Skull base osteomyelitis is a serious disease with a high risk of complications including neuroinfection. Typically, the inflammation of the skull base results from infection from neighboring tissues. In case of malignant otitis externa, inflammation disseminates from the external auditory canal. In this study, we present our experience with seven patients diagnosed with skull base osteomyelitis that began with otitis externa and have been treated in our department for the last 10 years. Department Patient Database was searched for the diagnosis skull base osteomyelitis. The search covered the last 10 years. The search revealed seven patients who met the above-described criteria. Medical records of those patients were carefully analyzed including age, gender, symptoms and signs, diagnostics details, treatment, performed procedures, number of hospitalization days, comorbid diseases, and complications including any cranial nerve palsy. Detailed analysis of medical records of patients included in this study showed that skull base osteomyelitis presents a challenge for diagnosis and treatment. Treatment strategy requires prolonged aggressive intravenous antibiotic therapy, and in some cases combined with surgical intervention. Cranial nerve paresis indicates progression of the disease and is associated with longer hospital stay. Similar relationship is observed in patients with skull base osteomyelitis that required surgery. Diabetes in patient’s medical history may complicate the healing process. Diabetes, neural involvement, and surgery may overlap each other resulting in longer hospital stay. Cranial nerve paresis may not resolve completely and some neural deficits become persistent.

<b>Background:</b> The aim was to present the methodology and interpretation of intraoperative hearing monitoring with simultaneous Transtympanic Electrocochleography (TT-ECochG) and direct Cochlear Nerve Action Potential (CNAP) measurements during vestibular schwannoma removal. <br><b>Materials and Methods:</b> Detailed methodology of measurements and interpretation of results are presented in three exemplary patients who underwent tumor removal via middle fossa approach (MFA) with the use of intraoperative monitoring of hearing with TT-ECochG and direct CNAP performed in real time. In addition, all responses were automatically recorded and stored along with surgical information and subjected to detailed analyses and calculation after surgery. <br><b>Results:</b> The following changes in TT-ECochG and direct CNAP responses were observed: Patient #1 – TT-ECochG and CNAP responses with minor, but transient, morphology changes (hearing was preserved); Patient #2 – CNAP responses changed significantly but, temporarily, from triphasic into biphasic responses later, with marked but partially reversible desynchronization of CNAP; changes in TT-ECochG responses were also observed but, at the end, returned to baseline (surgery-related deterioration of hearing); Patient #3 – irreversible changes of TT-ECochG and direct CNAP (complete loss of hearing). <br><b>Conclusions:</b> A combination of TT-ECochG and direct CNAP allows for real-time monitoring of auditory function during vestibular schwannoma resection and surgical manipulation which contribute to the risk of hearing loss. Therefore, the surgeon can be instantly informed about changes which could increase the possibility of preserving the patient’s hearing

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ObjectivesDespite the increasing number of research concerning the applications of the Laser Doppler Vibrometry (LDV) in medicine, its usefulness is still under discussion. The aim of this study is to present a methodology developed in our Department for the LDV intraoperative assessment of ossicular chain reconstruction.MethodsTen patients who underwent “second look” tympanoplasty were involved in the study. The measurements of the acoustic conductivity of the middle ear were performed using the LDV system. Tone bursts with carrier frequencies of 500, 1,000, 2,000, and 4,000 Hz set in motion the ossicular chain. The study was divided into four experiments that examined the intra- and interindividual reproducibility, the utility of the posterior tympanotomy, the impact of changes in the laser beam angle, and the influence of reflective tape presence on measurements.ResultsThere were no statistically significant differences between the two measurements performed in the same patient. However, interindividual differences were significant. In all cases, posterior tympanotomy proved to be useful for LDV measurements of the ossicular prosthesis vibrations. In most cases, changing the laser beam angle decreased signal amplitude about 1.5% (not significant change). The reflective tape was necessary to achieve adequate reflection of the laser beam.ConclusionLDV showed to be a valuable noncontact intraoperative tool for measurements of the middle ear conductive system mobility with a very good intraindividual repeatability. Neither a small change in the angle of the laser beam nor performing the measurements through posterior tympanotomy showed a significant influence on the results. Reflective tape was necessary to obtain good quality responses in LDV measurements.

In our experience, HHFA is effective treatment of facial palsy and gives a chance to reduce damage of the tongue.

