Preoperative Differences in Intracranial Facial Versus Vestibular Schwannomas: A Four Nerve Assessment

xlomafota13 shared this article with you from Inoreader Preoperative Differences in Intracranial Facial Versus Vestibular Schwannomas: A Four Nerve Assessment Via The Laryngoscope Objectives Assesses whether preoperative functional testing can distinguish vestibular schwannomas from facial nerve schwannomas medial to the labyrinthine segment. Study Design Retrospective cohort. Methods Retrospectively review surgically managed intracranial facial and vestibular schwannomas between January 2015 and December 2019 at two tertiary care centers. Patients with neurofibromatosis 2 and surgery for recurrence were excluded. Preoperative functional testing to include House-Brackmann scores, electroneuronography (ENoG), cervical vestibular evoked myogenic potentials (cVEMP), caloric testing, acoustic brainstem responses (ABRs), acoustic reflexes, and audiograms was compared between the two groups of schwannomas. Results Twelve facial and 128 vestibular schwannomas met inclusion criteria. In only one case was a facial schwannoma diagnosed preoperatively from imaging. No statistically significant difference was found in preoperative House-Brackmann scores, ENoG, cVEMP, caloric testing, ABRs, or acoustic reflexes. Pure tone average was worse in the vestibular schwannoma group (63 dB [95% CI: 58–68 dB] vs. 46 dB [95% CI: 34–58 dB], P = .01), and the difference was more apparent in the lower frequencies. Word recognition score was better in the facial schwannoma group (66% [95% CI: 45–86%] vs. 41% [95% CI: 34–47%], P = .02). Conclusion Specialized preoperative functional evaluation of the nerves of the internal auditory canal cannot reliably predict the presence of an intracranial facial schwannoma. Hearing is better in facial schwannomas, particularly in the lower frequencies. This should raise the index of suspicion for an intracranial facial schwannoma, especially in candidates for hearing preservation vestibular schwannoma surgery. Level of Evidence Level 3 Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

A Novel Performance‐Based Paradigm of Care for Cochlear Implant Follow‐Up

xlomafota13 shared this article with you from Inoreader A Novel Performance‐Based Paradigm of Care for Cochlear Implant Follow‐Up Via The Laryngoscope Objectives Utilize a multi-institutional outcomes database to determine expected performance for adult cochlear implant (CI) users. Estimate the percentage of patients who are high performers and achieve performance plateau. Study Design Retrospective database study. Methods Outcomes from 9,448 implantations were mined to identify 804 adult, unilateral recipients who had one preoperative and at least one postoperative consonant-nucleus-consonant (CNC) word score. Results were examined to determine percent-correct CNC word recognition preoperatively and at 1, 3, 6, 12, and 24 months after activation. Outcomes from 318 similar patients who also had at least three postoperative CNC word scores were examined. Linear mixed-effects regression was used to examine CNC word performance over time. The time when each patient achieved maximum performance was recorded as a surrogate for time of performance plateau. Patients were assigned as candidates for less intense follow-up if they were high performers and achieved performance plateau. Results Among 804 patients with at least one postoperative score, CNC score improved at all time intervals. Average performance after the 3-month time interval was 47.2% to 51.5%, indicating a CNC ≥ 50% cutoff for high performers. Among 318 patients with at least three postoperative scores, performance improved from 1 to 3 (P = .001), 3 to 6 (P = .001), and 6 to 12 (P = .01) months. Scores from the 12- and 24-month intervals did not significantly differ (P = .09). By 12 months after activation, 59.7% of patients were considered candidates for less intense follow-up. Conclusion Findings suggest that CNC ≥ 50% is a reasonable cutoff to separate high performers from low performers. Within 12 months after activation, 59.7% of patients were good candidates for less intense follow-up. Level of Evidence 3 Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Outcomes of a Postoperative Data‐Extraction Questionnaire After Adenotonsillectomy in Children

