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Objectives/hypothesis: Congenital aural atresia is a rare condition affecting 1 in 10,000–20,000 children a year. Surgery is required to restore hearing to facilitate normal development. The objective of this study was to compare outcomes in hearing, complications, and quality of life of surgical reconstruction of the external auditory canal reconstruction (EACR) and bone-anchored hearing aid (BAHA) in a pediatric population with congenital aural atresia.Study design: Subjects were children who had a diagnosis of congenital aural atresia or stenosis and who received either BAHA or EACR.Methods: The medical records of 68 children were reviewed for operative complications and audiometric results. A quality of life questionnaire was prospectively administered to a subset of subjects.Results: Pre-operatively, air conduction threshold was not significantly different between groups at 500, 1000, 2000, and 4000 Hz (p > 0.05). Post-operatively, the BAHA group (44.3 ± 14.3 and 44.5 ± 11.3) demonstrated a significantly larger hearing gain than the EACR group (20.0 ± 18.9 and 15.3 ± 19.9) in both the short and long-term periods (p < 0.001). Overall, the incidence of complications and need for revision surgery were comparable between groups (p > 0.05). Quality of life assessment revealed no statistical significance between the two groups (p > 0.05).Conclusion: Although the quality of life and incidence of surgical complications between the two interventions was not significantly different, BAHA implantation appears to provide a better, more reliable audiologic outcome than EACR.

Objective To compare the Kadish and the modified Dulguerov staging of individual participants to determine the impact of stage and other prognostic factors on disease-free (DFS) and overall survival (OS). Data Sources Systematic review of EMBASE, MEDLINE, Cochrane Library, and CINAHL databases. Review Methods The Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) was followed for this study. Articles including patients with olfactory neuroblastoma (ONB) staged with both Kadish and Dulguerov staging systems were reviewed. The raw data from eligible studies were requested to perform an individual participant data (IPD) meta-analysis. Results Pooled data from 21 studies representing 399 patients with ONB undergoing treatment with curative intent showed that increasing age, treatment with chemotherapy, and positive or unreported margin status portended worse DFS ( P < .05). Increasing stage for both Kadish and Dulguerov staging systems was prognostic for worse DFS and OS ( P < .05), with Kadish C representing a heterogeneous group with regard to outcome and corresponding Dulguerov T stage. Using the Akaike information criterion, the Dulguerov staging system had superior performance to the Kadish system for DFS (1088.72 vs 1092.54) and OS (632.71 vs 644.23). Conclusion This study represents the first IPD meta-analysis of ONB directly comparing the outcomes of Kadish and Dulguerov staging systems in patients treated with primary surgery. Both systems correlated with DFS and OS, with superior performance in the Dulguerov system. Furthermore, the Kadish C group represented a heterogeneous group with regard to outcomes after stratification by the Dulguerov system. Dulguerov T4 patients had the worst outcome, with most being approached with open resection.

).The head, deservedly, has been coined the central hub of individuality and communication with the outside world. By virtue of the critical structures encompassed by the craniofacial skeleton, head trauma can have devastating and debilitating consequences. With advancement of our understanding of brain trauma, technology, and medicine, more victims survive to face the sequelae of what were once terminal injuries. There are 30 million trauma-related hospital visits annually, and approximately 16% are associated with traumatic brain injuries (TBIs). Children, older adolescents, and adults aged 65 years or older are among those most likely to sustain TBIs. The incidence of TBIs is also higher in males. As per the Centers for Disease Control and Prevention (CDC) report, males aged 0 to 4 years have the highest rates of TBI-related emergency department visits. However, the rate of hospitalization and death is higher amongst patients 65 years of age and older. Mechanism of injury leading to TBI varies among the demographic parameters. For example, assault and motorized vehicle crashes are major causes of TBI-related deaths up to the third decade of life, whereas falls are implicated in most of the TBI-related deaths in individuals 65 years of age and older population. In 2010, $76.5 billion was the estimated economic burden of TBI. 1 In light of the societal and financial burdens involved in cranial trauma and as a result of critical anatomic relationships between important neurologic structures, such as the brain and skull, skull base injuries are an important part of the head trauma mélange. Skull base fractures have been reported in 12% of all head injuries and 20% of all skull fractures. 2 With the skull base being located at the anatomic gateway of neurovascular connections of the brain with the periphery, timely diagnosis and management of skull base fractures and their complications are of paramount importance. This work aims to briefly review demographics, diagnosis, complications, and surgical management of skull base injuries. Mechanism of Injury AbstractTraumatic injuries to the skull base can involve critical neurovascular structures and present with symptoms and signs that must be recognized by physicians tasked with management of trauma patients. This article provides a review of skull base anatomy and outlines demographic features in skull base trauma. The manifestations of various skull base injuries, including CSF leaks, facial paralysis, anosmia, and cranial nerve injury, are discussed, as are appropriate diagnostic and radiographic testing in patients with such injuries. While conservative management is sometimes appropriate in skull base trauma, surgical access to the skull base for reconstruction of traumatic injuries may be required. A variety of specific surgical approaches to the anterior cranial fossa are discussed, including the classic anterior craniofacial approach as well as less invasive and newer endoscope-assisted approaches to the traumatized skull base.