Introduction: Cisplatin-induced hearing loss (CIHL) is a well-described, long-term consequence of cisplatin treatment for malignancy. Intratympanic (IT) injections have been trialed to prevent CIHL in humans. To provide clarity on which agents have been studied through IT injection and to review their efficacy for hearing loss prevention, we performed a systematic review and meta-analysis.Data Sources: OVID Medline, Embase, Web of Science, and Cochrane Library were queried.Methods: Databases were searched in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Prospective randomized trials were included, and a systematic review was performed for all studies. Demographic, audiometric, and therapeutic data were collected. Random-effects models were used to compare across studies, and subgroup analyses were performed for each IT agent.Results: The initial database search yielded 1017 articles, which were screened according to inclusion and exclusion criteria. Ten studies were identified, involving a total of 284 patients. Studies included data on IT dexamethasone, IT N-acetylcysteine (NAC), and IT sodium thiosulfate (STS). Pooled analysis across all agents and frequencies did not reveal a significant difference in hearing thresholds between treatment and control ears [prediction interval [-3.77, 3.20], negative favors treatment). Subgroup analysis of IT dexamethasone [-1.74, 3.80] and IT NAC [-1.02, 4.64] also did not demonstrate significant differences. STS data were not amenable to pooled analysis; however, one study demonstrated a significant decrease in ASHA-defined ototoxicity (40% vs. 85%, P=0.0027).Conclusions: To date, no IT agent has consistently prevented CIHL, although limited data suggest that IT STS may decrease ototoxicity. More trials are necessary to fully elucidate these effects.
OBJECTIVE:To evaluate the feasibility and safety of active MRI surveillance as an alternative to immediate surgical re-exploration in patients with small, asymptomatic postoperative cholesteatoma recurrence. STUDY DESIGN:Prospective single-arm pilot study. SETTING:Secondary referral otology center. PATIENTS:Patients with prior cholesteatoma surgery demonstrating postoperative recurrence ≤5 mm on non-echo-planar diffusion-weighted MRI without otologic symptoms, suspicious findings on otoscopy for cholesteatoma, or radiologic proximity to critical structures. INTERVENTION:Structured active surveillance with serial non-echo-planar diffusion-weighted MRI scans at 12- to 18-month intervals. MAIN OUTCOME MEASURES:Surgery-free survival (SFS) is defined as the time from baseline MRI demonstrating recurrence to surgical intervention. The secondary outcome included the annual lesion growth rate. RESULTS:Thirteen patients were included in the longitudinal analysis with a mean follow-up of 43±17 months. Ten patients (77%) remained surgery-free throughout the surveillance. Three patients (23%) required surgical intervention due to lesion enlargement or symptom development. The mean lesion growth rate was 0.32±1.0 mm/year. Three patients (23%) demonstrated spontaneous radiologic regression during follow-up. Kaplan-Meier analysis demonstrated cumulative SFS of 100% at 24 months and 91% (95% CI: 74-100) at 36 months. CONCLUSIONS:In selected patients with small, asymptomatic postoperative cholesteatoma recurrence, active MRI surveillance may safely defer surgical re-exploration. These findings support further prospective evaluation of imaging-guided surveillance strategies for the management of MRI-detected recurrence.