xlomafota13 shared this article with you from Inoreader Outcomes of a Postoperative Data‐Extraction Questionnaire After Adenotonsillectomy in Children Via The Laryngoscope Objectives/Hypothesis To evaluate outcomes of a postoperative telephone questionnaire for children who underwent adenotonsillectomy (T&A). To determine whether episodes of postoperative hemorrhage were not captured until the call, and whether this impacted knowledge of physician rates of hemorrhage. Study Design Retrospective database analysis. Methods Retrospective analysis of outcomes of an 11-question data extraction tool utilized at a tertiary care children's hospital for follow-up in T&A patients <18 years of age over a 2-year period. Sub-analysis of positive responses to the question asking about incidence of postoperative hemorrhage. Results During the study period, 1,068/3,142 (34.0%) parents responded to the phone call. Median age was 6.0 years (interquartile range [IQR] 4.0–8.2), and 566 (53.0%) were male. Ninety (8.4%) noted that the child was still snoring, but only 9 (0.84%) reported signs of obstructed breathing. A total of 402 (37.6%) reported a voice change after surgery. Most children (n = 885, 82.9%) did not receive opioid analgesics, and 252 (23.6%) received acetaminophen/ibuprofen 7 days postoperatively. Return visits to the emergency department were reported in 149 patients; primarily for hemorrhage in 46 (30.8%). In 7 (15.2%) patients, the hemorrhage event was not recorded until the call. The majority-of respondents (n = 1,031, 96.5%) were satisfied with the outcome of the procedure. Conclusions The postoperative T&A tool provided a means of gathering information on success and satisfaction with surgical outcomes. Children were able to be managed primarily with acetaminophen and ibuprofen. Most complications were captured in the electronic record, although some episodes of hemorrhage were not noted until the call, emphasizing the importance of follow-up. Level of Evidence 3 Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Transoral Laser Microsurgical Excision of a Laryngeal Schwannoma Located in the Paraglottic Space

xlomafota13 shared this article with you from Inoreader Transoral Laser Microsurgical Excision of a Laryngeal Schwannoma Located in the Paraglottic Space Via The Laryngoscope Objectives/Hypothesis To report the first case of transoral excision of a paraglottic laryngeal schwannoma. Methods Case report. Results Laryngeal schwannomas are rare tumors, with approximately 75 cases reported to date worldwide. Most cases involve superficial supraglottic tumors excised transorally, and some have been found in deeper compartments and treated using transcervical approaches. This report describes the first excision of a schwannoma of the paraglottic space via endoscopic laser laryngotomy. The procedure allowed return to normal function, without recurrence within 8 months, after which the patient was lost to follow-up. Conclusions Transoral excision of benign paraglottic tumors is safe and feasible. Level of Evidence N/A. Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Intracochlear Electrocochleography and Speech Perception Scores in Cochlear Implant Recipients

xlomafota13 shared this article with you from Inoreader Intracochlear Electrocochleography and Speech Perception Scores in Cochlear Implant Recipients Via The Laryngoscope Objectives/Hypothesis Previous studies have demonstrated that electrocochleography (ECochG) measurements made at the round window prior to cochlear implant (CI) electrode insertion can account for 47% of the variability in 6-month speech perception scores. Recent advances have made it possible to use the apical CI electrode to record intracochlear responses to acoustic stimuli. Study objectives were to determine 1) the relationship between intracochlear ECochG response amplitudes and 6-month speech perception scores and 2) to determine the relationship between behavioral auditory thresholds and ECochG threshold estimates. The hypothesis was that intracochlear ECochG response amplitudes made immediately after electrode insertion would be larger than historical controls (at the extracochlear site) and explain more variability in speech perception scores. Study Design Prospective case series. Methods Twenty-two adult CI recipients with varying degrees of low-frequency hearing had intracochlear ECochG measurements made immediately after CI electrode insertion using 110 dB SPL tone bursts. Tone bursts were centered at five octave-spaced frequencies between 125 and 2,000 Hz. Results There was no association between intracochlear ECochG response amplitudes and speech perception scores. But, the data suggest a mild to moderate relationship between preoperative behavioral audiometric testing and intraoperative ECochG threshold estimates. Conclusion Performing intracochlear ECochG is highly feasible and results in larger response amplitudes, but performing ECochG before, rather than after, CI insertion may provide a more accurate assessment of a patient's speech perception potential. Level of Evidence 4 Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The Dynamic Tracheoesophageal Prosthesis Length

xlomafota13 shared this article with you from Inoreader The Dynamic Tracheoesophageal Prosthesis Length Via Journal of Voice In a postlaryngectomy patient, tracheoesophageal (TE) speech is considered to be the most effective and preferred method of communication. Previous research has demonstrated that despite an appropriately sized TE prosthesis placement at the time of puncture, there are a portion of patients that require resizing postoperatively. The purpose of this study was to report on the variability of the tracheoesophageal prosthesis length. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Un-sedated Office-Based Application of Blue Laser in Vocal Fold Lesions

xlomafota13 shared this article with you from Inoreader Un-sedated Office-Based Application of Blue Laser in Vocal Fold Lesions Via Journal of Voice Office-based laser procedures in laryngology have gained a lot of popularity in the last decade with the use of the KTP, PDL and Thulium lasers. Preliminary investigations currently report on the use of the 445 nm wavelength Blue laser for the treatment of various laryngeal pathologies, given its dual photoangiolytic and cutting properties. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.