In our series, the sensitivity of HRCT scan to otosclerosis was 95.1%. Hypodense otosclerotic foci were mostly localized at the anterior part of footplate. Negative or doubtful cases were associated with the highest incidence of stapes footplate complications. Foci involving otic capsule, internal auditory canal, or round window led to a significantly higher risk of sensorineural hearing loss.

This is the largest series of reported coexistence of STD and SCCD in the literature. Protrusion of the superior semicircular canal in the middle cranial fossa is probably an additional factor underlying STD and SCCD etiopathogeny. Semicircular canal dehiscence should always be looked for when STD is present.

Of 487 cochlear implantations, 3.8% of adults and 4.5% of children underwent a revision surgery. The mean time to device failure was 7.6 years in children and 1.5 year in adults. Causes of revision were seven hard failures, four soft failures, and nine medical reasons. Among the medical reasons, four patients had skin flap infection associated with an extended endaural approach. Audiologic performances were stable or improved following reimplantation in 90% of cases. We had two cases of electrode array misplaced into the vestibular system.

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We analyzed the outcomes of patients with large cerebellopontine angle (CPA) tumors treated by a skull-base team in which two surgeons (one neurosurgeon and one otological surgeon) were in the beginning of their careers (<40 years old). Data of patients operated on between April 2012 and March 2016 were reviewed. All factors related to surgical training were considered. Thirty-one patients had vestibular schwannomas, while 26 had meningiomas. Mean tumor diameter was 30.6 mm (range, 23-49 mm) for schwannomas and 35 mm (range, 22-51 mm) for meningiomas. Satisfactory postoperative facial nerve function (House-Brackmann's grade I or II) was achieved in 20 (64.5%) schwannoma patients and 21 (80.7%) meningioma patients. Gross total and near-total resections (residual tumor < 5 mm) were achieved in 21 (67.7%) and 9 (29%) schwannoma patients, respectively. Gross total resection (Simpson's grade II) was achieved in 18 (69.2%) meningioma patients. In both groups, the retrosigmoid approach was the most common approach. Regarding surgical training of the two younger surgeons, during the residency period, they attended high-volume centers for CPA tumors. Application of microsurgical techniques was systematically applied from the beginning of their personal series in every intracranial pathology case. During the first 2 years of the series, they were supervised by more experienced surgeons and followed a stepwise sharing of increasingly difficult surgical phases; by comparing results of this period with the last 2 years of the series, where they acquired a complete autonomy, no relevant difference was detected. Our results suggest that young surgeons may achieve good results even at the beginning of their careers, if specific conditions related to training and mentorship are met.

ObjectiveThe current study systematically reviewed the literature to compare auditory outcomes of patients treated for labyrinthine fistula (LF) based on characteristics of disease and surgical management.Databases ReviewedPubMed, Scopus, Web of Science.MethodsOriginal series (at least five cases) published from 2000 reporting management and hearing results of LF secondary to cholesteatoma were included. Proportion and odds-ratio (OR) meta-analyses were conducted through inverse variance random-effects models based on logit transformation.ResultsThe prevalence of LF is estimated to be 7% (95% confidence interval [CI], 5–9%). Fistulae involving the lateral semicircular canal (90%; 95% CI, 87–93%) and larger than 2 mm (53%; 95% CI, 43–64%) were common, whereas membranous involvement was less frequent (20%; 95% CI, 12–30%). Complete removal of the cholesteatoma matrix overlying the LF was mostly applied. Bone conduction (BC) preservation was frequently achieved (81%; 95% CI, 76–85%); new-onset postoperative anacusis was rarely reported (5%; 95% CI, 4–8%). A higher chance of BC preservation was associated with sparing the perilymphatic space (OR, 4.67; 95% CI, 1.26–17.37) or membranous labyrinth (OR, 4.56; 95% CI, 2.33–8.93), exclusive lateral semicircular canal involvement (OR, 3.52; 95% CI, 1.32–9.38), smaller size (<2 mm; OR, 3.03; 95% CI, 1.24–7.40), and intravenous steroid infusion (OR, 7.87; 95% CI, 2.34–26.42).ConclusionLF occurs in a significant proportion of patients with cholesteatoma. In the past two decades, complete removal of the cholesteatoma matrix followed by immediate sealing has been favored, supported by the high proportion of BC preservation. Hearing preservation depends primarily on characteristics of the LF, and specific surgical strategies should be pursued. Intraoperative and postoperative intravenous steroid infusion is recommended.