POSTERSMethod: Adjustable head-set positioned patients providing 3D representation of vestibular apparatus. Three latex free tubes positioned at 90-degree angles to one another representing SCC arrangement in both ears. Communication via hollow plasticcavity representing the utricle. Mobile metal ball bearing representing the canalith placed into the lumen posterior SCC tube of the affected ear determined following positive Dix-Hallpike test.Results: As described by Epley, the head is placed over the end of the table and turned 45 degrees to the affected ear so the canalith gravitates to the center of the posterior SCC. While the head is tilted below the horizontal it is rotated 45 degrees toward the other ear so the canalith reaches the common crus. At this stage the patient is then turned prone, looking directly at the floor, and subsequently the canalith enters the utricle. This method has 85% success rate in BPPV patients with a positive Dix-Hallpike test. Conclusion:The method incorporates fewer steps than the Epley maneuver and is less time consuming in busy otolaryngology clinics achieving the desired outcome, with the advantage of educating patients and junior doctors about canalith movement through SCCs with head-set resembling valuable visual aid-memoire. The senior author successfully used this technique for 10 years for short term resolution of BPPVassociated symptoms. Results: Postoperative complications occurred in 21 (20.2%) implants placed. Complications related to skin in 11 (10.5%) cases, implant extrusion occurred in 7 (6.7%) cases, and loss of abutment occurred in 3 (2.8%) cases. 40 dB average functional hearing gain was observed in the whole group of patients. Otology/Neurotology Conclusion:We found overall incidence (20.2%) of postoperative complications for this group involving 2 different centers and implantations in one surgical time frame, which is not higher than that reported in the 2 stage procedure. These results support the feasibility and safety of single-stage surgery for BAHA implantation in this group of patients. Otology/Neurotology Ossicle Erosion and Conductive Hearing Loss in Cholesteatoma Olga Martins (presenter); Samuel H. Selesnick, MD; Jonathan VictorObjective: Investigate and analyze the relationship between individual ossicular erosion and ABG among patients with cholesteatoma. Data from patients undergoing initial surgery for cholesteatoma were retrospectively reviewed to evaluate the relationships between preoperative PTA data, intraoperative assessment of individual ossicular destruction, and clinical characterization of cholesteatoma.Method: For each patient, the cholesteatoma was categorized as primary acquired, secondary acquired, congenital, or unable to discern. Ossicular destruction was graded, and ABG was calculated. For each ossicle, the relationship between degree of cholesteatoma involvement and ossicular erosion and the ABG were analyzed using univariate and multivariate linear regression.Results: A total of 158 primary cholesteatoma surgeries were perfo...

Back branch of stapes, front branch of stapes and umbo of eardrum are useful to intraoperatve measurements ossicular chain movability. Delimitation thresholds of ossicular chain movability can help in reconstruction's evaluation. After next experiments LDV can be use in practice-intraoperative.

Background and purpose Retrofacial approach (RFA) is an access route to sinus tympani (ST) and it is used in cholesteatoma surgery, especially when type C ST is encountered. It may also be used to gain an access to stapedius muscle to assess the evoked stapedius reflex threshold. The primary object of this study was to evaluate the morphology of sinus tympani and its relationship to facial nerve (FN) and posterior semicircular canal (PSC) in context of planning retrofacial approach in pneumatized temporal bones. Methods CBCT of 130 adults were reviewed. The type of sinus tympani was assessed according to Marchioni's classification. Width of entrance to sinus tympani (STW), depth of ST (STD), distance between the posterior semicircular canal and facial nerve (F-PSC), distance between the latter plane to the floor of ST at the right angle (P-ST) were measured at level of round window (RW) and pyramidal ridge (PR). Results All of the bones were well-aerated and classified in Dexian Tan pneumatization group 3 or 4. Type B of ST is dominant (70.8%) in adult population with no history of inflammatory otologic diseases, followed by type C (22.7%) and then type A (6.5%). The depth of ST (STD) presented significant deviations (ANOVA, p < 0.05) among all three types. STW reaches greater values on the level of PR. F-PSC does not correlate with type of ST. In over 75% of examined type C sinus tympani the distance P-ST was less than 1 mm. Conclusions The qualitative classification of the sinus tympani into types A, B and C, introduced by Marchioni is justified by statistically significant differences of depth between individual types of tympanic sinuses. The STW distance reaches greater values inferiorly—it may suggest that RFA should be performed in infero-superior manner rather than opposite direction. Preoperative assessment of temporal bones CT scans gives very important information about size of sinus tympani and distance between FN and PSC.