Oral Presentations P93Conclusions: In the absence of brainstem compression or concern of malignancy, initial observation of JPTs should be considered. A significant number of tumors do not grow after time of diagnosis, and symptoms frequently remain stable for many years. Even with disease progression, most JPTs exhibit indolent growth with slowly progressive cranial neuropathy affording satisfactory physiologic compensation in most patients. The Nervus Intermedius in Children withCochlear Nerve Deficiency Submitted to Auditory Brainstem Implantation Giacomo Colletti, MD (presenter); Marco Mandala, MD; Liliana Colletti; Vittorio Colletti, MD Objectives: Anatomical distortions of the neural structures surrounding the foramen of Luschka (FL) characterize children with cochlear nerve deficiency (CND). Our goal was to investigate the anatomical features of the nervus intermedius (NI) and cranial nerve 7 (CN) VII in children with CND and verify if the NI can provide an additional landmark during auditory brainstem implantation (ABI) surgery, preventing intraoperative injuries of the nearby vessels and nerves.Methods: Sixty-four CND children ranging in age from 8 months to 16 years (2.92 ± 1.54) were video-recorded during retrosigmoid surgery for fitting the ABI and retrospectively examined with particular reference to the number and variety of NI bundles, the associated malformations of CN VII, the relationship with CN VII, and the possibility that NI might represent a landmark for ABI insertion.Results: Absence of CNs VI, VII, and VIII was observed respectively in 3, 8, and all children. Eighteen children showed several abnormalities of CN VII in the cerebellopontine angle. The identification of CN VII and of the bundles comprising NI was possible anatomically in 46 children. In 12 the identification was obtained with the assistance of intraoperative monitoring. The number of bundles comprising the NI varied from 1 to 6. The NI and CN IX were useful landmarks for identifying the FL of the lateral recess.Conclusions: NI provides an additional landmark during ABI microsurgery. Knowledge of NI anatomy and its topographical relationship with the neurovascular structures around the FL may prevent iatrogenic injuries and ABI electrical stimulation of the surrounding cranial nerves.

Age-related hearing loss (presbyacusis) is the most common type of hearing impairment. One of the most consistent pathological changes seen in presbyacusis is the loss of spiral ganglion neurons (SGNs). Defining the cellular and molecular basis of SGN degeneration in the human inner ear is critical to gaining a better understanding of the pathophysiology of presbyacusis. However, information on age-related cellular and molecular alterations in the human spiral ganglion remains scant, owing to the very limited availably of human specimens suitable for high resolution morphological and molecular analysis. This study aimed at defining age-related alterations in the auditory nerve in human temporal bones and determining if immunostaining for myelin basic protein (MBP) can be used as an alternative approach to electron microscopy for evaluating myelin degeneration. For comparative purposes, we evaluated ultrastructural alternations and changes in MBP immunostaining in aging CBA/CaJ mice. We then examined 13 temporal bones from 10 human donors, including 4 adults aged 38–46 years (middle-aged group) and 6 adults aged 63–91 years (older group). Similar to the mouse, intense immunostaining of MBP was present throughout the auditory nerve of the middle-aged human donors. Significant declines in MBP immunoreactivity and losses of MBP+ auditory nerve fibers were observed in the spiral ganglia of both the older human and aged mouse ears. This study demonstrates that immunostaining for MBP in combination with confocal microscopy provides a sensitive, reliable, and efficient method for assessing alterations of myelin sheaths in the auditory nerve. The results also suggest that myelin degeneration may play a critical role in the SGN loss and the subsequent decline of the auditory nerve function in presbyacusis.

Objectives: 1) Review controversies pertaining to the pathophysiology, diagnosis, and treatment of idiopathic intracranial hypertension. 2) Discuss the evolving role of otolaryngologists in managing this disease and related disorders.Data Sources: Primary literature review, Centers for Disease Control and Prevention website, International Classification of Headache Disorders, Second Edition.Methods: A comprehensive review of the primary literature was performed from 1990 to 2016 utilizing keywords idiopathic intracranial hypertension, pseudotumor cerebri, benign intracranial hypertension, spontaneous cerebrospinal fluid leak, and encephalocele. Articles were included at the discretion of the authors based on novel and/or historical contributions to the literature.Results: The incidence of idiopathic intracranial hypertension is increasing along with the obesity epidemic. Undiagnosed patients may present to otolaryngologists with pulsatile tinnitus, dizziness, sleep apnea, and spontaneous cerebrospinal fluid leaks. Although diagnosis is predicated upon imaging findings and lumbar puncture, radiographic signs including empty sella, optic nerve dilation, and globe flattening may suggest the diagnosis. The most effective intervention is weight loss combined with acetazolamide. Surgery is reserved for severe or refractory symptoms and can be highly morbid. Otolaryngologists are increasingly responsible for managing a number of secondary disorders including cerebrospinal fluid rhinorrhea and otorrhea. Failure to manage intracranial hypertension may lead to adverse surgical outcomes.Conclusions: The knowledge base for idiopathic intracranial hypertension has greatly expanded over the past 25 years. This disease is associated with a number of conditions directly relevant to otolaryngologists. A keen understanding of this disorder and its management may optimize outcomes in a growing number of patients.

Patients with SSCD have a marked thinning of the lateral skull base, more so than patients with spontaneous CSF otorrhea and control groups with different BMIs. Skull base attenuation in SSCD patients did not correlate with BMI.

The varied videos were rated highly in terms of usefulness, promoting self-efficacy and as a high-priority for a resident's surgical preparation. Multimedia-formatted training videos should be further explored for this generation of electronic-learners. Future studies with a larger cohort, objective approaches, and multidisciplinary involvement are needed to determine the full impact of this education medium on surgical-training.