No abstract

Objective To investigate the effect of subtotal petrosectomy and mastoid obliteration (SPMO) on the overall success of adult and pediatric cochlear implant (CI) recipients. Study Design Retrospective Case Series Setting Tertiary Care Referral Center Patients 39 ears in 36 patients (23 adults and 13 children) received both surgeries between 1990 and 2012. Intervention CI candidates underwent SPMO to permit implantation and minimize the risks of infectious complications in the recipient ear. SPMO was performed prior to (69.3%), at the time of (25.6%) and after CI (5.13%). Mastoids were obliterated with fat (30.8%), muscle (66.7%), and bone pate (2.56%). Main Outcome Measure Feasibility, complications and success of SPMO and CI were assessed with standard statistical analysis and Fischer's Test with Two Sided P –Values. Results Ear disease was definitively managed and CI was successfully placed in all but one case. Complications including abscess (n=3), subcutaneous emphysema (n=1), ear canal granulation formation (n=1) and electrode extrusion (n=1) occurred in 15.4% of patients. Predisposing syndromes were present in children more often than adults (43.8% vs 13.0%, p=0.0598). Adults more often than children had previous mastoid surgery for middle ear disease (30.4% vs 0.0% p=0.0288). CIs were placed under local anesthetic and sedation (n=3) and after radiation treatment for nasopharyngeal cancer (n=2) in adult ears. Conclusions SPMO is an effective and safe procedure for definitively managing middle ear disease and implanting adult and pediatric CI candidates.

No abstract

While the benefits of continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BiPAP) for patients with obstructive sleep apnea are well described, reports in the literature of complications from its use are rare. A patient who received postoperative BiPAP after undergoing transsphenoidal craniopharyngioma resection developed severe pneumocephalus and unplanned intensive care unit admission. Although the pneumocephalus resolved with conservative management over two weeks, we propose caution in the use of CPAP postoperatively in patients undergoing procedures of the head and neck.

Objective To determine whether early gadolinium-enhanced magnetic resonance imaging (GdMRI) can reliably detect meningitic labyrinthitis and thereby predict which children are at high risk for hearing loss. Permanent sensorineural hearing loss (SNHL) remains a common sequela of bacterial meningitis, and early diagnosis of the associated suppurative labyrinthitis can be difficult, especially in critically ill, sedated patients and young children. Design Retrospective cohort study. Setting Tertiary pediatric hospital. Participants Twenty-three survivors of bacterial meningitis (median age, 15 months [range, 3 months–14 years]) who had undergone brain GdMRI during the acute disease and had subsequent ear-specific audiometric data. Main Outcome Measure Blinded to disease and outcome, a neuroradiologist rated the relative enhancement of each cochlea on T1-weighted images using a 4-point scale. Scores were then correlated with the degree of hearing loss on subsequent testing. Results Sensorineural hearing loss occurred in 15 of 46 ears (8 of 23 patients). Enhancement on GdMRI was detected in 13 of the 15 ears that later developed SNHL but was absent in all 31 unaffected ears. Thus, GdMRI was 87% sensitive and 100% specific for predicting which ears would develop permanent SNHL. In the subgroup with pneumococcal meningitis (n=15), GdMRI was 100% sensitive and 100% specific. Labyrinthine enhancement was detectable as early as 1 day after diagnosis. Conclusion Gadolinium-enhanced MRI detected meningitic labyrinthitis at early stages and accurately predicted which patients would later develop hearing loss.