Craniopharyngiomas (CP) are suprasellar tumors that can grow into vital nearby structures and thus cause significant visual, endocrine, and hypothalamic dysfunction. Debate persists as to the optimal treatment strategy for these benign lesions, particularly with regards to the extent of surgical resection. The goals of tumor resection are to eliminate the compressive effect of the tumor on surrounding structures and minimize recurrence. It remains unclear whether a gross total resection (GTR) or subtotal resection (STR) with adjuvant therapy confers a better prognosis. Chemotherapy and radiation therapy (RT) have been explored as both neoadjuvant and adjuvant treatments to decrease tumor burden and prevent recurrence. The objective of this paper is to review the risks and benefits of GTR versus STR, specifically with regard to risk of recurrence and postoperative morbidity. Aggregated data suggest that STR monotherapy is associated with higher rates of recurrence relative to GTR (50.6% ± 22.1% vs 20.2% ± 13.5%), while STR combined with RT leads to recurrence rates similar to GTR. However, both GTR and RT are independently associated with higher rates of comorbidities including panhypopituitarism, diabetes insipidus, and visual deficits. The treatment strategy for CPs should ultimately be tailored to each patient’s individual tumor characteristics, risk, symptoms, and therapeutic goals.

ObjectiveSubclinical hearing loss (SCHL) (previously defined by our group as a four-frequency pure tone average [PTA4] >0 to ≤25 dB) has recently been associated with depressive symptoms and cognitive decline. This suggests that the common 25 dB adult cutpoint in the United States for normal hearing may not be sensitive enough. We aim to characterize real-world hearing difficulties, as measured by hearing aid use and self-reported hearing difficulty, among individuals with SCHL.Study DesignAnalysis of biennial cross-sectional epidemiologic survey (National Health and Nutrition Examination Survey, 1999–2012, 2015–2016).SettingCommunity, multicentered, national.SubjectsNoninstitutionalized US citizens ≥12 years old, n = 19,246.MeasuresPTA4 (500, 1,000, 2,000, 4,000 Hz), high-frequency pure tone average (PTAhf) (6,000, 8,000 Hz), reported hearing aid use, subjective difficulty hearing.ResultsThere were 806,705 Americans with SCHL who wore hearing aids (or 0.35% of the 227,324,096 Americans with SCHL; 95% confidence interval = 0.23%–0.54%). Among those with SCHL, 14.6% (33.1 million Americans) perceived a little trouble hearing and 2.29% (5.21 million Americans) perceived moderate/a lot of trouble hearing. When restricted to the borderline subcategory (>20 to ≤25 dB), 42.43% (6.64 million Americans) had at least a little trouble hearing. Among those with SCHL who wore hearing aids, 81% had a PTAhf >25 dB.ConclusionDespite hearing loss traditionally being defined by PTA4 ≤ 25 dB in the United States, nearly 1 million adults and adolescents with SCHL wore hearing aids, and nearly half with borderline HL had subjective difficulty hearing. To better reflect real-world difficulties, stricter definitions of hearing loss should be explored, including a lower cutpoint for the PTA4 or by using the more sensitive PTAhf.

To investigate disparities in hearing aid use across the life span for borderline/mild hearing loss, a cross-sectional epidemiologic study in the National Health and Nutrition Examination Survey was conducted. Multivariable logistic regressions controlling for hearing level analyzed the association between hearing aid use and age in borderline/mild hearing loss. Age was grouped into quartiles. Of 2470 subjects, 2.0% (n = 50) were <25 years old; 12.0% (n = 297), 25 to 49 years; 65.5% (n = 1618), 50 to 74 years; and 20.5% (n = 505), ≥75 years. When compared with the youngest quartile and while controlling for hearing level, those in the second quartile were 4.6 times less likely to use hearing aids ( P < .01); those in the third were 4.2 times less likely ( P < .01); and those in the fourth were 4.7 times less likely ( P < .001). The dramatically lower hearing aid usage of all older age groups as compared with children/younger adults represents a large unaddressed age-related disparity in the treatment of borderline/mild hearing loss.