Hypothesis: Electrical stimulation of the external ear mediates cardiovascular changes in anesthetized rats. Background: Auricular vagus nerve stimulation (aVNS) has been proposed as a noninvasive treatment for cardiovascular disease. Stimulation is typically achieved via electrodes placed on the external ear, but the exact mechanisms by which aVNS induces cardiovascular changes remains unclear. In particular, the relative contributions of sympathetic and parasympathetic pathways have not been well elucidated. In this study, we use a rodent model to determine the hemodynamic effects of stimulating two auricular regions and assess the autonomic pathways mediating these responses. Methods: Bipolar transcutaneous electrical stimulation was applied to the external ear of adult Sprague-Dawley rats. Cardiovascular parameters including mean arterial pressure (MAP), photoplethysmography (PPG), and cardiac electrical activity were recorded. Cervical vagotomies and hexamethonium sympathetic blockade were performed to assess the parasympathetic and sympathetic contributions to evoked cardiovascular responses. Results: Electrical stimulation at the concha resulted in significant changes in MAP and PPG. MAP changes were larger with stimulation in the concha compared with the anterior pinna. MAP responses increased in a dose-dependent manner with increasing current amplitude. Bilateral vagotomy resulted in persistent but decreased evoked cardiovascular responses. Complete autonomic blockade using intravenous hexamethonium resulted in the absence of any evoked cardiovascular responses with aVNS. Conclusion: Cardiovascular changes from aVNS are mediated by modulation of both parasympathetic and sympathetic activity.
OBJECTIVE:This study aimed to determine whether radiologic and clinical data can predict the cochlear implant (CI) benefit in patients with otosclerosis, with a focus on the prognostic value of computed tomography (CT) features and relevant clinical variables. METHODS:A retrospective single-centre analysis was conducted on 126 otosclerotic patients (143 implanted ears) who underwent CI between 2009 and May 2025. Preoperative and postoperative CT scans were reviewed and classified using established grading systems (Symons/Fanning, Rotteveel, Veillon). Clinical variables included age at implantation, duration of hearing loss (HL), preoperative audiometric thresholds, history of stapes surgery, electrode design, and scala of insertion. Audiological outcomes were evaluated at 12 months postactivation using aided pure tone average and aided speech perception score. Univariate and multivariate statistical analyses were performed. RESULTS:No significant correlation was found between CT-based otosclerosis staging or radiologic features and post-CI audiological outcomes. Multivariate analysis identified increased age at implantation, electrode insertion into the scala vestibuli, and use of straight electrodes as predictors of poorer speech perception. A longer duration of HL also negatively impacted outcomes. Precurved electrodes and scala tympani placement were associated with superior results. Previous successful stapes surgery predicted better performance. CONCLUSIONS:While CI provides effective auditory rehabilitation in otosclerotic patients, radiologic CT staging does not predict functional outcomes. Instead, clinical factors-age, duration of HL, electrode design, and array placement-are more influential. Preoperative CT remains essential for surgical planning, but patient counselling should focus on clinical history and procedural details. LEVEL OF EVIDENCE:Level III.
OBJECTIVE:To investigate the factors affecting postoperative quality of life (QOL) and its longitudinal changes in patients undergoing vestibular schwannoma resection through the retrolabyrinthine approach (RLA). STUDY DESIGN:Retrospective case review. SETTING:Tertiary referral center. PATIENTS:Fifty-nine patients who underwent RLA for vestibular schwannoma between March 2016 and November 2022 and completed the Penn Acoustic Neuroma Quality of Life (PANQOL) questionnaire preoperatively and at least once at ≥6 months postoperatively. Patients were categorized into hearing preservation (n=37), hearing deterioration (n=19), and preoperative deafness (n=3) groups. INTERVENTION:Surgical resection of vestibular schwannoma through RLA with the intent of preserving hearing. MAIN OUTCOME MEASURES:Changes in PANQOL composite and subdomain scores over time. RESULTS:Total PANQOL scores remained stable postoperatively (mean scores: 69.7 preoperative, 72.3 at 6 mo, 76.4 at 1 y, and 75.1 at 2 y). Anxiety scores significantly improved after surgery. At 6 months postoperatively, hearing and balance scores were significantly lower in the hearing deterioration group compared with the hearing preservation group, though differences diminished by 1 and 2 years. Energy scores tended to be higher in the hearing preservation group. CONCLUSIONS:RLA contributes to maintaining or improving postoperative QOL. Hearing preservation supports not only auditory function but also emotional and social well-being.
