Laryngoscope, 125:2295–2297, 2015

Objectives: To review literature on the link between depression and anxiety in patients suffering from tinnitus. Method: A systematic review of published English-language literature was performed using PubMed, Ovid, and Cochrane databases. Results: Of the 56 eligible abstracts 15 were chosen to be included in the review. All articles showed an association of depression and anxiety in tinnitus patients. Conclusions: Because of the strong association between tinnitus, depression, and anxiety-all tinnitus patients should be screened for psychiatric disorders. Treatment for these complex conditions should involve a multidisciplinary team with cognitive behavioral therapy and possible pharmacological therapy.

Objective. A smartphone-enabled otoscope (SEO) can capture tympanic membrane (TM) images. We sought to compare a SEO to microscopic otoscopy in the detection and evaluation of TM pathology in an otology/neurotology practice.Study Design. Prospective single-site study in adults presenting over a 3-month period.Setting. Neurotology clinic within a tertiary care academic medical center.

Majority of MD patients who had all failed diuretic therapy responded positively to medications used for migraine prophylaxis, as indicated by a significant improvement in QOL. This study may further suggest a correlation between the pathophysiologic basis of disease in MD and vestibular migraine. Patients with MD may be successfully managed with medications intended to treat migraine.

Objectives. (1) Perform a meta-analysis of the available data on the outcomes of CyberKnife radiosurgery for treatment of vestibular schwannomas (VSs) in the published English-language literature and (2) evaluate the collective outcomes of CyberKnife treatment with respect to tumor control and hearing preservation. Data Sources. A thorough literature search of published English-language articles was performed in the PubMed, Ovid, and Cochrane databases. Review Methods. A database search was conducted with the keywords “CyberKnife” and “vestibular schwannoma” or “acoustic neuroma.” A total of 25 papers were found and reviewed. Data were extracted for patient demographics, number of patients with neurofibromatosis type 2, pretreatment hearing status, tumor size, margin dose, and follow-up duration. The primary outcome variables evaluated were tumor control and hearing preservation. Results. After careful review of the published articles, 11 papers reported data on outcomes of CyberKnife treatment for VS and were included in the analysis, comprising 800 patients studied during 1998 to 2012. The reported mean tumor volume ranged from 0.02 to 19.8 cm3, and the follow-up duration ranged from 6 to 120 months. Margin dose varied from 14 to 25 Gy. The collective mean tumor control rate was 96.3% (95% CI: 94.0%-98.5%). The collective hearing preservation rate was 79.1% (95% CI: 71.0%-87.3%) in 427 patients with measurable hearing. Conclusion. Clinical data on outcomes of CyberKnife radiosurgery for treatment of VSs are sparse and primarily limited to single-institution analyses, with considerable variation in tumor volume and follow-up time. This meta-analysis not only provides an in-depth analysis of available data in the literature but also reviews reported outcomes and complications.

ObjectivesPermanent injury to the cranial nerves can often result in a substantial reduction in quality of life. Novel and innovative interventions can help restore form and function in nerve paralysis, with bioelectric interfaces among the more promising of these approaches. The foreign body response is an important consideration for any bioelectric device as it influences the function and effectiveness of the implant. The purpose of this review is to describe tissue and functional effects of chronic neural implantation among the different categories of neural implants and highlight advances in peripheral and cranial nerve stimulation. Data Sources: PubMed, IEEE, and Web of Science literature search. Review Methods: A review of the current literature was conducted to examine functional and histologic effects of bioelectric interfaces for neural implants.ResultsBioelectric devices can be characterized as intraneural, epineural, perineural, intranuclear, or cortical depending on their placement relative to nerves and neuronal cell bodies. Such devices include nerve‐specific stimulators, neuroprosthetics, brainstem implants, and deep brain stimulators. Regardless of electrode location and interface type, acute and chronic histological, macroscopic and functional changes can occur as a result of both passive and active tissue responses to the bioelectric implant.ConclusionA variety of chronically implantable electrodes have been developed to treat disorders of the peripheral and cranial nerves, to varying degrees of efficacy. Consideration and mitigation of detrimental effects at the neural interface with further optimization of functional nerve stimulation will facilitate the development of these technologies and translation to the clinic.Level of Evidence3.

Objective Mal de debarquement syndrome (MdDS) is a balance disorder which typically starts after an extended exposure to passive motion, such as a boat or plane ride. Management is typically supportive (e.g. physical therapy), and symptoms that persist beyond six months have been described as unlikely to remit. This study was conducted to evaluate the response of patients with MdDS to management with migraine prophylaxis, including lifestyle changes and medical therapy. Study Design Prospective review Setting Ambulatory setting at a tertiary care medical center Methods Clinical history, detailed questionnaires, and audiograms were used to diagnose patients with MdDS. Those patients with the diagnosis of the MdDS were placed on our institutional vestibular migraine management protocol. Results Fifteen patients were diagnosed with MdDS with a predominance of females (73%), with a mean age of 50±13 years. Eleven patients (73%) responded well to management with a vestibular migraine protocol, which included lifestyle changes, as well as pharmacotherapy with verapamil, nortriptyline, topiramate, or a combination thereof. Conclusions Management of MdDS as vestibular migraine yields successful results in improving patients' symptoms and increasing the quality of life. Nearly all the patients suffering from MdDS had a personal or family history of migraine headaches or had signs or symptoms suggestive of atypical migraine.

Objectives: To assess and characterize patients' online ratings and comments of neurotologists and determine factors that correlate with higher ratings. Methods: All the American Neurotology Society members were queried on Healthgrades, Vitals, RateMDs, Yelp, and Google from March to June 2018. All ratings were normalized for comparison on a five-point Likert scale. All comments were categorized based on context and for positive/negative aspect. Results: Of the 560 American Neurotology Society members, 465 (83%) were rated on at least one online platform. Of those rated, 420 (90%) were on Healthgrades, 392 (84%) on Vitals, 283 (61%) on RateMDs, 232 (50%) on Google, and 56 (12%) on Yelp. Across all platforms, the average overall rating was 4.06 AE 0.68 (range: 1.00-5.00). There were significant positive correlations between overall rating and specific ratings (p < 0.01) on individual topics. Moreover, categorizing 5,317 narrative comments elicited the majority to be related to perceived physician bedside manner and clinical outcome. Although the number of positive comments outnumbered the negative ones, only the negative comments correlated (negatively) with the overall score (p < 0.01). Attending a top 25-or 50-medical schools or residency programs did not correlate with their rating. Conclusions: Online ratings and comments for neurotologists are highly dependent on patient perceptions of physician competence, caring bedside manner, and office management. Minimizing the number of negative comments, especially regarding perceived physicians' professionalism and communication, clinical outcome, bedside manners, and office management, leads to higher calculated overall scores and online perception.