Background Historically sinonasal malignancies were always addressed via open craniofacial surgery for an oncologic resection. Increasingly esthesioneuroblastomas are excised using an exclusively endoscopic approach, however, the rarity of this disease limits the availability of long‐term and large scale outcomes data. Objective The primary objective is to evaluate the treatment modalities used and the overall survival of patients with esthesioneuroblastoma managed with exclusively endoscopic surgery. Methods In accordance with PRISMA guidelines, PubMed was queried to identify studies describing outcomes associated with endoscopic management of esthesioneuroblastomas. Results Forty‐four out of 2462 articles met inclusion criteria, totaling 399 patients with esthesioneuroblastoma treated with an exclusively endoscopic approach. Seventy‐two patients (18.0%) received adjuvant chemotherapy and 331 patients (83.0%) received postoperative radiation therapy. The average age was 50.6 years old (range 6–83). Of the 399 patients, 57 (16.6%) were Kadish stage A, 121 (35.2%) were Kadish stage B, 145 (42.2%) were Kadish stage C, and 21 (6.1%) were Kadish stage D. Pooled analysis demonstrated that 66.0% of patients had Hyams histologic Grade Ⅰ or Ⅱ, while 34.0% of patients had Grade Ⅲ or Ⅳ disease. Negative surgical margins were achieved in 86.9% of patients, and recurrence was identified in 10.3% of patients. Of those with 5‐year follow‐up, reported overall survival was 91.1%. Conclusion Exclusively endoscopic surgery for esthesioneuroblastoma is performed for a wide range of disease stages and grades, and the majority of these patients are also treated with adjuvant chemotherapy or radiation therapy. Reported overall recurrence rate is 10.3% and 5‐year survival is 91.1%.

ObjectiveThe association between hearing loss and socialization has been characterized in limited detail and primarily among non-Hispanic Caucasians. We aimed to study this relationship using more detailed socialization measures than previously used and focusing on Hispanics.Study DesignCross-sectional epidemiologic study (Hispanic Community Health Study).SettingMulticentered, four U.S. communities.ParticipantsU.S. Hispanics ages 18 to 76 years.Main MeasuresMultivariable linear regression controlling for confounders (age, sex, education) was conducted to analyze the association between hearing loss (four-frequency pure tone average) and socialization. Socialization was assessed with three independent surveys: a modified Cohen Interpersonal Support Evaluation List (ISEL), the Cohen Social Network Index (SNI), and a modified Moos Family Environment Scale.ResultsAverage age was 46.7 years (standard deviation [SD], 13.6 yr; range, 18–75 yr). Average ISEL composite score was 25.9 (SD, 6.66; n = 4,330). Controlling for confounders, for every 10 dB worsening in hearing, the ISEL score decreased by 0.31 (95% confidence interval [CI], 0.08–0.52; p < 0.01). Average SNI network diversity score was 6.89 (SD, 1.81; n = 3,117) and average SNI network size was 15.4 individuals (SD, 8.11). Controlling for confounders, for every 10 dB worsening in hearing, the SNI network diversity decreased by 0.22 (95% CI, 0.15–0.29; p < 0.001), and SNI size decreased by 0.25 (95% CI, 0.07–0.62; p < 0.05). Average family cohesion score on the Moos Family Environment Scale was 12.9 (SD, 2.77; n = 4,234). Controlling for age, sex, and education, for every 10 dB worsening in hearing, family cohesion decreased by 0.14 (95% CI, 0.04–0.23; p < 0.01).ConclusionHearing loss is associated with less social support, smaller/less diverse social networks, and less family cohesion in U.S. Hispanics.

