.7±8.0 dB), WRS (94.2±3.5%), and hearing gain (36.4±12.3 dB) than the treatment group ( P <0.001). Frequency-specific analysis demonstrated significant spontaneous recovery across all measured frequencies (250 to 8000 Hz, P <0.05). Logistic regression identified initial PTA as the only significant predictor of spontaneous recovery, with a cutoff value of 71 dB (AUC=0.934). In the treatment group, PTA improved significantly from the end of observation to 3 months (mean change: 33.8±23.9 dB, P <0.001). CONCLUSIONS:Approximately one-third of patients with SSNHL recovered spontaneously within 1 week. Initial PTA was the strongest predictor of spontaneous recovery, with a threshold of 71 dB. For patients with limited early recovery, corticosteroid therapy resulted in meaningful hearing improvement.
Introduction: As the number of cochlear implant (CI) surgeries increases, greater emphasis should be placed on incremental improvements and on planning for a patient-centered approach. The shape of the basal turn (BT) of the cochlea has recently been evaluated and classified as either elliptical or round. However, the electrode position inside different shapes was not investigated. Objective: This study aims to evaluate the impact of different cochlear shapes on the electrode-to-modiolus distance (EMD) among the CI patients. Methods: A retrospective study was conducted on patients with normal cochleae who underwent cochlear implantation. Postoperative imaging was reconstructed using dedicated Otological planning software to assess cochlear morphology and electrode positioning. The cochlear shape was quantified using the basal turn width-to-height ratio (B/A ratio), and the EMD distance was measured. Results: The final analysis included 41 ears. The mean EMD was 3.3 mm in the basal electrodes, decreasing to 2.8 mm in the middle region and reaching 1.9 mm at the apical electrodes. The mean basal turn width-to-height ratio (B/A) was 0.8 (range: 0.7 to 0.9). Simple linear regression revealed that cochleae with a round-shaped basal turn (B/A >0.75) had a slightly shorter, but comparable, EMD in the basal region compared with those with an elliptical shape (3.3 vs. 3.5 mm). The apical region showed a bigger but nonsignificant distance in round-shaped cochleae (2.0 vs. 1.8 mm). In addition, impedance measurements at the 12-month interval showed a significant difference in basal electrode impedance between round and elliptical cochleae. Conclusion: This study reported no statistically significant association between cochlear anatomic parameters and electrode-to-modiolus distance. Lateral wall electrodes demonstrated comparable distances to the modiolus in both elliptical and round-shaped basal turn cochleae, suggesting stable positioning across anatomic variations. Although descriptive trends were observed, these findings should be interpreted as exploratory. Larger prospective studies are needed to further evaluate the influence of cochlear morphology on electrode positioning across different electrode designs.
HYPOTHESIS:Congenital unilateral conductive hearing impairment alters auditory white matter tract connections of the brain. BACKGROUND:Unilateral conductive hearing loss has negative effects on speech perception in noise and sound localization ability. This study examines auditory white matter tracts in a rat model with surgically induced unilateral ear canal atresia, compared with controls. MATERIALS AND METHODS:Twelve-month euthanized rats, 7 with left-sided surgically created ear canal atresia (UCA) and 4 controls, were scanned in a 9.4 T MRI scanner for animal research purposes. Diffusion-weighted images were acquired. Two different methods for probabilistic fiber tracking were used. Fractional anisotropy (FA) was calculated from whole brains and from tracts between defined auditory regions of interest. RESULTS:Both methods of fiber tracking show significantly higher global FA in rats with UCA. Within-group comparisons in UCA show higher FA on the hearing side between the cochlear nucleus and inferior colliculus, compared with the side of hearing loss, while in controls, there was no asymmetry. Lower FA was also found between the medial geniculate complex and the auditory cortex on the left side than on the right in UCA, in contrast to controls, where there was no difference between the hemispheres. CONCLUSION:The asymmetry found in UCA indicates alterations of auditory white matter tracts as a response to asymmetric hearing, partly confirming previous findings in experiments on ferrets.
BACKGROUND:Cochlear implantation (CI) following vestibular schwannoma (VS) resection, traditionally controversial, is increasingly accepted due to advances in surgical techniques. Current evidence is limited to small, short-term studies. This report presents the largest consecutive single-center cohort and offers long-term audiological outcomes. MATERIAL AND METHODS:This retrospective study analyzed 73 consecutive patients who underwent VS resection with either simultaneous (97%) or delayed (3%) CI at the Gruppo Otologico between 1985 and 2025, among more than 4000 patients who underwent VS removal during the same period. Sixty-three patients (86%) had sporadic VS, and 10 (14%) had neurofibromatosis type 2 (NF2). Tumor removal was performed using the enlarged translabyrinthine approach (ETLA). Outcomes were assessed through pure-tone average (PTA), speech discrimination scores (SDS), and open-set speech recognition. RESULTS:After a median 35-month follow-up, 48 patients (66%) were active CI users; 20 (27%) were nonusers or nonresponders. Five patients were "removed/non activated" (never activated due to postoperative complications or device malfunction or later explanted despite initial benefit) and were therefore not included in postoperative audiological outcome tables. Due to complications requiring explantation. Among users, the median postoperative PTA was 45.0 dB HL (IQR: 40.0-61.3), and the median SDS was 60.0% (IQR: 20.0-70.0). Open-set performance demonstrated high-to-median scores across word, sentence, and comprehension tests. Performance group analysis revealed that 52% of patients achieved intermediate-to-high outcomes, including 75% of NF2 patients. CONCLUSIONS:Performing CI immediately after VS resection is feasible and offers long-term functional benefits for most patients, including carefully selected NF2 cases. Although results can vary, more than half of the patients attain meaningful speech perception. This extensive, long-term, single-center experience strongly supports the feasibility of CI in this context, emphasizing the importance of surgical technique, nerve preservation, and precise patient selection.