Objective Hearing loss (HL) has been linked to commonly studied detrimental mood states, such as loneliness and depression. However, its relationship with other negative emotions remained largely unstudied. We explore the association between HL and anxiety, anger, hostility, poor self‐esteem, and pessimism in a national cohort of US Hispanic adults. Study Design Cross‐sectional study. Setting Multicentered US national epidemiologic study (Hispanic Community Health Study). Methods Subjects were ages 18 to 75 with completed audiometric and emotional survey data. Multivariable regressions controlling for age, gender, and education were conducted to analyze the association between HL, measured by 4‐frequency pure‐tone average (PTA), and emotional states. States included anxiety (Spielberger Trait Anxiety Scale‐10), anger (Spielberger Trait Anger Scale), hostility (Cook Medley Cynicism Scale‐13), poor self‐esteem (Self‐Esteem Scale‐10), and pessimism (Revised Life Orientation Test). Results A total of 4120 to 4341 participants met inclusion criteria, depending on the specific survey; the average age was 46.7 years (standard deviation [SD] = 13.7), and the average PTA was 13.8 dB (SD = 10.1). Controlling for age, gender, and education, HL was associated with all outcomes. Specifically, for every 10 dB worsening in HL, the anxiety score worsened by 0.41 (0.23‐0.60), the anger score worsened by 0.40 (0.22‐0.58), the hostility score worsened by 0.16 (0.04‐0.27), the self‐esteem score worsened by 0.25 (0.12‐0.38), and the pessimism score worsened by 0.17 (0.04‐0.30) (all p < .01). Conclusion HL is related to numerous negative mood states beyond loneliness and depression. This includes worse anxiety, anger, hostility, self‐esteem, and pessimism. Future studies should investigate whether treating HL improves negative emotional states.

ObjectiveCurrent definitions of hearing loss (HL) may be insufficiently strict, as subclinical hearing loss (SCHL; >0 and ≤25 dB hearing level) has been associated with deleterious age‐related conditions. SCHL prevalence and mean age of HL onset in the United States has not been characterized.Study DesignA cross‐sectional epidemiologic prevalence study.SettingUS Community.MethodsWe analyzed cross‐sectional audiometric data in the US National Health and Nutrition Examination Survey (2005‐2012, 2015‐2018, n = 15,649). Results were scaled to the current population using weighting.Results79.6% of participants (227.32 million Americans) had SCHL. The mean age of HL onset at thresholds of 25, 20, and 15 dB was 74, 66, and 55 years, respectively, for the 4‐frequency pure‐tone average, and 48, 44, and 35 years for the high‐frequency pure‐tone average.ConclusionWe present SCHL prevalence and define HL onset by various sensitive definitions. These results inform ongoing public health efforts to increase hearing aid utilization, particularly given the arrival of over‐the‐counter hearing aids.

Objective: The following research question was asked: In patients with vestibular schwannoma (VS) that underwent stereotactic radiosurgery (SRS) and cochlear implantation, were improvements in hearing function observed, and what was the cochlear implant (CI) failure rate of in these patients? Data Sources: PubMed/Medline, CINAHL (EBSCOhost), and Web of Science articles without restrictions on publication dates were searched. Study Selection: Inclusion criteria required that the article was a report, a series, or a retrospective review with individual case data available. Non-English articles were excluded. Inclusion criteria required that patients were with VS and underwent subsequent SRS and cochlear implantation. Patients receiving microsurgery or stereotactic radiotherapy on the ipsilateral ear were excluded from this study. Data Extraction: Included studies were evaluated using full-text evaluation, and data on study characteristics (author names, gender), clinical data (syndromic information, SRS modality), hearing outcomes, and device failure were extracted. Data Synthesis: Means and averages were obtained for all continuous variables. Percentages were ascertained for all categorical variables. Conclusions: The majority of patients undergoing CI placement in VS treated with SRS achieved open-set speech perception (79.2%) or environmental sound awareness (6.8%). Twelve implants (20.3%) failed. Three patterns were associated with failure: 1) immediate-onset failure, 2) initial benefit with delayed failure, 3) poor local control with device explantation.