OBJECTIVE:To evaluate total cochlear volume and its association with low-frequency hearing preservation for CI recipients receiving a straight electrode array. STUDY DESIGN:A retrospective clinical capsule report. SETTING:Tertiary academic referral center. PATIENTS:Adult CI recipients implanted with a 23 mm straight array between 2019 and 2023 with preoperative computed tomography (CT) imaging and an unaided low-frequency hearing threshold ≤45 dB HL at 250 Hz. MAIN OUTCOME MEASURE:Assess the relationship between total cochlear volume as estimated from the preoperative CT image and hearing preservation (at CI activation and 6 months postactivation). The shift in the low-frequency pure tone average (LFPTA; 125, 250, and 500 Hz) relative to the preoperative visit was calculated for the activation and 6-month visits. RESULTS:Fourteen patients met the inclusion criteria and had sufficient imaging to estimate total cochlear volume. There were significant correlations between total cochlear volume and LFPTA shifts at activation ( r =0.28, P =0.05; mean shift: 21 dB HL) and at 6 months postactivation ( r =0.29, P =0.048; mean shift: 22 dB HL). CONCLUSIONS:For CI recipients of a 23 mm straight array, a larger total cochlea volume is associated with better low-frequency hearing preservation. These data support review of an individual's cochlear anatomy to assist in stratifying individual patient risk for loss of residual hearing as well as for assisting in device selection.
OBJECTIVE:Computer-assisted navigation (CAN) is increasingly used in ENT surgery, notably in sinus and otoneurosurgical procedures. This study assessed the accuracy of a CAN system in temporal bone surgery using bone-anchored registration, without preoperative fiducial screws or facial CT imaging, focusing solely on the temporal bone. MATERIALS AND METHODS:Ten cadaveric temporal bones (5 left, 5 right) underwent high-resolution CT imaging. Dissections (mastoidectomy with facial recess approach) were conducted using the Collin Navigation Solutions system. Surface registration employed the iterative closest point (ICP) algorithm based on 3 anatomic landmarks. Positional accuracy (PA) was evaluated for 3 middle ear structures: short process of the incus (INC), head of the malleus (MAL), and anterior margin of the round window (COC) and one internal ear structure: lateral semicircular canal (LSC). PA was defined as the distance between each anatomic point and its corresponding CT location. RESULTS:Forty measurements were obtained. Initial PA was <1 mm in 77.5% of cases: 70% for both LSC and MAL, 90% for INC, and 80% for COC. The mean PA was 0.67 ± 0.46 mm before reregistration, and improved to 0.44 ± 0.32 mm after reregistration on the LSC. This improvement was statistically significant for LSC ( P = 0.0048) and INC ( P = 0.046), but not for MAL ( P = 0.2443) or COC ( P = 0.952). CONCLUSION:This study showed encouraging results regarding the accuracy of the CAN system for temporal bone surgery and supports further investigation.
OBJECTIVE:To evaluate whether a computer vision model can utilize monocular endoscopic images of the middle ear to generate three-dimensional (3D) surface reconstructions that register to ground-truth (GT) imaging with clinically acceptable accuracy for surgical navigation. METHODS:Eight temporal bone phantoms derived from the publicly available OpenEar data set were 3D-printed. Middle ear endoscopy was performed in each model using a standard monocular otologic endoscope, and a single endoscopic image captured of the mesotympanum. Images were processed with a monocular surface reconstruction model to generate predicted 3D surface reconstructions. Reconstructions were registered to GT meshes using natural anatomic landmarks. Surface reconstruction error (SRE) was quantified using the mean modified Hausdorff distance, and target registration error (TRE) was calculated using withheld test fiducials. RESULTS:Mean SRE across models was 0.58 ± 0.10 mm, with 81.6% of points within 1 mm of GT surfaces. Mean TRE was 0.96 ± 0.17 mm. CONCLUSION:Simple 2D, monocular endoscopic images can be converted into high-fidelity 3D surface reconstructions of middle ear anatomy, which can be registered to ground-truth imaging with submillimeter registration accuracy. These findings establish the preclinical feasibility of monocular, endoscope-centric navigation for transcanal endoscopic ear surgery.
